Skip to main content
Top
Published in: The Journal of Behavioral Health Services & Research 3/2007

01-07-2007 | Regular Article

Measuring Clinically Meaningful Change Following Mental Health Treatment

Authors: Susan V. Eisen, PhD, Gayatri Ranganathan, MS, Pradipta Seal, MS, Avron Spiro III, PhD

Published in: The Journal of Behavioral Health Services & Research | Issue 3/2007

Login to get access

Abstract

Assessment of clinically meaningful change is useful for treatment planning, monitoring progress, and evaluating treatment response. Outcome studies often assess statistically significant change, which may not be clinically meaningful. Study objectives are to: (1) evaluate responsiveness of the BASIS-24© using three methods for determining clinically meaningful change: reliable change index (RCI), effect size (ES), and standard error of measurement (SEM); and (2) determine which method provides an estimate of clinically meaningful change most concordant with other change measures. BASIS-24© assessments were obtained at two time points for 1,397 inpatients and 850 outpatients. The proportion showing clinically meaningful change using each method was compared to the proportion showing change in global mental health, retrospectively reported change, and clinician-assessed change. BASIS-24© demonstrated responsiveness at both aggregate and individual levels. Regarding clinically meaningful improvement and decline, SEM was most concordant with all three outcome measures; regarding no change, RCI was most concordant with all three measures.
Literature
1.
go back to reference Newman FL, Ciarlo JA, Carpenter D. Guidelines for selecting psychological instruments for treatment planning and outcome assessment. In: Maruish M, ed. The Use of Psychological Testing for Treatment Planning and Outcomes Assessment 2nd Edition. Mahwah, NJ: Lawrence Erlbaum; 1999:153–170. Newman FL, Ciarlo JA, Carpenter D. Guidelines for selecting psychological instruments for treatment planning and outcome assessment. In: Maruish M, ed. The Use of Psychological Testing for Treatment Planning and Outcomes Assessment 2nd Edition. Mahwah, NJ: Lawrence Erlbaum; 1999:153–170.
2.
go back to reference Guyatt G, Walter S, Norman G. Measuring change over time: assessing the usefulness of evaluative instruments. Journal of Chronic Disease. 1987;40:171–178.CrossRef Guyatt G, Walter S, Norman G. Measuring change over time: assessing the usefulness of evaluative instruments. Journal of Chronic Disease. 1987;40:171–178.CrossRef
3.
go back to reference Liang MH. Longitudinal construct validity: Establishment of clinical meaning in patient evaluation instruments. Medical Care. 2000;38(Suppl II):S84–S90. Liang MH. Longitudinal construct validity: Establishment of clinical meaning in patient evaluation instruments. Medical Care. 2000;38(Suppl II):S84–S90.
4.
go back to reference Hays RD, Anderson R, Revicki D. Psychometric considerations in evaluating health-related quality of life measures. Quality of Life Research. 1993;2:441–449.PubMedCrossRef Hays RD, Anderson R, Revicki D. Psychometric considerations in evaluating health-related quality of life measures. Quality of Life Research. 1993;2:441–449.PubMedCrossRef
5.
go back to reference Wyrwich KW, Wolinsky FD. Identifying meaningful intra-individual change standards for health-related quality of life measures. Journal of Evaluation in Clinical Practice. 2000;6:39–49.PubMedCrossRef Wyrwich KW, Wolinsky FD. Identifying meaningful intra-individual change standards for health-related quality of life measures. Journal of Evaluation in Clinical Practice. 2000;6:39–49.PubMedCrossRef
6.
go back to reference McHorney CA, Tarlow AR. Individual patient monitoring in clinical practice: are available health status surveys adequate? Quality of Life Research. 1995;4(4):293–307.PubMedCrossRef McHorney CA, Tarlow AR. Individual patient monitoring in clinical practice: are available health status surveys adequate? Quality of Life Research. 1995;4(4):293–307.PubMedCrossRef
7.
