Beyond emotional symptoms: multidomain routine outcome monitoring in psychiatric outpatient care

Background Routine psychiatric follow-up often relies on emotional symptom scales, although patients may also have persistent somatic symptoms and interpersonal or role-functioning difficulties. This narrow focus can obscure residual burden and misdirect follow-up priorities. This study examined whether routinely collected multidomain measures provide nonredundant follow-up signals in psychiatric outpatient routine outcome monitoring within a measurement-based care (MBC)-oriented workflow. Methods This single-center retrospective longitudinal study used routine-monitoring data from a tertiary psychiatric outpatient service in China, operating an MBC-oriented workflow from April 2024 to May 2026. The baseline sample included 667 patients (median age, 16 years; IQR, 14-20); 233 had at least two visits and 154 had at least three visits. Domains were emotional symptoms (POMP-transformed PHQ-9/GAD-7 sum), somatic symptoms (PHQ-15 POMP score), and interpersonal/role-functioning problems (POMP-transformed sum of the OQ-45.2 Interpersonal Relations and Social Role subscales). Stacked mixed-effects models tested monthly change and between-domain slope differences. Results In the primary linear model, emotional, somatic, and interpersonal/role-functioning scores decreased significantly, with monthly changes of −1.13, −0.60, and −0.67 POMP points, respectively. Emotional scores declined more without baseline-score adjustment, but baseline differences, regression to the mean, and scale responsiveness limit recovery-rate comparisons. Quadratic sensitivity analysis suggested nonlinearity. Among individual measures, PHQ-15 had the highest improvement and worsening proportions; 14.6% of evaluable patients had stable/improved emotional status but worsened PHQ-15 status. Conclusions Somatic symptoms and functioning-related problems provided follow-up information not captured by emotional symptom scales alone. Multidomain routine outcome monitoring may help psychiatric outpatient clinicians evaluate clinical improvement more comprehensively.