1
|
Andersen NK, Smith CL, Gao CX, Filia K, Simmons M, Chinnery G, Killackey E, Thompson A, Brown E. Vocational functioning in young people accessing services for first-episode psychosis and ultra-high risk of psychosis: A longitudinal naturalistic cohort study. Aust N Z J Psychiatry 2024:48674241261778. [PMID: 39075845 DOI: 10.1177/00048674241261778] [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: 07/31/2024]
Abstract
AIMS Young people with first-episode psychosis (FEP) or at ultra-high risk (UHR) of psychosis often have lower vocational engagement than their peers. This study examines the effect of treatment in early intervention for psychosis services in Australia on engagement in education and employment. METHODS This is a naturalistic sample of young people aged 12-25 with FEP (n = 1574) and UHR (n = 1515), accessing treatment in the headspace Early Psychosis (hEP) programme. Engagement in education and employment was assessed at baseline and every 90 days in treatment. Mixed effects logistic regression were used to analyse changes over time. RESULTS On entering the hEP programme, approximately 49% of the young people with FEP and 28% of the young people at UHR status identified as Not in Education, Employment or Training (NEET). The odds of being NEET were reduced by 27% (95% confidence interval = [14, 39]) for every 6 months treatment for the FEP group, but no change in NEET status was observed in the UHR group. In both groups, absence from daily activities was significantly reduced during time in treatment. CONCLUSION While there are methodological challenges analysing real-world non-control group cohort data, the findings indicate positive effects of the hEP programme on vocational and daily activity engagement for young people with FEP and at UHR status. A large proportion of the young people still identified as NEET after receiving treatment services, suggesting further refinement to ensure targeted and consistent vocational support throughout care.
Collapse
Affiliation(s)
- Naja Kirstine Andersen
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Catherine L Smith
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Caroline X Gao
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Kate Filia
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Magenta Simmons
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | | | - Eoin Killackey
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Andrew Thompson
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Ellie Brown
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, Sydney, NSW, Australia
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Hetlevik Ø, Smith-Sivertsen T, Haukenes I, Ruths S, Baste V. Young adults with depression: A registry-based longitudinal study of work-life marginalisation. The Norwegian GP-DEP study. Scand J Public Health 2024; 52:590-597. [PMID: 37066887 PMCID: PMC11292960 DOI: 10.1177/14034948231165089] [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: 10/20/2022] [Revised: 02/17/2023] [Accepted: 03/06/2023] [Indexed: 04/18/2023]
Abstract
AIMS To explore the association between a depression diagnosis in young adulthood and risk of marginalisation at age 29 years, among those who had completed upper secondary school and those who had not completed at age 21. METHODS In a longitudinal cohort study based on nationwide registers we followed 111,558 people from age 22-29 years. Outcomes were risk of marginalisation and educational achievement at age 29. Exposure was a diagnosed depression at ages 22-26 years. Comorbid mental and somatic health conditions, gender and country of origin were covariates. Relative risks were estimated with Poisson regression models, stratified by educational level at age 21. RESULTS For people who had not completed upper secondary school at age 21 years, a depression diagnosis at age 22-26 increased the risk of low income (relative risk = 1.33; 95% confidence interval = 1.25-1.40), prolonged unemployment benefit (1.46; 1.38-1.55) and social security benefit (1.56; 1.41-1.74) at age 29 compared with those with no depression. Among those who had completed upper secondary school at age 21 years, depression increased the risk of low income (1.71; 1.60-1.83), prolonged unemployment benefit (2.17; 2.03-2.31), social security benefit (3.62; 2.91-4.51) and disability pension (4.43; 3.26-6.01) compared with those with no depression. Mental comorbidity had a significant impact on risk of marginalisation in both groups. CONCLUSIONS Depression in one's mid-20s significantly increases the risk of marginalisation at age 29 years, and comorbid mental health conditions reinforce this association. Functional ability should be given priority in depression care in early adulthood to counteract marginalisation.
Collapse
Affiliation(s)
- Øystein Hetlevik
- Department of Global Public Health and Primary Care, University of Bergen, Norway
- Research Unit for General Practice, NORCE Norwegian Research Centre, Norway
| | - Tone Smith-Sivertsen
- Research Unit for General Practice, NORCE Norwegian Research Centre, Norway
- Division of Psychiatry, Haukeland University Hospital, Norway
| | - Inger Haukenes
- Department of Global Public Health and Primary Care, University of Bergen, Norway
- Research Unit for General Practice, NORCE Norwegian Research Centre, Norway
| | - Sabine Ruths
- Department of Global Public Health and Primary Care, University of Bergen, Norway
- Research Unit for General Practice, NORCE Norwegian Research Centre, Norway
| | - Valborg Baste
- Research Unit for General Practice, NORCE Norwegian Research Centre, Norway
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Norway
| |
Collapse
|
4
|
López-López JA, Tilling K, Pearson RM, Fazel MS, Washbrook E, Zhu Y, Smith BJ, Dunn EC, Smith ADAC. Depressive symptoms in adolescence and adult educational and employment outcomes: a structured life course analysis. Psychol Med 2024:1-8. [PMID: 38818779 DOI: 10.1017/s0033291724001090] [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] [Indexed: 06/01/2024]
Abstract
BACKGROUND Depression is a common mental health disorder that often starts during adolescence, with potentially important future consequences including 'Not in Education, Employment or Training' (NEET) status. METHODS We took a structured life course modeling approach to examine how depressive symptoms during adolescence might be associated with later NEET status, using a high-quality longitudinal data resource. We considered four plausible life course models: (1) an early adolescent sensitive period model where depressive symptoms in early adolescence are more associated with later NEET status relative to exposure at other stages; (2) a mid adolescent sensitive period model where depressive symptoms during the transition from compulsory education to adult life might be more deleterious regarding NEET status; (3) a late adolescent sensitive period model, meaning that depressive symptoms around the time when most adults have completed their education and started their careers are the most strongly associated with NEET status; and (4) an accumulation of risk model which highlights the importance of chronicity of symptoms. RESULTS Our analysis sample included participants with full information on NEET status (N = 3951), and the results supported the accumulation of risk model, showing that the odds of NEET increase by 1.015 (95% CI 1.012-1.019) for an increase of 1 unit in depression at any age between 11 and 24 years. CONCLUSIONS Given the adverse implications of NEET status, our results emphasize the importance of supporting mental health during adolescence and early adulthood, as well as considering specific needs of young people with re-occurring depressed mood.
