Abstract
Early intervention treatment programs for mood and anxiety disorders are desperately needed since incidence of these is increasing. Evaluating such programs can identify which model components are helpful in providing improved outcomes. Realist evaluations discuss context-mechanism-outcome configurations to identify which interventions help whom, how, and under what circumstances. This study presents a realist configuration to evaluate an early intervention mood and anxiety program. The intervention involves personalized treatment in a shared decision-making model. The context of the model and the intervention, which uses a personalized, holistic, patient-centered approach that supports and facilitates agency enhancement within patients is described. The hypothesized mechanism of recovery is improved individual agency of the patient. Mixed methods were used to assess the proposed configuration. Illness severity measures were compared before engagement and 1–2 years after treatment onset. Results show improved functioning as well as improved symptoms, better quality of life and satisfaction with care. Individuals experienced significant functional improvement, with a large effect size. Symptoms and quality of life also improved significantly with large effect sizes. Reported satisfaction was high. Improvement in functioning was correlated with improvement in coping style but not age, number of visits, duration between timepoints or total number of traumatic exposures. Qualitative data also addressed the hypothesized mechanism of recovery. Youth identified their own engagement in care as an essential source of recovery and attributed improved agency as integral to overcoming life disruptions caused by mental illness. This realist evaluation is preliminary or pilot, and future work is needed to assess the hypothesized configuration more comprehensively and in different populations.
Funder
London Health Sciences Centre
Publisher
Public Library of Science (PLoS)