Skip to main content Accessibility help
×
×
Home

Patient-reported outcome measures in community mental health teams: pragmatic evaluation of PHQ-9, GAD-7 and SWEMWBS

  • Paul Blenkiron (a1) and Lucy Goldsmith (a2)
Abstract
Aims and method

We evaluated routine use, acceptability and response rates for the Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder Scale (GAD-7) and Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS) within adult community mental health teams. Measures were repeated 3 months later. Professionals recorded the setting, refusal rates and cluster diagnosis.

Results

A total of 245 patients completed 674 measures, demonstrating good initial return rates (81%), excellent scale completion (98–99%) and infrequent refusal/unsuitability (11%). Only 32 (13%) returned follow-up measures. Significant improvements occurred in functioning (P = 0.01), PHQ-9 (P = 0.02) and GAD-7 (P = 0.003) scores (Cohen's d = 0.52–0.77) but not in SWEMWBS (P = 0.91) scores. Supercluster A had higher initial PHQ-9 and GAD-7 scores (P < 0.001) and lower SWEMWBS scores (P = 0.003) than supercluster B. Supercluster C showed the greatest functional impairment (P = 0.003).

Clinical implications

PHQ-9 and GAD-7 appear acceptable as patient-reported outcome measures in community mental health team. SWEMWBS seems insensitive to change. National outcome programmes should ensure good follow-up rates.

