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de Beer CRM, Nooteboom LA, van Domburgh L, de Vreugd M, Schoones JW, Vermeiren RRJM. A systematic review exploring youth peer support for young people with mental health problems. Eur Child Adolesc Psychiatry 2024; 33:2471-2484. [PMID: 36495354 PMCID: PMC11272732 DOI: 10.1007/s00787-022-02120-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
Youth peer support workers (YPSWs) are young adults with lived experience of mental illness during childhood or adolescence who support young people receiving treatment in mental health services. The contributions made by YPSWs are a promising development to facilitate consumer-centered and recovery-oriented care. Although the youth peer support workforce is expanding rapidly, structurally embedding YPSWs in practice is challenging. To overcome these challenges and thereby improve care for young people, insight into YPSW roles, barriers and facilitators for implementing and pursuing youth peer support (YPS) is a necessity. This systematic review examined the published literature to identify existing knowledge on YPSW roles in treatment settings, and the barriers and facilitators for implementing and pursuing YPS in practice. A total of 24 studies from a variety of youth serving contexts were included in this review. Thematic synthesis resulted in six YPSW roles and five themes with barriers and facilitators. The roles included the: engagement role, emotional support role, navigating and planning role, advocacy role, research role and the educational role. The themes explored the needs of YPSWs, experiences of YPSWs, relationships between service users and YPSWs, the collaboration process between YPSWs and non-peer staff, and organizational readiness. This review underlines that YPSWs likely are a valuable addition to numerous youth treatment contexts. Overall, the implementation of YPSWs is a multifaceted operation that requires careful planning. We recommend services to set clear and realistic expectations for YPSWs, to consider potential power imbalances between YPSWs and non-peer staff, to provide adequate resources to pursue YPS, and to approach the implementation of YPSWs with a growth mindset.
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Affiliation(s)
- C R M de Beer
- LUMC Curium, Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
| | - L A Nooteboom
- LUMC Curium, Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - L van Domburgh
- Department of Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam University Medical Center, Amsterdam, The Netherlands
- iHUB, Rotterdam, The Netherlands
| | - M de Vreugd
- LUMC Curium, Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - J W Schoones
- Directorate of Research Policy (Formerly: Walaeus Library), Leiden University Medical Center, Leiden, The Netherlands
| | - R R J M Vermeiren
- LUMC Curium, Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Youz, Parnassia Psychiatric Institute, The Hague, The Netherlands
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Ologundudu OM, Palaniyappan L, Cipriano LE, Wijnen BFM, Anderson KK, Ali S. Risk stratification for treating people at ultra-high risk for psychosis: A cost-effectiveness analysis. Schizophr Res 2023; 261:225-233. [PMID: 37804598 DOI: 10.1016/j.schres.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 08/27/2023] [Accepted: 09/04/2023] [Indexed: 10/09/2023]
Abstract
People who are at ultra-high risk (UHR) for psychosis receive clinical care with the aim to prevent first-episode psychosis (FEP), regardless of the risk of conversion to psychosis. An economic model from the Canadian health system perspective was developed to evaluate the cost-effectiveness of treating all with UHR compared to risk stratification over a 15-year time horizon, based on conversion probability, expected quality-of-life and costs. The analysis used a decision tree followed by a Markov model. Health states included: Not UHR, UHR with <20 % risk of conversion to FEP (based on the North American Prodrome Longitudinal Study risk calculator), UHR with ≥20 % risk, FEP, Remission, Post-FEP, and Death. The analysis found that: risk stratification (i.e., only treating those with ≥20 % risk) had lower costs ($1398) and quality-adjusted life-years (0.055 QALYs) per person compared to treating all. The incremental cost-effectiveness ratio for 'treat all' was $25,448/QALY, and suggests treating all may be cost-effective. The model was sensitive to changes to the probability of conversion.
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Affiliation(s)
- Olajumoke M Ologundudu
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Lena Palaniyappan
- Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada; Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Lauren E Cipriano
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada; Ivey Business School, Western University, London, Ontario, Canada
| | - Ben F M Wijnen
- Centre of Economic Evaluation (Trimbos Institute), Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands; Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Kelly K Anderson
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada; Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Shehzad Ali
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada; Department of Health Sciences, University of York, United Kingdom; Department of Psychology, Macquarie University, Australia.
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3
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Appleton R, Canaway A, Tuomainen H, Dieleman G, Gerritsen S, Overbeek M, Maras A, van Bodegom L, Franić T, de Girolamo G, Madan J, McNicholas F, Purper-Ouakil D, Schulze UME, Tremmery S, Singh SP. Predictors of transitioning to adult mental health services and associated costs: a cross-country comparison. BMJ MENTAL HEALTH 2023; 26:e300814. [PMID: 37879676 PMCID: PMC10603405 DOI: 10.1136/bmjment-2023-300814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/20/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Young people are at risk of falling through the care gap after leaving child and adolescent mental health services (CAMHS) despite an ongoing need for mental health support. Currently, little is known about the predictors of transitioning to adult mental health services (AMHS), and associated healthcare and societal costs as young people cross the transition boundary. OBJECTIVE To conduct a secondary data analysis exploring predictors of transitioning or falling through the gap and associated costs. METHODS Data were used from a longitudinal study, which followed young people from seven European countries for 2 years after reaching their CAMHS boundary. Predictors of transitioning (including sociodemographic and clinical variables) and longitudinal resource use were compared for 488 young people who transitioned to AMHS versus those who fell through the gap. FINDINGS Young people were more likely to transition to AMHS if they were severely ill. Those from Italy, the Netherlands and the UK were more likely to fall through the gap than transition to AMHS. Healthcare costs fell for all young people over the study, with a sharper decrease for those who fell through the gap. CONCLUSIONS Total healthcare costs fell for all participants, indicating that the intensity of mental health support reduces for all young people as they cross the CAMHS boundary, regardless of clinical need. CLINICAL IMPLICATIONS It is important that alternative forms of mental health support are available for young people who do not meet the AMHS care threshold but still have mental health needs after leaving CAMHS.
