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Crosland P, Marshall DA, Hosseini SH, Ho N, Vacher C, Skinner A, Nguyen KH, Iorfino F, Rosenberg S, Song YJC, Tsiachristas A, Tran K, Occhipinti JA, Hickie IB. Incorporating Complexity and System Dynamics into Economic Modelling for Mental Health Policy and Planning. PHARMACOECONOMICS 2024:10.1007/s40273-024-01434-3. [PMID: 39354214 DOI: 10.1007/s40273-024-01434-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/05/2024] [Indexed: 10/03/2024]
Abstract
Care as usual has failed to stem the tide of mental health challenges in children and young people. Transformed models of care and prevention are required, including targeting the social determinants of mental health. Robust economic evidence is crucial to guide investment towards prioritised interventions that are effective and cost-effective to optimise health outcomes and ensure value for money. Mental healthcare and prevention exhibit the characteristics of complex dynamic systems, yet dynamic simulation modelling has to date only rarely been used to conduct economic evaluation in this area. This article proposes an integrated decision-making and planning framework for mental health that includes system dynamics modelling, cost-effectiveness analysis, and participatory model-building methods, in a circular process that is constantly reviewed and updated in a 'living model' ecosystem. We describe a case study of this approach for mental health system policy and planning that synergises the unique attributes of a system dynamics approach within the context of economic evaluation. This kind of approach can help decision makers make the most of precious, limited resources in healthcare. The application of modelling to organise and enable better responses to the youth mental health crisis offers positive benefits for individuals and their families, as well as for taxpayers.
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Affiliation(s)
- Paul Crosland
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia.
- Brain and Mind Centre, University of Sydney, 94 Mallet Street, Camperdown, NSW, 2050, Australia.
| | - Deborah A Marshall
- Cumming School of Medicine, University of Calgary, Alberta Children's Hospital Research Institute, Calgary, Canada
| | - Seyed Hossein Hosseini
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia
| | - Nicholas Ho
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia
| | - Catherine Vacher
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia
| | - Adam Skinner
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia
| | - Kim-Huong Nguyen
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
- Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | - Frank Iorfino
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia
| | - Sebastian Rosenberg
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia
- Health Research Institute, University of Canberra, Bruce, ACT, Australia
| | - Yun Ju Christine Song
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia
| | - Apostolos Tsiachristas
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Kristen Tran
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia
| | - Jo-An Occhipinti
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia
| | - Ian B Hickie
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia
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Marchini S, Laroche MA, Nemorin H, Morin V, Tanguy G, Lucarini V, Iftimovici A, Chaumette B, Krebs MO, Charre M. From Adolescence to Adulthood: Understanding Care Trajectories in an Early Detection and Intervention Centre in France. Early Interv Psychiatry 2024. [PMID: 39223792 DOI: 10.1111/eip.13605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 07/08/2024] [Accepted: 07/27/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Psychiatric disorders often emerge during adolescence or young adulthood, leading to significant disability among youth. The transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) is critical for individuals experiencing emerging psychopathology, with delayed access to care negatively impacting long-term outcomes. Accessing mental health services for adolescents and young adults is often complex and delayed due to challenges in service visibility, accessibility and appropriateness. METHODS This study examines the care trajectories of individuals consecutively accessing the early detection and intervention (EDI) centre C'JAAD (Evaluation Centre for Young Adults and Adolescents) in Paris (France) over the year 2021. The main goal was to clarify the role of this EDI centre in the continuity of care and transition to AMHS. Data about their history of care, hospitalisations and referral sources were collected retrospectively. RESULTS The sample comprised 194 individuals, with 57.2% males and a median age of 20 years. Most patients (67.5%) were ≥18 years old upon arrival, with 31% in a situation of not being in education, employment, or training (NEET). Over one-third (35.2%) had prior psychiatric hospitalisations. Patients were mainly referred to our EDI centre from other hospital departments (42.3%). Regarding care in CAMHS, 50.3% of the total sample had medical follow-up during childhood, of whom 41.9% had discontinued care upon arrival at the EDI centre. The median onset age of care in CAMHS was 14, with a median duration of 12 months. Adult patients experienced an approximately 3-year gap between the end of CAMHS care and assessment at the EDI centre. DISCUSSION The sample's characteristics resemble those of other EDI centres, but concerns persist regarding referral timing and the NEET status of many youths. Lack of prior medical follow-up and challenges in transitioning to AMHS underscore the need to enhance care continuity and address difficulties in accessing care during the transition to adulthood.
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Affiliation(s)
- Simone Marchini
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Pôle PEPIT, C'JAAD (Centre d'évaluation pour adolescents et jeunes adultes), Paris, France
- Service de Psychiatrie du Bébé, de l'Enfant, de l'Adolescent et du Jeune Adulte, Hôpital Universitaire de Bruxelles (H.U.B.), Brussels, Belgium
- Faculté de Médecine, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Institut de psychiatrie - Réseau transition, GDR3557, Paris, France
| | - Marie-Alix Laroche
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Pôle PEPIT, C'JAAD (Centre d'évaluation pour adolescents et jeunes adultes), Paris, France
- Institut de psychiatrie - Réseau transition, GDR3557, Paris, France
| | - Harmony Nemorin
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Pôle PEPIT, C'JAAD (Centre d'évaluation pour adolescents et jeunes adultes), Paris, France
- Institut de psychiatrie - Réseau transition, GDR3557, Paris, France
| | - Valentine Morin
- Institut de psychiatrie - Réseau transition, GDR3557, Paris, France
- CH La Chartreuse, Centre Référent de Réhabilitation Psychosociale de Bourgogne (C2RB), Dijon, France
| | - Guillaume Tanguy
- Institut de psychiatrie - Réseau transition, GDR3557, Paris, France
- Groupe Hospitalier Nord-Essonne, Site d'Orsay Unité de Soins Pour les Jeunes (UniSonJe), Bures-sur-Yvette, France
| | - Valeria Lucarini
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Pôle PEPIT, C'JAAD (Centre d'évaluation pour adolescents et jeunes adultes), Paris, France
- Institut de psychiatrie - Réseau transition, GDR3557, Paris, France
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM, U1266, Pathophysiology of Psychiatric Disorders: Development and Vulnerability Team, Paris, France
| | - Anton Iftimovici
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Pôle PEPIT, C'JAAD (Centre d'évaluation pour adolescents et jeunes adultes), Paris, France
- Institut de psychiatrie - Réseau transition, GDR3557, Paris, France
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM, U1266, Pathophysiology of Psychiatric Disorders: Development and Vulnerability Team, Paris, France
| | - Boris Chaumette
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Pôle PEPIT, C'JAAD (Centre d'évaluation pour adolescents et jeunes adultes), Paris, France
- Institut de psychiatrie - Réseau transition, GDR3557, Paris, France
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM, U1266, Pathophysiology of Psychiatric Disorders: Development and Vulnerability Team, Paris, France
- Department of Psychiatry, McGill University, Quebec, Canada
| | - Marie-Odile Krebs
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Pôle PEPIT, C'JAAD (Centre d'évaluation pour adolescents et jeunes adultes), Paris, France
- Institut de psychiatrie - Réseau transition, GDR3557, Paris, France
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM, U1266, Pathophysiology of Psychiatric Disorders: Development and Vulnerability Team, Paris, France
| | - Mylene Charre
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Pôle PEPIT, C'JAAD (Centre d'évaluation pour adolescents et jeunes adultes), Paris, France
- Institut de psychiatrie - Réseau transition, GDR3557, Paris, France
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McGorry PD, Mei C, Dalal N, Alvarez-Jimenez M, Blakemore SJ, Browne V, Dooley B, Hickie IB, Jones PB, McDaid D, Mihalopoulos C, Wood SJ, El Azzouzi FA, Fazio J, Gow E, Hanjabam S, Hayes A, Morris A, Pang E, Paramasivam K, Quagliato Nogueira I, Tan J, Adelsheim S, Broome MR, Cannon M, Chanen AM, Chen EYH, Danese A, Davis M, Ford T, Gonsalves PP, Hamilton MP, Henderson J, John A, Kay-Lambkin F, Le LKD, Kieling C, Mac Dhonnagáin N, Malla A, Nieman DH, Rickwood D, Robinson J, Shah JL, Singh S, Soosay I, Tee K, Twenge J, Valmaggia L, van Amelsvoort T, Verma S, Wilson J, Yung A, Iyer SN, Killackey E. The Lancet Psychiatry Commission on youth mental health. Lancet Psychiatry 2024; 11:731-774. [PMID: 39147461 DOI: 10.1016/s2215-0366(24)00163-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/01/2024] [Accepted: 05/08/2024] [Indexed: 08/17/2024]
Affiliation(s)
- Patrick D McGorry
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia.
| | - Cristina Mei
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Vivienne Browne
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Barbara Dooley
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Cathrine Mihalopoulos
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Stephen J Wood
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia; School of Psychology, University of Birmingham, Birmingham, UK
| | | | | | - Ella Gow
- Orygen, Melbourne, VIC, Australia; Melbourne, VIC, Australia
| | | | | | | | - Elina Pang
- Hong Kong Special Administrative Region, China
| | | | | | | | - Steven Adelsheim
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Matthew R Broome
- Institute for Mental Health, University of Birmingham, Birmingham, UK; Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Mary Cannon
- Department of Psychiatry, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Andrew M Chanen
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Eric Y H Chen
- Institute of Mental Health, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; LKS School of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Andrea Danese
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; National and Specialist Child and Adolescent Mental Health Service Clinic for Trauma, Anxiety, and Depression, South London and Maudsley NHS Foundation Trust, London, UK
| | - Maryann Davis
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Pattie P Gonsalves
- Youth Mental Health Group, Sangath, New Delhi, India; School of Psychology, University of Sussex, Brighton, UK
| | - Matthew P Hamilton
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia; Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jo Henderson
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Ann John
- Swansea University Medical School, Swansea University, Swansea, UK
| | | | - Long K-D Le
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Christian Kieling
- Department of Psychiatry, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Ashok Malla
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada; ACCESS Open Minds and Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Verdun, QC, Canada
| | - Dorien H Nieman
- Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Debra Rickwood
- Faculty of Health, University of Canberra, Canberra, ACT, Australia; headspace National Youth Mental Health Foundation, Melbourne, VIC, Australia
| | - Jo Robinson
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Jai L Shah
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada; ACCESS Open Minds and Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Verdun, QC, Canada
| | - Swaran Singh
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick and Coventry and Warwickshire Partnership Trust, Coventry, UK
| | - Ian Soosay
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Karen Tee
- Foundry, Providence Health Care, Vancouver, BC, Canada
| | - Jean Twenge
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Lucia Valmaggia
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia; Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Therese van Amelsvoort
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | | | - Jon Wilson
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Alison Yung
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia; Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia; School of Health Sciences, The University of Manchester, Manchester, UK
| | - Srividya N Iyer
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada; ACCESS Open Minds and Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Verdun, QC, Canada
| | - Eóin Killackey
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
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Campos S, Nuñez D, Pérez JC, Robinson J. Characterization of Psychopathology in Latin American Adolescents Using a Web-Based Screening Tool: Cross-Sectional Study. JMIR Form Res 2024; 8:e57038. [PMID: 39116425 PMCID: PMC11342013 DOI: 10.2196/57038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 05/28/2024] [Accepted: 06/15/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Mental health problems and suicide ideation are common in adolescents. Early detection of these issues could prevent the escalation of mental health-related symptoms in the long term. Moreover, characterizing different profiles of prevalent symptoms in conjunction with emotional regulation strategies could guide the design of specific interventions. The use of web-based screening (WBS) tools has been regarded as a suitable strategy to timely detect symptomatology while improving the appeal, cost, timeliness, and reach of detection in young populations. However, the evidence regarding the accuracy of these approaches is not fully conclusive. OBJECTIVE The study aims (1) to examine the capability of a WBS to identify adolescents with psychiatric symptoms and suicidality and (2) to characterize the mental health profiles of a large sample of adolescents using WBS. METHODS A total of 1599 Latin American Spanish-speaking adolescents (mean age 15.56, SD 1.34 years), consisting of 47.3% (n=753) female, 98.5% Chilean (n=1570), and 1.5% Venezuelan (n=24) participants, responded to a mental health WBS. A randomized subsample of participants also responded to the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). McNemar χ2 and receiver-operating characteristic curves tested the detection accuracy of WBS contrasted with the MINI-KID. Latent profile analyses explored the symptomatic and emotional regulation profiles of participants. RESULTS Both measures showed an adequate level of agreement (area under the curve per symptom domain ranging from 0.70 to 0.89); however, WBS yielded a higher prevalence than MINI-KID for all psychiatric symptoms, except suicide ideation and depression. Latent profile analyses yielded 4 profiles-one of them presented elevated psychopathological symptoms, constituting 11% of the sample (n=175). Rumination (odds ratio [OR] 130.15, 95% CI 51.75-439.89; P<.001), entrapment (OR 96.35, 95% CI 29.21-317.79; P<.001), and defeat (OR 156.79, 95% CI 50.45-487.23; P<.001) contributed significantly to the prediction of latent profile memberships, while cognitive reappraisal did not contribute to the prediction of any latent profile memberships, and expressive suppression was only associated to profile-2 membership. CONCLUSIONS WBS is acceptable for the timely detection of adolescents at risk of mental health conditions. Findings from the symptomatic and emotional regulation profiles highlight the need for comprehensive assessments and differential interventions.
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Affiliation(s)
- Susana Campos
- Center of Applied Psychology, Faculty of Psychology, University of Talca, campus Talca, Talca, Chile
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile
| | - Daniel Nuñez
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile
- Center of Cognitive Sciences, Faculty of Psychology, University of Talca, Talca, Chile
- Faculty of Psychology, University of Talca, Campus Talca, Talca, Chile
| | - J Carola Pérez
- Instituto de Bienestar Socioemocional, Facultad de Psicología, Universidad del Desarrollo, Santiago, Chile
| | - Jo Robinson
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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Hirsig A, Häfeli XA, Schmidt SJ. Efficacy of a transdiagnostic Internet prevention approach in adolescents (EMPATIA study): study protocol of a randomized controlled trial. Trials 2024; 25:530. [PMID: 39118136 PMCID: PMC11308397 DOI: 10.1186/s13063-024-08241-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 06/10/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Most mental disorders have their onset in adolescence. Preventive interventions during this period are important; however, help-seeking behavior is generally poor in this age group resulting in low treatment rates. Internet interventions are expected to be an effective, low-threshold, and scalable approach to overcome barriers to help-seeking, particularly for individuals experiencing subclinical symptoms. Internet-delivered indicated prevention seems promising as it targets individuals with minimal symptoms of mental disorders who might need care but are not help-seeking yet. Previous indicated prevention-approaches have mainly targeted specific risk-syndromes. However, this contradicts the increasing recognition of emerging psychopathology as a complex system characterized by co-occurrence and rapid shifts of subclinical symptoms cutting across diagnostic categories. Therefore, this study will investigate the efficacy, mediators, moderators, and core symptomatic changes of a transdiagnostic Internet-delivered indicated prevention program (EMPATIA program) for adolescents. METHODS This randomized controlled trial (RCT) will be conducted in a general population sample (planned n = 152) of adolescents aged 12-18 years with subclinical symptoms but without any current or past mental disorder. Participants will be randomly assigned to the EMPATIA program or a care as usual (CAU) control condition. The 8-week guided EMPATIA program encompasses 8 modules targeting the following transdiagnostic mechanisms: repetitive negative thinking, self-perfectionism, emotion regulation, intolerance of uncertainty, rejection sensitivity, and behavioral avoidance. Participants will be asked to answer online self-report questionnaires at baseline, after 8 weeks, and at 6-, 9-, and 12-month follow-up. Diagnostic telephone interviews will be conducted at baseline and at 12-month follow-up. Additionally, intervention-specific constructs (motivation, alliance, negative effects, satisfaction, adherence) will be assessed during and after the EMPATIA program. The level of self-reported general psychopathology post-intervention is the primary outcome. DISCUSSION Results will be discussed considering the potential of Internet interventions as a scalable, low-threshold option for indicated prevention in adolescents experiencing subclinical symptoms. The EMPATIA program introduces a novel Internet prevention program targeting six transdiagnostic mechanisms associated with various mental health outcomes. Thereby, this trial pursues a very timely and important topic because it may contribute to narrow the current care gap for adolescents, to prevent mental health problems and related negative consequences, and to promote mental health in the long-term. TRIAL REGISTRATION The trial was approved by Swissmedic (Registration Number: 10001035, 08/22/2022) and the Ethics Committee of Bern (Registration Number: 2022-D0036, 08/22/2022). The trial was registered at ClinicalTrials.gov NCT05934019 on 07-03-2023.
