Patient Reported Outcome Measures for Mental Health: Development and Pragmatic Evaluation in the NHS

Blenkiron, Paul

Abstract

Background: Patient-reported outcome measures (PROMs) are standardised questionnaires or interviews that elicit subjective reports of health. They have growing potential for improving patient-centred care and decision making. The National Institute for Health and Care Excellence (NICE) recommends considering their use at regular points in the treatment pathway for common mental health conditions and physical problems such as cancer.
Aims: To assess the feasibility, acceptability and usefulness of implementing four established PROMS: the Patient Health Questionnaire-9 (PHQ-9) for depression, Generalised Anxiety Disorder-7 scale (GAD-7), Short Warwick & Edinburgh Mental Wellbeing Scale (SWEMWBS) and Distress Thermometer (DT), and to pilot two novel ‘developed for purpose’ satisfaction tools: Carers’ & Users’ Expectations of Service (CUES) and Recovering Quality of Life (ReQoL).
Setting: Mental health multidisciplinary teams within the UK National Health Service.
Methods: Outcomes evaluated were mental/physical symptoms, emotional distress, life/service satisfaction and global quality of life. Designs were pragmatic, including quantitative and mixed methods, cross sectional and prospective before and after studies.
Results: The thesis comprises five original research publications and three academic linked papers. Where assessed, PROM acceptability and completion rates were high (76-98%), leading to changes in care in 49% cases. Following therapeutic interventions, a large clinical effect size was observed: within community mental health teams PHQ-9, GAD-7 scores and functioning all improved (Cohen’s d = 0.52-0.77). In cancer psychology services, median distress (DT) scores decreased significantly (Wilcoxon’s z = -4.83, p<0.001, Cohen’s d =1.22). Sensitivity to change was greater for ReQoL, PHQ-9, GAD-7 and DT than for SWEMWBS.
Conclusions: This body of research provides cumulative evidence that validated mental health PROMS can reliably assess meaningful changes at key stages in a patient’s journey, with apparent absence of significant harms. PROMS should be more widely integrated into frontline care, to inform individual treatment planning and contribute to service improvements.

Citation

Blenkiron, P. (2025). Patient Reported Outcome Measures for Mental Health: Development and Pragmatic Evaluation in the NHS. (Thesis by Publication). University of Hull and University of York. https://hull-repository.worktribe.com/output/5287979

• Thesis Type: Thesis by Publication
• Deposit Date: Jul 18, 2025
• Publicly Available Date: Jul 21, 2025
• Keywords: Medicine
• Public URL: https://hull-repository.worktribe.com/output/5287979
• Additional Information: Health Sciences; Hull York Medical School; University of Hull and University of York; ; List of Papers comprising this Thesis:; A. Blenkiron P, Mo KH, Cuzen J and Hammill AC. Involving service users in their care: the CUES Project. Psychiatric Bulletin (The Journal of Psychiatric Practice), Oct 2003; 27(9): 334-338 (Print). Published online by Cambridge University Press 2Jan 2018 https://doi.org/10.1192/pb.27.9.334; B. Blenkiron P, Hammill CA. What determines patients’ satisfaction with their mental health care and quality of life? Postgraduate Medical Journal, 2003; 79(932): 337-340. http://dx.doi.org/10.1136/pmj.79.932.337; C. Blenkiron, P, Brooks A, Dearden R & McVey J. Use of the Distress Thermometer to Evaluate Symptoms, Outcome and Satisfaction in a Specialist Psycho-oncology Service. General Hospital Psychiatry 2014; 36(6): 607-612 https://doi.org/10.1016/j.genhosppsych.2014.06.003; D. Keetharuth AD, Brazier J, Connell J, et al, on behalf of the ReQoL Scientific Group: Recovering Quality of Life (ReQoL): a new generic self-reported outcome measure for use with people experiencing mental health difficulties. British Journal of Psychiatry, 2018; 212(1):42-49. https://doi.org/10.1192/bjp.2017.10; E. Blenkiron P & Goldsmith L. Patient Reported Outcomes Measures in Community Mental Health Teams: Pragmatic Evaluation of PHQ-9, GAD-7 and SWEMWBS. BJPsych Bulletin Oct 2019; 43(5): 221-227 http://dx.doi.org/10.1192/bjb.2019.20; F. Lynch S, Clarkson P, Blenkiron P, Fraser J. Scale based protocols for the detection and management of depression. Primary Care Psychiatry 2002; 8(3): 77-84. https://doi.org/10.1185/135525702125001506; G. Blenkiron P, Byng R, Chew-Graham C, Goldberg D, Ivbijaro G, Nipah R, D, Rathod S, Shafran R. NICE: Common Mental Health Problems: Clinical Case Scenarios for Primary Care. A learning & development resource to support the NICE guideline CG123 (Common Mental Health Disorders: Identification & Pathways to Care). Ch7: Active Monitoring & Psychoeducation. National Institute for Health and Clinical Excellence, 2012. https://www.nice.org.uk/guidance/cg123/resources/clinical-case-; scenarios-pdf-version-pdf-181726381; H. Ransom S & Blenkiron P: Mental Health Outcome Measures: A clinical review and descriptive survey of psychiatrists’ current practices. Scholarship & Special Interest Programme (SSIP) Project & Poster, Hull York Medical School (Unpublished).
• Award Date: Jul 10, 2025