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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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Fusar-Poli P, Estradé A, Esposito CM, Rosfort R, Basadonne I, Mancini M, Stanghellini G, Otaiku J, Olanrele O, Allen L, Lamba M, Alaso C, Ieri J, Atieno M, Oluoch Y, Ireri P, Tembo E, Phiri IZ, Nkhoma D, Sichone N, Siadibbi C, Sundi PRIO, Ntokozo N, Fusar-Poli L, Floris V, Mensi MM, Borgatti R, Damiani S, Provenzani U, Brondino N, Bonoldi I, Radua J, Cooper K, Shin JI, Cortese S, Danese A, Bendall S, Arango C, Correll CU, Maj M. The lived experience of mental disorders in adolescents: a bottom-up review co-designed, co-conducted and co-written by experts by experience and academics. World Psychiatry 2024; 23:191-208. [PMID: 38727047 PMCID: PMC11083893 DOI: 10.1002/wps.21189] [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] [Indexed: 05/13/2024] Open
Abstract
We provide here the first bottom-up review of the lived experience of mental disorders in adolescents co-designed, co-conducted and co-written by experts by experience and academics. We screened first-person accounts within and outside the medical field, and discussed them in collaborative workshops involving numerous experts by experience - representing different genders, ethnic and cultural backgrounds, and continents - and their family members and carers. Subsequently, the material was enriched by phenomenologically informed perspectives and shared with all collaborators. The inner subjective experience of adolescents is described for mood disorders, psychotic disorders, attention-deficit/hyperactivity disorder, autism spectrum disorders, anxiety disorders, eating disorders, externalizing disorders, and self-harm behaviors. The recollection of individuals' past histories also indexes the prodromal (often transdiagnostic) features predating the psychiatric diagnosis. The experience of adolescents with mental disorders in the wider society is described with respect to their family, their school and peers, and the social and cultural context. Furthermore, their lived experience of mental health care is described with respect to receiving a diagnosis of mental disorder, accessing mental health support, receiving psychopharmacological treatment, receiving psychotherapy, experiencing peer support and mental health activism, and achieving recovery. These findings can impact clinical practice, research, and the whole society. We hope that this co-designed, co-conducted and co-written journey can help us maintain our commitment to protecting adolescents' fragile mental health, and can help them develop into a healthy, fulfilling and contributing adult life.
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Affiliation(s)
- Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, King's College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian-University, Munich, Germany
| | - Andrés Estradé
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, King's College London, London, UK
| | - Cecilia M Esposito
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - René Rosfort
- S. Kierkegaard Research Centre, University of Copenhagen, Copenhagen, Denmark
| | - Ilaria Basadonne
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Milena Mancini
- Department of Psychological Sciences, Health and Territory, G. D'Annunzio University of Chieti and Pescara, Chieti, Italy
| | - Giovanni Stanghellini
- Department of Health Sciences, University of Florence, Florence, Italy
- Diego Portales University, Santiago, Chile
| | - Jummy Otaiku
- Young Person's Mental Health Advisory Group, King's College London, London, UK
| | | | - Lucas Allen
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
| | | | | | - Judy Ieri
- Global Mental Health Peer Network, Nairobi, Kenya
| | | | | | - Phides Ireri
- Global Mental Health Peer Network, Nairobi, Kenya
| | - Ephraim Tembo
- Global Mental Health Peer Network, Lusaka, Zambia
- University of Zambia, Lusaka, Zambia
| | | | | | - Noah Sichone
- Global Mental Health Peer Network, Lusaka, Zambia