go back to reference Hays RD, Brodsky M, Johnston MF, et al. Evaluating the statistical significance of health-related quality-of-life change in individual patients. Evaluation & the Health Professions. 2005;28:160–171.CrossRef Hays RD, Brodsky M, Johnston MF, et al. Evaluating the statistical significance of health-related quality-of-life change in individual patients. Evaluation & the Health Professions. 2005;28:160–171.CrossRef
8.
go back to reference Wyrwich KW, Bullinger M, Aaronson N, et al. Estimating clinically significant differences in quality of life outcomes. Quality of Life Research. 2005;14:285–295.PubMedCrossRef Wyrwich KW, Bullinger M, Aaronson N, et al. Estimating clinically significant differences in quality of life outcomes. Quality of Life Research. 2005;14:285–295.PubMedCrossRef
9.
go back to reference Glossary. Health outcomes methodology. Medical Care. 2000;38(9 Suppl. II,II-7-II-13):2–10). Glossary. Health outcomes methodology. Medical Care. 2000;38(9 Suppl. II,II-7-II-13):2–10).
10.
go back to reference Atkins DC, Bedics JD, McGlinchey JB, et al. Assessing clinical significance: Does it matter which method we use? Journal of Consulting & Clinical Psychology. 2005;73:982–989.CrossRef Atkins DC, Bedics JD, McGlinchey JB, et al. Assessing clinical significance: Does it matter which method we use? Journal of Consulting & Clinical Psychology. 2005;73:982–989.CrossRef
11.
go back to reference Eisen SV, Normand SLT, Belanger AJ, et al. The revised Behavior and Symptom Identification Scale (BASIS-24©): Reliability and validity. Medical Care. 2004;42:1230–1241.PubMedCrossRef Eisen SV, Normand SLT, Belanger AJ, et al. The revised Behavior and Symptom Identification Scale (BASIS-24©): Reliability and validity. Medical Care. 2004;42:1230–1241.PubMedCrossRef
12.
go back to reference Guyatt GH, Norman GR, Juniper EF, et al. A critical look at transition ratings. Journal of Clinical Epidemiology. 2002;55:900–908.PubMedCrossRef Guyatt GH, Norman GR, Juniper EF, et al. A critical look at transition ratings. Journal of Clinical Epidemiology. 2002;55:900–908.PubMedCrossRef
13.
go back to reference Spitzer RL, Gibbon M, Endicott J. Global Assessment Scale (GAS), Global Assessment of Functioning (GAF) Scale, Social and Occupational Functioning Assessment Scale (SOFAS). In: Handbook of Psychiatric Measures. Washington DC: American Psychiatric Association; 2000:96–100. Spitzer RL, Gibbon M, Endicott J. Global Assessment Scale (GAS), Global Assessment of Functioning (GAF) Scale, Social and Occupational Functioning Assessment Scale (SOFAS). In: Handbook of Psychiatric Measures. Washington DC: American Psychiatric Association; 2000:96–100.
14.
go back to reference Kazdin AE. Assessing the clinical or applied importance of behavior change through social validation. Behavior Modification. 1977;1:427–452.CrossRef Kazdin AE. Assessing the clinical or applied importance of behavior change through social validation. Behavior Modification. 1977;1:427–452.CrossRef
15.
go back to reference Streiner DL, Norman GR.Health Measurement Scales. A Practical Guide to Their Development and Use (3rd ed.). New York: Oxford University Press 2003 Streiner DL, Norman GR.Health Measurement Scales. A Practical Guide to Their Development and Use (3rd ed.). New York: Oxford University Press 2003
16.
go back to reference Jaeschke R, Singer J, Guyatt GH. Measurement of health status. Ascertaining the minimally important difference. Controlled Clinical Trials. 1991;10:407–415.CrossRef Jaeschke R, Singer J, Guyatt GH. Measurement of health status. Ascertaining the minimally important difference. Controlled Clinical Trials. 1991;10:407–415.CrossRef
17.
go back to reference Hurst H, Bolton J. Assessing the clinical significance of change scores recorded on subjective outcome measures. Journal of Manipulative Physiological Therapeutics. 2004;27:26–35.CrossRef Hurst H, Bolton J. Assessing the clinical significance of change scores recorded on subjective outcome measures. Journal of Manipulative Physiological Therapeutics. 2004;27:26–35.CrossRef
18.
go back to reference Ferguson RJ, Robinson AB, Splaine M. Use of the reliable change index to evaluate clinical significance in SF-36 outcomes. Quality of Life Research. 2002;11:509–516.PubMedCrossRef Ferguson RJ, Robinson AB, Splaine M. Use of the reliable change index to evaluate clinical significance in SF-36 outcomes. Quality of Life Research. 2002;11:509–516.PubMedCrossRef