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Affiliation(s)
| | | | | | - Gwen Dieleman
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Suzanne Gerritsen
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Mathilde Overbeek
- Yulius Academy, Yulius Mental Health Organization, Dordrecht, The Netherlands
- ARQ National Pyschotrauma Centre, Diemen, The Netherlands
- Clinical Child and Family Studies, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Athanasios Maras
- Yulius Academy, Yulius Mental Health Organization, Dordrecht, The Netherlands
- ARQ National Pyschotrauma Centre, Diemen, The Netherlands
| | - Larissa van Bodegom
- Yulius Academy, Yulius Mental Health Organization, Dordrecht, The Netherlands
| | - Tomislav Franić
- Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia
| | - Giovanni de Girolamo
- Unit of Epidemiological Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Jason Madan
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Fiona McNicholas
- Department of Academic Child and Adolescent Psychiatry, University College Dublin, School of Medicine & Medical Science, Dublin, Ireland
- Lucena Child and Adolescent Mental Health Services, St. John of God Community Services, Dublin, Ireland
| | - Diane Purper-Ouakil
- Service de Médecine Psychologique de l'Enfant et de l'Adolescent, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France
- Team PsyDev, CESP U1018, INSERM, Université de Versailles Saint-Quentin-en-Yvelines, University Paris Saclay, Paris, France
| | - Ulrike M E Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
- Centre for Psychiatry Calw, Böblingen, Germany
| | | | - Swaran P Singh
- Warwick Medical School, University of Warwick, Coventry, UK
- Children and Young People's Mental Health Service, Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
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Canaway A, Appleton R, van Bodegom L, Dieleman G, Franić T, Gerritsen S, de Girolamo G, Maras A, McNicholas F, Overbeek M, Paul M, Purper-Ouakil D, Santosh P, Schulze U, Singh SP, Street C, Tah P, Tremmery B, Tuomainen H, Verhulst FC, Wolke D, Madan J. Healthcare costs for young people transitioning the boundary between child/adolescent and adult mental health services in seven European countries: results from the MILESTONE study. BJPsych Open 2023; 9:e175. [PMID: 37749976 PMCID: PMC10617498 DOI: 10.1192/bjo.2023.559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND The boundary between services for children and adolescents and adults has been identified as problematic for young people with mental health problems. AIMS To examine the use and cost of healthcare for young people engaged in mental healthcare before and after the child/adolescent and adult service boundary. METHOD Data from 772 young people in seven European countries participating in the MILESTONE trial were analysed. We analysed and costed healthcare resources used in the 6-month period before and after the service boundary. RESULTS The proportion of young people engaging with healthcare services fell substantially after crossing the service boundary (associated costs €7761 pre-boundary v. €3376 post-boundary). Pre-boundary, the main cost driver was in-patient care (approximately 50%), whereas post-boundary costs were more evenly spread between services; cost reductions were correlated with pre-boundary in-patient care. Severity was associated with substantially higher costs pre- and post-boundary, and those who were engaged specifically with mental health services after the service boundary accrued the greatest healthcare costs post-service boundary. CONCLUSIONS Costs of healthcare are large in this population, but fall considerably after transition, particularly for those who were most severely ill. In part, this is likely to reflect improvement in the mental health of young people. However, qualitative evidence from the MILESTONE study suggests that lack of capacity in adult services and young people's disengagement with formal mental health services post-transition are contributing factors. Long-term data are needed to assess the adverse long-term effects on costs and health of this unmet need and disengagement.
