Grant: CIHR Fellowship

When diagnosing common mental health conditions like anxiety, depression, substance use or self-harm, or when evaluating treatments in youth aged 14-24 years, clinicians must consider both the severity of mental health symptoms, and the extent to which these symptoms cause functional impairment (i.e., limitations in the ability to perform activities of daily life). Impairment is central to clinical and public health decision-making. Yet, while symptom measurement is comparatively well developed in youth mental health, the measurement of impairment has been seriously neglected. Critical gaps include: (1) lack of data about how youth with the above-mentioned conditions experience impairment and whether existing measurement scales adequately capture their experiences; (2) lack of guidance on which measurement scale produces the highest-quality data; and (3) uncertainty as to how change in impairment scores should be interpreted in research and practice. My research program addresses these gaps. We are currently conducting a scoping literature review to identify all available impairment scales for youth mental health. Building upon this, we will then: (1) conduct focus groups with culturally and gender-diverse youth to explore what impairment means to them, and we will appraise the extent to which existing scales capture impairment in line with their perspectives; (2) we will systematically retrieve and appraise all evidence about the quality and trustworthiness of existing impairment scales identified through our scoping review, and identify the strongest option based on expert-developed criteria (COSMIN); and (3) we will identify indicators of a clinically meaningful change that might occur in a treatment program, to support interpretation of change scores. This research program will help move the youth mental health field towards a level of rigor and consistency in the assessment of impairment before and during treatment that matches its crucial clinical importance.