19.
go back to reference Clancy C, Eisenberg J. Outcomes research care: measuring the end results of health care. Science. 1998;282:245–246.PubMedCrossRef Clancy C, Eisenberg J. Outcomes research care: measuring the end results of health care. Science. 1998;282:245–246.PubMedCrossRef
20.
go back to reference Cohen J.Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates; 1988. Cohen J.Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.
21.
go back to reference Testa M. Interpreting quality of life clinical trial data for use in the clinical practice of antihypertensive therapy. Journal of Hypertension Supplement. 1987;5:S9–S13. Testa M. Interpreting quality of life clinical trial data for use in the clinical practice of antihypertensive therapy. Journal of Hypertension Supplement. 1987;5:S9–S13.
22.
go back to reference Kazis Le, Anderson JJ, Meenan RF. Effect sizes for interpreting changes in health status. Medical Care. 1989;27(Suppl 3):S178–S189.PubMedCrossRef Kazis Le, Anderson JJ, Meenan RF. Effect sizes for interpreting changes in health status. Medical Care. 1989;27(Suppl 3):S178–S189.PubMedCrossRef
23.
go back to reference Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life. The remarkable universality of half a standard deviation. Medical Care. 2003;5:582–592.CrossRef Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life. The remarkable universality of half a standard deviation. Medical Care. 2003;5:582–592.CrossRef
24.
go back to reference Jacobson NS, Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology. 1991;59:12–19.PubMedCrossRef Jacobson NS, Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology. 1991;59:12–19.PubMedCrossRef
25.
go back to reference Jacobson NS, Follette WC, Revenstorf. Psychotherapy outcome research. Methods for reporting variability and evaluating clinical significance. Behavior Therapy. 1984;15:336–352.CrossRef Jacobson NS, Follette WC, Revenstorf. Psychotherapy outcome research. Methods for reporting variability and evaluating clinical significance. Behavior Therapy. 1984;15:336–352.CrossRef
26.
go back to reference Jacobson NS, Roberts LJ, Berns SB, McGlinchey JB. Methods for defining and determining the clinical significance of treatment effects: description, application and alternatives. Journal of Consulting and Clinical Psychology. 1999;67:300–307.PubMedCrossRef Jacobson NS, Roberts LJ, Berns SB, McGlinchey JB. Methods for defining and determining the clinical significance of treatment effects: description, application and alternatives. Journal of Consulting and Clinical Psychology. 1999;67:300–307.PubMedCrossRef
27.
go back to reference Speer D. Methodological developments. Clinically significant change: Jacobson and Truax (1991) revisited. Journal of Consulting and Clinical Psychology. 1992;69(3):402–408.CrossRef Speer D. Methodological developments. Clinically significant change: Jacobson and Truax (1991) revisited. Journal of Consulting and Clinical Psychology. 1992;69(3):402–408.CrossRef
28.
go back to reference Hageman WJM, Arrindell WA. A further refinement of the reliable change (RC) index by improving the pre–post difference score: introducing RCID. Behaviour Research and Therapy. 1993;31:693–700.PubMedCrossRef Hageman WJM, Arrindell WA. A further refinement of the reliable change (RC) index by improving the pre–post difference score: introducing RCID. Behaviour Research and Therapy. 1993;31:693–700.PubMedCrossRef
29.
go back to reference Anastasi A, Urbina S.Psychological Testing (7th ed.). Upper Saddle River, NJ: Prentice-Hall; 1997. Anastasi A, Urbina S.Psychological Testing (7th ed.). Upper Saddle River, NJ: Prentice-Hall; 1997.
30.
go back to reference Wyrwich KW, Tierney WM, Wolinsky FD. Further evidence supporting an SEM-based criterion for identifying meaningful intra-individual changes in health-related quality of life. Journal of Clinical Epidemiology. 1999;52:861–873.PubMedCrossRef Wyrwich KW, Tierney WM, Wolinsky FD. Further evidence supporting an SEM-based criterion for identifying meaningful intra-individual changes in health-related quality of life. Journal of Clinical Epidemiology. 1999;52:861–873.PubMedCrossRef