| | - Candy Siadibbi
- Global Mental Health Peer Network, Lusaka, Zambia
- Psychology Association of Zambia, Lusaka, Zambia
| | | | - Nyathi Ntokozo
- Global Mental Health Peer Network, Bulawayo, Zimbabwe
- Youth Support Network Trust, Bulawayo, Zimbabwe
| | - Laura Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Valentina Floris
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Martina M Mensi
- National Neurological Institute, IRCCS C. Mondino Foundation, Pavia, Italy
| | - Renato Borgatti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- National Neurological Institute, IRCCS C. Mondino Foundation, Pavia, Italy
| | - Stefano Damiani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Umberto Provenzani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Natascia Brondino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Ilaria Bonoldi
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Joaquim Radua
- Institut d'Investigacions Biomediques August Pi i Sunyer, CIBERSAM, Instituto de Salud Carlos III, University of Barcelona, Barcelona, Spain
| | - Kate Cooper
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA
- Solent NHS Trust, Southampton, UK
- Department of Precision and Regenerative Medicine and Jonic Area, University of Bari, Bari, Italy
| | - Andrea Danese
- Social, Genetic and Developmental Psychiatry Centre and Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 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
| | - Sarah Bendall
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Celso Arango
- Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario G. Marañón, School of Medicine, Universidad Complutense, CIBERSAM, Madrid, Spain
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Universitätsmedizin Berlin, Berlin, Germany
- Departments of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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Della Rocca B, Bello R, Carbone M, Pezzella P, Toni C, Sampogna G, Tarsitani L, Luciano M, Fiorillo A. Promoting mental health and preventing mental health problems in child and adolescent refugees and asylum seekers: A systematic review on psychosocial interventions. Int J Soc Psychiatry 2024; 70:653-666. [PMID: 38069651 DOI: 10.1177/00207640231214964] [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] [Indexed: 06/02/2024]
Abstract
BACKGROUND According to the United Nations Commissioner for Refugees (UNHCR), children and adolescents represent 41% of all forcibly displaced individuals. They have to deal with conflicts, violence, and the many difficulties of flight and resettlement during a critical stage of their emotional, social, cognitive, and physical development. They are more likely to experience mental health problems during migration. Despite the several known risk factors, it is frequently challenging for refugees and asylum seekers to get mental health care. In this paper we review available studies on interventions aimed at promoting mental health and at preventing common mental disorders in immigrant adolescents and children. METHODS The relevant PubMed, Scopus, PsychINFO and Web of Science databases were searched for papers published until March 21, 2023, using ("immigrants" OR "migration" OR "asylum seekers" OR "refugees") AND ("promotion" OR "prevention") AND ("mental health" OR "mental disorders" OR "psych*") AND ("children" OR "adolescents" OR "young adults") as search string. Fourteen articles qualified for the detailed review. RESULTS AND CONCLUSIONS The majority of available interventions, although highly heterogeneous in format and content, showed significant improvement in several psychopathological dimensions, including trauma-related symptoms, psychological stress, anxiety, depressive and cognitive symptoms. Available studies on interventions for the prevention of mental disorders and the promotion of mental health in refugees and asylum seekers children and adolescents indicate that provided interventions were associated with a global improvement for participants. Implementation strategies to improve their scalability are highly needed.