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Affiliation(s)
- Anja Hirsig
- Division of Clinical Child and Adolescent Psychology, University of Bern, Fabrikstrasse 8, Bern, 3012, Switzerland.
| | - Xenia Anna Häfeli
- Division of Clinical Child and Adolescent Psychology, University of Bern, Fabrikstrasse 8, Bern, 3012, Switzerland
| | - Stefanie Julia Schmidt
- Division of Clinical Child and Adolescent Psychology, University of Bern, Fabrikstrasse 8, Bern, 3012, Switzerland
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Paquin V, Malla AK, Iyer SN, Lepage M, Joober R, Shah JL. Combinations and Temporal Associations Among Precursor Symptoms Before a First Episode of Psychosis. Schizophr Bull 2024; 50:860-870. [PMID: 37861419 PMCID: PMC11283192 DOI: 10.1093/schbul/sbad152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
BACKGROUND AND HYPOTHESIS Symptoms that precede a first episode of psychosis (FEP) can ideally be targeted by early intervention services with the aim of preventing or delaying psychosis onset. However, these precursor symptoms emerge in combinations and sequences that do not rest fully within traditional diagnostic categories. To advance our understanding of illness trajectories preceding FEP, we aimed to investigate combinations and temporal associations among precursor symptoms. STUDY DESIGN Participants were from PEPP-Montréal, a catchment-based early intervention program for FEP. Through semistructured interviews, collateral from relatives, and a review of health and social records, we retrospectively measured the presence or absence of 29 precursor symptoms, including 9 subthreshold psychotic and 20 nonpsychotic symptoms. Sequences of symptoms were derived from the timing of the first precursor symptom relative to the onset of FEP. STUDY RESULTS The sample included 390 participants (68% men; age range: 14-35 years). Combinations of precursor symptoms most frequently featured depression, anxiety, and substance use. Of 256 possible pairs of initial and subsequent precursor symptoms, many had asymmetrical associations: eg, when the first symptom was suspiciousness, the incidence rate ratio (IRR) of subsequent anxiety was 3.40 (95% confidence interval [CI]: 1.79, 6.46), but when the first symptom was anxiety, the IRR of subsequent suspiciousness was 1.15 (95% CI: 0.77, 1.73). CONCLUSIONS A detailed examination of precursor symptoms reveals diverse clinical profiles that cut across diagnostic categories and evolve longitudinally prior to FEP. Their identification may contribute to risk assessments and provide insights into the mechanisms of illness progression.
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Affiliation(s)
- Vincent Paquin
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Ashok K Malla
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Srividya N Iyer
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Martin Lepage
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Jai L Shah
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
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Iorfino F, Varidel M, Capon W, Richards M, Crouse JJ, LaMonica HM, Park SH, Piper S, Song YJC, Gorban C, Scott EM, Hickie IB. Quantifying the interrelationships between physical, social, and cognitive-emotional components of mental fitness using digital technology. NPJ MENTAL HEALTH RESEARCH 2024; 3:36. [PMID: 38977903 PMCID: PMC11231280 DOI: 10.1038/s44184-024-00078-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 06/08/2024] [Indexed: 07/10/2024]
Abstract
Mental fitness is a construct that goes beyond a simple focus on subjective emotional wellbeing to encompass more broadly our ability to think, feel, and act to achieve what we want in our daily lives. The measurement and monitoring of multiple (often interacting) domains is crucial to gain a holistic and complete insight into an individual's mental fitness. We aimed to demonstrate the capability of a new mobile app to characterise the mental fitness of a general population of Australians and to quantify the interrelationships among different domains of mental fitness. Cross-sectional data were collected from 4901 adults from the general population of Australians engaged in work or education who used a mobile app (Innowell) between September 2021 and November 2022. Individuals completed a baseline questionnaire comprised of 26 questions across seven domains of mental fitness (i.e., physical activity, sleep and circadian rhythms, nutrition, substance use, daily activities, social connection, psychological distress). Network analysis was applied at both a domain-level (e.g., 7 nodes representing each cluster of items) and an individual item-level (i.e., 26 nodes representing all questionnaire items). Only 612 people (12%) were functioning well across all domains. One quarter (n = 1204, 25%) had only one problem domain and most (n = 3085, 63%) had multiple problem domains. The two most problematic domains were physical activity (n = 2631, 54%) and social connection (n = 2151, 44%), followed closely by daily activity (n = 1914, 39%). At the domain-level, the strongest association emerged between psychological distress and daily activity (r = 0.301). Psychological distress was the most central node in the network (as measured by strength and expected influence), followed closely by daily activity, sleep and circadian rhythms and then social connection. The item-level network revealed that the nodes with the highest centrality in the network were: hopelessness, depression, functional impairment, effortfulness, subjective energy, worthlessness, and social connectedness. Social connection, sleep and circadian rhythms, and daily activities may be critical targets for intervention due to their widespread associations in the overall network. While psychological distress was not among the most common problems, its centrality may indicate its importance for indicated prevention and early intervention. We showcase the capability of a new mobile app to monitor mental fitness and identify the interrelationships among multiple domains, which may help people develop more personalised insights and approaches.
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Affiliation(s)
- Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Sydney, Australia.
| | - Mathew Varidel
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - William Capon
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Matthew Richards
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Jacob J Crouse
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Haley M LaMonica
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Shin Ho Park
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Sarah Piper
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | | | - Carla Gorban
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | | | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
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8
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Väisänen V, Linnaranta O, Sinervo T, Hietapakka L, Elovainio M. Healthcare use of young finnish adults with mental disorders - profiles and profile membership determinants. BMC PRIMARY CARE 2024; 25:238. [PMID: 38965514 PMCID: PMC11225417 DOI: 10.1186/s12875-024-02497-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/26/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Comprehensive, timely, and integrated primary care services have been proposed as a response to the increased demand for mental health and substance use services especially among young people. However, little is known about the care utilization patterns of young people with mental and substance use disorders. Our aim was to characterize profiles of care use in young Finnish adults with mental or substance use disorders, and the potential factors associated with the service use profiles. METHODS Primary and specialized care visits of young adults (16-29 years) diagnosed with a psychiatric or a substance use disorder (n = 7714) were retrieved from the national health care register from years 2020 and 2021. K-Means clustering was used to detect different profiles based on the utilization of care services. Multinomial logistic regression was used to analyze the factors associated with different profiles of care use. RESULTS Five different profiles were identified: low care use (75%), and use of principally primary health care (11%), student health services (9%), psychiatric services (5%), or substance use services (1%). Female gender was associated with membership in the primary health care focused profiles (OR 2.58 and OR 1.99), and patients in the primary health care and student health services profiles were associated with a better continuity of care (OR 1.04 and OR 1.05). Substance use disorders were associated with psychiatric service use (OR: 2.51) and substance use services (OR: 58.91). Living in smaller municipalities was associated with lower service use when comparing to the largest city. CONCLUSIONS Young adults diagnosed with a psychiatric or a substance use disorder had remarkably different and heterogeneous care patterns. Most of the participants had low care utilization, indicating potential gaps in service use and care needs. Measures should be taken to ensure equal access to and availability of mental health services. The profiles that utilized the most services highlights the importance of integrated services and patient-oriented improvement of treatment.
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Affiliation(s)
- Visa Väisänen
- Finnish Institute for Health and Welfare, Welfare State Research and Reform unit, Health and Social Service System Research team, Mannerheimintie 166, Helsinki, 00300, Finland.
- Faculty of Social Sciences and Business Studies, Department of Health and Social Management, University of Eastern Finland, Yliopistonranta 8 E, Kuopio, 70210, Finland.
| | - Outi Linnaranta
- Finnish Institute for Health and Welfare, Equality unit, Mental health team, Mannerheimintie 166, Helsinki, 00300, Finland
| | - Timo Sinervo
- Finnish Institute for Health and Welfare, Welfare State Research and Reform unit, Health and Social Service System Research team, Mannerheimintie 166, Helsinki, 00300, Finland
| | - Laura Hietapakka
- Finnish Institute for Health and Welfare, Welfare State Research and Reform unit, Health and Social Service System Research team, Mannerheimintie 166, Helsinki, 00300, Finland
| | - Marko Elovainio
- Finnish Institute for Health and Welfare, Welfare State Research and Reform unit, Health and Social Service System Research team, Mannerheimintie 166, Helsinki, 00300, Finland
- Faculty of Medicine, Research Program Unit, Department of Psychology, University of Helsinki, Haartmaninkatu 3, Helsinki, 00014, Finland
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9
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Scott J, Iorfino F, Capon W, Crouse J, Nelson B, Chanen AM, Dwyer D, Conus P, Bechdolf A, Ratheesh A, Raballo A, Yung A, Berk M, McKenna S, Hockey S, Hutcheon A, Scott E, McGorry P, Shah J, Hickie IB. Staging 2.0: refining transdiagnostic clinical staging frameworks to enhance reliability and utility for youth mental health. Lancet Psychiatry 2024; 11:461-471. [PMID: 38643773 DOI: 10.1016/s2215-0366(24)00060-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/11/2024] [Accepted: 02/16/2024] [Indexed: 04/23/2024]
Abstract
Globally, 75% of depressive, bipolar, and psychotic disorders emerge by age 25 years. However, these disorders are often preceded by non-specific symptoms or attenuated clinical syndromes. Difficulties in determining optimal treatment interventions for these emerging mental disorders, and uncertainties about accounting for co-occurring psychopathology and illness trajectories, have led many youth mental health services to adopt transdiagnostic clinical staging frameworks. In this Health Policy paper, an international working group highlights ongoing challenges in applying transdiagnostic staging frameworks in clinical research and practice, and proposes refinements to the transdiagnostic model to enhance its reliability, consistent recording, and clinical utility. We introduce the concept of within-stage heterogeneity and describe the advantages of defining stage in terms of clinical psychopathology and stage modifiers. Using examples from medicine, we discuss the utility of categorising stage modifiers into factors associated with progression (ie, potential predictors of stage transition) and extension (ie, factors associated with the current presentation that add complexity to treatment selection). Lastly, we suggest how it is possible to revise the currently used transdiagnostic staging approach to incorporate these key concepts, and how the revised framework could be applied in clinical and research practice.
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Affiliation(s)
- Jan Scott
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.
| | - Frank Iorfino
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - William Capon
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Jacob Crouse
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Barnaby Nelson
- Orygen and Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrew M Chanen
- Orygen and Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Dominic Dwyer
- Orygen and Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Philippe Conus
- General Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Andreas Bechdolf
- Department of Psychiatry and Psychotherapy, CCM, Charité Universitatsmedizin, Berlin, Germany
| | - Aswin Ratheesh
- Orygen and Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrea Raballo
- Faculty of Biomedical Sciences, Universita della Svizzera Italiana, Lugano, Switzerland
| | - Alison Yung
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University and Barwon Health, Geelong, VIC, Australia
| | - Michael Berk
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University and Barwon Health, Geelong, VIC, Australia
| | - Sarah McKenna
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Samuel Hockey
- Lived Experience Working Group, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Alexis Hutcheon
- Lived Experience Working Group, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Elizabeth Scott
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Pat McGorry
- Orygen and Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Jai Shah
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
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10
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Scott J, Crouse JJ, Medland S, Byrne E, Iorfino F, Mitchell B, Gillespie NA, Martin N, Wray N, Hickie IB. Polygenic risk scores and the prediction of onset of mood and psychotic disorders in adolescents and young adults. Early Interv Psychiatry 2024; 18:397-405. [PMID: 37787636 PMCID: PMC11100301 DOI: 10.1111/eip.13472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 09/02/2023] [Accepted: 09/25/2023] [Indexed: 10/04/2023]
Abstract
AIM To examine whether polygenic risk scores (PRS) for neuroticism, depression, bipolar disorder and schizophrenia are higher in individuals manifesting trans-diagnostic risk factors for the development of major mental disorders and whether PRS enhance prediction of early onset full-threshold disorders. METHODS Using data from the Brisbane Longitudinal Twin Study, we examined individual PRS for neuroticism, depression, bipolar disorder and schizophrenia, recorded evidence of subthreshold syndromes and family history of mood and/or psychotic disorders and noted progression to trans-diagnostic clinical caseness (onset of major mental disorders) at follow-up. We undertook multivariate, receiver operating curve and logistic regression analyses that were adjusted for known variables of influence (age, twin status, and so on). RESULTS Of 1473 eligible participants (female = 866, 59%; mean age 26.3 years), 28% (n = 409) met caseness criteria for a mood and/or psychotic disorder. All PRS were higher in cases versus non-cases but associations with different levels of risk were inconsistent. The prediction of caseness (reported as area under the curve with 95% confidence intervals [CI]) improved from 0.68 (95% CI: 0.65, 0.71) when estimated using clinical risk factors alone up to 0.71 (95% CI: 0.69, 0.73) when PRS were added to the model. Logistic regression identified five variables that optimally classified individuals according to caseness: age, sex, individual risk characteristics, PRS for depression and mental health case status of cotwins or siblings. CONCLUSIONS The findings need replication. However, this exploratory study suggests that combining PRS with other risk factors has the potential to improve outcome prediction in youth.
