(PS3-C70) Overcoming Outcome Obstacles: An Exploration of Mental Health Measures in Prevention and Early Intervention Research for Youth with Internalizing Concerns

Introduction: Global trends in mental health reflect salient internalizing symptomatology, with an estimated 25% and 21% of youth experiencing clinical elevations of depression and anxiety symptoms, respectively. Increasing utilization of therapeutic services among youth is encouraging; however, traditional therapy may be delayed until symptoms are severe and cause functional impairment. Prevention and early intervention strategies holds potential to promote protective factors and mitigate symptom onset among vulnerable youth. An array of interventions have been administered in schools and community-based settings, demonstrating the feasibility of delivering programs designed to reduce traditional barriers to care and risk of internalizing disorders. However, authors commonly cite the inability to detect meaningful symptom changes among universal and subclinical samples as a key limitation, suggesting that commonly used outcome measures may not be appropriate for capturing change in prevention research. The present study seeks to identify and describe frequently administered measurement tools to evaluate suitability for assessing the impact of prevention programming as well as guide considerations for the assessment of well-being and resilience as precursors to elevated symptomatology among subclinical youth.

Method: We systematically reviewed studies that aimed to prevent internalizing disorders among youth ages 12 to 18. A final sample of 116 articles consisting of 52 unique prevention programs were evaluated. Psychometrically validated measurement tools targeting internalizing concerns (e.g., anxiety, depression) and protective factors (e.g., self-regulation) were identified, yielding 154 unique self-report measures.

Results: The majority of studies (96.56%, n = 112) included outcome measures developed to assess internalizing symptoms (n = 108). The most frequently utilized mental health measure was the Center for Epidemiologic Studies–Depression Scale (CES-D) (20.69%, n = 24), followed by Children’s Depression Inventory (CDI) (16.38%, n = 19), and Spence Children’s Anxiety Scale (SCAS) (14.66%, n = 17). In contrast, a total of 50 studies (43.10%) additionally included 48 questionnaires designed to capture coping skills that may prevent the development of internalizing disorders. The most frequently administered coping scale was the Social Adjustment Scale (SAS-SR) (4.31%, n = 5), followed by Satisfaction with Life Scale (SWLS) (3.45%, n = 4), and Child and Adolescent Social and Adaptive Functioning Scale (CASAFS) (3.45%, n = 4).

Discussion: There was a substantial diversity in measurement tools used across studies seeking to prevent internalizing symptomatology among youth. Frequent inclusion of measures targeting clinically significant disorders severity may result in nonsignificant outcomes in the context of prevention programming, contributing to inaccurate interpretations about program effectiveness and barriers to the implementation of viable interventions. Future researchers are encouraged to identify and select relevant outcomes measures that are sensitive to internalizing vulnerabilities and positive coping skills among youth in broad school and community settings.