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Affiliation(s)
- Bianca Della Rocca
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Largo Madonna delle Grazie, Naples, Italy
| | - Rosaria Bello
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Largo Madonna delle Grazie, Naples, Italy
| | - Marco Carbone
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Largo Madonna delle Grazie, Naples, Italy
| | - Pasquale Pezzella
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Largo Madonna delle Grazie, Naples, Italy
| | - Claudia Toni
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Largo Madonna delle Grazie, Naples, Italy
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Largo Madonna delle Grazie, Naples, Italy
| | | | - Mario Luciano
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Largo Madonna delle Grazie, Naples, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Largo Madonna delle Grazie, Naples, Italy
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Hickie IB, Iorfino F, Rohleder C, Song YJC, Nichles A, Zmicerevska N, Capon W, Guastella AJ, Leweke FM, Scott J, McGorry P, Mihalopoulos C, Killackey E, Chong MK, McKenna S, Aji M, Gorban C, Crouse JJ, Koethe D, Battisti R, Hamilton B, Lo A, Hackett ML, Hermens DF, Scott EM. EMPOWERED trial: protocol for a randomised control trial of digitally supported, highly personalised and measurement-based care to improve functional outcomes in young people with mood disorders. BMJ Open 2023; 13:e072082. [PMID: 37821139 PMCID: PMC10583041 DOI: 10.1136/bmjopen-2023-072082] [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: 02/02/2023] [Accepted: 08/08/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVES Many adolescents and young adults with emerging mood disorders do not achieve substantial improvements in education, employment, or social function after receiving standard youth mental health care. We have developed a new model of care referred to as 'highly personalised and measurement-based care' (HP&MBC). HP&MBC involves repeated assessment of multidimensional domains of morbidity to enable continuous and personalised clinical decision-making. Although measurement-based care is common in medical disease management, it is not a standard practice in mental health. This clinical effectiveness trial tests whether HP&MBC, supported by continuous digital feedback, delivers better functional improvements than standard care and digital support. METHOD AND ANALYSIS This controlled implementation trial is a PROBE study (Prospective, Randomised, Open, Blinded End-point) that comprises a multisite 24-month, assessor-blinded, follow-up study of 1500 individuals aged 15-25 years who present for mental health treatment. Eligible participants will be individually randomised (1:1) to 12 months of HP&MBC or standardised clinical care. The primary outcome measure is social and occupational functioning 12 months after trial entry, assessed by the Social and Occupational Functioning Assessment Scale. Clinical and social outcomes for all participants will be monitored for a further 12 months after cessation of active care. ETHICS AND DISSEMINATION This clinical trial has been reviewed and approved by the Human Research Ethics Committee of the Sydney Local Health District (HREC Approval Number: X22-0042 & 2022/ETH00725, Protocol ID: BMC-YMH-003-2018, protocol version: V.3, 03/08/2022). Research findings will be disseminated through peer-reviewed journals, presentations at scientific conferences, and to user and advocacy groups. Participant data will be deidentified. TRIAL REGISTRATION NUMBER ACTRN12622000882729.
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Affiliation(s)
- Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Cathrin Rohleder
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Yun Ju Christine Song
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Alissa Nichles
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Natalia Zmicerevska
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - William Capon
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Adam J Guastella
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - F Markus Leweke
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Faculty of Medicine Mannheim, Psychiatry and Psychotherapy, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | - Jan Scott
- Newcastle University, Newcastle upon Tyne, UK
| | - Patrick McGorry
- Centre for Youth Mental Health, University of Melbourne Australia, Parkville, Victoria, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Cathrine Mihalopoulos
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Eoin Killackey
- Centre for Youth Mental Health, University of Melbourne Australia, Parkville, Victoria, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Min K Chong
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sarah McKenna
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Melissa Aji
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Carla Gorban
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Jacob J Crouse
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Dagmar Koethe
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | | | - Blake Hamilton
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
- headspace Camperdown, Camperdown, New South Wales, Australia
| | - Alice Lo
- Mind Plasticity, Sydney, New South Wales, Australia
| | - Maree L Hackett
- George Institute for Global Health, Newtown, New South Wales, Australia
| | - Daniel F Hermens
- Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
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Volpe U, Ramalho R, Orsolini L, Ransing R, de Filippis R, Gürcan A, Samal S, Gaebel W. An update from the WPA Working Group on Digitalization in Mental Health and Care. World Psychiatry 2023; 22:494-495. [PMID: 37713546 PMCID: PMC10503917 DOI: 10.1002/wps.21143] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2023] [Indexed: 09/17/2023] Open
