A comprehensive mapping of outcomes following psychotherapy for adolescent depression: The perspectives of young people, their parents and therapists

Abstract

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.

What Treatment Outcomes Matter Most? A Q-study of Outcome Priority Profiles Among Youth with Lived Experience of Depression

“…The consistent prioritization of improved mood and affect aligns with findings from a qualitative content analysis of change narratives, which found this to be the most salient outcome theme amongst adolescents, parents, and therapists discussing change observed over the course of psychotherapy [16]. In contrast, symptom change was not identified as a principal theme in a qualitative study about notions of "good outcomes" that involved adolescent service users with mixed presenting problems.…”

“…Our findings suggest that there are groups of youth that prioritize a range of other outcomes alongside improved mood and affect, in line with outcome themes that have been highlighted in previous research. These include outcomes related to coping and resilience [16,20,21,27,54,55], improved family relationships [16,27,[56][57][58], feeling heard and understood [16,[59][60][61][62][63][64], and recovering a sense of hope and optimism [20]. In contrast, youth in this study did not prioritize outcomes around personal growth (e.g., stronger autonomy and identity) which constitute central elements of a client-driven concept of recovery in the adult literature [65], and a key theme in at least one consultation with youth [20].…”

“…We compiled a candidate pool of outcomes through two interdisciplinary workshops involving young people; an interdisciplinary group of researchers (including psychologists, psychometricians, social scientists, and philosophers); a systematic literature review of treatment outcome studies for adolescent depression [15]; and qualitative content analysis of 102 semi-structured interviews with adolescents, their parents, and therapists following three types of psychotherapy for depression [16]. This process identified 73 possible outcomes, across the eight domains of symptoms, self-management, functioning, personal growth, relationships, feeling seen and seeing differently, youth well-being , and parental support and well-being .…”

“…Measurement approaches have historically been determined with minimal youth input, and focused on symptomatic change [13–15]. Consultations with young people in mental health contexts suggest they value additional outcomes such as improved coping skills, affirming their identity, increased autonomy, feeling more connected with others, improved family relationships, or better school functioning [16–21]. Youth have expressed a preference for outcome measurement that is meaningful and tailored to their individual priorities [22–24].…”

“…Consensus-building methodology is geared towards creating common ground, rather than investigating differences in perspective. Similarly, existing qualitative research into notions of “good outcomes” has focused on identifying dominant themes, rather than exploring heterogeneity or minority viewpoints [16, 20, 21, 27]. Within a framework of person-centered care, the latter are important to consider if outcome measurement is to be personalized and tailored to individual needs, beyond a common core set of consensus outcomes.…”