Research Department for Clinical, Educational and Health Psychology, University College London, Gower St, Bloomsbury,, WC1E 6BT, London, UK.
Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, 4-8 Rodney Street, London, N1 9JH, UK.
Eur Child Adolesc Psychiatry. 2021 Nov;30(11):1779-1791. doi: 10.1007/s00787-020-01648-8. Epub 2020 Oct 1.
As mental health systems move towards person-centred care, outcome measurement in clinical research and practice should track changes that matter to young people and their families. This study mapped the types of change described by three key stakeholder groups following psychotherapy for depression, and compared the salience of these outcomes with the frequency of their measurement in recent quantitative treatment effectiveness studies for adolescent depression.Using qualitative content analysis, this study identified and categorized outcomes across 102 semi-structured interviews that were conducted with depressed adolescents, their parents, and therapists, as part of a randomized superiority trial. Adolescents had been allocated to Cognitive-Behavioral Therapy, Short-Term Psychoanalytic Psychotherapy, or a Brief Psychosocial Intervention.The study mapped seven high-level outcome domains and 29 outcome categories. On average, participants discussed change in four domains and six outcome categories. The most frequently discussed outcome was an improvement in mood and affect (i.e., core depressive symptoms), but close to half of the participants also described changes in family functioning, coping and resilience, academic functioning, or social functioning. Coping had specific importance for adolescents, while parents and therapists showed particular interest in academic functioning. There was some variation in the outcomes discussed beyond these core themes, across stakeholder groups and treatment arms.Of the outcomes that were frequently discussed in stakeholder narratives, only symptomatic change has been commonly reported in recent treatment studies for adolescent depression. A shift towards considering multiple outcome domains and perspectives is needed to reflect stakeholder priorities and enable more nuanced insights into change processes.
随着心理健康系统向以患者为中心的护理模式转变，临床研究和实践中的结果测量应该跟踪对年轻人及其家庭重要的变化。本研究通过对三组关键利益相关者在接受抑郁症心理治疗后的变化进行描述，来绘制变化类型，并将这些结果的重要性与青少年抑郁症近期定量治疗效果研究中对这些结果的测量频率进行比较。
本研究采用定性内容分析，对 102 名接受认知行为治疗、短期精神分析心理治疗或简短心理社会干预的抑郁青少年及其父母和治疗师进行的半结构化访谈进行了识别和分类，这些访谈是一项随机优势试验的一部分。
该研究绘制了七个高级别结果领域和 29 个结果类别。平均而言，参与者讨论了四个领域和六个结果类别的变化。讨论最多的结果是情绪和情感的改善（即核心抑郁症状），但近一半的参与者还描述了家庭功能、应对和适应力、学业功能或社会功能的变化。应对能力对青少年尤为重要，而父母和治疗师则对学业功能特别感兴趣。除了这些核心主题之外，利益相关者群体和治疗组之间的讨论结果也存在一些差异。
在利益相关者的叙述中经常讨论的结果中，只有症状变化在青少年抑郁症的近期治疗研究中经常被报道。需要转向考虑多个结果领域和观点，以反映利益相关者的优先事项，并能够更深入地了解变化过程。
