Evidence Based Practice Unit


Q&A with Holly Bear

We ask researcher Holly Bear about her part in EBPU's evaluation of reliable improvement rates in depression and anxiety at the end of treatment in adolescents

What is this research about?

There is evidence to suggest that levels of anxiety and depression in adolescents is increasing. Currently, the central focus is about increasing the availability of treatment to meet this increasing demand and encouraging children and young people to seek help for the mental health problems they are experiencing. However, there is much less discussion about how many children and young people are significantly better following treatment nor how to discuss this at the outset of the treatments being provided. 

Why was this research conducted?  

There are certain limitations in the statistical methods currently used to estimate how effective treatments are, which potentially overestimate how helpful a particular treatment is. There has therefore been a call for a focus on statistical metrics of outcome that focus on individual responses to treatment that may be more clinically meaningful. The metric of ‘reliable change’ is being suggested for use as an estimate of change, which involves taking the noise of the measure into account. However, there has only been a handful of studies which looked at treatment outcomes in this way. This is crucial information to help practitioners set realistic expectations for outcomes and support adolescents to make informed choices about their care.

How was the research conducted?

Data was collected from 4464 adolescents (average age 14.5 years and 75% female) seen in 75 specialist mental health services in England. To measure the presence and severity of anxiety and depressive symptoms, the 47-item RCADS21 was used.

What were the main findings?

In the current sample, 53% of young people with anxiety and no comorbid depression reliably improved, 44% with depression and no comorbid anxiety reliably improved and 35% with comorbid depression and anxiety reliably improved. The difference between anxiety, depression and comorbid depression and anxiety were in line with earlier findings, although the overall rates of improvement were somewhat higher than in previous studies.

What are the implications of these findings?

These findings raise important implications for research and practice in relation to meeting the needs of young people with anxiety and depression. One key implication for practice is the need for a recalibration of what is said to young people and the wider public about the likely outcome of therapy, particularly, that not everyone will be measurably improved by the end of treatment.

Read the full paper