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Gao CX, Clarke E, Nicholas J, Teo SM, Koppe C, Peter G, Lum A, Barth T, Farish S, Rudd M, Gong Y, Gan DZQ, Browne V, Tjia T, Filia KM, Killackey E. Changes in Rates of Special Considerations in Higher Education Applications Pre- and During the COVID-19 Pandemic in Victoria, Australia. Early Interv Psychiatry 2024. [PMID: 39140403 DOI: 10.1111/eip.13603] [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: 02/01/2024] [Revised: 07/18/2024] [Accepted: 07/25/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND AND AIMS Since the onset of the COVID-19 pandemic, a significant rise in mental ill health has been observed globally in young people, particularly those in their final years of secondary school. Students' negative experiences coincide with a critical transitional period which can disrupt milestones in social and educational development. This study aimed to use innovative population-level data to map the impact of the pandemic on students entering higher education. METHODS Pre-pandemic (2019/2020) and pandemic (2020/2021) tertiary education application data were obtained from the Victorian Tertiary Admissions Centre. Prevalence of applications for special consideration related to mental ill health were compared between cohorts across various geographical areas and applicant demographic subgroups. Relative risk regression models were used to understand the role of different risk factors. RESULTS Rates of mental health-related special consideration applications increased by 38% among all applications (pre-pandemic: 7.8%, n = 56 916; pandemic: 10.8%, n = 58 260). Highest increases were observed among students in areas with both extended and close-quarter lockdown experiences, and areas impacted by 2019/2020 black summer bushfires. The increases were higher among Year 12 students and students with other special consideration needs (e.g., physical condition, learning disability). Slightly higher increases were observed in areas with higher socio-economic status, which may potentially be related to inequality in mental health service access. CONCLUSION As consequences of mental health difficulties and academic disruption in youth can be long lasting, it is critical to establish a mental health support framework both in and outside of higher education to facilitate young people's recovery from the pandemic.
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Affiliation(s)
- Caroline X Gao
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Orygen, Parkville, Victoria, Australia
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Emily Clarke
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Orygen, Parkville, Victoria, Australia
| | - Jennifer Nicholas
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Orygen, Parkville, Victoria, Australia
| | - Shu Mei Teo
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Orygen, Parkville, Victoria, Australia
| | - Caleb Koppe
- Victorian Tertiary Admissions Centre (VTAC), South Melbourne, Victoria, Australia
| | - Gavin Peter
- Victorian Tertiary Admissions Centre (VTAC), South Melbourne, Victoria, Australia
| | - Alex Lum
- Victorian Tertiary Admissions Centre (VTAC), South Melbourne, Victoria, Australia
| | - Tamara Barth
- Victorian Tertiary Admissions Centre (VTAC), South Melbourne, Victoria, Australia
| | - Steve Farish
- Victorian Tertiary Admissions Centre (VTAC), South Melbourne, Victoria, Australia
| | - Matthew Rudd
- Victorian Tertiary Admissions Centre (VTAC), South Melbourne, Victoria, Australia
| | - Yiting Gong
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Orygen, Parkville, Victoria, Australia
| | - Daniel Z Q Gan
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Orygen, Parkville, Victoria, Australia
| | | | - Teresa Tjia
- Victorian Tertiary Admissions Centre (VTAC), South Melbourne, Victoria, Australia
| | - Kate M Filia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Orygen, Parkville, Victoria, Australia
| | - Eóin Killackey
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Orygen, Parkville, Victoria, Australia
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Moyes A, McGough S, Wynaden D. Hidden and unacknowledged: The mental health and psychosocial interventions delivered by school nurses in Western Australia. Int J Ment Health Nurs 2024; 33:463-472. [PMID: 37994283 DOI: 10.1111/inm.13261] [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: 09/21/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 11/24/2023]
Abstract
Schools are an important setting for the early identification, assessment and intervention of mental health problems in children and young people. Internationally, many nurses work in schools, but the role of this group with young people experiencing mental health problems has had only limited investigation. This study explored the activities school nurses undertook with young people experiencing mental health problems in Australia. Reporting was guided by the COREQ checklist. Thirty-one nurses participated in a semi-structured interview. Data were analysed using the constant comparative method of analysis as developed by Glaser and Strauss (1967). The findings identified that nurses working in schools undertake a complex and sophisticated workload to support this cohort. In addition to assessment and referral for treatment, interventions assisted young people to manage challenging life circumstances, cope with intensely difficult emotions and improve their social and occupational functioning. The work of school nurses with young people experiencing mental health problems is hidden and unacknowledged. A better understanding of the mental health work school nurses undertake can inform enhanced service provision for children, young people and their families. The research findings will be of interest to mental health nurses, education professionals, parents, policy makers and governments.
