Measuring Outcomes of Psychological Well-Being within Paediatric Health Settings

Abstract

There are many widely used, validated patient reported outcome measures for physical and mental health. However, capturing outcomes from young people living with chronic health conditions presents a challenge, needing to take the complex interplay of physical and mental health into consideration. The authors found that regularly used outcome measures for child and adolescent emotional well-being in paediatric settings largely fall into two groups: paediatric quality of life and child and adolescent mental health measures. The applicability and potential for use of these measures within this context is discussed. Whilst offering some utility, neither approach leaves sufficient space for young people’s individual experiences of illness and treatment. The scope of using alternative qualitative approaches that capture the rich stories and experiences of young people living with chronic illnesses is considered.

Measuring psychological outcomes in paediatric settings: Making outcomes meaningful using client-defined perspectives

“…More research into young people’s perception of personal change, and how this might differ from clinical change, is required (Kelly & Coughlan, 2019) but it is likely that there will be crossover with existing research on adults. These existential elements of personal change may be particularly pertinent to the mental health difficulties associated with chronic illnesses and share similar themes to the outcomes of importance highlighted by young people living with chronic health conditions, such as social connectedness and peer relationships (Flannery et al, 2018; Ye et al, 2017).…”

“…The themes were similar in a thematic analysis of verbatim feedback from young people living with a range of chronic health conditions (including medically unexplained symptoms, diabetes, cancer, epilepsy, gastroenterological disorders, and rheumatological conditions) in a paediatric psychology service in London (Flannery et al, 2018). The themes found were ‘managing the health condition’ (including their relationship with the health condition and approaches to managing symptoms and treatment), ‘managing emotions’ (including sadness, anger, anxiety, and guilt), ‘finding space to talk’, ‘communication and relationships’ (particularly within families about the health condition), and ‘adaptive functioning and social connectedness’ (including attendance at school and engagement in social activities and friendships).…”

“…Conversely, the commonly used mental health PROMs, such as the Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997) and the Revised Child Anxiety and Depression Scale (RCADS; de Ross et al, 2002), were not designed to focus on the impact of living with a chronic health condition. Therefore, the subtle and complex interplay between a health condition and emotional well-being may become lost and some symptoms of illness or treatment (such as fatigue and appetite loss) may even be misinterpreted as indicative of mental health difficulties (Flannery et al, 2018). While PROMs used in children and young people’s mental health settings may have some utility for young people with chronic health conditions presenting with severe distress, with some caution taken over the use of certain items, they may not pick up on the subtleties of the frustration, anger and worry having to manage a condition such as diabetes, which may not amount to ‘depression’ but is likely to have an impact on their social and academic functioning and on their health (Flannery et al, 2018).…”

“…Therefore, the subtle and complex interplay between a health condition and emotional well-being may become lost and some symptoms of illness or treatment (such as fatigue and appetite loss) may even be misinterpreted as indicative of mental health difficulties (Flannery et al, 2018). While PROMs used in children and young people’s mental health settings may have some utility for young people with chronic health conditions presenting with severe distress, with some caution taken over the use of certain items, they may not pick up on the subtleties of the frustration, anger and worry having to manage a condition such as diabetes, which may not amount to ‘depression’ but is likely to have an impact on their social and academic functioning and on their health (Flannery et al, 2018). Furthermore, the validated measures available may seem reductionist to the breadth of a young person living with a chronic health conditions’ experience and the range of outcomes that they consider important.…”

Public Green Space and Mental Health building Self-Esteem for Elderly Population in Dhaka

“…Financial and emotional stress escorts them to hazardous states in the family as well as their social networks [23]. In this case, somebody assumes he is not socially accepted that lowers his self-esteem leading to emotional disturbance [24].…”