DSM-IV-TR Axes-I and II mental disorders in a representative and referred sample of unemployed youths – Results from a psychiatric liaison service in a job centre

Psychiatric Morbidity, Utilization and Quality of Mental Health Care in Long-Term Unemployed People

Research has shown complex interactions between unemployment and mental health. However, the prevalence of specific mental disorders, utilization of mental health care services and influences on help-seeking behavior have been investigated surprisingly little in the past. In this study, we investigated a sample of long-term unemployed people in a cooperation program of the local unemployment agency and a psychiatric university hospital in a larger city in Germany. Mental disorders, treatment history, accordance of treatment to national treatment guidelines and factors influencing previous treatment were assessed. Participants (n = 879; male 56%, female 44%, mean age 43.9 years) showed a high psychiatric morbidity, mostly with diagnoses from the ICD-10 categories F1 (22%), F3 (61%) and F4 (68%). Currently, 18% were in psychiatric treatment, 6% were in psychotherapeutic treatment, and 28% received psychopharmacological treatment. Mostly young men underutilized the psychiatric-psychotherapeutic system, with middle-aged men and women being most frequently in psychopharmacological treatment. Of those treated, only about 10% of the subjects currently received a treatment according to national guidelines. The utilization of psychotherapeutic treatment was strikingly poor. This study identified high psychiatric morbidity and severe treatment gaps in unemployed people. These results can help to target subjects with specific needs for interventions and to modify counseling programs.

Associations of Social and Psychological Resources with Different Facets of Chronic Stress: A Study with Employed and Unemployed Adolescents

Adolescents navigate many psychosocial changes. A critical transition in adolescence is the one from school to work life. Both taking the first steps in work life and the failure to achieve this transition and being unemployed can engender elevated levels of stress during adolescence. Stress, especially when experienced chronically, is an important risk factor for mental health problems. Social and psychological resources may mitigate the experience of chronic stress. This study explored associations of social and family support, self-esteem, and self-efficacy with different dimensions of chronic stress in a sample of 1405 employed and unemployed adolescents (M(age) = 17.84, SD = 1.63, range: 14.05–26.12) in Switzerland. Unemployed adolescents showed higher stress levels overall. Higher levels of social and psychological resources were generally linked to lower stress levels. Social support and self-esteem predicted stress levels most consistently and strongly. On several stress dimensions, the association between higher self-esteem and lower stress levels was more pronounced in employed youth whereas the association between higher social support and lower stress levels was stronger in unemployed youth. Our findings provide insights on the differential associations of social and psychological resources with various facets of chronic stress in the context of employment and unemployment during adolescence.

Placebo response rates and potential modifiers in double-blind randomized controlled trials of second and newer generation antidepressants for major depressive disorder in children and adolescents: a systematic review and meta-regression analysis

Children and adolescents with major depressive disorder (MDD) appear to be more responsive to placebo than adults in randomized placebo-controlled trials (RCTs) of second and newer generation antidepressants (SNG-AD). Previous meta-analyses obtained conflicting results regarding modifiers. We aimed to conduct a meta-analytical evaluation of placebo response rates based on both clinician-rating and self-rating scales. Based on the most recent and comprehensive study on adult data, we tested whether the placebo response rates in children and adolescents with MDD also increase with study duration and number of study sites. We searched systematically for published RCTs of SNG-AD in children and/or adolescents (last update: September 2017) in public domain electronic databases and additionally for documented studies in clinical trial databases. The log-transformed odds of placebo response were meta-analytically analyzed. The primary and secondary outcomes were placebo response rates at the end of treatment based on clinician-rating and self-rating scales, respectively. To examine the impact of study duration and number of study sites on placebo response rates, we performed simple meta-regression analyses. We selected other potential modifiers of placebo response based on significance in at least one previous pediatric meta-analysis and on theoretical considerations to perform explorative analyses. We applied sensitivity analyses with placebo response rates closest to week 8 to compare our data with those reported for adults. We identified 24 placebo-controlled trials (2229 patients in the placebo arms). The clinician-rated placebo response rates ranged from 22 to 62% with a pooled response rate of 45% (95% CI 41-50%). The number of study sites was a significant modifier in the simple meta-regression analysis [odds ratio (OR) 1.01, 95% CI 1.01-1.02, p = 0.0003, k = 24) with more study sites linked to a higher placebo response. Study duration was not significantly associated with the placebo response rate. The explorative simple analyses revealed that publication year may be an additional modifier. However, in the explorative multivariable analysis including the number of study sites and the publication year only the number of study sites reached a p value ≤ 0.05. The self-rated placebo response rates ranged from 1 to 68% with a pooled response rate of 26% (95% CI 10-54%) (k = 6; n = 396). This meta-analysis confirms a high pooled placebo response rate in children and adolescents based on clinician ratings, which exceeds that observed in the most recent meta-analysis of placebo effects in adults (36%; 95% CI 35-37%) published in 2016. However, and similar to findings in adults, the pooled response rates based on self-ratings were substantially lower. In accordance with previous meta-analyses, we corroborated the number of study sites as significant modifier. In comparison to the recent adult meta-analysis, the substantially lower number of pediatric studies entails a reduced power to detect modifiers. Future studies should provide more precise and homogenous information to support discovery of potential modifiers and consider no-treatment-if ethically permissible-to allow differentiation between placebo and spontaneous remission rates. If these differ, practicing clinicians should facilitate placebo effects as an addition to the verum effect to maximize benefits. Further research is required to explain the discrepant response rates between clinician and self-ratings.

Screening for posttraumatic stress disorder in young adult refugees from Syria and Iraq

INTRODUCTION

In January 2016, 2057 refugees from civil war-torn Syria and Iraq, aged 18.0 to 24.9 years, were first-time entrants into the German unemployment register and thus potentially eligible for the labor market. Civil war and forced migration may affect individuals' mental health. Traumatic experiences in particular are assumed to represent a major barrier, e.g., to labor-market integration. This study aimed to screen the rates of posttraumatic stress disorder (PTSD). Former refugee studies have reported PTSD screening rates between 3% and 44%.

METHOD

A total of 8.5% (N = 175 of 2057) of respondents were randomly interviewed either by telephone or web-based interviews. A total of 84 respondents (48% out of 175 respondents) were screened using the Essen Trauma Inventory (ETI) based on the DSM-IV, and 91 (52%) respondents used the Short Screening Scale for Posttraumatic Stress Disorder (SSS-PSD). All respondents were additionally questioned regarding psychological impairment (Symptom Checklist 10) and health status (Short Form 12).

RESULTS

Of the respondents, 59.4% reported at least one traumatic experience. The percentage of positive PTSD screenings obtained using the ETI was 9.5% (N = 84) and 6.6% (N = 91) using the SSS-PSD. The percentage of positive PTSD screenings obtained with both screening instruments was 8% (N = 175; 95%-CI: 3.9% to 12.1%). A total of 19.4% of the subjects were above the SCL-10 cut-off for psychiatric caseness.

DISCUSSION

The PTSD rate in this sample was in the average range compared to previous estimates from large samples of refugees. Psychiatric caseness was high. The results should be considered for planning labor-market integration programs and the design of supportive schemes.

How unemployment and precarious employment affect the health of young people: A scoping study on social determinants

Background: The impact of unemployment and precarious employment on the health of young people is not well understood. However, according to social causation, higher socio-economic positions and thus better working conditions are beneficial to health in general. We tried to synthesize the results of studies that test this hypothesis in the case of young people. Methods: We conducted a scoping study mapping all the academic articles published in the period 2006–2016 in Europe. The literature was searched in PubMed/Medline, Science Direct, Web of Science and Scopus. Results: We identified 1770 studies, of which only 46 met the inclusion criteria. There are more studies that focus on the relationship between unemployment and health than between precarious employment and health (28 and 16, respectively). The vast majority of the studies (44) found support for the social causation hypothesis, the most common health outcomes being mental health disorders, health risk behaviour, poor quality of life and occupational injuries. The causal mechanisms behind this association relied mainly on the life-course perspective, the breadwinner model, and the lack of social and economic benefits provided by standard employment. Conclusions:There is evidence that young people are especially vulnerable to health problems when unemployed or working in precarious conditions. Active labour market and training programmes, inclusive social security measures, improved working conditions and targeted health programmes are important for addressing this vulnerability. Further research should strive to enhance the causal model by including a gender perspective, longitudinal data, more indicators on precariousness and third factor explanations.