Collapse
Affiliation(s)
- José A López-López
- Department of Basic Psychology and Methodology, Faculty of Psychology and Speech Therapy, University of Murcia, Murcia, Spain
- Centre for Academic Mental Health at the University of Bristol, Oakfield House, Bristol, UK
| | - Kate Tilling
- Centre for Academic Mental Health at the University of Bristol, Oakfield House, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Rebecca M Pearson
- Centre for Academic Mental Health at the University of Bristol, Oakfield House, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Mina S Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Yiwen Zhu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Brooke J Smith
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Erin C Dunn
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School and the Massachusetts General Hospital, Boston, MA, USA
| | - Andrew D A C Smith
- Mathematics and Statistics Research Group, University of the West of England, Bristol, UK
| |
Collapse
|
5
|
Buckman JEJ, Stott J, Main N, Antonie DM, Singh S, Naqvi SA, Aguirre E, Wheatley J, Cirkovic M, Leibowitz J, Cape J, Pilling S, Saunders R. Understanding the psychological therapy treatment outcomes for young adults who are not in education, employment, or training (NEET), moderators of outcomes, and what might be done to improve them. Psychol Med 2023; 53:2808-2819. [PMID: 37449486 PMCID: PMC10235648 DOI: 10.1017/s0033291721004773] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/10/2021] [Accepted: 11/01/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND To determine: whether young adults (aged 18-24) not in education, employment or training (NEET) have different psychological treatment outcomes to other young adults; any socio-demographic or treatment-related moderators of differential outcomes; and whether service-level changes are associated with better outcomes for those who are NEET. METHODS A cohort was formed of 20 293 young adults treated with psychological therapies in eight Improving Access to Psychological Therapies services. Pre-treatment characteristics, outcomes, and moderators of differential outcomes were compared for those who were and were not NEET. Associations between outcomes and the following were assessed for those that were NEET: missing fewer sessions, attending more sessions, having a recorded diagnosis, and waiting fewer days between referral and starting treatment. RESULTS Those who were NEET had worse outcomes: odds ratio (OR) [95% confidence interval (CI)] for reliable recovery = 0.68 (0.63-0.74), for deterioration = 1.41 (1.25-1.60), and for attrition = 1.31 (1.19-1.43). Ethnic minority participants that were NEET had better outcomes than those that were White and NEET. Living in deprived areas was associated with worse outcomes. The intensity of treatment (high or low) did not moderate outcomes, but having more sessions was associated with improved outcomes for those that were NEET: odds (per one-session increase) of reliable recovery = 1.10 (1.08-1.12), deterioration = 0.94 (0.91-0.98), and attrition = 0.68 (0.66-0.71). CONCLUSIONS Earlier treatment, supporting those that are NEET to attend sessions, and in particular, offering them more sessions before ending treatment might be effective in improving clinical outcomes. Additional support when working with White young adults that are NEET and those in more deprived areas may also be important.
Collapse
Affiliation(s)
- Joshua E. J. Buckman
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
- iCope – Camden & Islington NHS Foundation Trust, St Pancras Hospital, London NW1 0PE, UK
| | - Joshua Stott
- ADAPT lab, Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, UK
| | - Nicole Main
- Let's Talk IAPT – Barnet, Enfield & Haringey Psychological Therapies Service, Barnet, Enfield & Haringey Mental Health Trust, London, UK
| | - Daniela M. Antonie
- Newham Talking Therapies – East London NHS Foundation Trust, Vicarage Lane Health Centre, Stratford, London E15 4ES, UK
| | - Satwant Singh
- Waltham Forest Talking Therapies – North East London Foundation Trust, Thorne House, London E11 4HU, UK
| | - Syed A. Naqvi
- Barking & Dagenham and Havering IAPT Services – North East London Foundation Trust, Church Elm Lane Health Centre, Dagenham, Essex RM10 9RR, UK
| | - Elisa Aguirre
- Redbridge Talking Therapies Service, North East London NHS Foundation Trust, London, UK
| | - Jon Wheatley
- Talk Changes: City & Hackney IAPT Service, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Mirko Cirkovic
- Talk Changes: City & Hackney IAPT Service, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Judy Leibowitz
- iCope – Camden & Islington NHS Foundation Trust, St Pancras Hospital, London NW1 0PE, UK
| | - John Cape
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Rob Saunders
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| |
Collapse
|
6
|
Associations between Adolescent Psychosocial Factors and Disengagement from Education and Employment in Young Adulthood among Individuals with Common Mental Health Problems. J Youth Adolesc 2022; 51:1397-1408. [PMID: 35275309 PMCID: PMC9135777 DOI: 10.1007/s10964-022-01592-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/16/2022] [Indexed: 11/16/2022]
Abstract
Transition to adulthood can be a challenging developmental task for adolescents with common mental health problems and is linked to adverse outcomes such as ‘not in education, employment or training’ (NEET). This study investigated longitudinal associations between adolescent psychosocial factors (e.g., self-esteem, aspirations, bullying, physical activity) and later NEET status among individuals with common mental health problems (i.e., depression and anxiety). A secondary data analysis of the Next Steps cohort study was completed using waves 2 and 8. Psychosocial factors, mental health, and background characteristics were captured when participants were aged 15–16 years (wave 2) while still in compulsory education. The 12-item General Health Questionnaire was used to identify adolescents with common mental health problems. The study population consisted of 2224 participants (females 66.8%) of which 1473 (66.2%) were aged 15 years and 751 (33.8%) were aged 16 years in wave 2. The outcome was NEET status at ages 25–26 years (wave 8). The results showed that after adjusting for background characteristics, adolescent self-esteem, locus of control, bullying, physical activity, job aspirations, and attitudes to school predicted NEET status. Educational aspirations, substance use, and behavioural problems were not significantly associated with NEET status. These findings provide new insights into the role of adolescent psychosocial factors in the context of education and employment outcomes for youth at risk and highlight the necessity of targeted mental health support to improve life chances.
Collapse
|
7
|
Juurlink TT, Betts JK, Nicol K, Lamers F, Beekman ATF, Cotton SM, Chanen AM. Characteristics and Predictors of Educational and Occupational Disengagement Among Outpatient Youth With Borderline Personality Disorder. J Pers Disord 2022; 36:116-128. [PMID: 34427492 DOI: 10.1521/pedi_2021_35_534] [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] [Indexed: 11/20/2022]
Abstract
This study aimed to investigate predictors of vocational disengagement (referred to as Not in Employment, Education, or Training [NEET]) in young people with borderline personality disorder (BPD). The sample comprised 112 outpatients with a BPD diagnosis, aged 15-25 years, who participated in a randomized controlled trial (ANZCTR12610000100099). The proportion of participants who were NEET (39.3%) at study entry did not improve after 18 months and NEET status frequently changed. Therefore, multinomial regression analyses were used to study three groups: Non-NEET, NEET, and Unstable NEET status. NEET status was predicted by not achieving expected age-appropriate educational milestones, greater instability in identity, and emptiness. Greater instability in interpersonal relationships and identity predicted Unstable NEET status. The findings suggest that specific vocational interventions, that also incorporate a focus on interpersonal functioning, emptiness, and identity disturbance, are needed to improve functioning in youth with BPD, especially when educational milestones are not achieved.
Collapse
Affiliation(s)
- Trees T Juurlink
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, The Netherlands and GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Jennifer K Betts
- Orygen and Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Katie Nicol
- Orygen and Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Femke Lamers
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, The Netherlands and GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Aartjan T F Beekman
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, The Netherlands and GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Sue M Cotton
- Orygen and Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Andrew M Chanen
- Orygen and Centre for Youth Mental Health, The University of Melbourne, Australia
| |
Collapse
|
8
|
The mental health of young people who are not in education, employment, or training: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1107-1121. [PMID: 34931257 PMCID: PMC8687877 DOI: 10.1007/s00127-021-02212-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 12/05/2021] [Indexed: 11/06/2022]
Abstract
PURPOSE There are increasing concerns about the intersection between NEET (not in education, employment, or training) status and youth mental ill-health and substance use. However, findings are inconsistent and differ across types of problems. This is the first systematic review and meta-analysis (PROSPERO-CRD42018087446) on the association between NEET status and youth mental health and substance use problems. METHODS We searched Medline, EMBASE, Web of Science, ERIC, PsycINFO, and ProQuest Dissertations and Theses (1999-2020). Two reviewers extracted data and appraised study quality using a modified Newcastle-Ottawa Scale. We ran robust variance estimation random-effects models for associations between NEET and aggregate groups of mental ill-health and substance use measures; conventional random-effects models for associations with individual mental/substance use problems; and subgroup analyses to explore heterogeneity. RESULTS We identified 24 studies from 6,120 references. NEET status was associated with aggregate groups of mental ill-health (OR 1.28, CI 1.06-1.54), substance use problems (OR 1.43, CI 1.08-1.89), and combined mental ill-health and substance use measures (OR 1.38, CI 1.15-1.64). Each disaggregated measure was associated with NEET status [mood (OR 1.43, CI 1.21-1.70), anxiety (OR 1.55, CI 1.07-2.24), behaviour problems (OR 1.49, CI 1.21-1.85), alcohol use (OR 1.28, CI 1.24-1.46), cannabis use (OR 1.62, CI 1.07-2.46), drug use (OR 1.99, CI 1.19-3.31), suicidality (OR 2.84, CI 2.04-3.95); and psychological distress (OR 1.10, CI 1.01-1.21)]. Longitudinal data indicated that aggregate measures of mental health problems and of mental health and substance use problems (combined) predicted being NEET later, while evidence for the inverse relationship was equivocal and sparse. CONCLUSION Our review provides evidence for meaningful, significant associations between youth mental health and substance use problems and being NEET. We, therefore, advocate for mental ill-health prevention and early intervention and integrating vocational supports in youth mental healthcare.
