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Cancer Survivorship and Care · Journal article
Bjpsych International · July 21, 2026
Encouraging direction, but not yet definitive.
This multicentre cross-sectional study of 7925 adults in Spanish outpatient mental health services demonstrates that digital PROM collection is operationally feasible and that severity scores on depression, anxiety, PTSD and substance misuse scales are significantly associated with self-harm, suicide attempts and medication non-adherence. However, the observational design cannot establish causation or whether PROM-guided care improves outcomes; the findings describe predictive associations suitable for risk stratification but do not yet support a causal or interventional claim.
Multicentre, cross-sectional study. Adults attending outpatient mental health clinics in a multicentre Spanish network; 7925 of 73,140 referred patients completed PROMs (median age 48 years; 68.8% women).. Intervention: Digital PROMs (e-PROMs) program delivering validated Spanish versions of WHO-5, PHQ-9, GAD-7, AUDIT-C, DAST-10 and PC-PTSD-5 via patient web portal integrated into electronic health record.. n = 7,925. Multicentre Spanish network; specific number of centres not stated..
Of 73,140 referred patients, 7925 (10.9%) completed PROMs; median age 48 years, 68.8% women. Severe depression affected 38.5%, severe anxiety 30.9%, PTSD risk 42.4% of completers. Severe depression was the strongest predictor of self-harm (odds ratio 4.52, p < 0.001), followed by substance misuse (odds ratio 2.38, p < 0.001) and PTSD risk (odds ratio 2.29, p < 0.001).
Severe depression was the strongest predictor of self-harm (odds ratio 4.52, p < 0.001), followed by substance misuse (odds ratio 2.38, p < 0.001) and PTSD risk (odds ratio 2.29, p < 0.001).
These findings support the operational feasibility of large-scale digital PROM deployment for risk stratification in routine psychiatry. Clinicians may use PROM-derived severity scores as adjuncts to identify patients at elevated risk of self-harm, suicidality and non-adherence, but should note this is observational evidence of association, not proof that PROM-guided interventions reduce these harms.
A large multicentre cross-sectional study demonstrating feasibility of digital PROMs implementation with clinically meaningful associations to self-harm, suicidality and adherence, but lacking a control group and unable to establish causation or interventional benefit.
As stated by the source record.
Quoted from the source exactly as published.
These findings support the operational feasibility of large-scale digital PROM deployment for risk stratification in routine psychiatry. Clinicians may use PROM-derived severity scores as adjuncts to identify patients at elevated risk of self-harm, suicidality and non-adherence, but should note this is observational evidence of association, not proof that PROM-guided interventions reduce these harms.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Background Patient-reported outcome measures (PROMs) are central to person-centred mental healthcare, yet evidence from large-scale digital implementation in routine psychiatry is limited. Aims To describe demographic characteristics and PROMs outcomes in out-patient mental health services across a multicentre Spanish network, and to analyse associations between PROMs and adherence, medication side-effects, self-harm and suicide attempts. Method A multicentre, cross-sectional study included adults attending out-patient mental health clinics (October 2023–March 2025) and who participated in a digital PROMs (e-PROMs) program. Validated Spanish versions of the World Health Organization-Five Well Being Index (WHO-5), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Alcohol Use Disorders Identification Test (AUDIT-C), Drug Abuse Screening Test-10 (DAST-10) and Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) scales were deployed via a patient web portal and integrated into the electronic health record. Associations were examined using univariate tests and multivariate logistic regression. Results Of 73 140 referred patients, 7925 (10.9%) completed PROMs (median age 48 years; 68.8% women). Well-being was low (WHO-5 median 36). Moderately severe–severe depression affected 38.5%, severe anxiety 30.9% and post-traumatic stress disorder (PTSD) risk 42.4%. Substance misuse risk was identified in 7.2% and hazardous drinking in 14.7%. Women reported lower well-being ( p < 0.001) and higher severe depression (40.6 v. 34.0%, p < 0.001), severe anxiety (33.1 v. 26.0%, p = 0.003) and PTSD risk (45.2 v. 36.1%, p = 0.002). Men had higher substance misuse (9.7 v. 6.0%, p = 0.033) and hazardous drinking (16.3 v. 14.0%, p = 0.034). In multivariate models, the strongest predictors of self-harm (odds ratio >2) included severe depression (odds ratio 4.52, p < 0.001), substance misuse (odds ratio 2.38, p < 0.001), PTSD risk (odds ratio 2.29, p < 0.001) and moderate depression (odds ratio 2.27, p < 0.001). The strongest predictors of suicide attempts included all grades of depression ( p < 0.001), PTSD risk (odds ratio 2.39, p < 0.001) and substance misuse (odds ratio 2.37, p < 0.001). Risk of alcohol abuse (odds ratio 0.60, p < 0.001) and substance misuse (odds ratio 0.73, p = 0.003) predicted non-adherence. Conclusions Large-scale digital PROMs collection is feasible and clinically informative. PROMs strongly predicted self-harm, suicidality and adherence, supporting their use for early risk detection and measurement-based psychiatric care.
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