Affiliation(s)
- Umberto Volpe
- Unit of Clinical Psychiatry, Università Politecnica delle Marche, Ancona, Italy
| | - Rodrigo Ramalho
- Department of Social and Community Health, University of Auckland, Auckland, New Zealand
| | - Laura Orsolini
- Unit of Clinical Psychiatry, Università Politecnica delle Marche, Ancona, Italy
| | - Ramdas Ransing
- Department of Psychiatry, Clinical Neurosciences, and Addiction Medicine, All India Institute of Medical Sciences, Guwahati, Asam, India
| | - Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, University of Catanzaro, Catanzaro, Italy
| | - Ahmet Gürcan
- Department of Psychiatry, Bas¸kent University Medical Faculty, Ankara, Turkey
| | - Shreyasta Samal
- Max Planck Institute for Intelligent Systems, Tübingen, Germany
| | - Wolfgang Gaebel
- WHO Collaborating Centre DEU-131, LVR-Klinikum Düsseldorf, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
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Perris F, Cipolla S, Catapano P, Sampogna G, Luciano M, Giallonardo V, Del Vecchio V, Fabrazzo M, Fiorillo A, Catapano F. Duration of Untreated Illness in Patients with Obsessive-Compulsive Disorder and Its Impact on Long-Term Outcome: A Systematic Review. J Pers Med 2023; 13:1453. [PMID: 37888064 PMCID: PMC10608019 DOI: 10.3390/jpm13101453] [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: 09/13/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023] Open
Abstract
Background: Duration of untreated illness (DUI)-defined as the time period between the onset of a mental disorder and its first adequate treatment-should influence patients' long-term prognosis and outcome. In patients with obsessive-compulsive disorder (OCD), DUI lasts on average from 87.5 up to 94.5 months, being significantly longer compared with data available from patients affected by other severe mental disorders, such as schizophrenia and bipolar disorder. We carried out a systematic review in order to assess the impact of DUI on long-term outcomes in OCD patients. Methods: A systemic review has been implemented, searching from inception to April 2023; only papers written in English were included. Results: Seventy-one articles were initially identified; only eight papers were included in the review. The DUI ranged from 7.0 ± 8.5 to 20.9 ± 11.2 years. Patients reporting a longer DUI have a poor long-term outcome in terms of lower level of treatment response and greater symptom severity. Conclusions: The present review confirms that longer DUI has a negative impact on the long-term outcome of patients with OCD. It should be useful to promote the dissemination of early interventions with a specific focus on OCD symptoms.
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Affiliation(s)
| | | | | | - Gaia Sampogna
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
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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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8
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Krausz M, Westenberg JN, Tsang V, Suen J, Ignaszewski MJ, Mathew N, Azar P, Cabanis M, Elsner J, Vogel M, Spijkerman R, Orsolini L, Vo D, Moore E, Moe J, Strasser J, Köck P, Marian C, Dürsteler KM, Backmund M, Röhrig J, Post M, Haltmayer H, Wladika W, Trabi T, Muller C, Rechberger G, Teesson M, Farrell M, Christie G, Merry S, Mamdouh M, Alinsky R, Levy S, Fishman M, Rosenthal R, Jang K, Choi F. Towards an International Consensus on the Prevention, Treatment, and Management of High-Risk Substance Use and Overdose among Youth. Medicina (B Aires) 2022; 58:medicina58040539. [PMID: 35454376 PMCID: PMC9028633 DOI: 10.3390/medicina58040539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/29/2022] [Accepted: 04/11/2022] [Indexed: 11/26/2022] Open
Abstract
Background and Objectives: Now more than ever, there is an obvious need to reduce the overall burden of disease and risk of premature mortality that are associated with mental health and substance use disorders among young people. However, the current state of research and evidence-based clinical care for high-risk substance use among youth is fragmented and scarce. The objective of the study is to establish consensus for the prevention, treatment, and management of high-risk substance use and overdose among youth (10 to 24 years old). Materials and Methods: A modified Delphi technique was used based on the combination of scientific evidence and clinical experience of a group of 31 experts representing 10 countries. A semi-structured questionnaire with five domains (clinical risks, target populations, intervention goals, intervention strategies, and settings/expertise) was shared with the panelists. Based on their responses, statements were developed, which were subsequently revised and finalized through three iterations of feedback. Results: Among the five major domains, 60 statements reached consensus. Importantly, experts agreed that screening in primary care and other clinical settings is recommended for all youth, and that the objectives of treating youth with high-risk substance use are to reduce harm and mortality while promoting resilience and healthy development. For all substance use disorders, evidence-based interventions should be available and should be used according to the needs and preferences of the patient. Involuntary admission was the only topic that did not reach consensus, mainly due to its ethical implications and resulting lack of comparable evidence. Conclusions: High-risk substance use and overdoses among youth have become a major challenge. The system’s response has been insufficient and needs substantial change. Internationally devised consensus statements provide a first step in system improvement and reform.
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Affiliation(s)
- Michael Krausz
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 2A1, Canada; (M.K.); (V.T.); (J.S.); (M.J.I.); (N.M.); (P.A.); (M.M.); (K.J.); (F.C.)
| | - Jean N. Westenberg
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 2A1, Canada; (M.K.); (V.T.); (J.S.); (M.J.I.); (N.M.); (P.A.); (M.M.); (K.J.); (F.C.)
- Center for Mental Health, Clinic for Addiction Medicine and Addictive Behavior, Klinikum Stuttgart, 70374 Stuttgart, Germany; (M.C.); (J.R.)
- Correspondence: ; Tel.: +1-604-827-4381
| | - Vivian Tsang
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 2A1, Canada; (M.K.); (V.T.); (J.S.); (M.J.I.); (N.M.); (P.A.); (M.M.); (K.J.); (F.C.)
| | - Janet Suen
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 2A1, Canada; (M.K.); (V.T.); (J.S.); (M.J.I.); (N.M.); (P.A.); (M.M.); (K.J.); (F.C.)
| | - Martha J. Ignaszewski
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 2A1, Canada; (M.K.); (V.T.); (J.S.); (M.J.I.); (N.M.); (P.A.); (M.M.); (K.J.); (F.C.)
- Complex Pain and Addiction Service, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
- BC Children’s Hospital, Vancouver, BC V6H 3N1, Canada;
| | - Nickie Mathew
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 2A1, Canada; (M.K.); (V.T.); (J.S.); (M.J.I.); (N.M.); (P.A.); (M.M.); (K.J.); (F.C.)
- Complex Pain and Addiction Service, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
- BC Mental Health & Substance Use Services, Provincial Health Services Authority, Vancouver, BC V5Z 3L7, Canada
| | - Pouya Azar
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 2A1, Canada; (M.K.); (V.T.); (J.S.); (M.J.I.); (N.M.); (P.A.); (M.M.); (K.J.); (F.C.)
- Complex Pain and Addiction Service, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
| | - Maurice Cabanis
- Center for Mental Health, Clinic for Addiction Medicine and Addictive Behavior, Klinikum Stuttgart, 70374 Stuttgart, Germany; (M.C.); (J.R.)
| | - Julie Elsner
- Department of Psychiatry, Psychiatric University Clinics Basel, University of Basel, 4002 Basel, Switzerland; (J.E.); (M.V.); (J.S.); (P.K.); (C.M.); (K.M.D.)
| | - Marc Vogel
- Department of Psychiatry, Psychiatric University Clinics Basel, University of Basel, 4002 Basel, Switzerland; (J.E.); (M.V.); (J.S.); (P.K.); (C.M.); (K.M.D.)
