Authors: Karolin Rose Krause; Sophie Chung; Abiodun Olugbenga Adewuya; Anne Marie Albano; Rochelle Babins-Wagner; Laura Birkinshaw; Peter G. Brann; Catharine S. Creswell; Kathleen Delaney; Bruno Falissard; Christopher B. Forrest; Jennifer L. Hudson; Shin-ichi Ishikawa; Meghna Khatwani; Christian Kieling; Judi Krause; Kanika Malik; Vania Martínez; Faraz Mughal; Thomas H. Ollendick; Say How Ong; Evie Thomas; George C. Patton; Ulrike Ravens-Sieberer; Peter Szatmari; Lucas Walters; Bryan Young; Yue Zhao; Miranda Wolpert · Research

What Are the Best Ways to Measure Treatment Outcomes for Anxiety and Depression in Children and Young People?

An international expert group recommends a standard set of outcome measures for anxiety, depression, OCD and PTSD in children and young people aged 6-24.

Source: Krause, K. R., Chung, S., Adewuya, A. O., Albano, A. M., Babins-Wagner, R., Birkinshaw, L., ... & Wolpert, M. (2021). International consensus on a standard set of outcome measures for child and youth anxiety, depression, obsessive-compulsive disorder, and post-traumatic stress disorder. The Lancet Psychiatry, 8(1), 76-86. https://doi.org/10.1016/S2215-0366(20)30356-4

What you need to know

  • An international expert group reached consensus on a standard set of outcome measures to track treatment progress for anxiety, depression, OCD and PTSD in children and young people aged 6-24.

  • The recommended measures focus on symptoms, suicidal thoughts/behaviors, and functioning, using primarily patient-reported tools that are brief, free to use, and psychometrically sound.

  • Implementing this standard set globally could help improve mental health care by enabling comparisons across services and informing quality improvement efforts.

Why measuring treatment outcomes matters

Depression and anxiety are major contributors to disability worldwide, often emerging in childhood or adolescence. Despite increased mental health care provision in recent decades, services have not succeeded in reducing the prevalence of these disorders in young people. One key barrier to improving care is the lack of agreement on how to measure treatment outcomes.

Currently, there is no global guidance on tracking response to treatment for anxiety and depression in children and young people. Where outcome measurement does occur, there is huge variation in the measures used. This makes it very difficult to compare different treatment approaches or identify best practices.

To address this challenge, an international group of experts came together to develop a standardized set of outcome measures that all services providing relevant care should use as a minimum. The goal was to create a recommendation that is meaningful, feasible to implement, and acceptable to patients, families, and clinicians.

How the expert group developed their recommendations

The International Consortium for Health Outcomes Measurement (ICHOM) convened a working group of 27 experts from 13 countries, including young people with lived experience of mental health difficulties, parents, mental health practitioners, and researchers. Over 14 months, they followed a structured consensus-building process to select outcome domains, measurement tools, case-mix factors (patient characteristics to consider when comparing outcomes), and measurement time points.

The process involved:

  • Eight group teleconferences
  • A three-round Delphi exercise to select outcome domains
  • Anonymous voting to reach consensus on recommendations
  • Systematic reviews to identify potential outcome measures and case-mix factors
  • Appraisal of measurement tools against criteria like feasibility and psychometric performance

The group aimed to recommend a simple, low-burden set of measures that could be used across different contexts globally. They focused on anxiety, depression, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD) in young people aged 6-24.

After extensive deliberation, the group reached consensus on tracking three core outcome domains:

  1. Symptoms
  2. Suicidal thoughts and behaviors
  3. Functioning

They recommended seven primarily patient-reported measurement tools to capture these outcomes:

For symptoms:

  • Revised Children’s Anxiety and Depression Scale (RCADS-25) - to measure anxiety and depression symptoms
  • Obsessive Compulsive Inventory - Child Version (OCI-CV) - to measure OCD symptoms
  • Children’s Revised Impact of Events Scale (CRIES-8/13) - to measure PTSD symptoms

For suicidal thoughts/behaviors:

  • Columbia Suicide Severity Rating Scale (C-SSRS) Recent Self-Report Screener

For functioning:

  • KIDSCREEN-10 - to measure health-related quality of life
  • Children’s Global Assessment Scale (CGAS) - for clinicians to rate overall functioning
  • Child Anxiety Life Interference Scale (CALIS) - to measure anxiety-related impairment

These tools were selected because they are:

  • Brief (can be completed in under 20 minutes)
  • Free to use in clinical settings
  • Validated for use with children/youth
  • Available in multiple languages
  • Psychometrically sound (reliable and sensitive to change)

The group acknowledged that no measure is perfect. They aimed to identify the best available tools that met their feasibility criteria, as a starting point for generating wider insights on improving outcome measurement.

When and how to measure

The group recommended measuring outcomes at these key time points:

  • At assessment/intake (baseline)
  • Every 3 months during treatment
  • At the end of treatment
  • At 1-year follow-up after baseline

They encouraged more frequent measurement where possible, including session-by-session tracking if feasible.

To enable meaningful comparisons across services, they also recommended collecting data on patient characteristics that may influence outcomes, including:

  • Demographics (e.g. age, gender, ethnicity, socioeconomic status)
  • Clinical factors (e.g. symptom duration, comorbidities)
  • Complexity factors (e.g. trauma history, parental mental health)
  • Intervention details (e.g. treatment approach, medication)

Potential impact and next steps

This standard set provides the first global recommendation for measuring outcomes in clinical care for anxiety, depression, OCD and PTSD in young people. If widely adopted, it could enable:

  • Comparisons of treatment effectiveness across services and countries
  • Benchmarking to identify top-performing services
  • Quality improvement efforts informed by outcomes data
  • A stronger evidence base on what works for whom

However, implementation will require changes to clinical processes and data systems in many services. Key next steps include:

  • Piloting the standard set in diverse clinical settings
  • Gathering feedback on feasibility and acceptability
  • Developing implementation guidance and resources
  • Ongoing review and refinement of the recommendations

Conclusions

Measuring outcomes consistently is essential for improving mental health care for children and young people. This expert consensus on a standard outcome measurement set is an important step towards enabling quality improvement and evidence-based practice globally. While not perfect, it provides a starting point for services to implement routine outcome tracking and contribute to a shared understanding of treatment effectiveness. Researchers should continue evaluating these measures, while clinicians and policymakers can begin adopting them to drive improvements in care quality and outcomes.

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