Individualised or Standardised Outcome Measures: A Co-habitation?

Ashworth, Mark; Guerra, Daniel; Kordowicz, Maria

doi:10.1007/s10488-019-00928-z

Cited by 33 publications

(30 citation statements)

References 11 publications

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“…By contrast, idiographic measures such as the YTP, which capture domains of personal importance to the respondent, are typically more responsive to psychotherapeutic change. 27 Furthermore, person-centred idiographic measures are also more sensitive to within-person dynamic effects than are relatively global and stable nomothetic measures of psychopathology, which rely on group-based norms for validation and interpretation. 28 This explanation could account for the finding that improvements in mental health symptoms lagged behind reductions in self-defined psychosocial problem severity.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of a brief lay counsellor-delivered, problem-solving intervention for adolescent mental health problems in urban, low-income schools in India: a randomised controlled trial

Michelson

Malik²,

Parikh

et al. 2020

The Lancet Child & Adolescent Health

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Background Mental health problems are a leading cause of disability in adolescents worldwide. Problem solving is a well-tested mental health intervention in many populations. We aimed to investigate the effectiveness of a brief, transdiagnostic problem-solving intervention for common adolescent mental health problems when delivered by non-specialist school counsellors in New Delhi, India. Methods This randomised trial was done in six government-run schools (three all-boys schools, two all-girls schools, and one coeducational school) that serve low-income communities. We recruited participants from grades 9 to 12 (ages 12-20 years) by selecting students with persistently elevated mental health symptoms accompanied by distress or functional impairment. Clinical eligibility criteria were assessed by research assistants using the Hindi-language version of the Strengths and Difficulties Questionnaire (SDQ), with reference to locally validated borderline cutoff scores of 19 or greater for boys and 20 or greater for girls on the SDQ Total Difficulties scale, an abnormal score of 2 or more on the SDQ Impact scale, and persistence of more than 1 month on the SDQ Chronicity index. Participants were randomly allocated (1:1) to problem solving delivered through a brief (2-3 week) counsellor-led intervention with supporting printed materials (intervention group), or problem solving delivered via printed booklets alone (control group). Primary outcomes were adolescent-reported mental health symptoms (SDQ Total Difficulties scale) and idiographic psychosocial problems (Youth Top Problems [YTP]) at 6 weeks. Primary analyses were done on an intention-to-treat basis at the 6-week endpoint. The trial is registered with ClinicalTrials.gov, NCT03630471. Findings Participants were enrolled between Aug 20, and Dec 4, 2018. 283 eligible adolescents were referred to the trial, and 251 (89%) of these were enrolled (mean age 15•61 years; 174 [69%] boys). 125 participants were allocated to each group (after accounting for one participant in the intervention group who withdrew consent after randomisation). Primary outcome data were available for 245 (98%) participants. At 6 weeks, the mean YTP scores were 3•52 (SD 2•66) in the intervention group and 4•60 (2•75) in the control group (adjusted mean difference-1•01, 95% CI-1•63 to-0•38; adjusted effect size 0•36, 95% CI 0•11 to 0•61; p=0•0015). The mean SDQ Total Difficulties scores were 17•48 (5•45) in the intervention group and 18•33 (5•45) in the control group (-0•86,-2•14 to 0•41; 0•16,-0•09 to 0•41; p=0•18). We observed no adverse events. Interpretation A brief lay counsellor-delivered problem-solving intervention combined with printed booklets seemed to have a modest effect on psychosocial outcomes among adolescents with diverse mental health problems compared with problem-solving booklets alone. This counsellor-delivered intervention might be a suitable first-line intervention in a stepped care approach, which is being evaluated in ongoing studies. Funding Wellcome Trust.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of a brief lay counsellor-delivered, problem-solving intervention for adolescent mental health problems in urban, low-income schools in India: a randomised controlled trial

Michelson

Malik²,

Parikh

et al. 2020

The Lancet Child & Adolescent Health

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“…In the past few decades, interest has also been increasing in patient-generated outcome measures, also known as individualized or idiographic outcome measures, as opposed to the traditional generalized or "normothetic" measures validated against population norms. Such individualized measures might better capture issues associated with personal relationships and employment difficulties and as such can be seen as an alternative or complementary type of measure (22). Examples used across disorders include the Canadian Occupational Performance Measure (23) and the Psychological Outcome Profiles measure (24).…”

Section: Key Concepts In Outcome Measure Design and Selectionmentioning

confidence: 99%

Outcome Measures for Functional Neurological Disorder: A Review of the Theoretical Complexities

Nicholson

Carson²,

Edwards

et al. 2020

JNP

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“…In mental health, there has been a long history of tension between nomothetic or standardized measures in which all patients complete the same items with the same interpretation guidelines and idiographic measures that are tailored and individualized to each patient but are difficult to compare between patients or to norms [ 6 ]. One reason for exploring methods of individualizing or tailoring PROs in the idiographic approach is the suggestion that these measures are more sensitive to change [ 7 ]. Initial research from counselors in 2017 suggested that healthcare providers might prefer PROs that are individualized or tailored to each patient’s values and condition [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

A comparison of oncologist versus mental health provider attitudes towards standardized and tailored patient-reported outcomes

Gaffney

Unger

2021

J Patient Rep Outcomes

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Background Patient-reported outcomes (PROs) can be used to monitor patients during treatment. Healthcare provider preferences for individualized vs. standardized PROs have been understudied. Methods This study surveyed oncology and mental health providers to compare attitudes towards individualized and standardized PROs. We have developed a method for individualizing PROs, called precision PROs, and the survey specifically assessed preferences for this method. We compared attitudes and preferences by provider type and by whether respondents were current or never users of PROs. Results Oncology providers expressed more positive attitudes for standardized PROs in treatment planning compared to mental health providers (F(1,440) = 5.978, p = 0.015). The interaction between provider type (oncology vs. mental health) and type of PRO (individualized vs. standardized) was not significant for the attitudes about the clinical utility of PROs (p = 0.709). When directly asked about the precision PRO approach, oncologists were less likely to prefer standardized items (OR = 0.478, p = 0.001) or have no preference (OR = 0.445, p = 0.007) to the precision PRO approach when compared to mental health providers. Qualitative analyses suggested standardized PROs may be simpler or easier to understand whereas individualized PROs better capture patient variability and the unique aspects of each patient’s condition. Some mental health providers expressed reticence about letting patients choose how to tailor PROs. Never users of PROs reported more positive attitudes towards individualized measures than standardized measures whereas current users of PROs did not have a difference in attitudes (p = 0.010). User status was mostly unrelated to preferences. Conclusion Results suggest that healthcare provider preference for individualized PROs may differ by medical specialty. How PROs are tailored may need to differ by discipline. This is particularly important given that previous research showing a preference for individualized PROs over standardized was conducted with psychotherapists. Further research on patient preferences for individualized and standardized PROs is warranted as is research on the clinical utility of individualized PROs such as the precision PRO approach.

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Individualised or Standardised Outcome Measures: A Co-habitation?

Cited by 33 publications

References 11 publications

Effectiveness of a brief lay counsellor-delivered, problem-solving intervention for adolescent mental health problems in urban, low-income schools in India: a randomised controlled trial

Effectiveness of a brief lay counsellor-delivered, problem-solving intervention for adolescent mental health problems in urban, low-income schools in India: a randomised controlled trial

Outcome Measures for Functional Neurological Disorder: A Review of the Theoretical Complexities

A comparison of oncologist versus mental health provider attitudes towards standardized and tailored patient-reported outcomes

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