31.
go back to reference Wyrwich KW, Nienaber NA, Tierney WM, Wolinsky FD. Linking clinical relevance and statistical significance in evaluating intra-individual changes in health-related quality of life. Medical Care. 1999;37:469–478.PubMedCrossRef Wyrwich KW, Nienaber NA, Tierney WM, Wolinsky FD. Linking clinical relevance and statistical significance in evaluating intra-individual changes in health-related quality of life. Medical Care. 1999;37:469–478.PubMedCrossRef
32.
go back to reference Eisen SV, Dill DL, Grob MC. Reliability and validity of a brief patient-report instrument for psychiatric outcome evaluation. Hospital & Community Psychiatry. 1994;45:242–247. Eisen SV, Dill DL, Grob MC. Reliability and validity of a brief patient-report instrument for psychiatric outcome evaluation. Hospital & Community Psychiatry. 1994;45:242–247.
33.
go back to reference American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. (DSM-IV). Washington D.C.: American Psychiatric Association; 1994. American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. (DSM-IV). Washington D.C.: American Psychiatric Association; 1994.
34.
go back to reference Burlingame GM, Dunn TW, Chen S, et al. Selection of outcome assessment instruments for inpatients with severe and persistent mental illness. Psychiatric Services. 2005;56:444–451.PubMedCrossRef Burlingame GM, Dunn TW, Chen S, et al. Selection of outcome assessment instruments for inpatients with severe and persistent mental illness. Psychiatric Services. 2005;56:444–451.PubMedCrossRef
35.
go back to reference Eisen SV, Gerena M, Rangathan G, et al. Reliability and validity of the BASIS-24© Mental Health Survey for Whites, African-Americans and Latinos. Journal of Behavioral Health Services & Research. 2006;33:304–323.CrossRef Eisen SV, Gerena M, Rangathan G, et al. Reliability and validity of the BASIS-24© Mental Health Survey for Whites, African-Americans and Latinos. Journal of Behavioral Health Services & Research. 2006;33:304–323.CrossRef
36.
go back to reference Jerrell JM. Behavior and Symptom Identification Scale 32. Sensitivity to change over time. Journal of Behavioral Health Services & Research. 2005;32:341–346.CrossRef Jerrell JM. Behavior and Symptom Identification Scale 32. Sensitivity to change over time. Journal of Behavioral Health Services & Research. 2005;32:341–346.CrossRef
37.
go back to reference Cohen J. A coefficient of agreement for nominal scales. Educational and Psychological Measurement. 1960;20:37–46.CrossRef Cohen J. A coefficient of agreement for nominal scales. Educational and Psychological Measurement. 1960;20:37–46.CrossRef
38.
go back to reference Lambert MJ, Lambert JM. Use of psychological tests for assessing treatment outcome. In: Maruish ME, ed. The Use of Psychological Testing for Treatment Planning and Outcomes Assessment (2nd ed.). Mahwah, NJ: Lawrence Erlbaum; 1999:115–152. Lambert MJ, Lambert JM. Use of psychological tests for assessing treatment outcome. In: Maruish ME, ed. The Use of Psychological Testing for Treatment Planning and Outcomes Assessment (2nd ed.). Mahwah, NJ: Lawrence Erlbaum; 1999:115–152.
39.
go back to reference Jacobson NS, Roberts LJ, Berns SB, et al. Methods for defining and determining the clinical significance of treatment effects. Journal of Consulting and Clinical Psychology. 1999;67:300–307.PubMedCrossRef Jacobson NS, Roberts LJ, Berns SB, et al. Methods for defining and determining the clinical significance of treatment effects. Journal of Consulting and Clinical Psychology. 1999;67:300–307.PubMedCrossRef
40.
go back to reference Ogles BM, Lambert MJ, Sawyer JD. Clinical significance of the National Institute of Mental Health treatment of depression collaborative research program data. Journal of Consulting and Clinical Psychology. 1995;63:321–326.PubMedCrossRef Ogles BM, Lambert MJ, Sawyer JD. Clinical significance of the National Institute of Mental Health treatment of depression collaborative research program data. Journal of Consulting and Clinical Psychology. 1995;63:321–326.PubMedCrossRef
41.