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Affiliation(s)
- Jan Scott
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
- Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom
| | - Jacob J Crouse
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Sarah Medland
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
- Institute of Molecular Bioscience, The University of Queensland, Brisbane, Australia
| | - Enda Byrne
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
| | - Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | | | - Nathan A. Gillespie
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond VA, USA
| | - Nicholas Martin
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
| | - Naomi Wray
- Institute of Molecular Bioscience, The University of Queensland, Brisbane, Australia
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland,Australia
| | - Ian B. Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
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11
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Clauss JA, Foo CYS, Leonard CJ, Dokholyan KN, Cather C, Holt DJ. Screening for psychotic experiences and psychotic disorders in general psychiatric settings: a systematic review and meta-analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.14.24305796. [PMID: 38699350 PMCID: PMC11065042 DOI: 10.1101/2024.04.14.24305796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Background The absence of systematic screening for psychosis within general psychiatric services contribute to substantial treatment delays and poor long-term outcomes. We conducted a meta-analysis to estimate rates of psychotic experiences, clinical high-risk for psychosis syndrome (CHR-P), and psychotic disorders identified by screening treatment-seeking individuals to inform implementation recommendations for routine psychosis screening in general psychiatric settings. Methods PubMed and Web of Science databases were searched to identify empirical studies that contained information on the point prevalence of psychotic experiences, CHR-P, or psychotic disorders identified by screening inpatient and outpatient samples aged 12-64 receiving general psychiatric care. Psychotic experiences were identified by meeting threshold scores on validated self-reported questionnaires, and psychotic disorders and CHR-P by gold-standard structured interview assessments. A meta-analysis of each outcome was conducted using the Restricted Maximum Likelihood Estimator method of estimating effect sizes in a random effects model. Results 41 independent samples (k=36 outpatient) involving n=25,751 patients (58% female, mean age: 24.1 years) were included. Among a general psychiatric population, prevalence of psychotic experiences was 44.3% (95% CI: 35.8-52.8%; 28 samples, n=21,957); CHR-P was 26.4% (95% CI: 20.0-32.7%; 28 samples, n=14,395); and psychotic disorders was 6.6% (95% CI: 3.3-9.8%; 32 samples, n=20,371). Conclusions High rates of psychotic spectrum illness in general psychiatric settings underscore need for secondary prevention with psychosis screening. These base rates can be used to plan training and resources required to conduct assessments for early detection, as well as build capacity in interventions for CHR-P and early psychosis in non-specialty mental health settings.
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Affiliation(s)
- Jacqueline A. Clauss
- Psychosis Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Cheryl Y. S. Foo
- Psychosis Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Katherine N. Dokholyan
- Psychosis Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Corinne Cather
- Psychosis Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daphne J. Holt
- Psychosis Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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12
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Destrée L, McGorry P, Chanen A, Ratheesh A, Davey C, Polari A, Amminger P, Yuen HP, Hartmann J, Dwyer D, Spooner R, Nelson B. Transdiagnostic risk identification: A validation study of the Clinical High At Risk Mental State (CHARMS) criteria. Psychiatry Res 2024; 333:115745. [PMID: 38271886 DOI: 10.1016/j.psychres.2024.115745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/19/2023] [Accepted: 01/17/2024] [Indexed: 01/27/2024]
Abstract
A set of clinical criteria, the Clinical High At-Risk Mental State (CHARMS) criteria, have been developed to identify symptomatic young people who are at-risk of disorder progression. The current study aimed to validate the CHARMS criteria by testing whether they prospectively identify individuals at-risk of progressing from attenuated symptomatology to a first episode of serious mental disorder, namely first episode psychosis, first episode mania, severe major depression, and borderline personality disorder. 121 young people completed clinical evaluations at baseline, 6- and 12-month follow-up. The Kaplan-Meier method was used to assess transition rates. Cox regression and LASSO were used to examine baseline clinical predictors of transition. Linear mixed effects modelling was used to examine symptom severity. 28 % of CHARMS+ individuals transitioned to a Stage 2 disorder by 12-month follow-up. The CHARMS+ group had more severe symptoms at follow-up than the CHARMS- group. 96 % of Stage 2 transitions were initially to severe depression. Meeting criteria for multiple CHARMS subgroups was associated with higher transition risk: meeting one at-risk group = 24 %; meeting two at-risk groups = 17 %, meeting three at-risk groups = 55 %, meeting four at-risk groups = 50 %. The strongest baseline predictor of transition was severity of depressive symptoms. The CHARMS criteria identified a group of individuals at-risk of imminent onset of severe mental disorder, particularly severe depression. Larger scale studies and longer follow-up periods are required to validate and extend these findings.
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Affiliation(s)
- Louise Destrée
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences & Monash Biomedical Imaging Facility, Monash University, Victoria, Australia; Orygen, Parkville, VIC, Australia.
| | - Patrick McGorry
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Andrew Chanen
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Aswin Ratheesh
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Christopher Davey
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Andrea Polari
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Paul Amminger
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Hok Pan Yuen
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Jessica Hartmann
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Dominic Dwyer
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Rachael Spooner
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Barnaby Nelson
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
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13
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Hickie IB, Crouse JJ. Sleep and circadian rhythm disturbances: plausible pathways to major mental disorders? World Psychiatry 2024; 23:150-151. [PMID: 38214638 PMCID: PMC10786001 DOI: 10.1002/wps.21154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Affiliation(s)
- Ian B Hickie
- Youth Mental Health and Technology Team, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Jacob J Crouse
- Youth Mental Health and Technology Team, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
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14
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Jalali S, Liu L, Wang J, Kennedy SH, MacQueen G, Lebel C, Goldstein BL, Bray S, Addington J. Factors Associated with Transition to Serious Mental Illness. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:79-88. [PMID: 37606525 PMCID: PMC10789229 DOI: 10.1177/07067437231195959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
OBJECTIVE There is increasing interest in early intervention and detection strategies for youth at-risk of developing a serious mental illness (SMI). Little is known about early factors that may be related to the later development of a SMI; thus, the aim of this study was to determine what clinical factors might relate to the development of in this study psychosis, bipolar disorder and severe or recurrent major depression in at-risk youth. METHOD The sample consisted of 162 youth aged 12-26 years at different stages of risk. Thirty-one participants developed a SMI during the study. Those who made a transition were compared on a range of baseline clinical and functional measures with those who did not make the transition. A Cox regression model was used to assess the association between measures and later development of a SMI. RESULTS Female sex, attenuated psychotic symptoms as assessed with the Scale of Psychosis-Risk Symptoms (SOPS) and ratings on the K-10 Distress Scale, were found to be significantly associated with the later transition to mental illness. Females were 2.77 times more likely to transition compared to males. For the SOPS and K-10 scales, there is a 14% increase in the transition rate relative to a one-scale increase in SOPS and a 7% increase in the transition rate relative to a one-point increase in the K-10. CONCLUSIONS Results from these longitudinal data provide further insight into the specific clinical measures that may be pertinent in early detection of mental illnesses.
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Affiliation(s)
- Sara Jalali
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Lu Liu
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - JianLi Wang
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sidney H. Kennedy
- Department of Psychiatry, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada
- Arthur Sommer Rotenberg Chair in Suicide and Depression Studies, St. Michael's Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Glenda MacQueen
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Catherine Lebel
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Child & Adolescent Imaging Research (CAIR) Program, Calgary, Alberta, Canada
| | - Benjamin l. Goldstein
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Departments of Psychiatry and Pharmacology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Signe Bray
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Child & Adolescent Imaging Research (CAIR) Program, Calgary, Alberta, Canada
| | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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15
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Dimitropoulos G, Bassi EM, Bright KS, Gondziola J, Bradley J, Fersovitch M, Stamp L, LaMonica HM, Iorfino F, Gaskell T, Tomlinson S, Johnson DW. Implementation of an Electronic Mental Health Platform for Youth and Young Adults in a School Context Across Alberta, Canada: Thematic Analysis of the Perspectives of Stakeholders. JMIR Ment Health 2024; 11:e49099. [PMID: 38231558 PMCID: PMC10831665 DOI: 10.2196/49099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 11/06/2023] [Accepted: 12/01/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Youth, aged 15 to 24 years, are more likely to experience mental health (MH) or substance use issues than other age groups. This is a critical period for intervention because MH disorders, if left unattended, may become chronic and serious and negatively affect many aspects of a young person's life. Even among those who are treated, poor outcomes will still occur for a percentage of youth. Electronic MH (eMH) tools have been implemented in traditional MH settings to reach youth requiring assistance with MH and substance use issues. However, the utility of eMH tools in school settings has yet to be investigated. OBJECTIVE The objective of this study was to gain an understanding of the perspectives of key school staff stakeholders regarding barriers and facilitators to the implementation of the Innowell eMH platform in secondary schools across the province of Alberta, Canada. METHODS Guided by a qualitative descriptive approach, focus groups were conducted to elicit stakeholder perspectives on the perceived implementation challenges and opportunities of embedding the Innowell eMH platform in secondary school MH services. In total, 8 focus groups were conducted with 52 key school staff stakeholders. RESULTS Themes related to barriers and facilitators to youth and school MH care professional (MHCP) capacity in implementing and using eMH tools were identified. With respect to youth capacity barriers, the following themes were inductively generated: (1) concerns about some students not being suitable for eMH services, (2) minors requiring consent from parents or caregivers to use eMH services as well as confidentiality and privacy concerns, and (3) limited access to technology and internet service among youth. A second theme related to school MHCP barriers to implementation, which included (1) feeling stretched with high caseloads and change fatigue, (2) concerns with risk and liability, and (3) unmasking MH issues in the face of limited resources. In contrast to the barriers to youth and MHCP capacity, many facilitators to implementation were discussed. Youth capacity facilitators included (1) the potential for youth to be empowered using eMH tools, (2) the platform fostering therapeutic relationships with school personnel, and (3) enhancing access to needed services and resources. MHCP capacity facilitators to implementation were (1) system transformation through flexibility and problem-solving, (2) opportunities for collaboration with youth and MHCPs and across different systems, and (3) an opportunity for the continuity of services. CONCLUSIONS Our findings highlight nuanced school MHCP perspectives that demonstrate critical youth and MHCP capacity concerns, with consideration for organizational factors that may impede or enhance the implementation processes for embedding eMH in a school context. The barriers and facilitators to implementation provide future researchers and decision makers with challenges and opportunities that could be addressed in the preimplementation phase.
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Affiliation(s)
- Gina Dimitropoulos
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
- Calgary Eating Disorders Program, Alberta Health Services, Calgary, AB, Canada
- Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Emilie M Bassi
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | - Katherine S Bright
- School of Nursing and Midwifery, Faculty of Health, Community, and Education, Mount Royal University, Calgary, AB, Canada
- Heroes in Mind, Advocacy, and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Jason Gondziola
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, AB, Canada
| | - Jessica Bradley
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, AB, Canada
| | - Melanie Fersovitch
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, AB, Canada
| | - Leanne Stamp
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, AB, Canada
| | | | - Frank Iorfino
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Tanya Gaskell
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, AB, Canada
| | - Sara Tomlinson
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, AB, Canada
| | - David Wyatt Johnson
- Departments of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Maternal Newborn Child and Youth Strategic Clinical Network, Alberta Health Services, Calgary, AB, Canada
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16
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Bassi E, Bright K, Norman L, Pintson K, Daniel S, Sidhu S, Gondziola J, Bradley J, Fersovitch M, Stamp L, Moskovic K, LaMonica H, Iorfino F, Gaskell T, Tomlinson S, Johnson D, Dimitropoulos G. Perceptions of mental health providers of the barriers and facilitators of using and engaging youth in digital mental-health-enabled measurement based care. Digit Health 2024; 10:20552076241253093. [PMID: 38726214 PMCID: PMC11080807 DOI: 10.1177/20552076241253093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
Objectives Increased rates of mental health disorders and substance use among youth and young adults have increased globally, furthering the strain on an already burdened mental health system. Digital solutions have been proposed as a potential option for the provision of timely mental health services for youth, with little research exploring mental health professional views about using such innovative tools. In Alberta, Canada, we are evaluating the implementation and integration of a digital mental health (dMH) platform into existing service pathways. Within this paper we seek to explore mental health professionals' perceptions of the barriers and facilitators that may influence their utilization of digital MH-enabled measurement-based care (MBC) with the youth who access their services. Methods A qualitative, descriptive methodology was used to inductively generate themes from focus groups conducted with mental health professionals from specialized mental health services and primary care networks in Alberta. Results As mental health professionals considered the barriers and facilitators of using dMH with youth, they referenced individual and family barriers and facilitators to consider. Providers highlighted perceived barriers, including: first, cultural stigma, family apprehension about mental health care, and parental access to dMH and MBC as deterrents to providers adopting digital platforms in routine care; second, perceptions of increased responsibility and liability for youth in crisis; third, perception that some psychiatric and neurodevelopmental disorders in youth are not amenable to dMH; fourth, professionals contemplated youth readiness to engage with dMH-enabled MBC. Participants also highlighted pertinent facilitators to dMH use, noting: first, the suitability of dMH for youth with mild mental health concerns; second, youth motivated to report their changes in mental health symptoms; and lastly, youth proficiency and preference for dMH options. Conclusions By identifying professionals' perceptions of barriers and facilitators for youth users, we may better understand how to address misconceptions about who is eligible and appropriate for dMH through training and education.
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Affiliation(s)
- E.M. Bassi
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - K.S. Bright
- School of Nursing and Midwifery, Faculty of Health, Community, and Education, Mount Royal University, Calgary, Alberta, Canada
- Heroes in Mind, Advocacy, and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, College of Health Science, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - L.G. Norman
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - K. Pintson
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - S. Daniel
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - S. Sidhu
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - J. Gondziola
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - J. Bradley
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - M. Fersovitch
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - L. Stamp
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - K. Moskovic
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - H.M. LaMonica
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - F. Iorfino
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - T. Gaskell
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - S. Tomlinson
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - D.W. Johnson
- Departments of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Maternal Newborn Child and Youth Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - G. Dimitropoulos
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
- Calgary Eating Disorders Program, Alberta Health Services, Calgary, Alberta, Canada
- Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
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17
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van Doorn M, Monsanto A, Wang CL, Verfaillie SCJ, van Amelsvoort TAMJ, Popma A, Jaspers MWM, Öry F, Alvarez-Jimenez M, Gleeson JF, Nieman DH. The Effects of a Digital, Transdiagnostic, Clinically and Peer-Moderated Treatment Platform for Young People With Emerging Mental Health Complaints: Repeated Measures Within-Subjects Study. JMIR Mhealth Uhealth 2023; 11:e50636. [PMID: 38090802 PMCID: PMC10753424 DOI: 10.2196/50636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/19/2023] [Accepted: 10/18/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND To address the growing prevalence of youth mental health problems, early intervention is crucial to minimize individual, societal, and economic impacts. Indicative prevention aims to target emerging mental health complaints before the onset of a full-blown disorder. When intervening at this early stage, individuals are more responsive to treatment, resulting in cost-effective outcomes. The Moderated Online Social Therapy platform, which was successfully implemented and proven effective in Australia, is a digital, peer- and clinically moderated treatment platform designed for young people. The Netherlands was the first country outside Australia to implement this platform, under the name Engage Young People Early (ENYOY). It has the potential to reduce the likelihood of young people developing serious mental health disorders. OBJECTIVE This study aims to investigate the effects on young people using the ENYOY-platform in relation to psychological distress, psychosocial functioning, and positive health parameters. METHODS Dutch-speaking young people with emerging mental health complaints (N=131) participated in the ENYOY-platform for 6 months in a repeated measures within-subjects study. Psychological distress, psychosocial functioning, and positive health parameters were assessed at baseline and 3, 6, and 12 months. Repeated measures ANOVA was conducted and adjusted for age, sex, therapy, and community activity. The Reliable Change Index and Clinically Significant Index were computed to compare the baseline with the 6- and 12-month measurements. The missing data rate was 22.54% and the dropout rate 62.6% (82/131). RESULTS The primary analysis (77/131, 58.8%) showed that psychological distress decreased and psychosocial functioning improved over time with large effect sizes (P<.001 in both cases; ηp2=0.239 and 0.318, respectively) independent of age (P=.76 for psychological distress and P=.48 for psychosocial functioning), sex (P=.24 and P=.88, respectively), therapy activity (P=.49 and P=.80, respectively), or community activity (P=.59 and P=.48, respectively). Similarly, secondary analyses (51/131, 38.9%) showed significant effects of time on the quality of life, well-being, and meaningfulness positive health parameters (P<.05; ηp2=0.062, 0.140, and 0.121, respectively). Improvements in all outcome measures were found between baseline and 3 and 6 months (P≤.001-.01; d=0.23-0.62) and sustained at follow-up (P=.18-.97; d=0.01-0.16). The Reliable Change Index indicated psychological distress improvements in 38% (39/102) of cases, no change in 54.9% (56/102) of cases, and worsening in 5.9% (6/102) of cases. Regarding psychosocial functioning, the percentages were 50% (51/102), 43.1% (44/102), and 6.9% (7/102), respectively. The Clinically Significant Index demonstrated clinically significant changes in 75.5% (77/102) of cases for distress and 89.2% (91/102) for functioning. CONCLUSIONS This trial demonstrated that the ENYOY-platform holds promise as a transdiagnostic intervention for addressing emerging mental health complaints among young people in the Netherlands and laid the groundwork for further clinical research. It would be of great relevance to expand the population on and service delivery of the platform. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12888-021-03315-x.