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Affiliation(s)
- Anita Moyes
- Edith Cowan University, Perth, Western Australia, Australia
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Gunawardena H, Leontini R, Nair S, Cross S, Hickie I. Teachers as first responders: classroom experiences and mental health training needs of Australian schoolteachers. BMC Public Health 2024; 24:268. [PMID: 38263048 PMCID: PMC10804620 DOI: 10.1186/s12889-023-17599-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 12/27/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Schoolteachers are often the first to respond when a student presents with a mental health issue in the classroom. This places a burden on schools that impacts school staff, healthcare workers and teachers. More broadly, it places a responsibility on the education system to address students' mental health. This study examines Australian teachers' classroom experiences and the training areas identified by teachers as necessary to manage these issues. METHOD Interviews were undertaken with 18 in-service teachers between 2020 and 2021 from Catholic, Independent and Public schools. Data were gathered via multiple interviews and analysed using thematic content analysis. RESULTS The major mental health issues identified by teachers related to mental disorders, depression, anxiety, and a complex range of negative emotional states. Teachers requested training in child and adolescent mental health, counselling skills, early detection and intervention, and training skills to manage the complex relationship with parents and external health and community personnel. Teachers also reported the need to access mental health resources, support and training, which were differentially accessed along socioeconomic status and postcodes. CONCLUSION The data show that teachers are often placed as first responders when a student has a mental health issue but feel inadequately trained to manage these issues in the classroom. We identified mental health issues presenting in Australian classrooms and documented critical features of mental-health training asked for by teachers in order to address those issues. Given the increasing demands on teachers to address the mental health of children and adolescents, we argue that an urgent review of mental health training for teachers is needed.
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Affiliation(s)
| | - Rose Leontini
- The University of New South Wales, Kensington, Australia
| | - Sham Nair
- Department of Education, New South Wales, Australia
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Holttinen T, Lindberg N, Rissanen P, Kaltiala R. Educational attainment of adolescents treated in psychiatric inpatient care: a register study over 3 decades. Eur Child Adolesc Psychiatry 2023; 32:2163-2173. [PMID: 35932327 PMCID: PMC10576713 DOI: 10.1007/s00787-022-02052-0] [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: 11/22/2021] [Accepted: 07/16/2022] [Indexed: 11/03/2022]
Abstract
Mental disorders may for various reasons impair educational attainment, and with far-reaching consequences given the impact of education on subsequent employment, social life, life choices and even health and mortality. This register-based study addresses trends in educational attainment among Finnish adolescents aged 13-17 with mental disorders severe enough to necessitate inpatient treatment between 1980 and 2010. Our subjects (N = 14,435), followed up until the end of 2014, were at greater risk of discontinuing education beyond compulsory comprehensive school or of lower educational attainment than their age-peers in general population. Only 50.0% had completed any post-comprehensive education compared to 84.9% in same-aged general population. Those at highest risk were males and those with organic, intellectual disabilities and developmental, externalizing disorders or schizophrenia group diagnoses. Despite improvements in adolescent psychiatric care, school welfare services and pedagogical support, risks have remained high. Greater effort in psychiatric treatment, school welfare and pedagogy are needed to combat this severe inequality.