Declaration of interest

None.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Patient-reported outcome measures in community mental health teams: pragmatic evaluation of PHQ-9, GAD-7 and SWEMWBS
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Patient-reported outcome measures in community mental health teams: pragmatic evaluation of PHQ-9, GAD-7 and SWEMWBS
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Patient-reported outcome measures in community mental health teams: pragmatic evaluation of PHQ-9, GAD-7 and SWEMWBS
      Available formats
      ×
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Correspondence to Paul Blenkiron (paul.blenkiron@nhs.net)
References
Hide All
1National Institute for Health and Care Excellence. Commissioning Stepped Care for People with Common Mental Health Disorders: Guide & Bench Marking Tool CMG41. NICE, 2011 (http://www.nice.org.uk/usingguidance/commissioningguides/commonmentalhealthdisorderservices/commonmentalhealthdisorderservices.jsp).
2Tadros, G. Intelligent outcome measures in liaison psychiatry: essential even if not desirable. BJPsych Bull 2016; 40: 195–8.
3Department of Health. The IAPT Data Handbook Version 2.0: Guidance on Recording and Monitoring Outcomes to Support Local Evidence-Based Practice. Department of Health, 2011 (http://www.iapt.nhs.uk/).
4Department of Health. NHS Outcomes Framework: List of Outcomes and Indicators in the NHS Outcomes Framework for 2016-17. Department of Health, 2016 (https://www.gov.uk/government/publications/nhs-outcomes-framework-2016-to-2017).
5Department of Health. The Operating Framework for the NHS in England 2012/2013. Department of Health, 2011.
6Devlin, NJ, Appleby, J. Getting the Most Out of PROMS: Putting Health Outcomes at the Heart of NHS Decision Making. The King's Fund, 2010 (https://www.kingsfund.org.uk/sites/files/kf/Getting-the-most-out-of-PROMs-Nancy-Devlin-John-Appleby-Kings–Fund-March-2010.pdf).
7Coulter, A. Measuring what matters to patients. BMJ 2017; 356: j816.
8Trevithick, L, Painter, J, Keown, P. Mental health clustering and diagnosis in psychiatric in-patients. BJPsych Bull 2015; 39(3): 119–23.
9NHS England. The Five Year Forward View for Mental Health. NHS England, 2016 (https://www.england.nhs.uk/wp-content/uploads/2016/07/fyfv-mh.pdf).
10Vale of York Clinical Commissioning Group. Vale of York Public Health Report: Equality Strategy – Population and Health Inequalities Data. Vale of York Clinical Commissioning Group, 2013 (http://www.valeofyorkccg.nhs.uk/data/uploads/governing-body-papers/4-july-2013/item-6-public-health-report.pdf).
11Kroenke, K, Spitzer, RL, Williams, JB. The PHQ-9: validity of a brief depression severity measure. J Gen Int Med 2001; 16: 606–13.
12Horton, M, Perry, AE. Screening for depression in primary care: a Rasch analysis of the PHQ-9. BJPsych Bull 2016; 40: 237–43.
13McMillan, D, Gilbody, S, Richards, D. Defining successful treatment outcome in depression using the PHQ-9: a comparison of methods. J Affect Disord 2010; 127: 122–9.
14Kroenke, K, Spitzer, RL, Williams, JB, Monahan, PO, Lowe, B. Anxiety disorders in primary care: prevalence, impairment, comorbidity and detection. Ann Int Med 2007; 146: 317–25.
15Tennant, R, Hiller, L, Fishwick, R, Stephen, P, Joseph, S, Weich, S, et al. The Warwick-Edinburgh Mental Well-being Scale (WEMWBS): development and UK validation. Health Qual Life Outcomes 2007; 5: 63.
16Stewart-Brown, S, Tennant, A, Tennant, R, Platt, S, Parkinson, J, Weich, S. Internal construct validity of the Warwick-Edinburgh Mental Well-being Scale (WEMWBS): a Rasch analysis using data from the Scottish Health Education Population Survey. Health Qual Life Outcomes 2009; 7: 1522.
17Haver, A, Akerjordet, K, Caputi, P, Furunes, T, Magee, C. Measuring mental well-being: A validation of the Short Warwick–Edinburgh Mental Well-Being Scale in Norwegian and Swedish. Scand J Public Health 2015; 43(7): 721–7.
18Milnes, D, Owens, D, Blenkiron, P. Problems reported by deliberate self-harm patients: perception, hopelessness and suicidal intent. J Psychosom Res 2002; 53(3): 819–22.
19IBM Corp. IBM SPSS Statistics for Windows, Version 22.0. IBM released, 2013.
20Bell, MA, Fairclough, DL, Fiero, MH, Butow, PN. Handling missing items in the Hospital Anxiety and Depression Scale (HADS): a simulation study. BMC Res Notes 2016; 9(1): 479.
21Fairclough, DL, Cella, DF. Functional Assessment of Cancer Therapy (FACT-G): non-response to individual questions. Qual Life Res 1996; 5(3): 321–9.
22Altman, DG. Practical Statistics for Medical Research. Chapman and Hall, 1991.
23Cohen, J. Statistical Power Analysis for the Behavioral Sciences (2nd edn). Lawrence Earlbaum Associates, 1988.
24World Health Organization. International Classification of Diseases (Vol. 10). WHO, 1992.
25Löwe, B, Decker, O, Müller, S, Brähler, E, Schellberg, D, Wolfgang, H, et al. Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Med Care 2008; 46(3): 266–74.
26Kertz, S, Bigda-Peyton, J, Bjorgvinsson, T. Validity of the Generalised Anxiety Disorder-7 scale in an acute psychiatric sample. Clin Psychol Psychother 2013; 20(5): 456–64.
27Richards, DA, Borglin, G. Implementation of psychological therapies for anxiety and depression in routine practice: two year prospective cohort study. J Affect Disord 2011; 133: 5160.
28Gilbody, S, Littlewood, E, Hewitt, C, Brierley, G, Tharmanathan, P, Araya, R. Computerised cognitive behaviour therapy as treatment for depression in primary care (REEACT trial): large scale pragmatic randomised controlled trial. BMJ 2015; 351: h5627.
29Timimi, S. Children and young people's improving access to psychological therapies: inspiring innovation or more of the same? BJPsych Bull 2015; 39: 5760.
30Keetharuth, AD, Brazier, J, Connell, J, Bjorner, JB, Carlton, C, Buck Taylor, E, et al. Recovering Quality of Life (ReQoL): a new generic self-reported outcome measure for use with people experiencing mental health difficulties. Br J Psychiatry 2018; 212(1): 42–9.
31Blenkiron, P, Hammill, CA. What determines patients’ satisfaction with their mental health care and quality of life? Postgrad Med J 2003; 79(932): 337–40.
32Van Sonderen, E, Middel, B. Statistical significant change versus relevant or important change in (quasi) experimental design: some conceptual and methodological problems in estimating magnitude of intervention-related change in health services research. Int J Integr Care 2002; 2: e15.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Bulletin
  • ISSN: 2056-4694
  • EISSN: 2056-4708
  • URL: /core/journals/bjpsych-bulletin
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Patient-reported outcome measures in community mental health teams: pragmatic evaluation of PHQ-9, GAD-7 and SWEMWBS

  • Paul Blenkiron (a1) and Lucy Goldsmith (a2)
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *