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Neurocognitive functioning predicts suicidal behaviour in young people with affective disorders. J Affect Disord 2021; 281:289-296. [PMID: 33341011 DOI: 10.1016/j.jad.2020.11.077] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/12/2020] [Accepted: 11/08/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Neurocognitive impairment is recognised as a risk factor for suicidal behaviour in adults. The current study aims to determine whether neurocognitive deficits also predict ongoing or emergent suicidal behaviour in young people with affective disorders. METHODS Participants were aged 12-30 years and presented to early intervention youth mental health clinics between 2008 and 2018. In addition to clinical assessment a standardised neurocognitive assessment was conducted at baseline. Clinical data was extracted from subsequent visits using a standardised proforma. RESULTS Of the 635 participants who met inclusion criteria (mean age 19.6 years, 59% female, average follow up 476 days) 104 (16%) reported suicidal behaviour during care. In 5 of the 10 neurocognitive domains tested (cognitive flexibility, processing speed, working memory, verbal memory and visuospatial memory) those with suicidal behaviour during care were superior to clinical controls. Better general neurocognitive function remained a significant predictor (OR=1.94, 95% CI 1.29- 2.94) of suicidal behaviour in care after controlling for other risk factors. LIMITATIONS The neurocognitive battery used was designed for use with affective and psychotic disorders and may not have detected some deficits more specific to suicidal behaviour. CONCLUSION Contrary to expectations, better neurocognitive functioning predicts suicidal behaviour during care in young people with affective disorders. While other populations with suicidal behaviour, such as adults with affective disorders or young people with psychotic disorders, tend to experience neurocognitive deficits which may limit their capacity to engage in some interventions, this does not appear to be the case for young people with affective disorders.
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Tickell AM, Rohleder C, Garland A, Song YJC, Carpenter JS, Harel K, Parker L, Hickie IB, Scott E. Protocol for a young adult mental health (Uspace) cohort: personalising multidimensional care in young people admitted to hospital. BMJ Open 2021; 11:e038787. [PMID: 33431486 PMCID: PMC7802707 DOI: 10.1136/bmjopen-2020-038787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Currently, the literature on personalised and measurement-based mental healthcare is inadequate with major gaps in the development and evaluation of 21st century service models. Clinical presentations of mental ill health in young people are heterogeneous, and clinical and functional outcomes are often suboptimal. Thus, treatments provided in a person-centred and responsive fashion are critical to meet the unique needs of young people and improve individual outcomes. Personalised care also requires concurrent assessment of factors relating to outcomes and underlying neurobiology. This study builds on a completed feasibility study and will be the first to incorporate clinical, cognitive, circadian, metabolic and hormonal profiling with personalised and measurement-based care in a cohort of young people admitted to hospital. METHODS AND ANALYSIS This prospective, transdiagnostic, observational study will be offered to all young people between the ages of 16 and 30 years admitted to the inpatient unit of the participating centre. In total, 400 participants will be recruited. On admission to hospital, young people will undergo clinical and diagnostic assessment, cognitive testing, self-report questionnaires, metabolic and hormonal data collection, and anthropomorphic measurements. Participants will wear an actigraphy watch for at least 1 week during admission to measure circadian patterns and sleep-wake cycles. A feedback session between clinician and participant will occur after clinical and other laboratory assessments to tailor individual treatment plans, explain the ongoing process of measurement-based care, and provide participant and family education. Associations between cognitive impairments, disturbed sleep-wake behaviours, circadian rhythms, clinical symptoms and functional impairments will be evaluated to improve the understanding of parameters affecting clinical outcomes. ETHICS AND DISSEMINATION This study protocol was approved by the Human Research Ethics Committees of the University of Sydney (HREC USYD 2015/867) and St Vincent's Hospital (HREC SVH 17/045). This study will be published on completion in a peer-reviewed journal.
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Affiliation(s)
- Ashleigh M Tickell
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Cathrin Rohleder
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Alexandra Garland
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | | | | | - Kate Harel
- Young Adult Mental Health Unit, St Vincent's Private Hospital, Darlinghurst, New South Wales, Australia
| | - Lisa Parker
- Young Adult Mental Health Unit, St Vincent's Private Hospital, Darlinghurst, New South Wales, Australia
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Elizabeth Scott
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Young Adult Mental Health Unit, St Vincent's Private Hospital, Darlinghurst, New South Wales, Australia
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Rohleder C, Song YJC, Crouse JJ, Davenport TA, Iorfino F, Hamilton B, Zmicerevska N, Nichles A, Carpenter JS, Tickell AM, Wilson C, Cross SP, Guastella AJ, Koethe D, Leweke FM, Scott EM, Hickie IB. Youth Mental Health Tracker: protocol to establish a longitudinal cohort and research database for young people attending Australian mental health services. BMJ Open 2020; 10:e035379. [PMID: 32513883 PMCID: PMC7282334 DOI: 10.1136/bmjopen-2019-035379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/12/2020] [Accepted: 05/05/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Mental disorders are a leading cause of long-term disability worldwide. Much of the burden of mental ill-health is mediated by early onset, comorbidities with physical health conditions and chronicity of the illnesses. This study aims to track the early period of mental disorders among young people presenting to Australian mental health services to facilitate more streamlined transdiagnostic processes, highly personalised and measurement-based care, secondary prevention and enhanced long-term outcomes. METHODS AND ANALYSIS Recruitment to this large-scale, multisite, prospective, transdiagnostic, longitudinal clinical cohort study ('Youth Mental Health Tracker') will be offered to all young people between the ages of 12 and 30 years presenting to participating services with proficiency in English and no history of intellectual disability. Young people will be tracked over 3 years with standardised assessments at baseline and 3, 6, 12, 24 and 36 months. Assessments will include self-report and clinician-administered measures, covering five key domains including: (1) social and occupational function; (2) self-harm, suicidal thoughts and behaviour; (3) alcohol or other substance misuse; (4) physical health; and (5) illness type, clinical stage and trajectory. Data collection will be facilitated by the use of health information technology. The data will be used to: (1) determine prospectively the course of multidimensional functional outcomes, based on the differential impact of demographics, medication, psychological interventions and other key potentially modifiable moderator variables and (2) map pathophysiological mechanisms and clinical illness trajectories to determine transition rates of young people to more severe illness forms. ETHICS AND DISSEMINATION The study has been reviewed and approved by the Human Research Ethics Committee of the Sydney Local Health District (2019/ETH00469). All data will be non-identifiable, and research findings will be disseminated through peer-reviewed journals and scientific conference presentations.
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Affiliation(s)
- Cathrin Rohleder
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | | | - Jacob J Crouse
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Tracey A Davenport
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Frank Iorfino
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Blake Hamilton
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Natalia Zmicerevska
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Alissa Nichles
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Joanne S Carpenter
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Ashleigh M Tickell
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Chloe Wilson
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Shane P Cross
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Adam J Guastella
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Dagmar Koethe
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - F Markus Leweke
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - 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
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