Are you bothered? Assessing the association between symptoms and botheredness using real-world data to help improve mental health services

Healthcare can be inappropriate and waste valuable and finite resources when it is not aligned to the needs and goals of patients. In mental health, although the importance of subjective experience and the patient's perspective is generally recognized, many current clinical measures do not reflect this. Mental health services might become more effective and efficient if the data being collected from patients more closely reflected patients' priorities and preferences. To promote embedded clinical research (EmCR) as well as leveraging its benefits, a service innovation was introduced to investigate the interchangeability of symptom ratings and botheredness ratings. A file audit examined routinely collected real-world data including ratings of impairment as well as ratings of botheredness from a clinical psychology outpatient clinic in a public mental health service. The Work and Social Adjustment Scale was modified and data from 61 files were analysed using resampling methods to explore associations between and interchangeability of the ratings. The data indicated that ratings of impairment and botheredness were strongly correlated. Null hypothesis significance testing, however, provided evidence that impairment and botheredness were not, in general, interchangeable. Current approaches to obtaining mental health information from patients might not be aligned with their priorities. These findings could have implications for making mental health services more effective and efficient by improving the extent to which service delivery is meaningful and useful to patients.