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Affiliation(s)
- Timo Holttinen
- Department of Adolescent Psychiatry, Faculty of Medicine and Health Technology, Tampere University Hospital, Tampere University, Arvo Ylpön katu 34, 33014, Tampere, Finland.
| | - Nina Lindberg
- Helsinki University and Helsinki University Hospital, Forensic Psychiatry, Helsinki, Finland
| | - Pekka Rissanen
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Riittakerttu Kaltiala
- Department of Adolescent Psychiatry, Faculty of Medicine and Health Technology, Tampere University Hospital, Tampere University, Arvo Ylpön katu 34, 33014, Tampere, Finland
- Vanha Vaasa Hospital, Vaasa, Finland
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Klinner C, Glozier N, Yeung M, Conn K, Milton A. A qualitative exploration of young people's mental health needs in rural and regional Australia: engagement, empowerment and integration. BMC Psychiatry 2023; 23:745. [PMID: 37833680 PMCID: PMC10571294 DOI: 10.1186/s12888-023-05209-6] [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: 04/12/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Australian rural and regional communities are marked by geographic isolation and increasingly frequent and severe natural disasters such as drought, bushfires and floods. These circumstances strain the mental health of their inhabitants and jeopardise the healthy mental and emotional development of their adolescent populations. Professional mental health care in these communities is often inconsistent and un-coordinated. While substantial research has examined the barriers of young people's mental health and help-seeking behaviours in these communities, there is a lack of research exploring what adolescents in rural and regional areas view as facilitators to their mental health and to seeking help when it is needed. This study aims to establish an in-depth understanding of those young people's experiences and needs regarding mental health, what facilitates their help-seeking, and what kind of mental health education and support they want and find useful. METHOD We conducted a qualitative study in 11 drought-affected rural and regional communities of New South Wales, Australia. Seventeen semi-structured (14 group; 3 individual) interviews were held with 42 year 9 and 10 high school students, 14 high school staff, and 2 parents, exploring participants' experiences of how geographical isolation and natural disasters impacted their mental health. We further examined participants' understandings and needs regarding locally available mental health support resources and their views and experiences regarding mental illness, stigma and help-seeking. RESULTS Thematic analysis highlighted that, through the lens of participants, young people's mental health and help-seeking needs would best be enabled by a well-coordinated multi-pronged community approach consisting of mental health education and support services that are locally available, free of charge, engaging, and empowering. Participants also highlighted the need to integrate young people's existing mental health supporters such as teachers, parents and school counselling services into such a community approach, recognising their strengths, limitations and own education and support needs. CONCLUSIONS We propose a three-dimensional Engagement, Empowerment, Integration model to strengthen young people's mental health development which comprises: 1) maximising young people's emotional investment (engagement); 2) developing young people's mental health self-management skills (empowerment); and, 3) integrating mental health education and support programs into existing community and school structures and resources (integration).
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Affiliation(s)
- Christiane Klinner
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Nick Glozier
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Australian Research Council (ARC), Centre of Excellence for Children and Families over the Life Course, Sydney, Australia
| | - Margaret Yeung
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Katrina Conn
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- NSW Department of Education, NSW, Australia
| | - Alyssa Milton
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
- Australian Research Council (ARC), Centre of Excellence for Children and Families over the Life Course, Sydney, Australia.
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Gao CX, Broder JC, Brilleman S, Campbell TCH, Berger E, Ikin J, Smith CL, Wolfe R, Johnston F, Guo Y, Carroll M. Evaluating the impact of Hazelwood mine fire event on students' educational development with Bayesian interrupted time-series hierarchical meta-regression. PLoS One 2023; 18:e0281655. [PMID: 36857352 PMCID: PMC9977026 DOI: 10.1371/journal.pone.0281655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/29/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Environmental disasters such as wildfires, floods and droughts can introduce significant interruptions and trauma to impacted communities. Children and young people can be disproportionately affected with additional educational disruptions. However, evaluating the impact of disasters is challenging due to difficulties in establishing studies and recruitment post-disasters. OBJECTIVES We aimed to (1) develop a Bayesian model using aggregated school-level data to evaluate the impact of environmental disasters on academic achievement and (2) evaluate the impact of the 2014 Hazelwood mine fire (a six-week fire event in Australia). METHODS Bayesian hierarchical meta-regression was developed to evaluate the impact of the mine fire using easily accessible aggregated school-level data from the standardised National Assessment Program-Literacy and Numeracy (NAPLAN) test. NAPLAN results and school characteristics (2008-2018) from 69 primary/secondary schools with different levels of mine fire-related smoke exposure were used to estimate the impact of the event. Using an interrupted time series design, the model estimated immediate effects and post-interruption trend differences with full Bayesian statistical inference. RESULTS Major academic interruptions across NAPLAN domains were evident in high exposure schools in the year post-mine fire (greatest interruption in Writing: 11.09 [95%CI: 3.16-18.93], lowest interruption in Reading: 8.34 [95%CI: 1.07-15.51]). The interruption was comparable to a four to a five-month delay in educational attainment and had not fully recovered after several years. CONCLUSION Considerable academic delays were found as a result of a mine fire, highlighting the need to provide educational and community-based supports in response to future events. Importantly, this work provides a statistical method using readily available aggregated data to assess the educational impacts in response to other environmental disasters.