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Affiliation(s)
- Alastair Canaway
- Centre for Health Economics at Warwick, Warwick Medical School, University of Warwick, UK
| | - Rebecca Appleton
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK
| | - Larissa van Bodegom
- Yulius Academy, Yulius Mental Health Organization, The Netherlands; and Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, The Netherlands
| | - Gwen Dieleman
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, The Netherlands
| | - Tomislav Franić
- Department of Psychiatry, University Hospital Split, Croatia; and School of Medicine, University of Split, Croatia
| | - Suzanne Gerritsen
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, The Netherlands
| | - Giovanni de Girolamo
- Unit of Epidemiological Psychiatry and Evaluation, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Italy
| | - Athanasios Maras
- Yulius Academy, Yulius Mental Health Organization, The Netherlands; and Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, The Netherlands
| | - Fiona McNicholas
- School of Medicine and Medical Science, University College Dublin, Republic of Ireland; and Lucena Child and Adolescent Mental Health Services, St. John of God Community Services, Republic of Ireland
| | - Mathilde Overbeek
- Yulius Academy, Yulius Mental Health Organization, The Netherlands and Clinical Child and Family Studies, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, The Netherlands
| | - Moli Paul
- Warwick Medical School, University of Warwick, UK and Children and Young People’s Mental Health Service, Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - Diane Purper-Ouakil
- Child and Adolescent Psychiatry Unit, Centre Hospitalier Universitaire de Montpellier, Saint Eloi Hospital, France; and Team PsyDev, CESP U1018, INSERM, Université de Versailles Saint-Quentin-en-Yvelines, University Paris Saclay, France
| | - Paramala Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, UK; and HealthTracker Ltd, UK
| | - Ulrike Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Germany
| | - Swaran P. Singh
- Warwick Medical School, University of Warwick, UK and Children and Young People’s Mental Health Service, Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - Cathy Street
- Warwick Medical School, University of Warwick, UK
| | - Priya Tah
- Warwick Medical School, University of Warwick, UK
| | | | | | - Frank C. Verhulst
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, The Netherlands; and Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Dieter Wolke
- Department of Psychology, University of Warwick, UK
| | - Jason Madan
- Centre for Health Economics at Warwick, Warwick Medical School, University of Warwick, UK
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“It cannot be boring!”: Developing a measure of function for young adults accessing integrated youth services. J Patient Rep Outcomes 2022; 6:92. [PMID: 36057736 PMCID: PMC9440742 DOI: 10.1186/s41687-022-00491-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background In Canada, the prevalence of mental health challenges is highest in young people aged 12–24. Mental health challenges frequently cause marked functional impairment. Despite this, we are unaware of any existing conceptualization and/or measures of function that has been developed from the perspective of young people. The objective of this paper is to develop a conceptual and measurement model, including a preliminary set of items, for an outcome measure of function for young adults accessing mental health services. Methods We conducted this study in three phases. In phase 1, we conducted three focus groups to conceptualize function as a construct from the perspective of young adults. In phase 2, we co-designed a set of items with youth (n = 4) to capture the construct. In phase 3, we invited young people (n = 12) accessing mental health services to complete workbooks and participate in one of two focus groups to evaluate whether items were clear, captured function comprehensively, and were relevant. We transcribed and compiled all data to eliminate, refine and generate new items. Results In phase 1, a conceptual model of function was developed with three main themes: basic needs, roles and responsibilities, and social connections. In phase 2, 97 candidate items were developed, and in phase 3, a candidate pool of 50 items resulted for psychometric testing. Conclusion This youth-centred conceptualization of function and preliminary item bank has the potential to advance person-centred care, outcomes, and experiences for youth seeking mental health services. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-022-00491-6.
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Mathias S, Tee K, Helfrich W, Gerty K, Chan G, Barbic SP. Foundry: Early learnings from the implementation of an integrated youth service network. Early Interv Psychiatry 2022; 16:410-418. [PMID: 34008340 PMCID: PMC9292689 DOI: 10.1111/eip.13181] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 05/06/2021] [Accepted: 05/09/2021] [Indexed: 12/16/2022]
Abstract
AIMS To provide the first profile of the demographic and service characteristics of young people (aged 12-24 years) who access Foundry, a provincial network of integrated youth health and social service centres in British Columbia, Canada and to share early learnings about implementation and service innovation. METHODS Using a retrospective chart review, we conducted a census of all young people accessing a Foundry centre in a 'proof of concept' phase. Six centres were assessed between October 2015 and March 2018. Data included demographics, mental health service access history, service type the youth was seeking, and information about how they found out about the centre. RESULTS A total of 4783 young people presented during this proof of concept period, for a total number of 35 791 visits. The most frequently accessed category of service was mental health/substance use (57%) followed by physical health (25%). Young people were most likely to be female, aged 15-19, and White. Youth demographic characteristics showed an over-representation of Indigenous and LGBTQ2 youth and under-representation of males and youth aged 20-24. Youth were most likely to learn about Foundry from a friend (44%) or family member (22%). Most youth (58%) reported that they would have gone 'nowhere' if not for Foundry. CONCLUSIONS Foundry is a model of integrated health and social services delivery, focused on early intervention, prevention and accessibility, driven by the needs and priorities of young people and their families. Leveraging international integrated youth health service evidence, the model addresses urgent priorities in Canadian health service delivery.
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Affiliation(s)
- Steve Mathias
- Foundry, Providence Health Care, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Psychiatry, Providence Health Care, St. Paul's Hospital, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.,Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Karen Tee
- Foundry, Providence Health Care, Vancouver, British Columbia, Canada
| | - Warren Helfrich
- Foundry, Providence Health Care, Vancouver, British Columbia, Canada
| | - Krista Gerty
- Foundry, Providence Health Care, Vancouver, British Columbia, Canada
| | - Godwin Chan
- Foundry, Providence Health Care, Vancouver, British Columbia, Canada
| | - Skye Pamela Barbic
- Foundry, Providence Health Care, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.,Providence Health Care Research Institute, Vancouver, British Columbia, Canada.,Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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7
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White C, Nash L, Karageorge A, van der Pol R, Hunt GE, Hamilton B, Isobel S. Bridging the gap: A new integrated early intervention service for young people with complex mental health issues. Early Interv Psychiatry 2022; 16:186-194. [PMID: 33949103 DOI: 10.1111/eip.13152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/17/2021] [Accepted: 04/20/2021] [Indexed: 11/29/2022]
Abstract
AIM Two integrated headspace Early Intervention Teams (hEITs) were established in 2017 to bridge gaps between headspace, the national primary care youth mental health programme in Australia, and the state funded secondary and tertiary mental health services. This study aims to describe functioning and outcomes of patients referred to hEIT over a 6-month period. METHODS A retrospective file audit was conducted for all patients accepted into the service over a 6-month period in 2018. Measures of distress, functioning and client satisfaction were collected and analysed. Exemplar vignettes were created to construct hypothetical examples and illustrate research findings. RESULTS At admission, the three most common presentations were depression/anxiety, trauma and stress related, and psychotic disorders. During their time in the service, young people displayed a statistically significant improvement in functioning, reduction in self-harm in those 18 years and under, and a trend to reduction in distress scores. hEIT delivered a broad range of services covering social, occupational, educational, medical and mental health care, and the service was experienced positively by the patient cohort. CONCLUSIONS hEIT appears to meet the needs of young people requiring greater care than primary care services can deliver. The integrated, wrap-around care coordination facilitates treatments across social, educational and health domains. Further exploration of young people who disengage from care, improved outcome data reporting and economic evaluation are indicated.