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Affiliation(s)
- Marilon van Doorn
- Amsterdam University Medical Centers (Location AMC), Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Anne Monsanto
- Amsterdam University Medical Centers (Location AMC), Amsterdam, Netherlands
- Antes, Rotterdam, Netherlands
| | - Chen Lu Wang
- Amsterdam University Medical Centers (Location AMC), Amsterdam, Netherlands
| | - Sander C J Verfaillie
- Amsterdam University Medical Centers (Location AMC), Amsterdam, Netherlands
- GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands
| | | | - Arne Popma
- Amsterdam University Medical Centers (Location AMC), Amsterdam, Netherlands
| | - Monique W M Jaspers
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers (Location AMC), Amsterdam, Netherlands
| | | | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
- Orygen, Melbourne, Australia
| | - John F Gleeson
- Healthy Brain and Mind Research Centre and School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Dorien H Nieman
- Amsterdam University Medical Centers (Location AMC), Amsterdam, Netherlands
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18
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Capon W, Hickie IB, Fetanat M, Varidel M, LaMonica HM, Prodan A, Piper S, Davenport TA, Mughal S, Shah JL, Scott EM, Iorfino F. A multidimensional approach for differentiating the clinical needs of young people presenting for primary mental health care. Compr Psychiatry 2023; 126:152404. [PMID: 37524044 DOI: 10.1016/j.comppsych.2023.152404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVES There is an ongoing necessity to match clinical interventions with the multidimensional needs of young people. A key step toward better service planning and the design of optimal models of care is to use multidimensional assessment to understand the clinical needs of those presenting to primary mental health care. METHODS 1284 people aged 12-25 years presenting to primary youth mental health services completed an online assessment at service entry. Latent class analysis was conducted for seven scales assessing anxiety, depression, psychosis, mania, functioning (indexed by Work and Social Adjustment Scale), and suicidality. RESULTS A three-class solution was identified as the optimal solution. Class 1 (n = 305, 23.75%), an early illness stage group, had low and mixed symptomatology with limited functional impairment, class 2 (n = 353, 27.49%) was made up of older persons with established depression and functional impairment, and class 3 (n = 626, 48.75%) had very high and complex needs, with functional impairment, suicidality, and at-risk mental states (psychosis or mania). Additional differentiating characteristics included psychological distress, circadian disturbances, social support, mental health history, eating disorder behaviours, and symptoms of post-traumatic stress disorder. CONCLUSIONS A large proportion of help-seeking young people present with symptoms and functional impairment that may exceed the levels of care available from basic primary care or brief intervention services. These subgroups highlight the importance of multidimensional assessments to determine appropriate service pathways and care options.
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Affiliation(s)
- William Capon
- Brain and Mind Centre, The University of Sydney, Australia.
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Australia.
| | - Masoud Fetanat
- Brain and Mind Centre, The University of Sydney, Australia.
| | - Mathew Varidel
- Brain and Mind Centre, The University of Sydney, Australia.
| | | | - Ante Prodan
- Brain and Mind Centre, The University of Sydney, Australia; Translational Health Research Institute, Western Sydney University, Australia; School of Computer, Data and Mathematical Sciences, Western Sydney University, Australia.
| | - Sarah Piper
- Brain and Mind Centre, The University of Sydney, Australia.
| | | | - Sarah Mughal
- McGill University, Department of Psychiatry, Montreal, Canada.
| | - Jai L Shah
- McGill University, Department of Psychiatry, Montreal, Canada.
| | | | - Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Australia.
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19
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Austin SF, Hastrup LH, van Os J, Simonsen E. Psychotic experiences and mental health outcomes in the general population: The Lolland-Falster Health Study. Schizophr Res 2023; 260:85-91. [PMID: 37633127 DOI: 10.1016/j.schres.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 06/28/2023] [Accepted: 08/13/2023] [Indexed: 08/28/2023]
Affiliation(s)
- Stephen F Austin
- Psychiatric Research Unit, Psychiatry Region Zealand, Faelledvej 6, 4200 Slagelse, Denmark; Department of Psychology, University of Southern Denmark, Odense, Denmark.
| | - Lene Halling Hastrup
- Psychiatric Research Unit, Psychiatry Region Zealand, Faelledvej 6, 4200 Slagelse, Denmark; Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark.
| | - Jim van Os
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Psychosis Studies and King's Health Partners, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Erik Simonsen
- Mental Health Services, East, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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20
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Iorfino F, McHugh C, Richards M, Skinner A, Prodan A, Occhipinti JA, Song YJC, Chiu S, Judkins S, Scott E, Hickie IB. Patterns of emergency department presentations for a youth mental health cohort: data-linkage cohort study. BJPsych Open 2023; 9:e170. [PMID: 37706294 PMCID: PMC10594097 DOI: 10.1192/bjo.2023.521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/23/2023] [Accepted: 06/09/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Primary youth mental health services in Australia have increased access to care for young people, yet the longer-term outcomes and utilisation of other health services among these populations is unclear. AIMS To describe the emergency department presentation patterns of a help-seeking youth mental health cohort. METHOD Data linkage was performed to extract Emergency Department Data Collection registry data (i.e. emergency department presentations, pattern of re-presentations) for a transdiagnostic cohort of 7024 youths (aged 12-30 years) who presented to mental health services. Outcome measures were pattern of presentations and reason for presentations (i.e. mental illness; suicidal behaviours and self-harm; alcohol and substance use; accident and injury; physical illness; and other). RESULTS During the follow-up period, 5372 (76.5%) had at least one emergency department presentation. The presentation rate was lower for males (IRR = 0.87, 95% CI 0.86-0.89) and highest among those aged 18 to 24 (IRR = 1.117, 95% CI 1.086-1.148). Almost one-third (31.12%) had an emergency department presentation that was directly associated with mental illness or substance use, and the most common reasons for presentation were for physical illness and accident or injury. Index visits for mental illness or substance use were associated with a higher rate of re-presentation. CONCLUSIONS Most young people presenting to primary mental health services also utilised emergency services. The preventable and repeated nature of many presentations suggests that reducing the ongoing secondary risks of mental disorders (i.e. substance misuse, suicidality, physical illness) could substantially improve the mental and physical health outcomes of young people.
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Affiliation(s)
- Frank Iorfino
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Catherine McHugh
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Matthew Richards
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Adam Skinner
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Ante Prodan
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia; Translational Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia; and School of Computer, Data and Mathematical Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | - Jo-an Occhipinti
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia; and Computer Simulation & Advanced Research Technologies, Sydney, New South Wales, Australia
| | | | - Simon Chiu
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | | | - Elizabeth Scott
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia; and St Vincent's Private Hospital, Sydney, New South Wales, Australia
| | - Ian B. Hickie
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
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21
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Iorfino F, Varidel M, Marchant R, Cripps S, Crouse J, Prodan A, Oliveria R, Carpenter JS, Hermens DF, Guastella A, Scott E, Shah J, Merikangas K, Scott J, Hickie IB. The temporal dependencies between social, emotional and physical health factors in young people receiving mental healthcare: a dynamic Bayesian network analysis. Epidemiol Psychiatr Sci 2023; 32:e56. [PMID: 37680185 PMCID: PMC10539737 DOI: 10.1017/s2045796023000616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 06/13/2023] [Accepted: 06/26/2023] [Indexed: 09/09/2023] Open
Abstract
AIMS The needs of young people attending mental healthcare can be complex and often span multiple domains (e.g., social, emotional and physical health factors). These factors often complicate treatment approaches and contribute to poorer outcomes in youth mental health. We aimed to identify how these factors interact over time by modelling the temporal dependencies between these transdiagnostic social, emotional and physical health factors among young people presenting for youth mental healthcare. METHODS Dynamic Bayesian networks were used to examine the relationship between mental health factors across multiple domains (social and occupational function, self-harm and suicidality, alcohol and substance use, physical health and psychiatric syndromes) in a longitudinal cohort of 2663 young people accessing youth mental health services. Two networks were developed: (1) 'initial network', that shows the conditional dependencies between factors at first presentation, and a (2) 'transition network', how factors are dependent longitudinally. RESULTS The 'initial network' identified that childhood disorders tend to precede adolescent depression which itself was associated with three distinct pathways or illness trajectories; (1) anxiety disorder; (2) bipolar disorder, manic-like experiences, circadian disturbances and psychosis-like experiences; (3) self-harm and suicidality to alcohol and substance use or functioning. The 'transition network' identified that over time social and occupational function had the largest effect on self-harm and suicidality, with direct effects on ideation (relative risk [RR], 1.79; CI, 1.59-1.99) and self-harm (RR, 1.32; CI, 1.22-1.41), and an indirect effect on attempts (RR, 2.10; CI, 1.69-2.50). Suicide ideation had a direct effect on future suicide attempts (RR, 4.37; CI, 3.28-5.43) and self-harm (RR, 2.78; CI, 2.55-3.01). Alcohol and substance use, physical health and psychiatric syndromes (e.g., depression and anxiety, at-risk mental states) were independent domains whereby all direct effects remained within each domain over time. CONCLUSIONS This study identified probable temporal dependencies between domains, which has causal interpretations, and therefore can provide insight into their differential role over the course of illness. This work identified social, emotional and physical health factors that may be important early intervention and prevention targets. Improving social and occupational function may be a critical target due to its impacts longitudinally on self-harm and suicidality. The conditional independence of alcohol and substance use supports the need for specific interventions to target these comorbidities.
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Affiliation(s)
- Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Mathew Varidel
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Roman Marchant
- Human Technology Institute, University of Technology, Sydney, NSW, Australia
- School of Mathematical and Physical Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - Sally Cripps
- Human Technology Institute, University of Technology, Sydney, NSW, Australia
- School of Mathematical and Physical Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - Jacob Crouse
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Ante Prodan
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
- School of Computer, Data and Mathematical Sciences, Western Sydney University, Sydney, NSW, Australia
| | - Rafael Oliveria
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- School of Computer Science, The University of Sydney, Sydney, NSW, Australia
| | | | - Daniel F. Hermens
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia
| | - Adam Guastella
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Elizabeth Scott
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Jai Shah
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Kathleen Merikangas
- Genetic Epidemiology Research Branch, Division of Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Ian B. Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
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22
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Chong MK, Hickie IB, Cross SP, McKenna S, Varidel M, Capon W, Davenport TA, LaMonica HM, Sawrikar V, Guastella A, Naismith SL, Scott EM, Iorfino F. Digital Application of Clinical Staging to Support Stratification in Youth Mental Health Services: Validity and Reliability Study. JMIR Form Res 2023; 7:e45161. [PMID: 37682588 PMCID: PMC10517388 DOI: 10.2196/45161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 05/31/2023] [Accepted: 06/26/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND As the demand for youth mental health care continues to rise, managing wait times and reducing treatment delays are key challenges to delivering timely and quality care. Clinical staging is a heuristic model for youth mental health that can stratify care allocation according to individuals' risk of illness progression. The application of staging has been traditionally limited to trained clinicians yet leveraging digital technologies to apply clinical staging could increase the scalability and usability of this model in services. OBJECTIVE The aim of this study was to validate a digital algorithm to accurately differentiate young people at lower and higher risk of developing mental disorders. METHODS We conducted a study with a cohort comprising 131 young people, aged between 16 and 25 years, who presented to youth mental health services in Australia between November 2018 and March 2021. Expert psychiatrists independently assigned clinical stages (either stage 1a or stage 1b+), which were then compared to the digital algorithm's allocation based on a multidimensional self-report questionnaire. RESULTS Of the 131 participants, the mean age was 20.3 (SD 2.4) years, and 72% (94/131) of them were female. Ninety-one percent of clinical stage ratings were concordant between the digital algorithm and the experts' ratings, with a substantial interrater agreement (κ=0.67; P<.001). The algorithm demonstrated an accuracy of 91% (95% CI 86%-95%; P=.03), a sensitivity of 80%, a specificity of 93%, and an F1-score of 73%. Of the concordant ratings, 16 young people were allocated to stage 1a, while 103 were assigned to stage 1b+. Among the 12 discordant cases, the digital algorithm allocated a lower stage (stage 1a) to 8 participants compared to the experts. These individuals had significantly milder symptoms of depression (P<.001) and anxiety (P<.001) compared to those with concordant stage 1b+ ratings. CONCLUSIONS This novel digital algorithm is sufficiently robust to be used as an adjunctive decision support tool to stratify care and assist with demand management in youth mental health services. This work could transform care pathways and expedite care allocation for those in the early stages of common anxiety and depressive disorders. Between 11% and 27% of young people seeking care may benefit from low-intensity, self-directed, or brief interventions. Findings from this study suggest the possibility of redirecting clinical capacity to focus on individuals in stage 1b+ for further assessment and intervention.
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Affiliation(s)
- Min K Chong
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | | | - Sarah McKenna
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Mathew Varidel
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - William Capon
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Tracey A Davenport
- Design and Strategy Division, Australian Digital Health Agency, Sydney, Australia
| | - Haley M LaMonica
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Vilas Sawrikar
- School of Health and Social Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Adam Guastella
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
- Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sharon L Naismith
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
- Healthy Brain Ageing Program, University of Sydney, Sydney, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
- St Vincent's and Mater Clinical School, The University of Notre Dame, Sydney, Australia
| | - Frank Iorfino
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
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23
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Wilson CE, Carpenter JS, Crouse JJ, Park S, Koethe D, Scott EM, Hickie IB. Cross-sectional and longitudinal associations between cardiometabolic measures and clinical stage in young people accessing early intervention mental health services. Early Interv Psychiatry 2023; 17:893-900. [PMID: 36682384 PMCID: PMC10946614 DOI: 10.1111/eip.13381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/13/2022] [Accepted: 01/02/2023] [Indexed: 01/24/2023]
Abstract
AIM This retrospective cohort study aimed to identify the cardiometabolic characteristics, cross-sectionally and longitudinally, associated with clinical stage in youth accessing early intervention mental health services. METHODS Cardiometabolic data we collected in 511 young people (aged 12-25 years at entry) receiving mental health care at the early intervention services in Sydney, Australia. RESULTS The majority of young people (N = 448, 87.67%) were classified in stage 1a or 1b at entry. At entry to care, there was no cross-sectional relationship between clinical stage and age, gender, fasting insulin, fasting glucose, updated homeostatic model assessment for insulin resistance (HOMA2-IR) score, BMI or waist circumference. Of the 111 (21.7%) young people initially classified at stage 1a ('non-specific symptoms') and the 337 (65.9%) classified in stage 1b ('attenuated syndromes'), 40 individuals transitioned to stage 2+ (7.8%) ("full-threshold disorders") longitudinally. No cardiometabolic factors predicted clinical stage transitions. However, those with an increase in BMI over the course of care (n = 54) were 1.46 (OR; 95% CI: 1.02-2.17) times more likely to progress to stage 2+ at follow up. CONCLUSIONS Whilst no relationships were found between demographic or cardiometabolic variables and clinical stage at entry to care, an increased BMI over time was associated with clinical stage transition longitudinally. Further longitudinal research is needed to understand the demographic, clinical, illness progression or treatment factors associated with changes in cardiometabolic status.