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Affiliation(s)
- Caroline X. Gao
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkview, Victoria, Australia
- Orygen, Parkview, Victoria, Australia
- * E-mail:
| | - Jonathan C. Broder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sam Brilleman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Emily Berger
- Department of Education, Monash University, Melbourne, Victoria, Australia
| | - Jillian Ikin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Catherine L. Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Fay Johnston
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Yuming Guo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Matthew Carroll
- Monash Rural Health, Monash University, Churchill, Victoria, Australia
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Bennett H, Allitt B, Hanna F. A perspective on mental health literacy and mental health issues among Australian youth: Cultural, social, and environmental evidence! Front Public Health 2023; 11:1065784. [PMID: 36741953 PMCID: PMC9891461 DOI: 10.3389/fpubh.2023.1065784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/02/2023] [Indexed: 01/19/2023] Open
Abstract
Mental health literacy (MHL) helps improve mental health outcomes and reduce the impacts of mental illness. This study aims to reflect on scientific evidence on MHL levels, barriers to MHL, their impacts on mental health among Australian youth and interventions to overcome these barriers. The factors explored in the Perspective included; influence of social determinants, culturally and linguistically diverse (CALD) communities, help-seeking attitudes and behaviors. MHL intervention programs and MHL for improving mental health outcomes due to the recent COVID-19 pandemic were also explored. Adequate levels of youth MHL significantly improved one's ability to recognize own mental health status as well as provide peer support. Practical considerations such as designing more gender and culturally specific youth MHL programs are proposed.
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Affiliation(s)
- Hirukshi Bennett
- Public Health Program, Torrens University Australia, Melbourne, VIC, Australia
| | - Ben Allitt
- Higher Education College, Chisholm Institute, Dandenong, VIC, Australia
| | - Fahad Hanna
- Public Health Program, Torrens University Australia, Melbourne, VIC, Australia,Higher Education College, Chisholm Institute, Dandenong, VIC, Australia,*Correspondence: Fahad Hanna ✉
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A Scoping and Systematic Review of Employment Processes and Outcomes for Young Adults Experiencing Psychosis. Community Ment Health J 2022; 59:728-755. [PMID: 36463531 DOI: 10.1007/s10597-022-01056-z] [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: 02/07/2022] [Accepted: 11/11/2022] [Indexed: 12/07/2022]
Abstract
Young adults who experience psychosis want to work but are less likely to be employed than their peers. Sixty two studies relating to young adults with psychosis and employment were reviewed following a systematic search of five databases: CINAHL, PsycINFO, MEDLINE, SCOPUS and EMBASE. Publication date ranged from 1973 to 2019 with > 70% between 2010 and 2019. Intervention was considered in 29 papers; critical appraisal revealed 90% of these had moderate to good methodological quality with only three RCTs. Of 11 intervention types "Early Intervention" and "Individual Placement and Support" were most common; both demonstrating positive impact on obtaining employment. The review identified minimal participant perspectives and great variability in: terminology used; the reporting of participant attributes; intervention characteristics and ways employment outcomes were measured. Employment processes identified were preparing for, seeking, obtaining, keeping and re-obtaining employment, with current research efforts focused on obtaining work. More focus is required on keeping and re-obtaining employment.