Collapse
|
9
|
Laliberte S, Varcoe C. The contradictions between Canadian capitalist processes and youth mental health: implications for mental health promotion. Health Promot Int 2021; 36:250-261. [PMID: 32361740 DOI: 10.1093/heapro/daz073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Understanding how socio-economic processes inter-relate with young people's mental health is important to inform the development of responsive mental health promotion initiatives. Thirty diverse Canadian young people were engaged within a process of social praxis, underpinned by a historical-dialectical ontological perspective, to explore the inter-relation among socio-economic processes and youth mental health and implications for mental health promotion initiatives. Findings show several inter-related contradictory processes within two overarching contradictory dynamics that Canadian youth are navigating as they seek to realize their mental health needs. The first overarching contradictory dynamic is between monetized, private, individualistic, profit-oriented economic processes and young people's need for resources, freedom and time, and inclusive social spaces to enable their mental health needs. Participants' descriptions of their approaches to seeking to realize their mental health needs in this context reflects a second inter-related overarching contradiction between communal and individual approaches to enabling young people's mental health needs. In this context, young people are oriented inward to meet their mental health needs at the individual and inter-personal level, despite the crucial role of socio-economic processes to enabling their mental health needs. Despite varied access to resources, all participants struggled to balance meeting their mental health needs. Implications of these findings entail the need to focus on promoting synergistic relations among young people and socio-economic processes whereby enabling universal access to resources for young people's survival, physical health and comfort is foundational to multi-level mental health promotion initiatives.
Collapse
Affiliation(s)
- Shari Laliberte
- School of Health Sciences, Vancouver Community College, 1155 East Broadway, Vancouver, BC, Canada V5T 4V5
| | - Colleen Varcoe
- School of Nursing, University of British Columbia, T153 2211, Westbrook Mall, Vancouver, B.C. Canada V6T 2B5
| |
Collapse
|
10
|
Crouse JJ, Chitty KM, White D, Lee RSC, Moustafa AA, Naismith SL, Scott J, Hermens DF, Hickie IB. Modelling change in neurocognition, symptoms and functioning in young people with emerging mental disorders. J Psychiatr Res 2020; 131:22-30. [PMID: 32916374 DOI: 10.1016/j.jpsychires.2020.08.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/11/2020] [Accepted: 08/22/2020] [Indexed: 02/08/2023]
Abstract
Mental disorders and their functional impacts evolve dynamically over time. Neurocognition and clinical symptoms are commonly modelled as predictors of functioning, however, studies tend to rely on static variables and adult samples with chronic disorders, with limited research investigating change in these variables in young people with emerging mental disorders. These relationships were explored in a longitudinal clinical cohort of young people accessing early intervention mental health services in Australia, around three-quarters of whom presented with a mood disorder (N = 176, aged 12-30 at baseline). Bivariate latent change score models quantified associations between neurocognition (a latent variable of working memory, verbal memory, visuospatial memory, and cognitive flexibility), global clinical symptoms, and functioning (self- and clinician-rated) and their relative change over follow-up (median = 20 months). We found that longitudinal changes in functioning were coupled with changes in global clinical symptoms (β = -0.43, P < 0.001), such that improvement in functioning was related to improvement in clinical symptoms. Changes in neurocognition were not significantly associated with changes in functioning or clinical symptoms. Main findings were upheld in three sensitivity analyses restricting the sample to: (a) adults aged 18-30; (b) participants with 12-24 months of follow-up; and (c) participants without a psychotic disorder. Our findings show that global symptom reduction and functional improvement are related in young people with emerging mental disorders. More work is needed to determine the temporal precedence of change in these variables. Future studies should apply this methodology to intervention studies to untangle the causal dynamics between neurocognition, symptoms, and functioning.
Collapse
Affiliation(s)
- Jacob J Crouse
- Youth Mental Health and Technology Team, Brain and Mind Centre, University of Sydney, NSW, Australia.
| | - Kate M Chitty
- The University of Sydney Faculty of Medicine and Health, Discipline of Pharmacology, Translational Australian Clinical Toxicology Program, Sydney, NSW, 2006, Australia
| | - Django White
- Youth Mental Health and Technology Team, Brain and Mind Centre, University of Sydney, NSW, Australia
| | - Rico S C Lee
- Turner Institute for Brain and Mental Health, Monash University, VIC, Australia
| | - Ahmed A Moustafa
- MARCS Institute for Brain, Development, and Behaviour, NSW, Australia; School of Social Sciences and Psychology, Western Sydney University, Australia
| | - Sharon L Naismith
- Healthy Brain Ageing Clinic, Brain and Mind Centre, University of Sydney, NSW, Australia; Charles Perkins Centre, University of Sydney, NSW, Australia
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, University of Newcastle, UK; Diderot University, Sorbonne City, Paris, France; Norwegian University of Science and Technology, Trondheim, Norway
| | - Daniel F Hermens
- Youth Mental Health and Technology Team, Brain and Mind Centre, University of Sydney, NSW, Australia; Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia
| | - Ian B Hickie
- Youth Mental Health and Technology Team, Brain and Mind Centre, University of Sydney, NSW, Australia
| |
Collapse
|
11
|
Bowman S, McKinstry C, Howie L, McGorry P. Expanding the search for emerging mental ill health to safeguard student potential and vocational success in high school: A narrative review. Early Interv Psychiatry 2020; 14:655-676. [PMID: 32026624 DOI: 10.1111/eip.12928] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/29/2022]
Abstract
AIM Young people experiencing mental ill health are more likely than their healthy aged peers to drop out of high school. This can result in social exclusion and vocational derailment. Identifying young people at risk and taking action before an illness is established or school dropout occurs is an important goal. This study aimed to examine evidence for the risk markers and at risk mental states of the clinical staging model (stage 0-1b) and whether these risk states and early symptoms impact school participation and academic attainment. METHOD This narrative review assembles research from both the psychiatry and education literature. It examines stage 0 to stage 1b of the clinical staging model and links the risk states and early symptoms to evidence about the academic success of young people in high school. RESULTS In accordance with the clinical staging model and evidence from education literature, childhood trauma and parental mental illness can impact school engagement and academic progress. Sleep disturbance can result in academic failure. Undifferentiated depression and anxiety can increase the risk for school dropout. Subthreshold psychosis and hypomanic states are associated with functional impairment and high rates of Not in Employment, Education, or Training (NEET) but are not recognized in the education literature. CONCLUSION Risk markers for emerging mental ill health can be identified in education research and demonstrate an impact on a student's success in high school. Clear referral protocols need to be embedded into school life to reduce risk of progression to later stages of illness and support school participation and success.
Collapse
Affiliation(s)
- Siann Bowman
- Department of Occupational Therapy, School of Allied Health, LaTrobe University, Melbourne, Australia
| | - Carol McKinstry
- Department of Occupational Therapy, LaTrobe Rural Health School, LaTrobe University, Melbourne, Australia
| | - Linsey Howie
- Department of Occupational Therapy, School of Clinical and Community Allied Health, LaTrobe University, Melbourne, Australia
| | - Patrick McGorry
- The National Centre of Excellence in Youth Mental Health, Orygen, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
12
|
Kristensen P, Hanvold TN, Hasting RL, Merkus SL, Hoff R, Mehlum IS. Work participation in young Norwegians: a 19-year follow up in a registry-based life-course cohort. Scand J Public Health 2020; 49:176-187. [PMID: 32449464 PMCID: PMC7917564 DOI: 10.1177/1403494820917507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Aims: The study objectives were to provide a quantitative
description of work participation among young adults, and to outline the
relations between work participation and social, educational and health-related
characteristics throughout the life-course. Methods: We
collected data in several national registries for all 318,705 individuals born
in Norway 1967–1971 who were national residents on 1 January 1993. The criterion
for work was annual occupational income above the boundary which identifies the
core workforce. We analysed associations between social, educational and
health-related characteristics, and the number of years at work and the risk of
never working during 19 years of follow-up (1993–2011; age 22–44 years).
Results: The overall work participation was high, with a
median of 14 years and a 0.074 risk of never working. Women worked fewer years
than men (medians 11 v. 16 years) and had higher risk of never working (0.103 v.
0.047). Combined educational and health problems before 1993 had a strong
influence on subsequent work participation. The educational gradient in risks of
never working was considerably stronger for women than for men. Diagnostic
groups of mental disorders had high risks of never working, ranging from
affective (risk 0.150) and stress-related disorders (risk 0.163) to intellectual
disability (risk 0.933). Conclusions: The complex
problems characterising individuals with low work participation suggest that
preventive measures should take sex into account and be targeted at social,
educational and mental issues in early life, and focusing on identified
vulnerable groups.
Collapse
Affiliation(s)
- Petter Kristensen
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Norway.,Department of Community Medicine and Global Health, University of Oslo, Norway
| | - Therese N Hanvold
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Norway.,Department of Occupational Health Surveillance, National Institute of Occupational Health Norway
| | - Rachel L Hasting
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Norway
| | - Suzanne L Merkus
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Norway
| | - Rune Hoff
- Oslo Centre for Biostatistics and Epidemiology, University of Oslo and Oslo University Hospital, Norway
| | - Ingrid S Mehlum
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Norway
| |
Collapse
|
13
|
Hickie IB, Scott EM, Cross SP, Iorfino F, Davenport TA, Guastella AJ, Naismith SL, Carpenter JS, Rohleder C, Crouse JJ, Hermens DF, Koethe D, Markus Leweke F, Tickell AM, Sawrikar V, Scott J. Right care, first time: a highly personalised and measurement-based care model to manage youth mental health. Med J Aust 2020; 211 Suppl 9:S3-S46. [PMID: 31679171 DOI: 10.5694/mja2.50383] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Mood and psychotic syndromes most often emerge during adolescence and young adulthood, a period characterised by major physical and social change. Consequently, the effects of adolescent-onset mood and psychotic syndromes can have long term consequences. A key clinical challenge for youth mental health is to develop and test new systems that align with current evidence for comorbid presentations and underlying neurobiology, and are useful for predicting outcomes and guiding decisions regarding the provision of appropriate and effective care. Our highly personalised and measurement-based care model includes three core concepts: ▶ A multidimensional assessment and outcomes framework that includes: social and occupational function; self-harm, suicidal thoughts and behaviour; alcohol or other substance misuse; physical health; and illness trajectory. ▶ Clinical stage. ▶ Three common illness subtypes (psychosis, anxious depression, bipolar spectrum) based on proposed pathophysiological mechanisms (neurodevelopmental, hyperarousal, circadian). The model explicitly aims to prevent progression to more complex and severe forms of illness and is better aligned to contemporary models of the patterns of emergence of psychopathology. Inherent within this highly personalised approach is the incorporation of other evidence-based processes, including real-time measurement-based care as well as utilisation of multidisciplinary teams of health professionals. Data-driven local system modelling and personalised health information technologies provide crucial infrastructure support to these processes for better access to, and higher quality, mental health care for young people. CHAPTER 1: MULTIDIMENSIONAL OUTCOMES IN YOUTH MENTAL HEALTH CARE: WHAT MATTERS AND WHY?: Mood and psychotic syndromes present one of the most serious public health challenges that we face in the 21st century. Factors including prevalence, age of onset, and chronicity contribute to substantial burden and secondary risks such as alcohol or other substance misuse. Mood and psychotic syndromes most often emerge during adolescence and young adulthood, a period characterised by major physical and social change; thus, effects can have long term consequences. We propose five key domains which make up a multidimensional outcomes framework that aims to address the specific needs of young people presenting to health services with emerging mental illness. These include social and occupational function; self-harm, suicidal thoughts and behaviours; alcohol or other substance misuse; physical health; and illness type, stage and trajectory. Impairment and concurrent morbidity are well established in young people by the time they present for mental health care. Despite this, services and health professionals tend to focus on only one aspect of the presentation - illness type, stage and trajectory - and are often at odds with the preferences of young people and their families. There is a need to address the disconnect between mental health, physical health and social services and interventions, to ensure that youth mental health care focuses on the outcomes that matter to young people. CHAPTER 2: COMBINING CLINICAL STAGE AND PATHOPHYSIOLOGICAL MECHANISMS TO UNDERSTAND ILLNESS TRAJECTORIES IN YOUNG PEOPLE WITH EMERGING MOOD AND PSYCHOTIC SYNDROMES: Traditional diagnostic classification systems for mental disorders map poorly onto the early stages of illness experienced by young people, and purport categorical distinctions that are not readily supported by research into genetic, environmental and neurobiological risk factors. Consequently, a key clinical challenge in youth mental health is to develop and test new classification systems that align with current evidence on comorbid presentations, are consistent with current understanding of underlying neurobiology, and provide utility for predicting outcomes and guiding decisions regarding the provision of appropriate and effective care. This chapter outlines a transdiagnostic framework for classifying common adolescent-onset mood and psychotic syndromes, combining two independent but complementary dimensions: clinical staging, and three proposed pathophysiological mechanisms. Clinical staging reflects the progression of mental disorders and is in line with the concept used in general medicine, where more advanced stages are associated with a poorer prognosis and a need for more intensive interventions with a higher risk-to-benefit ratio. The three proposed pathophysiological mechanisms are neurodevelopmental abnormalities, hyperarousal and circadian dysfunction, which, over time, have illness trajectories (or pathways) to psychosis, anxious depression and bipolar spectrum disorders, respectively. The transdiagnostic framework has been evaluated in young people presenting to youth mental health clinics of the University of Sydney's Brain and Mind Centre, alongside a range of clinical and objective measures. Our research to date provides support for this framework, and we are now exploring its application to the development of more personalised models of care. CHAPTER 3: A COMPREHENSIVE ASSESSMENT FRAMEWORK FOR YOUTH MENTAL HEALTH: GUIDING HIGHLY PERSONALISED AND MEASUREMENT-BASED CARE USING MULTIDIMENSIONAL AND OBJECTIVE MEASURES: There is an urgent need for improved care for young people with mental health problems, in particular those with subthreshold mental disorders that are not sufficiently severe to meet traditional diagnostic criteria. New comprehensive assessment frameworks are needed to capture the biopsychosocial profile of a young person to drive highly personalised and measurement-based mental health care. We present a range of multidimensional measures involving five key domains: social and occupational function; self-harm, suicidal thoughts and behaviours; alcohol or other substance misuse; physical health; and illness type, stage and trajectory. Objective measures include: neuropsychological function; sleep-wake behaviours and circadian rhythms; metabolic and immune markers; and brain