Ability of the Child Behavior Checklist-Dysregulation Profile and the Youth Self Report-Dysregulation Profile to identify serious psychopathology and association with correlated problems in high-risk children and adolescents

BACKGROUND

The current analyses examined whether the dysregulation profile (DP) 1) could be used to identify children and adolescents at high risk for complex and serious psychopathology and 2) was correlated to other emotional and behavioral problems (such as delinquent behavior or suicide ideation). DP was assessed using both the Child Behavior Checklist (CBCL) and the Youth Self Report (YSR) in a residential care sample.

METHODS

Children and adolescents (N=374) aged 10-18 years living in residential care in Switzerland completed the YSR, and their professional caregivers completed the CBCL. Participants meeting criteria for DP (T-score ≥67 on the anxious/‌depressed, attention problems, and aggressive behavior scales of the YSR/CBCL) were compared against those who did not for the presence of complex psychopathology (defined as the presence of both emotional and behavioral disorders), and also for the prevalence of several psychiatric diagnoses, suicidal ideation, traumatic experiences, delinquent behaviors, and problems related to quality of life.

RESULTS

The diagnostic criteria for CBCL-DP and YSR-DP were met by just 44 (11.8%) and 25 (6.7%) of participants. Only eight participants (2.1%) met the criteria on both instruments. Further analyses were conducted separately for the CBCL-DP and YSR-DP groups. DP was associated with complex psychopathology in only 34.4% of cases according to CBCL and in 60% of cases according to YSR. YSR-DP was somewhat more likely to be associated with psychiatric disorders and associated problems than was the CBCL-DP.

LIMITATIONS

Because of the relatively small overlap between the CBCL-DP and YSR-DP, analyses were conducted largely with different samples, likely contributing to the different results.

CONCLUSIONS

Despite a high rate of psychopathology in the population studied, both the YSR-DP and the CBCL-DP were able to detect only a small proportion of those with complex psychiatric disorders. This result questions the validity of YSR-DP and the CBCL-DP in detecting subjects with complex and serious psychopathology. It is possible that different screening instruments may be more effective.

Can We Foster a Culture of Peer Support and Promote Mental Health in Adolescence Using a Web-Based App? A Control Group Study

BACKGROUND

Adolescence with its many transitions is a vulnerable period for the development of mental illnesses. Establishing effective mental health promotion programs for this age group is a challenge crucial to societal health. Programs must account for the specific developmental tasks that adolescents face. Considering peer influence and fostering adolescent autonomy strivings is essential. Participation in a program should be compelling to young people, and their affinity to new technologies offers unprecedented opportunities in this respect.

OBJECTIVE

The Companion App was developed as a Web-based app giving adolescents access to a peer mentoring system and interactive, health-relevant content to foster a positive peer culture among adolescents and thereby strengthen social support and reduce stress.

METHODS

In a control group study design, a group of employed (n=546) and unemployed (n=73) adolescents had access to the Companion App during a 10-month period. The intervention was evaluated using a combination of quantitative and qualitative approaches. Linear mixed effects models were used to analyze changes in chronic stress levels and perception of social support. Monthly feedback on the app and qualitative interviews at the end of the study allowed for an in-depth exploration of the adolescents' perception of the intervention.

RESULTS

Adolescents in the intervention group did not use the Companion App consistently. The intervention had no significant effect on chronic stress levels or the perception of social support. Adolescents reported endorsing the concept of the app and the implementation of a peer mentoring system in particular. However, technical difficulties and insufficiently obvious benefits of using the app impeded more frequent usage.

CONCLUSIONS

The Companion Project implemented a theory-driven and innovative approach to mental health promotion in adolescence, taking into account the specifics of this developmental phase. Particularities of the implementation context, technical aspects of the app, and insufficient incentives may have played considerable roles concerning the difficulties of the Companion Project to establish commitment. However, adopting peer mentoring as a strategy and using an app still seems to us a promising approach in mental health promotion in adolescents. Future projects should be careful to invest enough resources into the technical development of an app and consider a large use of incentives to establish commitment. When targeting risk groups, such as unemployed adolescents, it may be expedient to use more structured approaches including face-to-face support.