Most teenagers with anxiety or depression do not show meaningful change across the categories of symptoms, daily function and goals after treatment, according to new research from University College London and the Wellcome Trust.
Anxiety and depression are two of the most common mental health conditions among adolescents, and according to the World Health Organization, half of all mental illnesses start by the time a child is 14. But many aren't treated, and among those who do receive treatment, their improvement is not well-reported.
The study, published April 7 in Child Psychiatry & Human Development, looked at data from young people among 60 mental health services in England who received regular specialist care for either of these mental illnesses. The 1,641 adolescents included in the research were anywhere from 12 to 18 years old, and their median age was 14.8.
Mental health goes deeper than just our minds. "It affects everybody just as much as other aspects of health do," corresponding author Karolin Rose Krause told The Academic Times.
When Krause first started her Ph.D. research in child mental health at University College London, she "thought, something's odd here." Most studies and practices measured outcomes in just one or two variables — symptom change and the severity of symptoms — and saw any improvement in these variables as a success. "But it doesn't seem that people are questioning whether there could be other indicators, or even whether symptom change is meaningful for young people themselves and their families," Krause explained.
There's a problem in current data, Krause said: Countries across the world, including the U.S. and the U.K., lack a standard way to measure outcomes in their practices. The quality of this data affects research like her own — the authors cited missing data as the biggest challenge and limitation in the study — and more importantly, can keep patients in the real world from getting proper treatment.
"At the moment, a lot of decisions about what treatments work are based on clinical control trials," where the environment is very different from the everyday lives of most adolescents, Krause explained. Results from psychologists or the young people themselves "have a really important role in complementing the trial data," she continued, because it gives providers a more holistic view of which strategies work. But these results are only useful if the data are strong.
Routinely collected data is somewhat rare when it comes to mental health in adolescents. Different service providers are likely to ask young people different questions about their symptoms and goals. Even those who try to measure the same outcomes might collect data at separate time points, making it hard for researchers or doctors to connect relevant data. All this variability leads to less effective treatment for adolescents, who are already more apt to drop out of therapy or trials.
The team found that only 15.6% of the 1,641 adolescents improved in all three domains of symptoms, functioning and goal progress, while 30.6% improved in a combination of two. Symptoms are typical manifestations of depression or anxiety such as panic disorder, while functioning is the effect of symptoms on everyday life. The last metric, "goal progress," was defined as progressing toward self-defined goals.
Krause and her team were surprised to see that 69.9% of young people improved in goal progress, a number more than twice as high as the number of adolescents who improved in functioning. The result is encouraging, she thinks, since young people define their own goals and their treatment was at least partially successful if they address what they perceived to be the biggest issues, even if day-to-day symptoms or function do not benefit. She mentioned that the authors had no information on the actual goals due to confidentiality, so future research is needed to understand which personal goals are more attainable than others.
Krause and her colleagues at The Centre for Addiction and Mental Health are exploring a new area of symptom change based on numbers. Specific outcome data can help young people understand their improvement over a period of time. For example, if separation anxiety decreases by 8 points on a scale designed to measure that phenomenon, the doctor can explain to a patient that this is the minimum amount of change that is meaningful. After outcome data is shared, a young person's treatment plan can be adjusted based on feedback that is driven by data, not subjective reasoning. Harmonizing the outcome data will not only make for more consistent research, Krause said, but it will also help patients and doctors navigate treatments.
The global pandemic adds another layer of stress to young individuals who are dealing with mental illness, said Krause. People are worried about heavy topics such as family or friends falling ill, and "at the same time, coping mechanisms that we intuitively use aren't available anymore, like playing a sport or distracting ourselves so that we're not at home … We may well see a big increase of people of all ages coming into services seeking help," she added.
The bright side? According to Krause, "Maybe there is some spark of hope that [the pandemic] will help reduce the stigma of mental health difficulties," creating an opportunity for anyone to seek professional help if they need it.
The study, "Are we comparing apples with oranges? Assessing improvement across symptoms, functioning, and goal progress for adolescent anxiety and depression," published April 7 in Child Psychiatry & Human Development, was authored by Karolin Rose Krause, Julian Edbrooke‐Childs and Rosie Singleton, University College London and Anna Freud National Centre for Children and Families; and Miranda Wolpert, University College London and Wellcome Trust.