structure and function. The recommended multidimensional measures facilitate the development of a comprehensive clinical picture. The objective measures help to further develop informative and novel insights into underlying pathophysiological mechanisms and illness trajectories to guide personalised care plans. A panel of specific multidimensional and objective measures are recommended as standard clinical practice, while others are recommended secondarily to provide deeper insights with the aim of revealing alternative clinical paths for targeted interventions and treatments matched to the clinical stage and proposed pathophysiological mechanisms of the young person. CHAPTER 4: PERSONALISING CARE OPTIONS IN YOUTH MENTAL HEALTH: USING MULTIDIMENSIONAL ASSESSMENT, CLINICAL STAGE, PATHOPHYSIOLOGICAL MECHANISMS, AND INDIVIDUAL ILLNESS TRAJECTORIES TO GUIDE TREATMENT SELECTION: New models of mental health care for young people require that interventions be matched to illness type, clinical stage, underlying pathophysiological mechanisms and individual illness trajectories. Narrow syndrome-focused classifications often direct clinical attention away from other key factors such as functional impairment, self-harm and suicidality, alcohol or other substance misuse, and poor physical health. By contrast, we outline a treatment selection guide for early intervention for adolescent-onset mood and psychotic syndromes (ie, active treatments and indicated and more specific secondary prevention strategies). This guide is based on experiences with the Brain and Mind Centre's highly personalised and measurement-based care model to manage youth mental health. The model incorporates three complementary core concepts: ▶A multidimensional assessment and outcomes framework including: social and occupational function; self-harm, suicidal thoughts and behaviours; alcohol or other substance misuse; physical health; and illness trajectory. ▶Clinical stage. ▶Three common illness subtypes (psychosis, anxious depression, bipolar spectrum) based on three underlying pathophysiological mechanisms (neurodevelopmental, hyperarousal, circadian). These core concepts are not mutually exclusive and together may facilitate improved outcomes through a clinical stage-appropriate and transdiagnostic framework that helps guide decisions regarding the provision of appropriate and effective care options. Given its emphasis on adolescent-onset mood and psychotic syndromes, the Brain and Mind Centre's model of care also respects a fundamental developmental perspective - categorising childhood problems (eg, anxiety and neurodevelopmental difficulties) as risk factors and respecting the fact that young people are in a period of major biological and social transition. Based on these factors, a range of social, psychological and pharmacological interventions are recommended, with an emphasis on balancing the personal benefit-to-cost ratio. CHAPTER 5: A SERVICE DELIVERY MODEL TO SUPPORT HIGHLY PERSONALISED AND MEASUREMENT-BASED CARE IN YOUTH MENTAL HEALTH: Over the past decade, we have seen a growing focus on creating mental health service delivery models that better meet the unique needs of young Australians. Recent policy directives from the Australian Government recommend the adoption of stepped-care services to improve the appropriateness of care, determined by severity of need. Here, we propose that a highly personalised approach enhances stepped-care models by incorporating clinical staging and a young person's current and multidimensional needs. It explicitly aims to prevent progression to more complex and severe forms of illness and is better aligned to contemporary models of the patterns of emergence of psychopathology. Inherent within a highly personalised approach is the incorporation of other evidence-based processes, including real-time measurement-based care and use of multidisciplinary teams of health professionals. Data-driven local system modelling and personalised health information technologies provide crucial infrastructure support to these processes for better access to, and higher quality of, mental health care for young people.
Collapse
Affiliation(s)
- Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, NSW
| | - Elizabeth M Scott
- Brain and Mind Centre, University of Sydney, Sydney, NSW.,University of Notre Dame Australia, Sydney, NSW
| | - Shane P Cross
- Brain and Mind Centre, University of Sydney, Sydney, NSW
| | - Frank Iorfino
- Brain and Mind Centre, University of Sydney, Sydney, NSW
| | | | | | | | | | | | - Jacob J Crouse
- Brain and Mind Centre, University of Sydney, Sydney, NSW
| | - Daniel F Hermens
- Brain and Mind Centre, University of Sydney, Sydney, NSW.,Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Birtinya, QLD
| | - Dagmar Koethe
- Brain and Mind Centre, University of Sydney, Sydney, NSW
| | | | | | - Vilas Sawrikar
- Brain and Mind Centre, University of Sydney, Sydney, NSW.,University of Edinburgh, Edinburgh, UK
| | - Jan Scott
- Brain and Mind Centre, University of Sydney, Sydney, NSW.,Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
| |
Collapse
|
14
|
Pedersen J, Thorsen SV, Andersen MF, Hanvold TN, Schlünssen V, Bültmann U. Impact of depressive symptoms on worklife expectancy: a longitudinal study on Danish employees. Occup Environ Med 2019; 76:838-844. [PMID: 31582420 PMCID: PMC6839798 DOI: 10.1136/oemed-2019-105961] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/30/2019] [Accepted: 09/07/2019] [Indexed: 11/06/2022]
Abstract
Objective Depressive symptoms are associated with sickness absence, work disability and unemployment, but little is known about worklife expectancy (WLE). This study investigates the impact of depressive symptoms on the WLE of a large sample of Danish employees. Methods We used occupational health survey data of 11 967 Danish employees from 2010 and linked them with register data on salary and transfer payments from 2010 to 2015. Depressive symptoms were self-reported using the Major Depression Inventory. We used multistate data and a life table approach with Cox proportional hazard modelling to estimate the WLE of employees, expressed by time in work, unemployment and sickness absence. Separate analyses were conducted for sex and employees with a voluntary early retirement pension scheme. Using age as time axis, we used inverse probability weights to account for differences in educational level, sector, body mass index, smoking habits and loss of employment during sickness absence. Results The WLE of employees reporting depressive symptoms was shorter compared with those not reporting depressive symptoms; that is, the expected time in unemployment and sickness absence was longer, while the expected time in work was shorter. The shorter WLE was most pronounced in women; for example, a 40-year-old woman with depressive symptoms can expect 3.3 years less in work, 0.8 years more in unemployment and 0.7 years more in sickness absence. Employees with a voluntary early retirement pension scheme showed an even lower WLE. Conclusions Our study showed a meaningful impact of depressive symptoms on the WLE of Danish employees using a multistate framework.
Collapse
Affiliation(s)
- Jacob Pedersen
- The National Research Center for the Working Environment, Copenhagen, Denmark
| | | | | | | | - Vivi Schlünssen
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Ute Bültmann
- Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
15
|
Caruana E, Allott K, Farhall J, Parrish EM, Davey CG, Chanen AM, Killackey E, Cotton SM. Factors associated with vocational disengagement among young people entering mental health treatment. Early Interv Psychiatry 2019; 13:961-968. [PMID: 30019851 DOI: 10.1111/eip.12718] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 06/12/2018] [Accepted: 06/19/2018] [Indexed: 11/27/2022]
Abstract
AIM Most mental disorders have their onset by age 25, disrupting normative vocational engagement. Factors associated with vocational disengagement at first contact with specialist treatment are important for service planning. The aim of this paper was to investigate the association between theoretically important factors and vocational disengagement for youth entering mental health treatment. METHODS A file audit was used to extract vocational data of 145 young people aged 15 to 25 years entering treatment in 2011 at a public youth mental health service in Melbourne, Australia. Comparisons were made across three specialist programs for: psychosis (n = 50), mood disorders (n = 52) and borderline personality pathology (n = 43). Individual characteristics were entered into univariate and multivariate logistic regressions to investigate their associations with vocational disengagement. RESULTS Educational disengagement was associated with being older (OR = 4.38, P = 0.004) and not living with parents (OR = 2.87, P = 0.038). Unemployment and being NEET (Not in Education, Employment or Training) were both associated with not having commenced tertiary education (OR = 0.23, P = 0.022; OR = 0.05, P = 0.002; respectively). Being NEET was also associated with being older (OR = 6.18, P = 0.004). Primary diagnostic grouping was not associated with vocational disengagement, once accounting for other factors. CONCLUSIONS The likelihood of vocational disengagement did not differ across disorder groups, implying that intervention should be "transdiagnostic" and might best target education first, specifically post-secondary qualifications. Other domains or variables not measured in this study are also likely to be important, and this might include young people's support systems and symptom severity. Qualitative studies may be useful for exploring further factors relevant to vocational engagement.
Collapse
Affiliation(s)
- Emma Caruana
- Department of Psychology and Counselling, La Trobe University, Bundoora, Victoria
| | - Kelly Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Bundoora, Victoria.,North Western Mental Health, Parkville, Victoria
| | - Emma M Parrish
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria.,Northeastern University, Boston, Massachusetts
| | - Christopher G Davey
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria.,Orygen Youth Health, Parkville, Victoria
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria.,North Western Mental Health, Parkville, Victoria.,Orygen Youth Health, Parkville, Victoria
| | - Eoin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria
| | - Susan M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria
| |
Collapse
|
16
|
Basta M, Karakonstantis S, Koutra K, Dafermos V, Papargiris A, Drakaki M, Tzagkarakis S, Vgontzas A, Simos P, Papadakis N. NEET status among young Greeks: Association with mental health and substance use. J Affect Disord 2019; 253:210-217. [PMID: 31054446 DOI: 10.1016/j.jad.2019.04.095] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 03/27/2019] [Accepted: 04/21/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Prior studies have shown that young people "not in education, employment or training" ("NEET") are at higher risk for psychopathology and substance abuse. Similar studies are lacking in Southern European populations. We aimed to examine the associations of anxiety and depressive symptoms, and substance use with NEET status in a large, randomized population-based sample in Greece. METHODS A telephone structured questionnaire was conducted in a representative sample of 2771 young Greeks aged 15-24 years. Anxiety and depressive symptoms were assessed with GAD-7 and PHQ-9 scales, respectively. Substances use and several sociodemographic parameters were also examined. RESULTS In our sample 16.4% were NEETs. In multivariate analyses, NEETs compared to non-NEETs were older, with lower family income, without insurance and more likely to be married and smoke. Furthermore, NEET status was associated with a higher GAD-7 score among older NEETs and long-term NEETs (NEETs unemployed for more than a year). Moreover, being NEET among older participants was associated with severe symptoms of anxiety and moderate/severe symptoms of depression. LIMITATIONS This was a telephone survey and a clinical evaluation of the patients was not performed. Furthermore, the structured interview was not designed to detect the level of substance use or the reasons for being NEET. CONCLUSIONS NEET status is frequent among young Greeks. Older, and long-term NEETs appear to be at higher risk for presenting anxiety/depression symptoms. Whether NEET status is associated with adverse outcomes later in life requires longitudinal studies.
Collapse
Affiliation(s)
- Maria Basta
- Department of Psychiatry, University Hospital of Heraklion, Voutes, Heraklion, Crete Zip Code 71110, Greece..
| | - Stamatis Karakonstantis
- Department of Psychiatry, University Hospital of Heraklion, Voutes, Heraklion, Crete Zip Code 71110, Greece
| | - Katerina Koutra
- Department of Psychology, University of Crete, Rethymno, Greece
| | - Vassilis Dafermos
- Department of Political Science, University of Crete, Rethymno, Greece
| | | | - Maria Drakaki
- Department of Political Science, University of Crete, Rethymno, Greece
| | | | - Alexandros Vgontzas
- Department of Psychiatry, University Hospital of Heraklion, Voutes, Heraklion, Crete Zip Code 71110, Greece
| | - Panagiotis Simos
- Department of Psychiatry, University Hospital of Heraklion, Voutes, Heraklion, Crete Zip Code 71110, Greece
| | - Nikos Papadakis
- Department of Political Science, University of Crete, Rethymno, Greece
| |
Collapse
|
17
|
Caruana E, Farhall J, Cotton SM, Parrish E, van-der-El K, Davey CG, Chanen AM, Bryce SD, Killackey E, Allott K. Vocational engagement among young people entering mental health treatment compared with their general population peers. Early Interv Psychiatry 2019; 13:692-696. [PMID: 29968285 DOI: 10.1111/eip.12712] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/23/2018] [Accepted: 06/10/2018] [Indexed: 11/26/2022]
Abstract
AIM To compare rates of vocational engagement for youth entering specialist mental health treatment with the general population. METHODS A file audit retrieved vocational data for 145 youth aged 15 to 25 entering treatment. Clinical and population data were stratified by age and sex and compared between cohorts. RESULTS Compared to the population, young people entering mental health treatment were less likely to have completed at least Year 11 in school (77% vs 42%, P < 0.001); and demonstrated higher rates of "Not in Education, Employment or Training" (9% vs 33%, P < 0.001). Individuals aged 15 to 18 years entering treatment experienced greater rates of educational disengagement than the population (30% vs 11%, P < 0.001), whereas people aged 19 to 25 years showed higher unemployment rates (52% vs 35%, P = 0.003). CONCLUSIONS Youth entering specialist mental health treatment have marked levels of vocational disengagement compared to demographically-matched peers. Early vocational intervention for these young people is essential.
Collapse
Affiliation(s)
- Emma Caruana
- Department of Psychology and Counselling, La Trobe University, Bundoora, Victoria, Australia
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Bundoora, Victoria, Australia.,North Western Mental Health, Parkville, Victoria, Australia
| | - Susan M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Emma Parrish
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kristi van-der-El
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Christopher G Davey
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen Youth Health, Parkville, Victoria, Australia
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen Youth Health, Parkville, Victoria, Australia
| | - Shayden D Bryce
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Monash School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Eoin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Kelly Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| |
Collapse
|
18
|
Gariépy G, Iyer S. The Mental Health of Young Canadians Who Are Not Working or in School. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:338-344. [PMID: 30595044 PMCID: PMC6591889 DOI: 10.1177/0706743718815899] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Recent studies suggest that youth who have a mental health problem are more likely to be NEET-not in education, employment, or training-but findings remain mixed, and evidence from Canada is limited. We examined this association across a range of mental and substance disorders in a representative sample of Canadian youth. METHOD Data were from the 2012 Canadian Community Health Survey-Mental Health ( n = 5622; ages 15-29). The survey identified past-year mental (depression, bipolar, generalized anxiety) and substance (alcohol, cannabis, other drugs) disorders from a structured interview and included questions on suicidal ideation. We classified as NEET respondents who were not in school or employed in the past week. Logistic regression models tested the associations between mental and substance disorders and NEET status, adjusted for sociodemographic, health, and geographic variables. RESULTS About 10% of youth were NEET. Being NEET was associated with past-year depression (odds ratio [OR] = 1.67; 95% confidence interval [CI], 1.06 to 2.63); bipolar (OR = 2.31; 95% CI, 0.98 to 5.45), generalized anxiety (OR = 2.65; 95% CI, 1.37 to 5.12), and drug use (OR = 3.22; 95% CI, 1.33 to 7.76) disorders; and suicidal ideation (OR = 1.75; 95% CI, 0.99 to 3.09) but was not associated with alcohol (OR = 1.03; 95% CI, 0.63 to 1.69) or cannabis (OR = 0.97; 95% CI, 0.47 to 2.00) disorders. CONCLUSIONS Poor mental health was associated with being NEET in Canadian youth. Efforts targeting NEET should include provisions for mental health. Moreover, youth mental health initiatives should consider educational and employment outcomes. Further longitudinal and intervention studies are warranted.
Collapse
Affiliation(s)
- Geneviève Gariépy
- 1 Douglas Mental Health University Institute, McGill University, Montreal, Quebec.,2 Department of Psychiatry, McGill University, Montreal, Quebec
| | - Srividya Iyer
- 1 Douglas Mental Health University Institute, McGill University, Montreal, Quebec.,2 Department of Psychiatry, McGill University, Montreal, Quebec
| |
Collapse
|
19
|
Neurocognitive clusters: A pilot study of young people with affective disorders in an inpatient facility. J Affect Disord 2019; 242:80-86. [PMID: 30172228 DOI: 10.1016/j.jad.2018.08.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 07/18/2018] [Accepted: 08/12/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND There is growing evidence to support the need for personalised intervention in the early stages of a major psychiatric illness, as well as the clear delineation of subgroups in psychiatric disorders based on cognitive impairment. Affective disorders are often accompanied by neurocognitive deficits; however a lack of research among young adult inpatients highlights the need to assess the utility of cognitive testing in this population. METHODS A computerised cognitive battery was administered to 50 current inpatient young adults (16-30 years; 75% female) with an affective disorder. Patients also completed a computerised self-report questionnaire (to measure demographics and clinical features) that included items evaluating subjective impressions of their cognition. RESULTS Hierarchical cluster analysis determined two neurocognitive subgroups: cluster 1 (n = 16) showed more severe impairments in sustained attention and memory as well as higher anxiety levels, compared to their peers in cluster 2 (n = 30) who showed the most impaired attentional switching. Across the sample, poor sustained attention was significantly correlated with higher levels of current anxiety and depressive symptoms, whereas poor verbal memory was significantly associated with increased psychological distress. LIMITATIONS This study has a relatively small sample size (due to it being a pilot/feasibility study). Furthermore, future studies should aim to assess inpatient samples compared to community care samples, as well as healthy controls, on a larger scale. CONCLUSIONS The findings suggest neurocognitive profiles are important in understanding phenotypes within young people with severe affective disorders. With clear subgroups based on cognitive impairment being demonstrated, the clinical utility and use of new and emerging technologies is warranted in such inpatients facilities. This pilot/feasibility study has strengthened the utility of cognitive screening as standard clinical care in an inpatient unit.
Collapse
|
20
|
Lee RSC, Hermens DF, Naismith SL, Kaur M, Guastella AJ, Glozier N, Scott J, Scott EM, Hickie IB. Clinical, neurocognitive and demographic factors associated with functional impairment in the Australian Brain and Mind Youth Cohort Study (2008-2016). BMJ Open 2018; 8:e022659. [PMID: 30567821 PMCID: PMC6303611 DOI: 10.1136/bmjopen-2018-022659] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES We sought to determine the unique and shared contributions of clinical, neurocognitive and demographic factors to functional impairment in a large, transdiagnostic, clinical cohort of adolescents and young adults. DESIGN Cross-sectional baseline data from a prospective, cohort study. SETTING Help-seeking youth referred from outpatient services were recruited to the Brain and Mind Youth Cohort (2008-2016) in Sydney, Australia. PARTICIPANTS In total, 1003 outpatients were recruited, aged between 12 and 36 years (mean= 20.4 years, 54% female), with baseline diagnoses of affective, psychotic, developmental or behavioural disorders. INTERVENTIONS Treatment as usual. PRIMARY OUTCOME MEASURES Social and occupational functioning was used to index level of functional impairment. Structural equation modelling was used to examine associations between neurocognition, core clinical symptoms and alcohol and substance use, and clinician-rated and researcher-rated functional impairment. Moderator analyses were conducted to determine the potential influence of demographic and clinical factors (eg, medication exposure). RESULTS Independent of diagnosis, we found that neurocognitive impairments, and depressive, anxiety and negative symptoms, were significantly associated with functioning. The association of neurocognition with social and occupational functioning remained significant even when constraining for age (15-25-year-olds only) or diagnosis (affective disorders only) in the final model. CONCLUSIONS This study demonstrated that, in a clinically representative sample of youth, the key determinants of functioning may not be disorder specific. Further, evidence of neurocognitive dysfunction suggests that interventions that target cognition and functioning should not necessarily be reserved just for older adults with established illness.
Collapse
Affiliation(s)
- Rico S C Lee
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
- Brain and Mental Health Research Hub, Monash University, Melbourne, Victoria, Australia
| | - Daniel F Hermens
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Sharon L Naismith
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Manreena Kaur
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
- The Monash Alfred Psychiatry Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Adam J Guastella
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Nick Glozier
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
- Marie Bashir Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle, UK
- Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Elizabeth M Scott
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
21
|
Caruana E, Cotton SM, Farhall J, Parrish EM, Chanen A, Davey CG, Killackey E, Allott K. A Comparison of Vocational Engagement Among Young People with Psychosis, Depression and Borderline Personality Pathology. Community Ment Health J 2018; 54:831-841. [PMID: 29159496 DOI: 10.1007/s10597-017-0197-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 11/04/2017] [Indexed: 12/13/2022]
Abstract
Poor vocational engagement is well documented among young people experiencing first-episode psychosis (FEP). The aim of the present study was to establish and compare rates of vocational engagement across young people with first-episode psychosis, depression, and borderline personality pathology. A file audit was used to collect vocational data of young people aged 15-25 entering tertiary mental health treatment in 2011. Rates of vocational engagement were similar across groups, indicating that like those with FEP, young people with depression and borderline personality pathology experience impaired vocational engagement and are in need of targeted vocational interventions. Post hoc analysis indicated that that the depression group had significantly more people who were partially vocationally engaged compared with the psychosis group, suggesting that vocational interventions might need to be targeted differently across different diagnostic groups. Future research should explore risk factors for vocational disengagement across diagnostic groups in order to inform intervention development.
Collapse
Affiliation(s)
- E Caruana
- La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia. .,La Trobe University, Bundoora, VIC, 3083, Australia.
| | - S M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, 3052, Australia
| | - J Farhall
- La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia.,North Western Mental Health, Parkville, VIC, Australia
| | - E M Parrish
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, 3052, Australia.,Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA
| | - A Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, 3052, Australia.,North Western Mental Health, Parkville, VIC, Australia.,Orygen Youth Health, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - C G Davey
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, 3052, Australia.,Orygen Youth Health, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - E Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, 3052, Australia
| | - K Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, 3052, Australia
| |
Collapse
|
22
|
Rodwell L, Romaniuk H, Nilsen W, Carlin JB, Lee KJ, Patton GC. Adolescent mental health and behavioural predictors of being NEET: a prospective study of young adults not in employment, education, or training. Psychol Med 2018; 48:861-871. [PMID: 28874224 DOI: 10.1017/s0033291717002434] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Young adults who are not in employment, education, or training (NEET) are at risk of long-term economic disadvantage and social exclusion. Knowledge about risk factors for being NEET largely comes from cross-sectional studies of vulnerable individuals. Using data collected over a 10-year period, we examined adolescent predictors of being NEET in young adulthood. METHODS We used data on 1938 participants from the Victorian Adolescent Health Cohort Study, a community-based longitudinal study of adolescents in Victoria, Australia. Associations between common mental disorders, disruptive behaviour, cannabis use and drinking behaviour in adolescence, and NEET status at two waves of follow-up in young adulthood (mean ages of 20.7 and 24.1 years) were investigated using logistic regression, with generalised estimating equations used to account for the repeated outcome measure. RESULTS Overall, 8.5% of the participants were NEET at age 20.7 years and 8.2% at 24.1 years. After adjusting for potential confounders, we found evidence of increased risk of being NEET among frequent adolescent cannabis users [adjusted odds ratio (ORadj) = 1.74; 95% confidence interval (CI) 1.10-2.75] and those who reported repeated disruptive behaviours (ORadj = 1.71; 95% CI 1.15-2.55) or persistent common mental disorders in adolescence (ORadj = 1.60; 95% CI 1.07-2.40). Similar associations were present when participants with children were included in the same category as those in employment, education, or training. CONCLUSIONS Young people with an early onset of mental health and behavioural problems are at risk of failing to make the transition from school to employment. This finding reinforces the importance of integrated employment and mental health support programmes.