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Affiliation(s)
| | - Louise Nash
- Sydney Local Health District, Sydney, Australia.,Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Aspasia Karageorge
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | | | - Glenn E Hunt
- Sydney Local Health District, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | | | - Sophie Isobel
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Waite M, Atkinson C. A review of mental health and wellbeing measures for universal secondary school screening. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2021. [DOI: 10.1080/13632752.2021.1939997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Michael Waite
- Educational Psychologist, Waite Psychology, Lancashire, UK
| | - Cathy Atkinson
- Curriculum Director, Doctorate in Educational and Child Psychology, Room A6.5, School of Environment, Education and Development (SEED), Ellen Wilkinson Building, the University of Manchester, Manchester, UK
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9
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Barnett P, Arundell LL, Matthews H, Saunders R, Pilling S. 'Five hours to sort out your life': qualitative study of the experiences of university students who access mental health support. BJPsych Open 2021; 7:e118. [PMID: 36043691 PMCID: PMC8269927 DOI: 10.1192/bjo.2021.947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Previous qualitative research suggests that university students feel that current service provision does not meet their needs. Exploring the reasons for this may help to promote service change, encourage the uptake of care, improve outcomes and increase satisfaction within university services. AIMS This study aimed to improve the understanding of how students experience the process of accessing and using mental health support, barriers and facilitators to treatment, and how students would adapt provision to improve experiences. METHOD Semi-structured interviews were conducted with 16 full-time students who had used mental health services at university. Data were analysed using thematic analysis. RESULTS Five higher-order themes were identified: personalisation and informed choice, simplifying the process, feeling abandoned ignored or invisible, stigma, and superiority of private and external services. Sixteen subthemes were identified within these themes. CONCLUSIONS Findings indicate that access to mental health support should be simplified, with collaboration across university and external health and care services, to prevent students feeling lost or abandoned when seeking care. An inclusive approach to support access and provision of services for all presentations of mental health problems should be developed.
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Affiliation(s)
- Phoebe Barnett
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational, and Health Psychology, University College London, UK
| | - Laura-Louise Arundell
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational, and Health Psychology, University College London, UK; and National Collaborating Centre for Mental Health, Royal College of Psychiatrists, UK
| | | | - Rob Saunders
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational, and Health Psychology, University College London, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational, and Health Psychology, University College London, UK; National Collaborating Centre for Mental Health, Royal College of Psychiatrists, UK; and Camden and Islington NHS Foundation Trust, UK
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10
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Evaluated Interventions Addressing Developmental Transitions for Youth with Mental Health Disorders: an Updated Scoping Review. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2021. [DOI: 10.1007/s40474-020-00221-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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11
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Ostinelli EG, Cavallotti S, Fanti V, Demartini B, Gambini O, D'Agostino A. The reMAP project: A retrospective, 15-year register study on inpatient care for youth with mental disorders. Early Interv Psychiatry 2020; 14:705-713. [PMID: 31769192 DOI: 10.1111/eip.12899] [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: 05/12/2019] [Revised: 08/21/2019] [Accepted: 10/20/2019] [Indexed: 12/30/2022]
Abstract
AIM We aimed to characterize youth hospitalization trends in a psychiatric inpatient unit from a large, public university hospital with a broad catchment area in Milan, Italy. METHODS Hospitalization data of patients with an age at admission ≤ 35 were retrospectively retrieved over a time span of 15 years. The sample was comprised of 1982 admissions to a psychiatric ward, aggregated into ICD-10 diagnostic clusters and then analysed. We investigated the epidemiological trends with a focus on age at admission, gender, nationality and hospitalization rates, length of stay and "revolving door" readmissions within a year. RESULTS Hospitalization rates increased for eating Disorders and decreased for non-affective psychotic disorders; median length of stay generally decreased; hospitalization rates for foreign youth increased, in particular for those diagnosed with non-affective psychotic disorders, personality disorders, and substance-related and addictive disorders. The revolving door phenomenon was also associated with non-affective psychoses and neurodevelopmental disorders, while found to increase for eating disorders. CONCLUSIONS Hospitalization patterns reflect the general increase of foreign youth in the suburban tissue of a large metropolitan area like Milan. However, our data might underestimate the constant growth of mental health problems in foreign youth due to a generally lower access to services. Novel pharmacological treatments and early intervention programs might explain the decrease of hospitalization duration and hospitalization rate for youth with non-affective psychoses. The observed increase in hospitalization for young patients with eating disorders sustains the development of adequate policies tailored towards specialty wards.
