Using stakeholder-weighted outcomes in depression trials

Mental health randomised controlled trials (RCTs) base treatment benefit on a sole primary outcome, that is typically symptom-based in depression trials. However, research with stakeholders, including service-users and clinicians, often reports that although symptoms are important, but other domains such as quality-of-life, social, and occupational functioning are also prioritised. This evidence is not influencing current RCT practice, with sole primary outcomes remaining the norm. This short communication discusses how Multi-criteria Decision Modelling (MCDM) could offer a solution to this mismatch of expectations, by using stakeholder priorities for outcomes collected in RCTs and combining them with outcome data to produce stakeholder-weighted composites. These can be substituted for the primary outcome, to provide a complementary view of benefit from a broader, stakeholder-weighted multidomain lens. This could reveal nuances in treatment benefit and an understanding of treatment alignment with stakeholder expectations.