Collapse
Affiliation(s)
- L Rodwell
- Clinical Epidemiology and Biostatistics Unit,Murdoch Childrens Research Institute,Parkville, VIC,Australia
| | - H Romaniuk
- Clinical Epidemiology and Biostatistics Unit,Murdoch Childrens Research Institute,Parkville, VIC,Australia
| | - W Nilsen
- Work Research Institute,Oslo and Akershus University College of Applied Sciences,Oslo,Norway
| | - J B Carlin
- Clinical Epidemiology and Biostatistics Unit,Murdoch Childrens Research Institute,Parkville, VIC,Australia
| | - K J Lee
- Clinical Epidemiology and Biostatistics Unit,Murdoch Childrens Research Institute,Parkville, VIC,Australia
| | - G C Patton
- Department of Paediatrics,Faculty of Medicine,Dentistry and Health Sciences,The University of Melbourne,Melbourne, VIC,Australia
| |
Collapse
|
23
|
Robertson PJ. The casualties of transition: the health impact of NEET status and some approaches to managing it. BRITISH JOURNAL OF GUIDANCE & COUNSELLING 2018. [DOI: 10.1080/03069885.2018.1455168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
24
|
Iorfino F, Hermens DF, Cross SPM, Zmicerevska N, Nichles A, Badcock CA, Groot J, Scott EM, Hickie IB. Delineating the trajectories of social and occupational functioning of young people attending early intervention mental health services in Australia: a longitudinal study. BMJ Open 2018; 8:e020678. [PMID: 29588325 PMCID: PMC5875606 DOI: 10.1136/bmjopen-2017-020678] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/06/2018] [Accepted: 02/16/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Mental disorders typically emerge during adolescence and young adulthood and put young people at risk for prolonged socioeconomic difficulties. This study describes the longitudinal course of social and occupational functioning of young people attending primary care-based, early intervention services. DESIGN A longitudinal study of young people receiving mental healthcare. SETTING Data were collected between January 2005 and August 2017 from a designated primary care-based mental health service. PARTICIPANTS 554 young people (54% women) aged 12-32 years. MEASURES A systematic medical file audit collected clinical and functional information at predetermined time intervals (ie, 3 months to 5+ years) using a clinical pro forma. Group-based trajectory modelling (GBTM) was used to identify distinct trajectories of social and occupational functioning over time (median number of observations per person=4; median follow-up time=23 months). RESULTS Between first clinical contact and time last seen, 15% of young people had reliably deteriorated, 23% improved and 62% did not demonstrate substantive change in function. Of the whole cohort, 69% had functional scores less than 70 at time last seen, indicative of ongoing and substantive impairment. GBTM identified six distinct functional trajectories whereby over 60% had moderate-to-serious functional impairment at entry and remained chronically impaired over time; 7% entered with serious impairment and deteriorated further; a quarter were mildly impaired at entry and functionally recovered and only a small minority (4%) presented with serious impairments and functionally improved over time. Not being in education, employment or training, previous hospitalisation and a younger age at baseline emerged as significant predictors of these functional trajectories. CONCLUSION Young people with emerging mental disorders have significant functional impairment at presentation for care, and for the majority, it persists over the course of clinical care. In addition to providing clinical care earlier in the course of illness, these data suggest that more sophisticated and more intensive individual-level and organisational strategies may be required to achieve significant and sustained functional improvements.
Collapse
Affiliation(s)
- Frank Iorfino
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Daniel F Hermens
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Mind and Neuroscience Thompson Institute, University of the Sunshine Coast, Sunshine Coast, QLD, Australia
| | - Shane, PM Cross
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Natalia Zmicerevska
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Alissa Nichles
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Caro-Anne Badcock
- Statistical Consulting, The University of Sydney, Sydney, New South Wales, Australia
| | - Josine Groot
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Elizabeth M Scott
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Ian B Hickie
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
25
|
Hetrick SE, Bailey AP, Smith KE, Malla A, Mathias S, Singh SP, O'Reilly A, Verma SK, Benoit L, Fleming TM, Moro MR, Rickwood DJ, Duffy J, Eriksen T, Illback R, Fisher CA, McGorry PD. Integrated (one-stop shop) youth health care: best available evidence and future directions. Med J Aust 2017; 207:S5-S18. [PMID: 29129182 DOI: 10.5694/mja17.00694] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 09/26/2017] [Indexed: 01/07/2023]
Abstract
Although mental health problems represent the largest burden of disease in young people, access to mental health care has been poor for this group. Integrated youth health care services have been proposed as an innovative solution. Integrated care joins up physical health, mental health and social care services, ideally in one location, so that a young person receives holistic care in a coordinated way. It can be implemented in a range of ways. A review of the available literature identified a range of studies reporting the results of evaluation research into integrated care services. The best available data indicate that many young people who may not otherwise have sought help are accessing these mental health services, and there are promising outcomes for most in terms of symptomatic and functional recovery. Where evaluated, young people report having benefited from and being highly satisfied with these services. Some young people, such as those with more severe presenting symptoms and those who received fewer treatment sessions, have failed to benefit, indicating a need for further integration with more specialist care. Efforts are underway to articulate the standards and core features to which integrated care services should adhere, as well as to further evaluate outcomes. This will guide the ongoing development of best practice models of service delivery.
Collapse
Affiliation(s)
- Sarah E Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health and The Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC
| | - Alan P Bailey
- Orygen, The National Centre of Excellence in Youth Mental Health and The Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC
| | | | - Ashok Malla
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Steve Mathias
- Foundry, Department of Psychiatry, University of British Columbia, and FRAYME/CADRE Knowledge Network, Vancouver, British Columbia, Canada
| | - Swaran P Singh
- Division of Health Sciences, University of Warwick, Coventry, UK
| | - Aileen O'Reilly
- Jigsaw, The National Centre for Youth Mental Health, Dublin, Ireland
| | - Swapna K Verma
- Department of Early Psychosis Intervention, Institute of Mental Health, Singapore, Singapore
| | - Laelia Benoit
- Sorbonne University and Maisons des Adolescents, Maison de Solenn, Cochin Hospital, Paris, France
| | - Theresa M Fleming
- Department of Psychological Medicine, University of Auckland, Auckland, and Te Wāhanga Tātai Hauora, Victoria University of Wellington, Wellington, New Zealand
| | - Marie Rose Moro
- Sorbonne University and Maisons des Adolescents, Maison de Solenn, Cochin Hospital, Paris, France
| | - Debra J Rickwood
- headspace, National Youth Mental Health Foundation, Melbourne, VIC
| | - Joseph Duffy
- Jigsaw, The National Centre for Youth Mental Health, Dublin, Ireland
| | - Trissel Eriksen
- Youth One Stop Shop, Network of Youth One Stop Shops, Palmerston North, New Zealand
| | | | - Caroline A Fisher
- Allied Health - Psychology, Royal Melbourne Hospital, Melbourne, VIC
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health and The Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC
| |
Collapse
|