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Affiliation(s)
- Edoardo G Ostinelli
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
| | | | - Valentina Fanti
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
| | - Benedetta Demartini
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
| | - Orsola Gambini
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
| | - Armando D'Agostino
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
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12
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Lake JK, Tablon Modica P, Chan V, Weiss JA. Considering efficacy and effectiveness trials of cognitive behavioral therapy among youth with autism: A systematic review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:1590-1606. [PMID: 32423224 DOI: 10.1177/1362361320918754] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
LAY ABSTRACT Cognitive behavioral therapy is a common treatment for emotional problems in people with autism. Most studies of cognitive behavioral therapy and autism have focused on efficacy, meaning whether a treatment produces results under "ideal" conditions, like a lab or research setting. Effectiveness trials, by contrast, investigate whether a treatment produces results under "real-world" conditions, like a community setting (e.g. hospital, community mental health center, school). There can be challenges in bringing a cognitive behavioral therapy treatment out of a lab or research setting into the community, and the field of implementation science uses frameworks to help guide researchers in this process. In this study, we reviewed efficacy and effectiveness studies of cognitive behavioral therapy treatments for emotional problems (e.g. anxiety, depression) in children and youth with autism. Our search found 2959 articles, with 33 studies meeting our criteria. In total, 13 studies were labelled as effectiveness and 20 as efficacy. We discuss how the effectiveness studies used characteristics of an implementation science framework, such as studying how individuals learn about the treatment, accept or reject it, how it is used in the community over time, and any changes that happened to the individual or the organization (e.g. hospital, school, community mental health center) because of it. Results help us better understand the use of cognitive behavioral therapy in the community, including how a framework can be used to improve effectiveness studies.
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Affiliation(s)
- Johanna K Lake
- Centre for Addiction and Mental Health, Canada.,University of Toronto, Canada
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13
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Bentley N, Hartley S, Bucci S. Systematic Review of Self-Report Measures of General Mental Health and Wellbeing in Adolescent Mental Health. Clin Child Fam Psychol Rev 2020; 22:225-252. [PMID: 30617936 DOI: 10.1007/s10567-018-00273-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The assessment of general mental health and wellbeing is important within child and adolescent mental health services (CAMHS) for both clinicians and policy makers. Measurement tools are routinely relied upon to aid assessment and to monitor and evaluate treatment and service effectiveness. We conducted a systematic review using the COSMIN checklist to identify measures of general mental health and wellbeing for an adolescent mental health population. A systematic database search was performed using PsychINFO, MEDLINE, EMBASE, and CINAHL in accordance with PRISMA guidelines. Database searching produced 9587 records, with 27 papers meeting eligibility criteria and 16 measures identified and critically appraised. The Y-QOL-R and the Y-QOL.30.1 had the most robust psychometric properties. When considering the clinical utility of measures alongside psychometric properties of measures, the GHQ-12, ORS and YP CORE had the greatest clinical utility. The psychometric quality of measures reviewed overall, however, were generally poor in quality. Measuring outcomes in CAMHS and ensuring appropriate treatment pathways for young people is important. This review highlights the need for more robust testing of the psychometric properties of adolescent measures. When selecting measurement tools, clinicians should not only consider the purpose of the measure, (i.e., discriminative, predictive, and evaluative) and characteristics of the instrument (e.g., intended population, measure length), but should also the quality of the psychometric properties of the instrument.
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Affiliation(s)
- Natalie Bentley
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, 2nd Floor, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
| | - Samantha Hartley
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, 2nd Floor, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.,Pennine Care NHS Foundation Trust, Manchester, M13 9PL, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, 2nd Floor, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK. .,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
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14
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Broersen M, Frieswijk N, Kroon H, Vermulst AA, Creemers DHM. Young Patients With Persistent and Complex Care Needs Require an Integrated Care Approach: Baseline Findings From the Multicenter Youth Flexible ACT Study. Front Psychiatry 2020; 11:609120. [PMID: 33324268 PMCID: PMC7724087 DOI: 10.3389/fpsyt.2020.609120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/29/2020] [Indexed: 12/27/2022] Open
Abstract
Background: The Multicenter Youth Flexible ACT Study is an ongoing observational prospective cohort study that examines the effects of Youth Flexible ACT (Assertive Community Treatment) on young people with complex care needs who are difficult to engage in traditional (office-based) mental health services. However, a clear and detailed description of this patient group is lacking. In the current paper, we present baseline characteristics and psychosocial outcomes of the Youth Flexible ACT target group and explore the existence of underlying specific patient subgroups. Methods: Sixteen Youth Flexible ACT teams from seven mental healthcare institutes in the Netherlands participated in the study. Research participants were monitored for 18 months and administered questionnaires measuring psychiatric- and social functioning every 6 months, yielding four measurements. Baseline data were obtained from 199 adolescents, their mental health workers, and parents/carers. Latent Class Analysis based on HoNOSCA scores (measuring psychosocial and daily functioning) was conducted to identify underlying subgroups. Results: The target group of Youth Flexible ACT mainly consisted of patients older than 15 years of age with a history of (specialized) mental healthcare. They face many complex problems, including trauma; developmental, mood, and anxiety disorders; and problems with school attendance, family life, and peer relationships. Other frequently reported difficulties were substance misuse, the involvement of the legal system or police, problems with intellectual functioning, and personal finance. Patients were classified into four distinct classes: the "internalizing," "externalizing," "non-specific," and the "overly impulsive" subgroup. Each subgroup had its unique pattern of difficulties and focus, respectively, high levels of depression and anxiety, disruptive behavior, unspecific difficulties, and substance misuse. Conclusions: As expected, patients in Youth Flexible ACT experienced many severe problems, rendering them vulnerable to fragmented and, thus, ineffective care. Our findings underscore the need for an integrated care approach with a multidisciplinary team of skilled professionals that can bridge these wide-ranging psychosocial problems, as each class of participants experienced a different set of difficulties. Youth Flexible ACT teams need to adjust their care services accordingly.