go back to reference Guyatt H, Osoba D, Wu A, et al. Methods to explain the clinical significance of health status measures. Mayo Clinic Proceedings. 2002;77(4):373–383. Guyatt H, Osoba D, Wu A, et al. Methods to explain the clinical significance of health status measures. Mayo Clinic Proceedings. 2002;77(4):373–383.
42.
go back to reference Jones SH, Thornicroft G, Coffey M, et al. A brief mental health outcome scale-reliability and validity of the Global Assessment of Functioning (GAF). British Journal of Psychiatry. 1995;166:654–650.PubMedCrossRef Jones SH, Thornicroft G, Coffey M, et al. A brief mental health outcome scale-reliability and validity of the Global Assessment of Functioning (GAF). British Journal of Psychiatry. 1995;166:654–650.PubMedCrossRef
43.
go back to reference Startup M, Jackson MC, Bendix S. The concurrent validity of the Global Assessment of Functioning (GAF). British Journal of Clinical Psychology. 2002;41:417–422.PubMedCrossRef Startup M, Jackson MC, Bendix S. The concurrent validity of the Global Assessment of Functioning (GAF). British Journal of Clinical Psychology. 2002;41:417–422.PubMedCrossRef
44.
go back to reference Greenberg GA, Rosenheck RA. Using the GAS as a national mental health outcome measure in the Department of Veterans Affairs. Psychiatric Services. 2005;56:420–426.PubMedCrossRef Greenberg GA, Rosenheck RA. Using the GAS as a national mental health outcome measure in the Department of Veterans Affairs. Psychiatric Services. 2005;56:420–426.PubMedCrossRef
45.
go back to reference Wilkinson G, Hesdon B, Wild D, et al. Self-report quality of life measure for people with schizophrenia: the SQLS. British Journal of Psychiatry. 2000;177:42–46.PubMedCrossRef Wilkinson G, Hesdon B, Wild D, et al. Self-report quality of life measure for people with schizophrenia: the SQLS. British Journal of Psychiatry. 2000;177:42–46.PubMedCrossRef
46.
go back to reference Srebnick D, Hendryx M, Stevenson J, et al. Development of outcome indicators for monitoring the quality of public mental health care. Psychiatric Services. 1997;48:903–909. Srebnick D, Hendryx M, Stevenson J, et al. Development of outcome indicators for monitoring the quality of public mental health care. Psychiatric Services. 1997;48:903–909.
47.
go back to reference Norman GR, Sridhar FG, Guyatt GH. Relation of distribution- and anchor-based approaches in interpretation of changes in health-related quality of life. Medical Care. 2001;39:1039–1047.PubMedCrossRef Norman GR, Sridhar FG, Guyatt GH. Relation of distribution- and anchor-based approaches in interpretation of changes in health-related quality of life. Medical Care. 2001;39:1039–1047.PubMedCrossRef
48.
go back to reference Nunnally JC.Psychometric Theory. New York: McGraw-Hill; 1994. Nunnally JC.Psychometric Theory. New York: McGraw-Hill; 1994.
49.
go back to reference Gilbody SM, House AO, Sheldon T. Routine administration of health related quality of life (HRQoL) and needs assessment instruments to improve psychological outcome—a systematic review. Psychological Medicine. 2002;32:1345–1356.PubMedCrossRef Gilbody SM, House AO, Sheldon T. Routine administration of health related quality of life (HRQoL) and needs assessment instruments to improve psychological outcome—a systematic review. Psychological Medicine. 2002;32:1345–1356.PubMedCrossRef
50.
go back to reference Garland AF, Kruse M, Aarons GA. Clinicians and outcome measurement: What’s the use? Journal of Behavioral Health Services & Research. 2003;30:393–405.CrossRef Garland AF, Kruse M, Aarons GA. Clinicians and outcome measurement: What’s the use? Journal of Behavioral Health Services & Research. 2003;30:393–405.CrossRef
Metadata
Title
Measuring Clinically Meaningful Change Following Mental Health Treatment
Authors
Susan V. Eisen, PhD
Gayatri Ranganathan, MS
Pradipta Seal, MS
Avron Spiro III, PhD
Publication date
01-07-2007
Publisher
Springer US
Published in
The Journal of Behavioral Health Services & Research / Issue 3/2007
Print ISSN: 1094-3412
Electronic ISSN: 2168-6793
DOI
https://doi.org/10.1007/s11414-007-9066-2

Other articles of this Issue 3/2007

The Journal of Behavioral Health Services & Research 3/2007 Go to the issue

Letter to the Editor

Gain Is Not Always Good