Article Text

Original research
Evaluating quality in adolescent mental health services: a systematic review
  1. Meaghen Quinlan-Davidson1,
  2. Kathryn J Roberts1,
  3. Delan Devakumar1,
  4. Susan M. Sawyer2,
  5. Rafael Cortez3,
  6. Ligia Kiss1
  1. 1Institute for Global Health, University College London, London, UK
  2. 2Centre for Adolescent Health, Royal Children's Hospital; Murdoch Children's Research Institute; and Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
  3. 3Health, Nutrition and Population, The World Bank, Washington, District of Columbia, USA
  1. Correspondence to Meaghen Quinlan-Davidson; meaghen.quinlan-davidson.17{at}


Objectives To evaluate the quality of adolescent mental health service provision globally, according to the WHO Global Standards of adolescent mental health literacy, appropriate package of services and provider competencies.

Design and data sources Systematic review of 5 databases, and screening of eligible articles, from 1 January 2008 to 31 December 2020.

Study eligibility criteria We focused on quantitative and mixed-method studies that evaluated adolescent mental health literacy, appropriate package of services and provider competencies in mental health services, and that targeted depression, anxiety and post-traumatic stress disorder among adolescents (10–19 years). This included adolescents exposed to interventions or strategies within mental health services.

Study appraisal and synthesis methods Study quality was assessed using the National Institutes for Health Study Quality Assessment Tools. Data were extracted and grouped based on WHO quality Standards.

Results Of the 20 104 studies identified, 20 articles were included. The majority of studies came from high-income countries, with one from a low-income country. Most of the studies did not conceptualise quality. Results found that an online decision aid was evaluated to increase adolescent mental health literacy. Studies that targeted an appropriate package of services evaluated the quality of engagement between the therapist and adolescent, patient-centred communication, mental health service use, linkages to mental health services, health facility culture and intensive community treatment. Provider competencies focused on studies that evaluated confidence in managing and referring adolescents, collaboration between health facility levels, evidence-based practices and technology use.

Conclusions and implications There is limited evidence on quality measures in adolescent mental health services (as conforms to the WHO Global Standards), pointing to a global evidence gap for adolescent mental health services. There are several challenges to overcome, including a need to develop consensus on quality and methods to measure quality in mental health settings.

PROSPERO registration number CRD42020161318.

  • quality in health care
  • child & adolescent psychiatry
  • mental health
  • international health services

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study. Not applicable.

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study. Not applicable.

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  • Correction notice This article has been corrected since it was first published. The correct licence type is CC BY.

  • Contributors MQ-D led the study design, data searches, data extraction, quality appraisal, synthesis and drafted the manuscript. KJR contributed to the design, data extraction, quality appraisal and writing of the manuscript. LK and DD provided significant and critical contribution to the conceptualisation, design and interpretation of findings. SS critically reviewed the manuscript and offered key intellectual input to the synthesis and interpretation of findings. RC critically reviewed the manuscript and offered important intellectual input.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. KJR is supported by an Economic Social Research Council (ESRC) PhD studentship through the UBEL DTP (kr0001).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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