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Affiliation(s)
- Marieke Broersen
- GGZ Oost Brabant, Oss, Netherlands.,Tranzo - Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | | | - Hans Kroon
- Tranzo - Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Trimbos Institute, Utrecht, Netherlands
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15
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Haidl TK, Seves M, Eggers S, Rostamzadeh A, Genske A, Jünger S, Woopen C, Jessen F, Ruhrmann S, Vogeley K. Health literacy in clinical-high-risk individuals for psychosis: A systematic mixed-methods review. Early Interv Psychiatry 2019; 13:1293-1309. [PMID: 30688012 DOI: 10.1111/eip.12776] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/30/2018] [Accepted: 12/26/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Numerous studies suggest that health literacy (HL) plays a crucial role in maintaining and improving individual health. Empirical findings highlight the relation between levels of a person's HL and her/his clinical outcome. To date, the role of HL in persons at-risk for psychosis has not been systematically reviewed. METHODS We conducted a systematic review using a mixed-methods approach to analyse a variety of study types. Peer-reviewed publications were systematically searched in PUBMED, Cochrane Library, PsycINFO and Web of Science. RESULTS The search string returned 10587 publications. After screening, 15 quantitative, four qualitative studies and two reviews were included. Only one study assessed HL as primary outcome, assessing knowledge and beliefs about psychosis among the general population. In the other studies, sub-dimensions of HL were investigated. None of the publications operationalized HL or it's sub-dimensions with a validated measure. CONCLUSIONS A lack of understanding of their condition, and fear of stigmatization, were associated with a delay in help-seeking among people with clinical-high-risk state for psychosis. Family members, school personnel, general practitioners and the internet play a crucial role in the HL process. Considerable barriers in obtaining adequate specialist support emphasize the urgent need of a "HL environment" for persons at risk for psychosis.
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Affiliation(s)
- Theresa K Haidl
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Mauro Seves
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Susanne Eggers
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Ayda Rostamzadeh
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Anna Genske
- Cologne Center for Ethics, Rights, Economics and Social Sciences of Health (CERES), University of Cologne, Cologne, Germany.,Research Unit Ethics, Institute for the History of Medicine and Medical Ethics, University of Cologne, Cologne, Germany
| | - Saskia Jünger
- Cologne Center for Ethics, Rights, Economics and Social Sciences of Health (CERES), University of Cologne, Cologne, Germany.,Research Unit Ethics, Institute for the History of Medicine and Medical Ethics, University of Cologne, Cologne, Germany
| | - Christiane Woopen
- Cologne Center for Ethics, Rights, Economics and Social Sciences of Health (CERES), University of Cologne, Cologne, Germany.,Research Unit Ethics, Institute for the History of Medicine and Medical Ethics, University of Cologne, Cologne, Germany
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Kai Vogeley
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
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16
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Gmitroski T, Bradley C, Heinemann L, Liu G, Blanchard P, Beck C, Mathias S, Leon A, Barbic SP. Barriers and facilitators to employment for young adults with mental illness: a scoping review. BMJ Open 2018; 8:e024487. [PMID: 30567825 PMCID: PMC6303634 DOI: 10.1136/bmjopen-2018-024487] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES The issue of gaining employment for those with mental illness is a growing global concern. For many in the young adult population, who are at a transitional age, employment is a central goal. In response, we conducted a scoping review to answer the question, 'What are the barriers and facilitators to employment for young adults with mental illness?' DESIGN We conducted a scoping review in accordance to the Arksey and O'Malley framework. We performed a thorough search of Medline, EMBASE, CINAHL, ABI/INFORM, PsycINFO and Cochrane. We included studies that considered young adults aged 15-29 years of age with a mental health diagnosis, who were seeking employment or were included in an employment intervention. RESULTS Our search resulted in 24 research articles that focused on employment for young adults with mental illness. Four main themes were extracted from the literature: (1) integrated health and social services, (2) age-exposure to employment supports, (3) self-awareness and autonomy and (4) sustained support over the career trajectory. CONCLUSIONS Our review suggests that consistent youth-centred employment interventions, in addition to usual mental health treatment, can facilitate young adults with mental illness to achieve their employment goals. Aligning the mental health and employment priorities of young adults may result in improved health and social outcomes for this population while promoting greater engagement of young adults in care.