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Affiliation(s)
- Chloe E. Wilson
- Brain and Mind Centre, Youth Mental Health and Technology TeamThe University of SydneyCamperdownAustralia
| | - Joanne S. Carpenter
- Brain and Mind Centre, Youth Mental Health and Technology TeamThe University of SydneyCamperdownAustralia
| | - Jacob J. Crouse
- Brain and Mind Centre, Youth Mental Health and Technology TeamThe University of SydneyCamperdownAustralia
| | - Shin Park
- Brain and Mind Centre, Youth Mental Health and Technology TeamThe University of SydneyCamperdownAustralia
| | - Dagmar Koethe
- Brain and Mind Centre, Youth Mental Health and Technology TeamThe University of SydneyCamperdownAustralia
| | - Elizabeth M. Scott
- Brain and Mind Centre, Youth Mental Health and Technology TeamThe University of SydneyCamperdownAustralia
| | - Ian B. Hickie
- Brain and Mind Centre, Youth Mental Health and Technology TeamThe University of SydneyCamperdownAustralia
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Paetzold I, Schick A, Rauschenberg C, Hirjak D, Banaschewski T, Meyer-Lindenberg A, Boehnke JR, Boecking B, Reininghaus U. Exploring putative therapeutic mechanisms of change in a hybrid compassion-focused, ecological momentary intervention: Findings from the EMIcompass trial. Behav Res Ther 2023; 168:104367. [PMID: 37467549 DOI: 10.1016/j.brat.2023.104367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 03/07/2023] [Accepted: 07/03/2023] [Indexed: 07/21/2023]
Abstract
Compassion-focused interventions represent a promising transdiagnostic approach, but the mechanisms involved in hybrid delivery combining face-to-face sessions and an ecological momentary intervention remain unexplored. The current study aimed at exploring associations of putative mechanisms with clinical outcomes at post-intervention/follow-up and mediation of outcome at follow-up by preceding pre-to post-intervention changes in putative mechanisms. The compassion-focused EMIcompass intervention was applied in an exploratory randomized controlled trial (treatment as usual (TAU) vs. TAU + EMIcompass) with youth with early mental health problems. Data was collected before randomization, at post-intervention and at four-week follow-up. We recruited N = 92 participants, N = 46 were allocated to the experimental condition. After control for baseline levels of the target outcomes, baseline-to post-intervention improvement in adaptive emotion regulation was associated with lower levels of clinical outcomes (e.g. psychological distress b = -1.15; 95%CI = -1.92 to -0.39) across time points. We could not detect indirect effects, but we observed associations of change in self-compassion and adaptive emotion regulation with outcomes at follow-up in the mediation analysis (e.g., β = -0.35, 95%CI = -0.52 to -0.16). If successfully targeted by interventions, self-compassion and emotion regulation may be promising putative therapeutic mechanisms of change.
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Affiliation(s)
- Isabell Paetzold
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden-Württemberg, Germany
| | - Anita Schick
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden-Württemberg, Germany
| | - Christian Rauschenberg
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden-Württemberg, Germany
| | - Dusan Hirjak
- Department for Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Andreas Meyer-Lindenberg
- Department for Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jan R Boehnke
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden-Württemberg, Germany; School of Health Sciences, University of Dundee, Dundee, UK
| | - Benjamin Boecking
- Tinnitus Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden-Württemberg, Germany; ESRC Centre for Society and Mental Health and Social Epidemiology Research Group, King's College London, London, London, UK; Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
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Trent ES, Viana AG, Raines EM, Busch HEC, Silva K, Storch EA, Zvolensky MJ. Childhood exposure to parental threatening behaviors and anxiety in emerging adulthood: Indirect effects of perceived stress. J Clin Psychol 2023; 79:1984-2008. [PMID: 36971223 PMCID: PMC10440255 DOI: 10.1002/jclp.23516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 03/03/2023] [Accepted: 03/14/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Although childhood exposure to parental threatening behaviors is associated with elevated anxiety in emerging adulthood, the underlying mechanisms remain unexplored. Perceived stress-a subjective experience comprised of feelings of helplessness (being unable to cope or exert control) and poor self-efficacy (confidence in one's ability to manage stressors)-is one candidate mechanism. The present investigation examined the underlying role of perceived stress in the association between childhood exposure to parental threatening behaviors and anxiety symptom severity in a sample of emerging adults. METHODS Participants (N = 855; Mage = 18.75 years, SD = 1.05, range 18-24; 70.8% female) were recruited from a large state university and administered a battery of self-report questionnaires assessing constructs of interest. RESULTS Structural equation modeling (SEM) analyses indicated that only greater childhood exposure to maternal threatening behaviors was directly associated with greater feelings of helplessness and lower self-efficacy. Furthermore, only childhood exposure to maternal threatening behaviors was indirectly associated with anxiety severity through greater feelings of helplessness and lower self-efficacy. In contrast, childhood exposure to paternal threatening behaviors was neither directly nor indirectly associated with anxiety severity. LIMITATIONS Limitations include a cross-sectional design, use of self-report measures, and a nonclinical sample. Replicating these findings in a clinical sample and testing the hypothesized model in a longitudinal design is necessary. CONCLUSIONS Findings underscore the need for intervention efforts that screen for and target perceived stress in emerging adults exposed to negative maternal parenting behaviors.
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Affiliation(s)
- Erika S. Trent
- Department of Psychology, University of Houston, Houston, TX
| | - Andres G. Viana
- Department of Psychology, University of Houston, Houston, TX
- Texas Institute of Measurement, Evaluation, & Statistics, University of Houston, Houston, TX
| | | | | | - Karina Silva
- Department of Psychology, University of Houston, Houston, TX
| | - Eric A. Storch
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
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Karcher NR, Hicks R, Schiffman J, Asarnow JR, Calkins ME, Dauberman JL, Garrett CD, Koli RL, Larrauri CA, Loewy RL, McGough CA, Murphy JM, Niendam TA, Roaten K, Rodriguez J, Staglin BK, Wissow L, Woodberry KA, Young JF, Gur RE, Bearden CE, Barch DM. Youth Mental Health Screening and Linkage to Care. Psychiatr Serv 2023; 74:727-736. [PMID: 36695011 PMCID: PMC10329990 DOI: 10.1176/appi.ps.202200008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
One Mind, in partnership with Meadows Mental Health Policy Institute, convened several virtual meetings of mental health researchers, clinicians, and other stakeholders in 2020 to identify first steps toward creating an initiative for early screening and linkage to care for youths (individuals in early adolescence through early adulthood, ages 10-24 years) with mental health difficulties, including serious mental illness, in the United States. This article synthesizes and builds on discussions from those meetings by outlining and recommending potential steps and considerations for the development and integration of a novel measurement-based screening process in youth-facing school and medical settings to increase early identification of mental health needs and linkage to evidence-based care. Meeting attendees agreed on an initiative incorporating a staged assessment process that includes a first-stage brief screener for several domains of psychopathology. Individuals who meet threshold criteria on the first-stage screener would then complete an interview, a second-stage in-depth screening, or both. Screening must be followed by recommendations and linkage to an appropriate level of evidence-based care based on acuity of symptoms endorsed during the staged assessment. Meeting attendees proposed steps and discussed additional considerations for creating the first nationwide initiative for screening and linkage to care, an initiative that could transform access of youths to mental health screening and care.
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Affiliation(s)
- Nicole R. Karcher
- Department of Psychiatry, Washington University in St. Louis, School of Medicine, St. Louis, MO
| | | | - Jason Schiffman
- Department of Psychological Science, University of California, Irvine, CA
| | - Joan R. Asarnow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA
| | - Monica E. Calkins
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Judith L. Dauberman
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Chantel D. Garrett
- Department of Health Services, Strong 365, University of Washington, Seattle, WA
| | - Roshni L. Koli
- Department of Psychiatry, University of Texas at Austin, Dell Medical School, Austin, TX, USA
| | | | - Rachel L. Loewy
- Department of Psychiatry, University of California, San Francisco, CA
| | | | - J. Michael Murphy
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Tara A. Niendam
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA
| | - Kimberly Roaten
- Department of Psychiatry, Meadows Mental Health Policy Institute, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jacqueline Rodriguez
- Student Support & Health Services, Sacramento City Unified School District, Sacramento, CA
| | | | - Lawrence Wissow
- Department of Psychiatry, University of Washington, Seattle, WA
| | - Kristen A. Woodberry
- Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, ME
- Department of Psychiatry, Tufts School of Medicine, Boston, MA
| | - Jami F. Young
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, PA
| | - Raquel E. Gur
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, PA
| | - Carrie E. Bearden
- Department of Psychiatry and Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA
| | - Deanna M. Barch
- Department of Psychiatry, Washington University in St. Louis, School of Medicine, St. Louis, MO
- Departments of Psychological & Brain Sciences and Radiology, Washington University in St. Louis, St. Louis, MO
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Skarphedinsson G, Karlsson GK. The Feasibility and Efficacy of a Group-Based, Brief Transdiagnostic Cognitive-Behavioral Treatment for Adolescents with Internalizing Problems. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01552-7. [PMID: 37294420 DOI: 10.1007/s10578-023-01552-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 06/10/2023]
Abstract
The present study aimed to assess the efficacy of a group-based, brief transdiagnostic cognitive-behavioral therapy (CBT) program for adolescents with internalizing problems, such as anxiety and depressive disorders, seeking help in a primary health care clinic in Iceland. The group-based CBT program consisted of eight weekly 110-min sessions covering psychoeducation, cognitive restructuring, behavioral activation, exposure, problem-solving, social skills, and mindfulness. The study recruited 53 participants, who were randomly assigned to either receive the group treatment or be placed on a wait-list for monitoring purposes. Measures were taken at baseline, during treatment (week 4), at posttreatment (week 8), and at 2-, 4-month, and 1-year follow-ups. The primary outcome measures were the self-reported total scores of total anxiety and depression using the Revised Children's Anxiety and Depression Scale (RCADS). The study found a significant effect of time and time * treatment interaction on the depression and anxiety total scores. The secondary outcome measures, RCADS parent-rated depression and anxiety total scores, did not show significant effects of time * treatment interaction. However, during naturalistic follow-up, a significant reduction in parent-reported depression and anxiety total scores was observed. The study also observed good treatment adherence, as well as high satisfaction among parents and youth. The results suggest that this group-based, brief transdiagnostic CBT group treatment is feasible and effective in reducing depressive and anxiety symptoms in adolescents with internalizing problems and highlights the importance of addressing comorbidity in treatment.
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Reininghaus U, Paetzold I, Rauschenberg C, Hirjak D, Banaschewski T, Meyer-Lindenberg A, Boehnke JR, Boecking B, Schick A. Effects of a Novel, Transdiagnostic Ecological Momentary Intervention for Prevention, and Early Intervention of Severe Mental Disorder in Youth (EMIcompass): Findings From an Exploratory Randomized Controlled Trial. Schizophr Bull 2023; 49:592-604. [PMID: 36738168 PMCID: PMC10154707 DOI: 10.1093/schbul/sbac212] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND/HYPOTHESIS Digital interventions targeting transdiagnostic mechanisms in daily life may be a promising translational strategy for prevention and early intervention of psychotic and other severe mental disorders. We aimed to investigate the feasibility and initial signals of efficacy of a transdiagnostic, compassion-focused, hybrid ecological momentary intervention for improving resilience (ie, EMIcompass) in youth with early mental health problems. STUDY DESIGN In an exploratory, assessor-blind randomized controlled trial, youth aged 14-25 with current distress, broad at-risk mental state, or first episode of severe mental disorder were randomly allocated to experimental (EMIcompass+treatment as usual [TAU]) or control condition (TAU). Data on primary (stress reactivity) and secondary candidate mechanisms as well as candidate primary (psychological distress) and secondary outcomes were collected. STUDY RESULTS Criteria for the feasibility of trial methodology and intervention delivery were met (n = 92 randomized participants). No serious adverse events were observed. Initial outcome signals were evident for reduced momentary stress reactivity (stress×time×condition, B = -0.10 95%CI -0.16--0.03, d = -0.10), aberrant salience (condition, B = -0.38, 95%CI -0.57--0.18, d = -0.56) as well as enhanced momentary resilience (condition, B = 0.55, 95%CI 0.18-0.92, d = 0.33) and quality of life (condition, B = 0.82, 95%CI 0.10-1.55, d = 0.60) across post-intervention and 4-week follow-up. No outcome signals were observed for self-reported psychological distress (condition, B = 0.57, 95%CI -1.59-2.72, d = 0.09), but there was suggestive evidence of reduced observer-rated symptoms at the 4-week follow-up (B = -1.41, 95%CI -2.85-0.02, d = -0.41). CONCLUSIONS Our findings provide evidence of feasibility and initial signals that EMIcompass may reduce stress reactivity and improve quality of life. A definitive trial is now warranted.
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Affiliation(s)
- Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- ESRC Centre for Society and Mental Health, King’s College London, London, UK
| | - Isabell Paetzold
- Department of Public Mental Health, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christian Rauschenberg
- Department of Public Mental Health, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jan R Boehnke
- Department of Public Mental Health, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Benjamin Boecking
- Tinnitus Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Anita Schick
- Department of Public Mental Health, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Reininghaus U, Rauschenberg C, Schick A, Hartmann JA. [Public mental health from an international perspective: from "shifting the curve" to inclusion of vulnerable populations]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:371-378. [PMID: 36847854 PMCID: PMC9969372 DOI: 10.1007/s00103-023-03673-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/03/2023] [Indexed: 03/01/2023]
Abstract
In recent years, efforts in the field of public mental health have increased that seek to promote mental health and mental health literacy at population level and yield advances in the prevention, treatment and care of mental health conditions. This paper provides an overview of contemporary conceptualisations of indicators and determinants of public mental health as well as population-based intervention strategies from an international perspective. Current conceptual and methodological challenges of so-called high-risk, whole-population and vulnerable population strategies are critically discussed. Future efforts in research, policy and practice need to address fundamental causes of social and health inequalities, drawing on all societal fields, to contribute to improving population mental health.
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Affiliation(s)
- Ulrich Reininghaus
- Abteilung Public Mental Health, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland.
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, Großbritannien.