- Psychiatric Services of Thurgovia, Division of Substance Use Disorders, 8596 Münsterlingen, Switzerland
| | - Renske Spijkerman
- Parnassia Addiction Research Centre (PARC), Brijder Addiction Treatment, Parnassia Group, 2512 The Hague, The Netherlands; (R.S.); (M.P.)
| | - Laura Orsolini
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, School of Medicine and Surgery, Polytechnic University of Marche, 60121 Ancona, Italy;
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9EU, UK
| | - Dzung Vo
- BC Children’s Hospital, Vancouver, BC V6H 3N1, Canada;
- Division of Adolescent Health and Medicine, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada;
| | - Eva Moore
- Division of Adolescent Health and Medicine, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada;
| | - Jessica Moe
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada;
- BC Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada
| | - Johannes Strasser
- Department of Psychiatry, Psychiatric University Clinics Basel, University of Basel, 4002 Basel, Switzerland; (J.E.); (M.V.); (J.S.); (P.K.); (C.M.); (K.M.D.)
| | - Patrick Köck
- Department of Psychiatry, Psychiatric University Clinics Basel, University of Basel, 4002 Basel, Switzerland; (J.E.); (M.V.); (J.S.); (P.K.); (C.M.); (K.M.D.)
| | - Calin Marian
- Department of Psychiatry, Psychiatric University Clinics Basel, University of Basel, 4002 Basel, Switzerland; (J.E.); (M.V.); (J.S.); (P.K.); (C.M.); (K.M.D.)
| | - Kenneth M. Dürsteler
- Department of Psychiatry, Psychiatric University Clinics Basel, University of Basel, 4002 Basel, Switzerland; (J.E.); (M.V.); (J.S.); (P.K.); (C.M.); (K.M.D.)
| | - Markus Backmund
- Praxiszentrum im Tal, 80331 Munich, Germany;
- Ludwig-Maximilians-University, 80539 Munich, Germany
| | - Jeanette Röhrig
- Center for Mental Health, Clinic for Addiction Medicine and Addictive Behavior, Klinikum Stuttgart, 70374 Stuttgart, Germany; (M.C.); (J.R.)
| | - Marianne Post
- Parnassia Addiction Research Centre (PARC), Brijder Addiction Treatment, Parnassia Group, 2512 The Hague, The Netherlands; (R.S.); (M.P.)
| | | | - Wolfgang Wladika
- Department of Neurology and Psychiatry of Childhood and Adolescence, Klinikum Klagenfurt am Wörthersee, 9020 Klagenfurt, Austria;
| | - Thomas Trabi
- Department for Child and Adolescent Psychiatry and Pschotherapy, LKH Graz II, 8053 Graz, Austria;
| | - Christian Muller
- Department of Child & Youth Psychiatry and Psychotherapy, Psychosocial Service Burgenland GmbH, 7000 Eisenstadt, Austria;
| | - Gerhard Rechberger
- Verein Dialog, Integrative Suchtberatung Gudrunstraße, 1100 Wien, Austria;
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, NSW 2006, Australia;
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2031, Australia;
| | - Grant Christie
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand; (G.C.); (S.M.)
| | - Sally Merry
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand; (G.C.); (S.M.)
| | - Mostafa Mamdouh
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 2A1, Canada; (M.K.); (V.T.); (J.S.); (M.J.I.); (N.M.); (P.A.); (M.M.); (K.J.); (F.C.)
- Department of Neuropsychiatry, Tanta University, Tanta 31527, Egypt
| | - Rachel Alinsky
- Division of Adolescent/Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA;
| | - Sharon Levy
- Adolescent Substance Use and Addiction Program, Boston Children’s Hospital, Boston, MA 02115, USA;
| | - Marc Fishman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD 21205, USA;
- Mountain Manor Treatment Center, Baltimore, MD 21229, USA
| | - Richard Rosenthal
- Department of Psychiatry and Behavioral Health, Stony Brook University, New York, NY 11794, USA;
| | - Kerry Jang
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 2A1, Canada; (M.K.); (V.T.); (J.S.); (M.J.I.); (N.M.); (P.A.); (M.M.); (K.J.); (F.C.)
| | - Fiona Choi
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 2A1, Canada; (M.K.); (V.T.); (J.S.); (M.J.I.); (N.M.); (P.A.); (M.M.); (K.J.); (F.C.)
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