Minimally important change on the Columbia Impairment Scale and Strengths and Difficulties Questionnaire in youths seeking mental healthcare

Karolin R Krause; Alina Lee; Di Shan; Katherine Tombeau Cost; Lisa D Hawke; Amy H Cheung; Kristin Cleverley; Claire de Oliveira; Meaghen Quinlan-Davidson; Myla E Moretti; Jo L Henderson; Clement Ma; Peter Szatmari

doi:10.1136/bmjment-2024-301425

Minimally important change on the Columbia Impairment Scale and Strengths and Difficulties Questionnaire in youths seeking mental healthcare

BMJ Ment Health. 2025 Jan 22;28(1):e301425. doi: 10.1136/bmjment-2024-301425.

Authors

Karolin R Krause^{1

2}, Alina Lee³, Di Shan³, Katherine Tombeau Cost^{4

5}, Lisa D Hawke^{6

7}, Amy H Cheung^{6

8}, Kristin Cleverley^{6

9

10}, Claire de Oliveira^{11

7

12

13}, Meaghen Quinlan-Davidson⁹, Myla E Moretti^{13

14}, Jo L Henderson^{6

9}, Clement Ma^{3

15}, Peter Szatmari^{11

6

16}

Affiliations

¹ Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada karolin.krause@u-paris.fr.
² Centre for Research in Epidemiology and Statistics (CRESS), Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAe, Paris, France.
³ Biostatistics Core, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
⁴ Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.
⁵ Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
⁶ Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
⁷ Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
⁸ Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
⁹ Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
¹⁰ Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
¹¹ Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
¹² Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
¹³ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
¹⁴ Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
¹⁵ Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
¹⁶ Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada.

PMID: 39848629
DOI: 10.1136/bmjment-2024-301425

Abstract

Background: Evidence-based mental health requires patient-relevant outcome data, but many indicators lack clinical meaning and fail to consider youth perceptions. The minimally important change (MIC) indicator designates change as meaningful to patients, yet is rarely reported in youth mental health trials.

Objective: This study aimed to establish MIC thresholds for two patient-reported outcome measures (PROMs), the Columbia Impairment Scale (CIS) and the Strengths and Difficulties Questionnaire (SDQ), using different estimation methods.

Methods: A sample of 247 youths (14-17 years) completed the CIS and SDQ at baseline and at 6 months in a youth mental health and substance use trial. At 6 months, youths also reported perceived change. Three anchor-based (mean change, receiver operating characteristic analysis, predictive modelling) and three distribution-based methods (0.5 SD, measurement error, smallest detectable change) were compared.

Findings: Different methods yielded varying MIC thresholds. Predictive modelling provided the most precise anchor-based MIC: -2.6 points (95% CI -3.6, -1.6) for the CIS and -1.7 points (95% CI -2.2, -1.2) for the SDQ, indicating that score improvements of 12% for the CIS and 8% for the SDQ may be perceived as 'important' by youths. However, correlations between change score and anchor were below 0.5 for both measures, indicating suboptimal anchor credibility. Stronger correlations between the anchor and T2 PROM scores compared with T1 scores suggest the presence of recall bias. All MIC estimates were smaller than the smallest detectable change.

Conclusions: Predictive modelling offers the most precise MIC, but limited anchor credibility suggests careful anchor calibration is necessary.

Clinical implications: Clinicians may consider the MIC CI as indicative of meaningful change when discussing treatment impact with patients.

Trial registration number: NCT02836080.

Keywords: Child & adolescent psychiatry; Data Interpretation, Statistical.

MeSH terms

Adolescent
Female
Humans
Male
Mental Disorders* / diagnosis
Mental Disorders* / psychology
Mental Disorders* / therapy
Mental Health Services
Minimal Clinically Important Difference
Patient Reported Outcome Measures
Surveys and Questionnaires

Associated data

ClinicalTrials.gov/NCT02836080