- ESRC Centre for Society and Mental Health, King's College London, London, Großbritannien.
| | - Christian Rauschenberg
- Abteilung Public Mental Health, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Anita Schick
- Abteilung Public Mental Health, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Jessica A Hartmann
- Abteilung Public Mental Health, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australien
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Wang D, Zhou L, Chen C, Sun M. Psychotic-like experiences during COVID-19 lockdown among adolescents: Prevalence, risk and protective factors. Schizophr Res 2023; 252:309-316. [PMID: 36706476 PMCID: PMC9868397 DOI: 10.1016/j.schres.2023.01.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/31/2022] [Accepted: 01/18/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Although plenty of evidence has shown the huge negative impact of COVID-19 on individuals' mental health conditions, little is known about its impact on the psychotic-like experiences (PLEs) in the general population. We aim to explore the prevalence of PLEs and relevant influential factors among adolescents during COVID-19 lockdown. METHODS A total of 3234 students completed one online survey between April to May 2020. PLEs were assessed using the 15-item Positive Subscale of the Community Assessment of Psychic Experiences (CAPE-P15). Resilience, social support, childhood trauma, and a series of socio-demographic factors were also evaluated. RESULTS In this sample, 51.4 % adolescents reported having at least one PLE, while 11.6 % experienced PLEs frequently during COVID-19 lockdown. Senior high school students showed more frequent PLEs than college students (p < 0.001). Female gender (OR = 1.77), history of mental disorders (OR = 3.07) or chronic physical illness (OR = 2.04), having relatives or friends being infected with COVID-19 (OR = 3.12), longer daily exposure to media coverage of the COVID-19 (OR = 1.60), and more childhood trauma (OR = 1.54-3.49) were correlated with more frequent PLEs, while higher resilience (OR = 0.35-0.54) and more perceived social support (OR = 0.63-0.72) were associated with decreased odds for frequent PLEs. Additionally, there were several differences among the influential factors between senior high school and college students. CONCLUSIONS PLEs were relatively common among Chinese adolescents, with higher prevalence among senior high school students during COVID-19 lockdown. Adolescents with specific characteristics should receive more attention in the development of intervention measures in mental health during pandemic lockdown.
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Affiliation(s)
- Dongfang Wang
- Department of Social Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China; School of Psychology, Centre for Studies of Psychological Applications, Guangdong Key Laboratory of Mental Health and Cognitive Science, Ministry of Education Key Laboratory of Brain Cognition and Educational Science, South China Normal University, Guangzhou, China
| | - Liang Zhou
- Department of Social Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Chunping Chen
- Institute of Education, Xiamen University, Xiamen, China
| | - Meng Sun
- Department of Social Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
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Bruno A, Iannuzzo F, Muscatello MRA. Comorbidity from a Categorical to a Transdiagnostic-Dimensional Approach: New Perspectives for Researchers and Clinicians. CLINICAL NEUROPSYCHIATRY 2023; 20:7-8. [PMID: 36936623 PMCID: PMC10016098 DOI: 10.36131/cnfioritieditore20230101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Affiliation(s)
- Antonio Bruno
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria 1, Contesse, Messina 98125, Italy
- Corresponding author Prof. Antonio Bruno – Department of Biomedical and Dental Sciences and Morphofunctional Imaging Policlinico Universitario Via Consolare Valeria, 1 – 98125 Messina - Italy Phone: 0039-090-22212092 - Fax: 0039-090-695136
| | - Fiammetta Iannuzzo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria 1, Contesse, Messina 98125, Italy
| | - Maria Rosaria Anna Muscatello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria 1, Contesse, Messina 98125, Italy
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Wolfson PE, Andries J, Ahlers D, Whippo M. Ketamine-assisted psychotherapy in adolescents with multiple psychiatric diagnoses. Front Psychiatry 2023; 14:1141988. [PMID: 37065886 PMCID: PMC10098148 DOI: 10.3389/fpsyt.2023.1141988] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/28/2023] [Indexed: 04/18/2023] Open
Abstract
Ketamine-assisted psychotherapy is a promising new treatment for a variety of mental disorders of adolescence. There is currently an adolescent mental health crisis, with a high prevalence of disorders, diagnostic complexity, and many adolescents failing to respond to conventional treatments. While there is strong evidence for the use of ketamine in adults for a variety of treatment-refractory mental illnesses, research in adolescents is in its early stages. Ketamine-assisted psychotherapy (KAP) has been described in adults with promising results and here we present the first published cases of the use of KAP in adolescents. The four cases include adolescents aged 14-19 at the initiation of treatment, each with a variety of comorbid diagnoses including treatment-resistant depression, bipolar disorder, eating disorders, anxiety, panic, and trauma-related symptoms. They each initially received sublingual ketamine, followed by sessions with intramuscular ketamine. Their courses varied, but each had symptomatic and functional improvements, and the treatment was well-tolerated. Subjective patient reports are included. Rapid resolution of symptomatology and suffering often occurs within months as the result of the application of KAP to adolescent psychiatric care but is not inevitable. Family involvement in the treatment process appears to be essential to success. The development of this modality may have a singularly positive impact that will expand the psychiatric toolbox and its healing potency.
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Affiliation(s)
- Philip E. Wolfson
- The Center for Transformational Psychotherapy, San Anselmo, CA, United States
- Ketamine Research Foundation, San Anselmo, CA, United States
- *Correspondence: Philip E. Wolfson
| | - Julane Andries
- The Center for Transformational Psychotherapy, San Anselmo, CA, United States
- Ketamine Research Foundation, San Anselmo, CA, United States
| | - Daniel Ahlers
- The Center for Transformational Psychotherapy, San Anselmo, CA, United States
- Ketamine Research Foundation, San Anselmo, CA, United States
| | - Melissa Whippo
- The Center for Transformational Psychotherapy, San Anselmo, CA, United States
- Ketamine Research Foundation, San Anselmo, CA, United States
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Capon W, Hickie IB, Varidel M, Prodan A, Crouse JJ, Carpenter JS, Cross SP, Nichles A, Zmicerevska N, Guastella AJ, Scott EM, Scott J, Shah J, Iorfino F. Clinical staging and the differential risks for clinical and functional outcomes in young people presenting for youth mental health care. BMC Med 2022; 20:479. [PMID: 36514113 PMCID: PMC9749194 DOI: 10.1186/s12916-022-02666-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Clinical staging proposes that youth-onset mental disorders develop progressively, and that active treatment of earlier stages should prevent progression to more severe disorders. This retrospective cohort study examined the longitudinal relationships between clinical stages and multiple clinical and functional outcomes within the first 12 months of care. METHODS Demographic and clinical information of 2901 young people who accessed mental health care at age 12-25 years was collected at predetermined timepoints (baseline, 3 months, 6 months, 12 months). Initial clinical stage was used to define three fixed groups for analyses (stage 1a: 'non-specific anxious or depressive symptoms', 1b: 'attenuated mood or psychotic syndromes', 2+: 'full-threshold mood or psychotic syndromes'). Logistic regression models, which controlled for age and follow-up time, were used to compare clinical and functional outcomes (role and social function, suicidal ideation, alcohol and substance misuse, physical health comorbidity, circadian disturbances) between staging groups within the initial 12 months of care. RESULTS Of the entire cohort, 2093 young people aged 12-25 years were followed up at least once over the first 12 months of care, with 60.4% female and a baseline mean age of 18.16 years. Longitudinally, young people at stage 2+ were more likely to develop circadian disturbances (odds ratio [OR]=2.58; CI 1.60-4.17), compared with individuals at stage 1b. Additionally, stage 1b individuals were more likely to become disengaged from education/employment (OR=2.11, CI 1.36-3.28), develop suicidal ideations (OR=1.92; CI 1.30-2.84) and circadian disturbances (OR=1.94, CI 1.31-2.86), compared to stage 1a. By contrast, we found no relationship between clinical stage and the emergence of alcohol or substance misuse and physical comorbidity. CONCLUSIONS The differential rates of emergence of poor clinical and functional outcomes between early versus late clinical stages support the clinical staging model's assumptions about illness trajectories for mood and psychotic syndromes. The greater risk of progression to poor outcomes in those who present with more severe syndromes may be used to guide specific intervention packages.
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Affiliation(s)
- William Capon
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia
| | - Mathew Varidel
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia
| | - Ante Prodan
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia
- Translational Health Research Institute, Western Sydney University, Sydney, 2751, Australia
- School of Computer, Data and Mathematical Sciences, Western Sydney University, Sydney, 2751, Australia
| | - Jacob J Crouse
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia
| | - Joanne S Carpenter
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia
| | - Shane P Cross
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, 2109, Australia
| | - Alissa Nichles
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia
| | | | - Adam J Guastella
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - Jai Shah
- Department of Psychiatry, McGill University, Montreal, H3A 0G4, Canada
| | - Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia.
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Jackson B, Booth R, Jackson KT. The Good, the Bad, and the Vision: Exploring the Mental Health Care Experiences of Transitional-Aged Youth Using the Photovoice Method. QUALITATIVE HEALTH RESEARCH 2022; 32:1915-1931. [PMID: 36036205 DOI: 10.1177/10497323221121209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Transitional-aged youth (TAY) between the ages of 16 and 24 experience higher rates of mental distress than any other age group. It has long been recognized that stability, consistency, and continuity in mental health care delivery are of paramount importance; however, the disjointed progression from paediatric to adult psychiatric services leaves many TAY vulnerable to deleterious health outcomes. In Spring 2019, eight TAY living with mental health challenges participated in a Photovoice study designed to: (1) illuminate their individual transition experiences; and, (2) support a collective vision for optimal mental health care at this nexus. Participants took photographs that reflected three weekly topics-the good, the bad, and the vision-and engaged in a series of three corresponding photo-elicitation focus group sessions. Twenty-four images with accompanying titles and captions were sorted into nine participant-selected themes. Findings contribute to an enhanced awareness of psychiatric service delivery gaps experienced by TAY, and advocate for seamless and supportive transitions that more effectively meet the mental health care needs of this population.
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Affiliation(s)
- Brianna Jackson
- Yale School of Nursing, 5755Yale University, Orange, CT, USA
| | - Richard Booth
- Arthur Labatt Family School of Nursing, 6221Western University, London, ON, Canada
| | - Kimberley T Jackson
- Arthur Labatt Family School of Nursing, 6221Western University, London, ON, Canada
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Tickell AM, Rohleder C, Ho N, McHugh C, Jones G, Song YJC, Hickie IB, Scott EM. Identifying pathways to early-onset metabolic dysfunction, insulin resistance and inflammation in young adult inpatients with emerging affective and major mood disorders. Early Interv Psychiatry 2022; 16:1121-1129. [PMID: 34852406 DOI: 10.1111/eip.13260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 09/09/2021] [Accepted: 11/07/2021] [Indexed: 12/17/2022]
Abstract
AIM Young people with common mood disorders face the prospect of shortened life expectancy largely due to premature cardiovascular disease. Metabolic dysfunction is a risk factor for premature cardiovascular disease. There is an ongoing debate whether metabolic dysfunction can be simply explained by weight gain secondary to psychotropic medications or whether shared genetic vulnerability, intrinsic immune-metabolic disturbances or other system perturbations (e.g. dysregulated sympathetic nervous system, circadian dysfunction) are more relevant determinants of premature cardiovascular disease. Thus, we aimed to investigate underlying drivers of metabolic dysfunction and premature cardiovascular disease in young people in the early phases of common mood disorders. METHODS We evaluated the relationships between insulin resistance (assessed by HOMA2-IR) and body mass index (BMI), sex, diagnosis, medication, inflammatory markers and hormonal factors in 327 inpatients with emerging affective and major mood disorders admitted to the Young Adult Mental Health Unit, St Vincent's Private Hospital, Sydney. RESULTS While HOMA2-IR scores were positively associated with BMI (rs = 0.465, p < .001), they were also higher in those prescribed mood stabilizers (p = .044) but were not associated with specific diagnoses, other medication types or the number of prescribed medications. Further, high-sensitivity C-reactive protein levels (but not thyroid-stimulating hormone and ferritin levels) were positively associated with HOMA2-IR (rs = 0. 272, p < .001) and BMI (rs = . 409, p < .001). CONCLUSIONS In addition to BMI, other non-specific markers of inflammation are associated with early metabolic dysfunction in young people with emerging affective and major mood disorders.
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Affiliation(s)
| | - Cathrin Rohleder
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Nicholas Ho
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Catherine McHugh
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Graham Jones
- SydPath, St Vincent's Hospital, Sydney, Australia.,St Vincent's Clinical School, University of NSW, Australia
| | | | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, University of Sydney, Camperdown, Australia.,Young Adult Mental Health Unit, St Vincent's Private Hospital, Sydney, Australia
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Reininghaus U, Schomerus G, Hölling H, Seidler A, Gerhardus A, Gusy B, Riedel-Heller S. „Shifting the Curve“: Neue Entwicklungen und Herausforderungen im Bereich der Public Mental Health. PSYCHIATRISCHE PRAXIS 2022; 50:160-164. [PMID: 36096131 DOI: 10.1055/a-1823-5191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
ZusammenfassungIn der nationalen und internationalen Forschung nimmt das noch relativ junge Fach der Public Mental Health einen immer wichtigeren Stellenwert ein. Allerdings bleibt eine zentrale Herausforderung, dieses Fach in seiner Interdisziplinarität abzubilden und den Diskurs im Spannungsfeld von Public Health, psychiatrischer Epidemiologie, psychischer Gesundheitsförderung, Prävention und Versorgungsforschung zu führen, um sein innovatives Potenzial vollständig auszuschöpfen. In diesem Spannungsfeld stellen sich eine Reihe von grundsätzlichen konzeptionellen und methodischen Fragen, die in diesem Essay unter Bezugnahme auf die Populationsstrategie von Geoffrey Rose exemplarisch auch hinsichtlich fundamentaler Ursachen von sozialen und gesundheitlichen Ungleichheiten erörtert und adressiert werden sollen, mit dem letztendlichen Ziel, die Grundlage zur Erfassung und Veränderung von psychischer Gesundheit auf Populationsebene zu verbessern.
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Affiliation(s)
- Ulrich Reininghaus
- Abteilung Public Mental Health; Zentralinstitut für Seelische Gesundheit, Public Mental Health, ZI Seelische Gesundheit Mannheim
| | - Georg Schomerus
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig
| | - Heike Hölling
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut
| | - Andreas Seidler
- Institut und Poliklinik für Arbeits- und Sozialmedizin, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden
| | - Ansgar Gerhardus
- Abteilung für Versorgungsforschung, Institut für Public Health und Pflegeforschung, Universität Bremen
| | - Burkhard Gusy
- Fachbereich Erziehungswissenschaft und Psychologie, Arbeitsbereich Public Health: Prävention und psychosoziale Gesundheitsforschung, Freie Universität Berlin
| | - Steffi Riedel-Heller
- Medizinische Fakultät, Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig
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Sawrikar V, Macbeth A, Gillespie-Smith K, Brown M, Lopez-Williams A, Boulton K, Guestella A, Hickie I. Transdiagnostic Clinical Staging for Childhood Mental Health: An Adjunctive Tool for Classifying Internalizing and Externalizing Syndromes that Emerge in Children Aged 5-11 Years. Clin Child Fam Psychol Rev 2022; 25:613-626. [PMID: 35598197 PMCID: PMC9427921 DOI: 10.1007/s10567-022-00399-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 11/20/2022]
Abstract
Clinical staging is now recognized as a key tool for facilitating innovation in personalized and preventative mental health care. It places a strong emphasis on the salience of indicated prevention, early intervention, and secondary prevention of major mental disorders. By contrast to established models for major mood and psychotic syndromes that emerge after puberty, developments in clinical staging for childhood-onset disorders lags significantly behind. In this article, criteria for a transdiagnostic staging model for those internalizing and externalizing disorders that emerge in childhood is presented. This sits alongside three putative pathophysiological profiles (developmental, circadian, and anxious-arousal) that may underpin these common illness trajectories. Given available evidence, we argue that it is now timely to develop a transdiagnostic staging model for childhood-onset syndromes. It is further argued that a transdiagnostic staging model has the potential to capture more precisely the dimensional, fluctuating developmental patterns of illness progression of childhood psychopathology. Given potential improvements in modelling etiological processes, and delivering more personalized interventions, transdiagnostic clinical staging for childhood holds much promise for assisting to improve outcomes. We finish by presenting an agenda for research in developments of transdiagnostic clinical staging for childhood mental health.
