Transdiagnostic risk profiling for poor prognosis: a Delphi study

ObjectiveIdentifying transdiagnostic risk profiles can complement traditional diagnostic classification systems by highlighting risk factors that offer additional insights for predicting prognosis and guiding treatment planning. Existing reviews of risk factors may have limited value due to their incompleteness and lack of clinical utility for decision-making. This study aimed to address these limitations by incorporating the perspectives of experts in the field. Our objective was to reach a consensus among specialists from various disciplines in mental health care on risk factors associated with poor prognosis and (accelerated) stage progression in youth across different diagnostic categories. Additionally, we aimed to develop an easy-to-use tool for assessing individual risk profiles in young people with emerging psychopathology.MethodTo achieve this, we conducted two focus groups with 11 experts who were specifically selected from different areas of mental healthcare. We then conducted a Delphi procedure with 12 experts to validate the expert consensus. We predetermined a threshold of two-thirds (67%) consensus, which required two Delphi rounds to achieve.ResultsThe results highlight four main areas of risk factors: 1) child factors, 2) context factors, 3) characteristics of the symptoms and 4) treatment attitude. A user-friendly tool designed for clinical and research use was derived from these findings to facilitate the assessment of individual risk profiles.ConclusionsOur findings partly overlap with existing review data but also expand their scope by highlighting the significance of contextual risk factors, specific symptom features, and the family's attitude towards treatment.