How much is enough? Considering minimally important change in youth mental health outcomes
Abstract
To make decisions in mental health care, service users, clinicians, and administrators need to make sense of research findings. Unfortunately, study results are often presented as raw questionnaire scores at different time points and regression coefficients, which are difficult to interpret with regards to their clinical meaning. Other commonly reported treatment outcome indicators in clinical trials or meta-analyses do not convey whether a given change score would make a noticeable difference to service users. There is an urgent need to improve the interpretability and relevance of outcome indicators in youth mental health (aged 12-24 years), in which shared decision making and person-centred care are cornerstones of an ongoing global transformation of care. In this Personal View, we make a case for considering minimally important change (MIC) as a meaningful, accessible, and user-centred outcome indicator. We discuss what the MIC represents, how it is calculated, and how it can be implemented in dialogues between clinician and researcher, and between youth and clinician. We outline how use of the MIC could enhance reporting in clinical trials, meta-analyses, clinical practice guidelines, and measurement-based care. Finally, we identify current methodological challenges around estimating the MIC and areas for future research. Efforts to select outcome domains and valid measurement instruments that resonate with youth, families, and clinicians have increased in the past 5 years. In this context, now is the time to define demarcations of changes in outcome scores that are clinically relevant, and meaningful to youth and families. Through the use of MIC, youth-centred outcome measurement, analysis, and reporting would support youth-centred therapeutic decision making.
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It is not known what clinically meaningful improvements are in the outcomes measured (Krause 2022).
“particularly because it is not known what clinically meaningful improvements are in the outcomes measured (Krause 2022).”
From Prevention of self-harm and suicide in young people up to the age of 25 in education settings (2024) · cites this paper as Krause 2022
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Prevention of self-harm and suicide in young people up to the age of 25 in education settings
Sharma, V., Marshall, D., Fortune, S., Prescott, A. E., Boggiss, A., Macleod, E., Mitchell, C., Clarke, A., Robinson, J., Witt, K. G., et al. (2024) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013844.pub2 · Cited by 11 · see citing works
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- Authors
- Krause, K. R., Hetrick, S. E., Courtney, D. B., Cost, K. T., Butcher, N. J., Offringa, M., Monga, S., Henderson, J., & Szatmari, P.
- Affiliations
- Centre for Addiction and Mental Health (CA)
- University of Auckland (NZ)
- Hospital for Sick Children (CA)
- University of Toronto (CA)
- ORCID
- Venue
- The Lancet Psychiatry
- Publisher
- Elsevier BV
- Published
- 2022-12
- Volume
- 9
- Issue
- 12
- Pages
- 992-998
- ISSN
- 2215-0366 (ISSN-L)
- OpenAlex
- W4309661217
- Cited by
- 15
- References
- 63
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 5 · 2023: 1
- FWCI
- 0.51
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- The Lancet Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research
- Cundill Centre for Child and Youth Depression
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Health Professions › General Health Professions › Mental Health and Patient Involvement
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Keywords
- minimally important change, youth mental health, outcome indicators, shared decision-making, person-centred care, measurement-based care, clinical trial reporting, meta-analysis
- MeSH terms
- Decision Making, Shared, Adolescent, Humans, Longitudinal Studies, Mental Health, Surveys and Questionnaires, Treatment Outcome
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