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Affiliation(s)
- Vilas Sawrikar
- Centre of Applied Developmental Psychology, University of Edinburgh, Edinburgh, UK.
- Department of Clinical & Health Psychology, School of Health in Social Sciences, The University of Edinburgh, Medical School (Doorway 6), Room 1M.8, Teviot Place, Edinburgh, EH8 9AG, UK.
| | - Angus Macbeth
- Centre of Applied Developmental Psychology, University of Edinburgh, Edinburgh, UK
- Department of Clinical & Health Psychology, School of Health in Social Sciences, The University of Edinburgh, Medical School (Doorway 6), Room 1M.8, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Karri Gillespie-Smith
- Centre of Applied Developmental Psychology, University of Edinburgh, Edinburgh, UK
- Department of Clinical & Health Psychology, School of Health in Social Sciences, The University of Edinburgh, Medical School (Doorway 6), Room 1M.8, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Megan Brown
- ADHD & Autism Psychological Services and Advocacy, Utica, NY, USA
| | | | - Kelsie Boulton
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Adam Guestella
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Ian Hickie
- Brain and Mind Centre, University of Sydney, Sydney, Australia
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Staines L, Healy C, Coughlan H, Clarke M, Kelleher I, Cotter D, Cannon M. Psychotic experiences in the general population, a review; definition, risk factors, outcomes and interventions. Psychol Med 2022; 52:1-12. [PMID: 36004805 PMCID: PMC9772919 DOI: 10.1017/s0033291722002550] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 12/31/2022]
Abstract
Psychotic experiences (PE) are common in the general population, in particular in childhood, adolescence and young adulthood. PE have been shown to be associated with an increased risk for later psychotic disorders, mental disorders, and poorer functioning. Recent findings have highlighted the relevance of PE to many fields of healthcare, including treatment response in clinical services for anxiety & depression treatment, healthcare costs and service use. Despite PE relevance to many areas of mental health, and healthcare research, there remains a gap of information between PE researchers and experts in other fields. With this review, we aim to bridge this gap by providing a broad overview of the current state of PE research, and future directions. This narrative review aims to provide an broad overview of the literature on psychotic experiences, under the following headings: (1) Definition and Measurement of PE; (2) Risk Factors for PE; (3) PE and Health; (4) PE and Psychosocial Functioning; (5) Interventions for PE, (6) Future Directions.
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Affiliation(s)
- Lorna Staines
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Colm Healy
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Helen Coughlan
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Mary Clarke
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- Department Psychology, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- Department Psychiatry Beaumont Hospital, Dublin 9, Ireland
| | - Ian Kelleher
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- School of Medicine, University College, Dublin 4, Ireland
- Lucena Clinic Child and Adolescent Mental Health Service, Rathgar, Dublin 6, Ireland
| | - David Cotter
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- Department Psychiatry Beaumont Hospital, Dublin 9, Ireland
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- Department Psychiatry Beaumont Hospital, Dublin 9, Ireland
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Iorfino F, Scott EM, Hickie IB. Social and occupational outcomes for young people who attend early intervention mental health services: a longitudinal study. Med J Aust 2022; 217:218. [DOI: 10.5694/mja2.51653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/11/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Frank Iorfino
- Brain and Mind Centre University of Sydney Sydney NSW Australia
| | | | - Ian B Hickie
- Brain and Mind Centre University of Sydney Sydney NSW Australia
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Rosen M, Betz LT, Montag C, Kannen C, Kambeitz J. Transdiagnostic Psychopathology in a Help-Seeking Population of an Early Recognition Center for Mental Disorders: Protocol for an Experience Sampling Study. JMIR Res Protoc 2022; 11:e35206. [PMID: 35916702 PMCID: PMC9379784 DOI: 10.2196/35206] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Prevention in psychiatry provides a promising way to address the burden of mental illness. However, established approaches focus on specific diagnoses and do not address the heterogeneity and manifold potential outcomes of help-seeking populations that present at early recognition services. Conceptualizing the psychopathology manifested in help-seeking populations from a network perspective of interacting symptoms allows transdiagnostic investigations beyond binary disease categories. Furthermore, modern technologies such as smartphones facilitate the application of the Experience Sampling Method (ESM). OBJECTIVE This study is a combination of ESM with network analyses to provide valid insights beyond the established assessment instruments in a help-seeking population. METHODS We will examine 75 individuals (aged 18-40 years) of the help-seeking population of the Cologne early recognition center. For a maximally naturalistic sample, only minimal exclusion criteria will be applied. We will collect data for 14 days using a mobile app to assess 10 transdiagnostic symptoms (ie, depressive, anxious, and psychotic symptoms) as well as distress level 5 times a day. With these data, we will generate average group-level symptom networks and personalized symptom networks using a 2-step multilevel vector autoregressive model. Additionally, we will explore associations between symptom networks and sociodemographic, risk, and resilience factors, as well as psychosocial functioning. RESULTS The protocol was designed in February 2020 and approved by the Ethics Committee of the University Hospital Cologne in October 2020. The protocol was reviewed and funded by the Köln Fortune program in September 2020. Data collection began in November 2020 and was completed in November 2021. Of the 258 participants who were screened, 93 (36%) fulfilled the inclusion criteria and were willing to participate in the study. Of these 93 participants, 86 (92%) completed the study. The first results are expected to be published in 2022. CONCLUSIONS This study will provide insights about the feasibility and utility of the ESM in a help-seeking population of an early recognition center. Providing the first explorative phenotyping of transdiagnostic psychopathology in this population, our study will contribute to the innovation of early recognition in psychiatry. The results will help pave the way for prevention and targeted early intervention in a broader patient group, and thus, enable greater intended effects in alleviating the burden of psychiatric disorders. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/35206.
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Affiliation(s)
- Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Linda T Betz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Christian Montag
- Institute of Psychology and Education, Ulm University, Ulm, Germany
| | | | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
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Denissoff A, Mustonen A, Miettunen J, Alakokkare AE, Veijola J, Scott JG, Sami MB, Niemelä S. Trajectories of adolescent psychotic-like experiences and early cannabis exposure: Results from a Finnish Birth Cohort Study. Schizophr Res 2022; 246:95-102. [PMID: 35753121 DOI: 10.1016/j.schres.2022.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 04/09/2022] [Accepted: 06/17/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Longitudinal studies examining the effect of cannabis exposure (CE) on the prognosis of adolescents with psychotic-like experiences (PLEs) are scarce. We examined trajectories of mental health in adolescents with PLEs and cannabis exposure. METHODS The Northern Finland Birth Cohort 1986 (n = 6552) with linkage to nationwide register data was used. Information on lifetime cannabis exposure was collected when participants were aged 15/16. Register-based outcome data on diagnoses made in clinical practice were obtained until age 33. Logistic regression was used to study the association of PLE/CE patterns and subsequent psychiatric disorders. The group with neither PLEs nor CE was utilized as the reference group. Parental psychiatric disorders, family structure, sex, frequent alcohol intoxications, daily smoking and illicit substance use other than cannabis were adjusted for. RESULTS In all, 6552 subjects (49.2 % males) were included in analysis. PLEs with cannabis exposure were associated with any psychiatric disorder (OR = 2.59; 95 % CI 1.82-3.68), psychotic disorders (OR = 3.86; 95 % CI 1.83-8.11), mood disorders (OR 4.07; 95 % CI 2.74-6.04), depressive disorders (OR = 4.35; 95 % CI 2.93-6.48), anxiety disorders (OR = 2.06; 95 % CI 1.34-3.17) and substance use disorders (OR = 2.26; 95 % CI 1.13-4.50) compared to reference group. Effect sizes were greater for group with both PLEs and cannabis use than for group with PLEs only. CONCLUSIONS Early-onset cannabis use is an adverse prognostic marker for adolescents with PLEs after extensive confounder control including other substance use.
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Affiliation(s)
- Alexander Denissoff
- University of Turku, Faculty of Medicine, Department of Psychiatry, Turku, Finland; Addiction Psychiatry Unit, Department of Psychiatry, Turku University Hospital, Turku, Finland.
| | - Antti Mustonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Psychiatry, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Jouko Miettunen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Anni-Emilia Alakokkare
- University of Turku, Faculty of Medicine, Department of Psychiatry, Turku, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Juha Veijola
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - James G Scott
- QIMR Berghofer Medical Research Institute, Herston, Qld, Australia; Metro North Mental Health Service, Herston, Qld, Australia; Queensland Centre for Mental Health Research, Wacol, Qld, Australia
| | - Musa B Sami
- Institute of Mental Health, University of Nottingham, Nottingham, UK; Nottinghamshire Healthcare Trust, Nottingham, UK
| | - Solja Niemelä
- University of Turku, Faculty of Medicine, Department of Psychiatry, Turku, Finland; Addiction Psychiatry Unit, Department of Psychiatry, Turku University Hospital, Turku, Finland
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Carpenter JS, Scott J, Iorfino F, Crouse JJ, Ho N, Hermens DF, Cross SPM, Naismith SL, Guastella AJ, Scott EM, Hickie IB. Predicting the emergence of full-threshold bipolar I, bipolar II and psychotic disorders in young people presenting to early intervention mental health services. Psychol Med 2022; 52:1990-2000. [PMID: 33121545 DOI: 10.1017/s0033291720003840] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Predictors of new-onset bipolar disorder (BD) or psychotic disorder (PD) have been proposed on the basis of retrospective or prospective studies of 'at-risk' cohorts. Few studies have compared concurrently or longitudinally factors associated with the onset of BD or PDs in youth presenting to early intervention services. We aimed to identify clinical predictors of the onset of full-threshold (FT) BD or PD in this population. METHOD Multi-state Markov modelling was used to assess the relationships between baseline characteristics and the likelihood of the onset of FT BD or PD in youth (aged 12-30) presenting to mental health services. RESULTS Of 2330 individuals assessed longitudinally, 4.3% (n = 100) met criteria for new-onset FT BD and 2.2% (n = 51) met criteria for a new-onset FT PD. The emergence of FT BD was associated with older age, lower social and occupational functioning, mania-like experiences (MLE), suicide attempts, reduced incidence of physical illness, childhood-onset depression, and childhood-onset anxiety. The emergence of a PD was associated with older age, male sex, psychosis-like experiences (PLE), suicide attempts, stimulant use, and childhood-onset depression. CONCLUSIONS Identifying risk factors for the onset of either BD or PDs in young people presenting to early intervention services is assisted not only by the increased focus on MLE and PLE, but also by recognising the predictive significance of poorer social function, childhood-onset anxiety and mood disorders, and suicide attempts prior to the time of entry to services. Secondary prevention may be enhanced by greater attention to those risk factors that are modifiable or shared by both illness trajectories.
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Affiliation(s)
- Joanne S Carpenter
- Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
| | - Jan Scott
- Department of Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle, England
- Diderot University, Sorbonne City, Paris, France
| | - Frank Iorfino
- Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
| | - Jacob J Crouse
- Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
| | - Nicholas Ho
- Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
| | - Daniel F Hermens
- Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
- Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Shane P M Cross
- Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
- School of Psychology, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sharon L Naismith
- Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
- School of Psychology, The University of Sydney, Camperdown, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Adam J Guastella
- Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
| | - Elizabeth M Scott
- Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
- School of Medicine, University of Notre Dame, Sydney, Australia
| | - Ian B Hickie
- Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
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Crouse JJ, Ho N, Scott J, Parker R, Park SH, Couvy-Duchesne B, Mitchell BL, Byrne EM, Hermens DF, Medland SE, Martin NG, Gillespie NA, Hickie IB. Dynamic networks of psychological symptoms, impairment, substance use, and social support: The evolution of psychopathology among emerging adults. Eur Psychiatry 2022; 65:e32. [PMID: 35694845 PMCID: PMC9280922 DOI: 10.1192/j.eurpsy.2022.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Subthreshold/attenuated syndromes are established precursors of full-threshold mood and psychotic disorders. Less is known about the individual symptoms that may precede the development of subthreshold syndromes and associated social/functional outcomes among emerging adults. METHODS We modeled two dynamic Bayesian networks (DBN) to investigate associations among self-rated phenomenology and personal/lifestyle factors (role impairment, low social support, and alcohol and substance use) across the 19Up and 25Up waves of the Brisbane Longitudinal Twin Study. We examined whether symptoms and personal/lifestyle factors at 19Up were associated with (a) themselves or different items at 25Up, and (b) onset of a depression-like, hypo-manic-like, or psychotic-like subthreshold syndrome (STS) at 25Up. RESULTS The first DBN identified 11 items that when endorsed at 19Up were more likely to be reendorsed at 25Up (e.g., hypersomnia, impaired concentration, impaired sleep quality) and seven items that when endorsed at 19Up were associated with different items being endorsed at 25Up (e.g., earlier fatigue and later role impairment; earlier anergia and later somatic pain). In the second DBN, no arcs met our a priori threshold for inclusion. In an exploratory model with no threshold, >20 items at 19Up were associated with progression to an STS at 25Up (with lower statistical confidence); the top five arcs were: feeling threatened by others and a later psychotic-like STS; increased activity and a later hypo-manic-like STS; and anergia, impaired sleep quality, and/or hypersomnia and a later depression-like STS. CONCLUSIONS These probabilistic models identify symptoms and personal/lifestyle factors that might prove useful targets for indicated preventative strategies.
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Affiliation(s)
- Jacob J Crouse
- Youth Mental Health & Technology Team, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas Ho
- Youth Mental Health & Technology Team, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom.,Université de Paris, Paris, France.,Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Richard Parker
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Shin Ho Park
- Youth Mental Health & Technology Team, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Baptiste Couvy-Duchesne
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland, Australia.,Paris Brain Institute (ICM), INSERM U 1127, CNRS UMR 7225, Sorbonne University, Inria, Aramis Project-Team, 75013Paris, France
| | | | - Enda M Byrne
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Daniel F Hermens
- Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Sarah E Medland
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Nicholas G Martin
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Nathan A Gillespie
- Virginia Institute for Psychiatric and Behavior Genetics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ian B Hickie
- Youth Mental Health & Technology Team, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
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44
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McCarthy MJ, Gottlieb JF, Gonzalez R, McClung CA, Alloy LB, Cain S, Dulcis D, Etain B, Frey BN, Garbazza C, Ketchesin KD, Landgraf D, Lee H, Marie‐Claire C, Nusslock R, Porcu A, Porter R, Ritter P, Scott J, Smith D, Swartz HA, Murray G. Neurobiological and behavioral mechanisms of circadian rhythm disruption in bipolar disorder: A critical multi-disciplinary literature review and agenda for future research from the ISBD task force on chronobiology. Bipolar Disord 2022; 24:232-263. [PMID: 34850507 PMCID: PMC9149148 DOI: 10.1111/bdi.13165] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM Symptoms of bipolar disorder (BD) include changes in mood, activity, energy, sleep, and appetite. Since many of these processes are regulated by circadian function, circadian rhythm disturbance has been examined as a biological feature underlying BD. The International Society for Bipolar Disorders Chronobiology Task Force (CTF) was commissioned to review evidence for neurobiological and behavioral mechanisms pertinent to BD. METHOD Drawing upon expertise in animal models, biomarkers, physiology, and behavior, CTF analyzed the relevant cross-disciplinary literature to precisely frame the discussion around circadian rhythm disruption in BD, highlight key findings, and for the first time integrate findings across levels of analysis to develop an internally consistent, coherent theoretical framework. RESULTS Evidence from multiple sources implicates the circadian system in mood regulation, with corresponding associations with BD diagnoses and mood-related traits reported across genetic, cellular, physiological, and behavioral domains. However, circadian disruption does not appear to be specific to BD and is present across a variety of high-risk, prodromal, and syndromic psychiatric disorders. Substantial variability and ambiguity among the definitions, concepts and assumptions underlying the research have limited replication and the emergence of consensus findings. CONCLUSIONS Future research in circadian rhythms and its role in BD is warranted. Well-powered studies that carefully define associations between BD-related and chronobiologically-related constructs, and integrate across levels of analysis will be most illuminating.