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Affiliation(s)
- Taryn Gmitroski
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, UBC, Vancouver, British Columbia, Canada
| | - Christl Bradley
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, UBC, Vancouver, British Columbia, Canada
| | - Lyn Heinemann
- Canadian Mental Health Association, Vancouver, British Columbia, Canada
| | - Grace Liu
- Providence Health, Vancouver, British Columbia, Canada
- Foundry, Vancouver, British Columbia, Canada
| | - Paige Blanchard
- Providence Health, Vancouver, British Columbia, Canada
- Foundry, Vancouver, British Columbia, Canada
| | - Charlotte Beck
- UBC Library, University of British Columbia, Vancouver, British Columbia, Canada
| | - Steve Mathias
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Foundry, Vancouver, British Columbia, Canada
- UBC Library, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adelena Leon
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, UBC, Vancouver, British Columbia, Canada
| | - Skye Pamela Barbic
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, UBC, Vancouver, British Columbia, Canada
- Foundry, Vancouver, British Columbia, Canada
- UBC Library, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Psychiatry, St Paul's Hospital, Vancouver, British Columbia, Canada
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17
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Carter PM, Dora-Laskey AD, Goldstick JE, Heinze JE, Walton MA, Zimmerman MA, Roche JS, Cunningham RM. Arrests Among High-Risk Youth Following Emergency Department Treatment for an Assault Injury. Am J Prev Med 2018; 55:812-821. [PMID: 30344036 PMCID: PMC6246796 DOI: 10.1016/j.amepre.2018.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/20/2018] [Accepted: 07/03/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Violence is a leading cause of morbidity and mortality for youth, with more than 600,000 emergency department visits annually for assault-related injuries. Risk for criminal justice involvement among this population is poorly understood. The objective of this study was to characterize arrests among high-risk, assault-injured, drug-using youth following emergency department treatment. METHODS Youth (aged 18-24 years) with past 6-month drug use who were seeking emergency department treatment for either an assault or for non-violence reasons were enrolled (December 2009-September 2011) in a 2-year longitudinal study. Arrests in the 24 months following the emergency department visit were analyzed in 2016-2017 using survival analysis of objective Law Enforcement Information Network data. Hazard ratios quantifying the association between risk factors for arrest were estimated using Cox regression. RESULTS In the longitudinal cohort, 511 youth seeking emergency department care (assault injury group n=299, comparison group n=212) were aged ≥18 years and were included for analysis. Youth in the assault injury group cohort had a 47% higher risk of arrest than the comparison group (38.1% vs 25.9%, RR=1.47, p<0.05). In unadjusted analyses, male sex, assault injury, binge drinking, drug use disorder, and community violence exposure were all associated with increased risk of arrest during the follow-up period. Cox regression identified that male sex (hazard ratio=2.57), drug use disorder diagnosis (hazard ratio=1.42), assault injury at baseline (hazard ratio=1.63), and community violence exposure (hazard ratio=1.35) increased risk for arrest. CONCLUSIONS Drug-using assault-injured youth have high rates of arrest. Emergency department and community interventions addressing substance use and violence involvement may aid in decreasing negative violence and criminal justice outcomes among high-risk youth. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT01152970.
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Affiliation(s)
- Patrick M Carter
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan.
| | - Aaron D Dora-Laskey
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; Hurley Medical Center, Department of Emergency Medicine, Flint, Michigan
| | - Jason E Goldstick
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Justin E Heinze
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan; Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Maureen A Walton
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan; University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Marc A Zimmerman
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan; Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Jessica S Roche
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Rebecca M Cunningham
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan; Hurley Medical Center, Department of Emergency Medicine, Flint, Michigan; Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
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18
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Aas E, Iversen T, Holt T, Ormhaug SM, Jensen TK. Cost-Effectiveness Analysis of Trauma-Focused Cognitive Behavioral Therapy: A Randomized Control Trial among Norwegian Youth. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2018; 48:S298-S311. [PMID: 29877724 DOI: 10.1080/15374416.2018.1463535] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Traumatic events by young people can adversely affect their psychological and social well-being when left untreated. This can result in high costs for society. In this study, we aimed to evaluate whether trauma-focused cognitive behavioral therapy (TF-CBT) is a cost-effective alternative to therapy as usual (TAU). Individual-level data were collected from 2008 to 2013, as part of a randomized control trial in Norwegian youth, 10-18 years of age, presenting with symptoms of posttraumatic stress (N = 156). Health outcomes, costs, and patient and family characteristics were recorded. Health-related quality of life (HRQoL) was measured with the 16D instrument, and quality-adjusted life-years (QALYs) were derived; total costs included the costs of therapy, and last we calculated the incremental cost-effectiveness ratio (ratio of differences in costs and QALYs gained). We performed nonparametric bootstrapping and used the results to draw a cost-effectiveness acceptability curve depicting the probability that TF-CBT is cost-effective. HRQoL increased in both treatment groups, whereas no significant differences in QALYs were observed. Resource use measured in minutes per session was significantly higher in the TF-CBT group; however, total minutes of therapy and costs were not significantly different between the two groups. In addition, use of resources, such as psychological counseling services, welfare services, and medication, was lower in the TF-CBT group posttreatment. The likelihood of TF-CBT being cost-effective varied from 91% to 96%. TF-CBT is likely to be a cost-effective alternative to standard treatment and should be recommended as the guideline treatment for youth with posttraumatic stress disorder.
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Affiliation(s)
- Eline Aas
- a Department of Health Management and Health Economics , University of Oslo
| | - Tor Iversen
- a Department of Health Management and Health Economics , University of Oslo
| | - Tonje Holt
- b Norwegian Centre for Violence and Traumatic Stress Studies
| | | | - Tine K Jensen
- b Norwegian Centre for Violence and Traumatic Stress Studies.,d Department of Psychology , University of Oslo
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19
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Hamilton MP, Hetrick SE, Mihalopoulos C, Baker D, Browne V, Chanen AM, Pennell K, Purcell R, Stavely H, McGorry PD. Identifying attributes of care that may improve cost‐effectiveness in the youth mental health service system. Med J Aust 2017; 207:S27-S37. [DOI: 10.5694/mja17.00972] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 10/17/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Matthew P Hamilton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Sarah E Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
- Centre of Youth Mental Health, University of Melbourne, Melbourne, VIC
| | | | - David Baker
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Vivienne Browne
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
- Centre of Youth Mental Health, University of Melbourne, Melbourne, VIC
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
- Centre of Youth Mental Health, University of Melbourne, Melbourne, VIC
| | - Kerryn Pennell
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Rosemary Purcell
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
- Centre of Youth Mental Health, University of Melbourne, Melbourne, VIC
| | - Heather Stavely
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
- Centre of Youth Mental Health, University of Melbourne, Melbourne, VIC
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20
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Schubert KO, Clark SR, Van LK, Collinson JL, Baune BT. Depressive symptom trajectories in late adolescence and early adulthood: A systematic review. Aust N Z J Psychiatry 2017; 51:477-499. [PMID: 28415879 DOI: 10.1177/0004867417700274] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE In adolescents and young adults, depressive symptoms are highly prevalent and dynamic. For clinicians, it is difficult to determine whether a young person reporting depressive symptoms is at risk of developing ongoing mood difficulties or whether symptoms form part of a transient maturational process. Trajectory analyses of longitudinally assessed symptoms in large cohorts have the potential to untangle clinical heterogeneity by determining subgroups or classes of symptom course and their risk factors, by interrogating the impact of known or suspected risk factors on trajectory slope and intercept and by tracing the interrelation between depressive symptoms and other clinical outcomes over time. METHOD We conducted a systematic review of trajectory studies conducted in cohorts including people aged between 15 and 25 years. RESULTS We retrieved 47 relevant articles. These studies suggest that young people fall into common mood trajectory classes and that class membership and symptom course are mediated by biological and environmental risk factors. Furthermore, studies provide evidence that high and persistent depressive symptoms are associated with a range of concurrent health and behavioral outcomes. CONCLUSION Findings could assist in the formulation of novel concepts of depressive disorders in young people and inform preventive strategies and predictive models for clinical practice.
