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

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.

Metadata

Supervisors:	Simon, Gilbody
Related URLs:	Paper A - CUES Project - BJPsych Bull 2018 - Blenkiron et al (Publisher) Paper B- CUES Satisfaction - PMJ 2003 - Blenkiron & Hammill (Publisher) Paper C- Distress Thermometer - GHP - Blenkiron et al 2014 (Publisher) Paper D - ReQoL - BJPsych - Keetharuth et al 2018 (Publisher) Paper E - CMHT PROMS - BJPsych Bull - Blenkiron & Goldsmith 2018 (Publisher) Paper F - Depression Scales - PCP - Lynch et al 2002 (Publisher) Paper G - CMHD Clinical Case Scenarios - NICE 2012 (Organisation) Paper H - MH Outcomes Survey - HYMS SSIP - Ransom & Blenkiron 2018 (Unpublished) (Organisation)
Publicly visible additional information:	As this is an MD by Published Work, the linked papers A to H comprising the themed body of research, have been uploaded. All outcome measures used are also uploaded to aid understanding of the published papers and thesis summary.
Keywords:	Outcome measures; rating scales; questionnaires; patient satisfaction; wellbeing; quality of life; community mental health teams; cancer psychology; NICE; PHQ-9; GAD-7; distress thermometer; ReQoL; SWEMWBS; CUES
Awarding institution:	University of York
Academic Units:	The University of York > Hull York Medical School (York)
Academic unit:	Hull York Medical School
Depositing User:	Professor Paul Blenkiron
Date Deposited:	16 Jul 2025 11:05
Last Modified:	16 Jul 2025 11:05
Open Archives Initiative ID (OAI ID):	oai:etheses.whiterose.ac.uk:37133

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Filename: 0. THE MD THESIS - Patient Reported Outcomes For Mental Health - HYMS - Paul Blenkiron - April 2025.pdf

Description: Main MD Thesis - MH PROMS - Summary (9K) -Tables Boxes References - List of Appendices

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Filename: Paper A - Blenkiron et al CUES Project Bulletin BJPsych 2003 e2018 pdf.pdf

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Filename: Paper B - Blenkiron & Hammill CUES Satisfaction PostGrad Med J 2003 pdf.pdf

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Filename: Paper D - ReQol Scientific Group - Recovering Quality of Life BJPsych 2018 Paper.pdf

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Filename: Paper E - Blenkiron & Goldsmith PROMS in CMHTs BJPsych Bulletin 2019 Paper.pdf

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Filename: Paper F - Lynch Clarkson Blenkiron Scale Based Protocols PCP 2002.pdf

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Filename: Paper G - NICE Guideline CMHD Clinical Case Scenarios May 2012 pdf.pdf

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Filename: Paper H - Ransom & Blenkiron P MH Outcomes SSIP HYMS 2018 & Poster.pdf

Description: Paper H - Ransom & Blenkiron MH Outcomes Survey of Psychiatrists Practice SSIP HYMS 2018 & Poster

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Filename: APPENDIX 2 - THE PUBLISHED PAPERS -References-Abstracts-Citations.pdf

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Filename: APPENDIX 3 - CUES Paper B MRCPsych Exam Questions.pdf

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Filename: APPENDIX 4 - SSIP Questionnaire Survey of PROMS use by Psychiatrists.pdf

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Supplementary Material

Filename: PROM 1 - Papers A & B - CUES (Carers' & Users' Expectations of Service) - RCPsych Service User Outcomes Measure.pdf

Description: CUES Outcome Measure - PROM 1- Papers A and B -- Carers' & Users' Expectations of Service - RCPsych

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Supplementary Material

Filename: PROM 2 - Paper C - DT (Distress Thermometer & Problem Checklist) - Pre & Post Questionnaires.pdf

Description: DT Outcome Measure - PROM2 - Paper C -Distress Thermometer & Problem Checklist - Pre & Post Questionnaires

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Supplementary Material

Filename: PROM 3a - Paper D - ReQoL-10 (Recovering Quality of Life) - English UK Final Questionnaire.pdf

Description: ReQoL Outcome Measure - PROM 3a - Paper D - Recovering Quality of Life - English UK Final Questionnaire

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Supplementary Material

Filename: PROM 3b - Paper D - ReQoL-10 (Recovering Quality of Life) - Summary Leaflet & Scale.pdf

Description: ReQoL-10 Outcome Measure - PROM 3b - Paper D - Recovering Quality of Life - Summary Leaflet & Scale

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Supplementary Material

Filename: PROM 3c - Paper D - ReQoL (Recovering Qualiy of Life) Scoring Guide.pdf

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Filename: PROM 3d - Paper D - ReQoL-20 (Recovering Quality of Life) - English UK Final Questionnaire.pdf

Description: ReQoL-20 Outcome Measure - Paper D - PROM 3d - Recovering Quality of Life - English UK Final Questionnaire

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Supplementary Material

Filename: PROM 4 - Paper E - PHQ-9 & GAD-7 Scales+Scoring+Notes PB.pdf

Description: PHQ-9 & GAD-7 Outcome Measures - Paper E - PROM 4 - Scales + Scoring + Notes

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Supplementary Material

Filename: PROM 5 - Paper E - SWEMWBS (Short Warwick & Edinburgh Mental Wellbeing Scale).pdf

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

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