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Affiliation(s)
- Michael J. McCarthy
- UC San Diego Department of Psychiatry & Center for Circadian BiologyLa JollaCaliforniaUSA
- VA San Diego Healthcare SystemSan DiegoCaliforniaUSA
| | - John F. Gottlieb
- Department of PsychiatryFeinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Robert Gonzalez
- Department of Psychiatry and Behavioral HealthPennsylvania State UniversityHersheyPennsylvaniaUSA
| | - Colleen A. McClung
- Department of PsychiatryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Lauren B. Alloy
- Department of PsychologyTemple UniversityPhiladelphiaPennsylvaniaUSA
| | - Sean Cain
- School of Psychological Sciences and Turner Institute for Brain and Mental HealthMonash UniversityMelbourneVictoriaAustralia
| | - Davide Dulcis
- UC San Diego Department of Psychiatry & Center for Circadian BiologyLa JollaCaliforniaUSA
| | - Bruno Etain
- Université de ParisINSERM UMR‐S 1144ParisFrance
| | - Benicio N. Frey
- Department Psychiatry and Behavioral NeuroscienceMcMaster UniversityHamiltonOntarioCanada
| | - Corrado Garbazza
- Centre for ChronobiologyPsychiatric Hospital of the University of Basel and Transfaculty Research Platform Molecular and Cognitive NeurosciencesUniversity of BaselBaselSwitzerland
| | - Kyle D. Ketchesin
- Department of PsychiatryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Dominic Landgraf
- Circadian Biology GroupDepartment of Molecular NeurobiologyClinic of Psychiatry and PsychotherapyUniversity HospitalLudwig Maximilian UniversityMunichGermany
| | - Heon‐Jeong Lee
- Department of Psychiatry and Chronobiology InstituteKorea UniversitySeoulSouth Korea
| | | | - Robin Nusslock
- Department of Psychology and Institute for Policy ResearchNorthwestern UniversityChicagoIllinoisUSA
| | - Alessandra Porcu
- UC San Diego Department of Psychiatry & Center for Circadian BiologyLa JollaCaliforniaUSA
| | | | - Philipp Ritter
- Clinic for Psychiatry and PsychotherapyCarl Gustav Carus University Hospital and Technical University of DresdenDresdenGermany
| | - Jan Scott
- Institute of NeuroscienceNewcastle UniversityNewcastleUK
| | - Daniel Smith
- Division of PsychiatryUniversity of EdinburghEdinburghUK
| | - Holly A. Swartz
- Department of PsychiatryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Greg Murray
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
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45
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Shah JL, Jones N, van Os J, McGorry PD, Gülöksüz S. Early intervention service systems for youth mental health: integrating pluripotentiality, clinical staging, and transdiagnostic lessons from early psychosis. Lancet Psychiatry 2022; 9:413-422. [PMID: 35430004 DOI: 10.1016/s2215-0366(21)00467-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/29/2021] [Accepted: 11/16/2021] [Indexed: 12/21/2022]
Abstract
Challenges associated with operationalising services for the at-risk mental state for psychosis solely in that same diagnostic silo are increasingly well recognised-namely, the differential risk for psychosis being a function of sampling enrichment strategies, declining transition rates to psychosis, questions regarding the validity of transition as an outcome, and the frequent development of non-psychotic disorders. However, recent epidemiological and clinical research suggests that not all threshold-level psychoses are likely to occur homotypically; early-stage non-psychotic syndromes might exhibit heterotypic shifts to a first episode of psychosis, without an identifiable at-risk mental state. These findings, along with the relevance of outcomes beyond traditional diagnoses or syndromes, have substantive implications for developing next-generation early intervention infrastructures. Along with the idea of general at-risk clinics for early-stage pluripotential syndromes, we examine how this reality might affect service design, such as the need for close linkage with centres of expertise for threshold-level disorders when transitions to later stages occur, the balance between generic and specific interventions amid the need for person-centred care, and the challenges this reorientation might pose for broader mental health systems.
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Affiliation(s)
- Jai L Shah
- Prevention and Early Intervention Program for Psychosis (PEPP)-Montreal, Montreal, QC, Canada; ACCESS Open Minds, Douglas Hospital Research Centre, Montreal, QC, Canada; Department of Psychiatry, McGill University, Montreal, QC, Canada.
| | - Nev Jones
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Jim van Os
- Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands; Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands; Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Sinan Gülöksüz
- Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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46
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McHugh C, Song YJC, Zmicerevska N, Crouse J, Nichles A, Wilson C, Ho N, Iorfino F, Skinner A, Scott EM, Hickie IB. Premature mortality in early-intervention mental health services: a data linkage study protocol to examine mortality and morbidity outcomes in a cohort of help-seeking young people. BMJ Open 2022; 12:e054264. [PMID: 35190432 PMCID: PMC8860051 DOI: 10.1136/bmjopen-2021-054264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Understanding the risk of premature death from suicide, accident and injury and other physical health conditions in people seeking healthcare for mental disorders is essential for delivering targeted clinical interventions and secondary prevention strategies. It is not clear whether morbidity and mortality outcomes in hospital-based adult cohorts are applicable to young people presenting to early-intervention services. METHODS AND ANALYSIS The current data linkage project will establish the Brain and Mind Patient Research Register-Mortality and Morbidity (BPRR-M&M) database. The existing Brain and Mind Research Institute Patient Research Register (BPRR) is a cohort of 6743 young people who have accessed primary care-based early-intervention services; subsets of the BPRR contain rich longitudinal clinical, neurobiological, social and functional data. The BPRR will be linked with the routinely collected health data from emergency department (ED), hospital admission and mortality databases in New South Wales from January 2010 to November 2020. Mortality will be the primary outcome of interest, while hospital presentations will be a secondary outcome. The established BPRR-M&M database will be used to establish mortality rates and rates of ED presentations and hospital admissions. Survival analysis will determine how time to death or hospital presentation varies by identified social, demographic and clinical variables. Bayesian modelling will be used to identify predictors of these morbidity and mortality outcomes. ETHICS AND DISSEMINATION The study has been reviewed and approved by the human research ethics committee of the Sydney Local Health District (2019/ETH00469). All data will be non-identifiable, and research findings will be disseminated through peer-reviewed journals and scientific conference presentations.
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Affiliation(s)
- Catherine McHugh
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Natalia Zmicerevska
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Jacob Crouse
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Alissa Nichles
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Chloe Wilson
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas Ho
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Adam Skinner
- The Sax Institute, Sydney, New South Wales, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
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47
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Scott J, Etain B, Miklowitz D, Crouse JJ, Carpenter J, Marwaha S, Smith D, Merikangas K, Hickie I. A systematic review and meta-analysis of sleep and circadian rhythms disturbances in individuals at high-risk of developing or with early onset of bipolar disorders. Neurosci Biobehav Rev 2022; 135:104585. [PMID: 35182537 PMCID: PMC8957543 DOI: 10.1016/j.neubiorev.2022.104585] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 11/27/2022]
Abstract
Sleep and circadian rhythms disturbances (SCRD) in young people at high risk or with early onset of bipolar disorders (BD) are poorly understood. We systematically searched for studies of self, observer or objective estimates of SCRD in asymptomatic or symptomatic offspring of parents with BD (OSBD), individuals with presentations meeting recognized BD-at-risk criteria (BAR) and youth with recent onset of full-threshold BD (FT-BD). Of 76 studies eligible for systematic review, 35 (46%) were included in random effects meta-analyses. Pooled analyses of self-ratings related to circadian rhythms demonstrated greater preference for eveningness and more dysregulation of social rhythms in BAR and FT-BD groups; analyses of actigraphy provided some support for these findings. Meta-analysis of prospective studies showed that pre-existing SCRD were associated with a 40% increased risk of onset of BD, but heterogeneity in assessments was a significant concern. Overall, we identified longer total sleep time (Hedges g: 0.34; 95% confidence intervals:.1,.57), especially in OSBD and FT-BD and meta-regression analysis indicated the effect sizes was moderated by the proportion of any sample manifesting psychopathology or receiving psychotropic medications. This evolving field of research would benefit from greater attention to circadian rhythm as well as sleep quality measures.
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Affiliation(s)
- Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle, NE1 7RU, UK.
| | - Bruno Etain
- Université de Paris, Paris, France; AP-HP Nord, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, Paris, France
| | - David Miklowitz
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Jacob J Crouse
- Brain and Mind Centre, University of Sydney, 94-100 Mallett Street, Camperdown, 2050, NSW, Australia
| | - Joanne Carpenter
- Brain and Mind Centre, University of Sydney, 94-100 Mallett Street, Camperdown, 2050, NSW, Australia
| | - Steven Marwaha
- Institute for Mental Health, University of Birmingham, and Birmingham and Solihull Mental Health Trust, UK
| | - Daniel Smith
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Kathleen Merikangas
- Genetic Epidemiology Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, USA
| | - Ian Hickie
- Brain and Mind Centre, University of Sydney, 94-100 Mallett Street, Camperdown, 2050, NSW, Australia
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48
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Hickie IB. Implementing 21st century "end-to-end" and technology-enhanced care for young people. World Psychiatry 2022; 21:79-81. [PMID: 35015351 PMCID: PMC8751552 DOI: 10.1002/wps.20928] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Ian B Hickie
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney Central Clinical School, Sydney, NSW, Australia
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49
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Nelson B, Yuen HP, Amminger GP, Berger G, Chen EYH, de Haan L, Hartmann JA, Hickie IB, Lavoie S, Markulev C, Mossaheb N, Nieman DH, Nordentoft M, Polari A, Riecher-Rössler A, Schäfer MR, Schlögelhofer M, Smesny S, Tedja A, Thompson A, Verma S, Yung AR, McGorry PD. Distress Related to Attenuated Psychotic Symptoms: Static and Dynamic Association With Transition to Psychosis, Nonremission, and Transdiagnostic Symptomatology in Clinical High-Risk Patients in an International Intervention Trial. SCHIZOPHRENIA BULLETIN OPEN 2022; 3:sgaa006. [PMID: 39144772 PMCID: PMC11205873 DOI: 10.1093/schizbullopen/sgaa006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
This study examined whether distress in relation to attenuated psychotic symptoms (DAPS) is associated with clinical outcomes in an ultra-high risk (UHR) for psychosis sample. We also investigated whether DAPS is associated with cognitive style (attributional style and cognitive biases) and whether amount of psychosocial treatment provided is associated with reduction in DAPS. The study was a secondary analysis of the "Neurapro" clinical trial of omega-3 fatty acids. Three hundred and four UHR patients were recruited across 10 early intervention services. Data from baseline assessment, regular assessments over 12 months, and medium term follow-up (mean = 3.4 years) were used for analysis. Findings indicated: a positive association between DAPS assessed over time and transition to psychosis; a significant positive association between baseline and longitudinal DAPS and transdiagnostic clinical and functional outcomes; a significant positive association between baseline and longitudinal DAPS and nonremission of UHR status. There was no relationship between severity of DAPS and cognitive style. A greater amount of psychosocial treatment (cognitive-behavioral case management) was associated with an increase in DAPS scores. The study indicates that UHR patients who are more distressed by their attenuated psychotic symptoms are more likely to have a poorer clinical trajectory transdiagnostically. Assessment of DAPS may therefore function as a useful marker of risk for a range of poor outcomes. The findings underline the value of repeated assessment of variables and incorporation of dynamic change into predictive modeling. More research is required into mechanisms driving distress associated with symptoms and the possible bidirectional relationship between symptom severity and associated distress.
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Affiliation(s)
- Barnaby Nelson
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Hok Pan Yuen
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - G Paul Amminger
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Gregor Berger
- Child and Adolescent Psychiatric Service of the Canton of Zurich, Zurich, Switzerland
| | - Eric Y H Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong
| | | | - Jessica A Hartmann
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ian B Hickie
- Brain and Mind Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Suzie Lavoie
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Connie Markulev
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nilufar Mossaheb
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | | | - Merete Nordentoft
- CORE-Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Andrea Polari
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Miriam R Schäfer
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Monika Schlögelhofer
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
| | | | - Amy Tedja
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Thompson
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Swapna Verma
- Institute of Mental Health, Singapore, Singapore
| | - Alison R Yung
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick D McGorry
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
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50
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van der Tuin S, Balafas SE, Oldehinkel AJ, Wit EC, Booij SH, Wigman JTW. Dynamic symptom networks across different at-risk stages for psychosis: An individual and transdiagnostic perspective. Schizophr Res 2022; 239:95-102. [PMID: 34871996 DOI: 10.1016/j.schres.2021.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 11/08/2021] [Accepted: 11/15/2021] [Indexed: 11/29/2022]
Abstract
The clinical staging model distinguishes different stages of mental illness. Early stages, are suggested to be more mild, diffuse and volatile in terms of expression of psychopathology than later stages. This study aimed to compare individual transdiagnostic symptom networks based on intensive longitudinal data between individuals in different early clinical stages for psychosis. It was hypothesized that with increasing clinical stage (i) density of symptom networks would increase and (ii) psychotic experiences would be more central in the symptom networks. Data came from a 90-day diary study, resulting in 8640 observations within N = 96 individuals, divided over four subgroups representing different early clinical stages (n1 = 25, n2 = 27, n3 = 24, n4 = 20). Sparse Time Series Chain Graphical Models were used to create individual contemporaneous and temporal symptom networks based on 10 items concerning symptoms of depression, anxiety, psychosis, non-specific and vulnerability domains. Network density and symptom centrality (strength) were calculated individually and compared between and within the four subgroups. Level of psychopathology increased with clinical stage. The symptom networks showed large between-individual variation, but neither network density not psychotic symptom strength differed between the subgroups in the contemporaneous (pdensity = 0.59, pstrength > 0.51) and temporal (pdensity = 0.75, pstrength > 0.35) networks. No support was found for our hypothesis that higher clinical stage comes with higher symptom network density or a more central role for psychotic symptoms. Based on the high inter-individual variability, our results highlight the importance of individualized assessment of symptom networks.
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Affiliation(s)
- Sara van der Tuin
- University of Groningen, University Medical Center Groningen, Dept of Psychiatry, Interdisciplinary Centre Psychopathology and Emotion Regulation, Groningen, the Netherlands.
| | - Spyros E Balafas
- University of Groningen, Bernoulli Institute, Groningen, the Netherlands
| | - Albertine J Oldehinkel
- University of Groningen, University Medical Center Groningen, Dept of Psychiatry, Interdisciplinary Centre Psychopathology and Emotion Regulation, Groningen, the Netherlands
| | - Ernst C Wit
- University of Groningen, Bernoulli Institute, Groningen, the Netherlands; Università della Svizzera Italiana, Lugano, Switzerland
| | - Sanne H Booij
- University of Groningen, Dept of Developmental Psychology, Groningen, the Netherlands; Center for Integrative Psychiatry, Lentis, Groningen, the Netherlands
| | - Johanna T W Wigman
- University of Groningen, University Medical Center Groningen, Dept of Psychiatry, Interdisciplinary Centre Psychopathology and Emotion Regulation, Groningen, the Netherlands
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