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Affiliation(s)
- Klaus Oliver Schubert
- 1 Discipline of Psychiatry, The University of Adelaide, Adelaide, SA, Australia.,2 Lyell McEwin Hospital, Northern Adelaide Local Health Network, Mental Health Service, Adelaide, SA, Australia
| | - Scott R Clark
- 1 Discipline of Psychiatry, The University of Adelaide, Adelaide, SA, Australia
| | - Linh K Van
- 1 Discipline of Psychiatry, The University of Adelaide, Adelaide, SA, Australia
| | - Jane L Collinson
- 1 Discipline of Psychiatry, The University of Adelaide, Adelaide, SA, Australia
| | - Bernhard T Baune
- 1 Discipline of Psychiatry, The University of Adelaide, Adelaide, SA, Australia
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21
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Cuando la asistencia no sigue a la evidencia: el caso de la falta de programas de intervención temprana en psicosis en España. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2017; 10:78-86. [DOI: 10.1016/j.rpsm.2017.01.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 11/11/2016] [Accepted: 01/03/2017] [Indexed: 12/14/2022]
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22
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Shah JL, Chakravarty MM, Joober R, Lepage M. Dynamic endophenotypes and longitudinal trajectories: capturing changing aspects of development in early psychosis. J Psychiatry Neurosci 2016; 41:148-51. [PMID: 27116900 PMCID: PMC4853205 DOI: 10.1503/jpn.160053] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Jai L. Shah
- From PEPP-Montréal, Douglas Mental Health University Institute (Shah, Chakravarty, Joober, Lepage); Cerebral Imaging Centre, Douglas Mental Health University Institute (Chakravarty); and the Department of Psychiatry, McGill University (Shah, Chakravarty, Joober, Lepage), Montreal, Que., Canada
| | - M. Mallar Chakravarty
- From PEPP-Montréal, Douglas Mental Health University Institute (Shah, Chakravarty, Joober, Lepage); Cerebral Imaging Centre, Douglas Mental Health University Institute (Chakravarty); and the Department of Psychiatry, McGill University (Shah, Chakravarty, Joober, Lepage), Montreal, Que., Canada
| | - Ridha Joober
- From PEPP-Montréal, Douglas Mental Health University Institute (Shah, Chakravarty, Joober, Lepage); Cerebral Imaging Centre, Douglas Mental Health University Institute (Chakravarty); and the Department of Psychiatry, McGill University (Shah, Chakravarty, Joober, Lepage), Montreal, Que., Canada
| | - Martin Lepage
- From PEPP-Montréal, Douglas Mental Health University Institute (Shah, Chakravarty, Joober, Lepage); Cerebral Imaging Centre, Douglas Mental Health University Institute (Chakravarty); and the Department of Psychiatry, McGill University (Shah, Chakravarty, Joober, Lepage), Montreal, Que., Canada
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23
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Grant WB. The role of geographical ecological studies in identifying diseases linked to UVB exposure and/or vitamin D. DERMATO-ENDOCRINOLOGY 2016; 8:e1137400. [PMID: 27195055 PMCID: PMC4862381 DOI: 10.1080/19381980.2015.1137400] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 12/28/2015] [Indexed: 02/06/2023]
Abstract
Using a variety of approaches, researchers have studied the health effects of solar ultraviolet (UV) radiation exposure and vitamin D. This review compares the contributions from geographical ecological studies with those of observational studies and clinical trials. Health outcomes discussed were based on the author's knowledge and include anaphylaxis/food allergy, atopic dermatitis and eczema, attention deficit hyperactivity disorder, autism, back pain, cancer, dental caries, diabetes mellitus type 1, hypertension, inflammatory bowel disease, lupus, mononucleosis, multiple sclerosis, Parkinson disease, pneumonia, rheumatoid arthritis, and sepsis. Important interactions have taken place between study types; sometimes ecological studies were the first to report an inverse correlation between solar UVB doses and health outcomes such as for cancer, leading to both observational studies and clinical trials. In other cases, ecological studies added to the knowledge base. Many ecological studies include other important risk-modifying factors, thereby minimizing the chance of reporting the wrong link. Laboratory studies of mechanisms generally support the role of vitamin D in the outcomes discussed. Indications exist that for some outcomes, UVB effects may be independent of vitamin D. This paper discusses the concept of the ecological fallacy, noting that it applies to all epidemiological studies.
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Affiliation(s)
- William B. Grant
- Sunlight, Nutrition, and Health Research Center, San Francisco, CA, USA
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