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Mitchell RJ, McMaugh A, Schniering C, Cameron CM, Lystad RP, Badgery-Parker T, Nielssen O. Mental disorders and their impact on school performance and high school completion by gender in Australia: A matched population-based cohort study. Aust N Z J Psychiatry 2022; 56:1602-1616. [PMID: 34875885 DOI: 10.1177/00048674211061684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Young people with a mental disorder often perform poorly at school and can fail to complete high school. This study aims to compare scholastic performance and high school completion of young people hospitalised with a mental disorder compared to young people not hospitalised for a mental disorder health condition by gender. METHOD A population-based matched case-comparison cohort study of young people aged ⩽18 years hospitalised for a mental disorder during 2005-2018 in New South Wales, Australia using linked birth, health, education and mortality records. The comparison cohort was matched on age, gender and residential postcode. Generalised linear mixed modelling examined risk of school performance below the national minimum standard and generalised linear regression examined risk of not completing high school for young people with a mental disorder compared to matched peers. RESULTS Young males with a mental disorder had over a 1.7 times higher risk of not achieving the national minimum standard for numeracy (adjusted relative risk: 1.71; 95% confidence interval: [1.35, 2.15]) and reading (adjusted relative risk: 1.99; 95% confidence interval: [1.80, 2.20]) compared to matched peers. Young females with a mental disorder had around 1.5 times higher risk of not achieving the national minimum standard for numeracy (adjusted relative risk: 1.50; 95% confidence interval: [1.14, 1.96]) compared to matched peers. Both young males and females with a disorder had around a three times higher risk of not completing high school compared to peers. Young males with multiple disorders had up to a sixfold increased risk and young females with multiple disorders had up to an eightfold increased risk of not completing high school compared to peers. CONCLUSION Early recognition and support could improve school performance and educational outcomes for young people who were hospitalised with a mental disorder. This support should be provided in conjunction with access to mental health services and school involvement and assistance.
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Affiliation(s)
- Rebecca J Mitchell
- Australian Institute of Health Innovation (AIHI), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Anne McMaugh
- The Macquarie School of Education, Macquarie University, Sydney, NSW, Australia
| | - Carolyn Schniering
- Centre for Emotional Health, Department of Psychology, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Cate M Cameron
- Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, QLD, Australia.,Queensland University of Technology (QUT), Centre for Healthcare Transformation, Australian Centre for Health Services Innovation (AusHSI), Brisbane, QLD, Australia
| | - Reidar P Lystad
- Australian Institute of Health Innovation (AIHI), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Tim Badgery-Parker
- Australian Institute of Health Innovation (AIHI), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Olav Nielssen
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
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Mitchell RJ, McMaugh A, Lystad RP, Cameron CM, Nielssen O. Health service use for young males and females with a mental disorder is higher than their peers in a population-level matched cohort. BMC Health Serv Res 2022; 22:1359. [DOI: 10.1186/s12913-022-08789-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/04/2022] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
To inform healthcare planning and resourcing, population-level information is required on the use of health services among young people with a mental disorder. This study aims to identify the health service use associated with mental disorders among young people using a population-level matched cohort.
Method
A population-based matched case-comparison retrospective cohort study of young people aged ≤ 18 years hospitalised for a mental disorder during 2005–2018 in New South Wales, Australia was conducted using linked birth, health, and mortality records. The comparison cohort was matched on age, sex and residential postcode. Adjusted rate ratios (ARR) were calculated for key demographics and mental disorder type by sex.
Results
Emergency department visits, hospital admissions and ambulatory mental health service contacts were all higher for males and females with a mental disorder than matched peers. Further hospitalisation risk was over 10-fold higher for males with psychotic (ARR 13.69; 95%CI 8.95–20.94) and anxiety (ARR 11.44; 95%CI 8.70-15.04) disorders, and for both males and females with cognitive and behavioural delays (ARR 10.79; 95%CI 9.30-12.53 and ARR 14.62; 95%CI 11.20-19.08, respectively), intellectual disability (ARR 10.47; 95%CI 8.04–13.64 and ARR 11.35; 95%CI 7.83–16.45, respectively), and mood disorders (ARR 10.23; 95%CI 8.17–12.80 and ARR 10.12; 95%CI 8.58–11.93, respectively) compared to peers.
Conclusion
The high healthcare utilisation of young people with mental disorder supports the need for the development of community and hospital-based services that both prevent unnecessary hospital admissions in childhood and adolescence that can potentially reduce the burden and loss arising from mental disorders in adult life.
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11
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Schniedermann I, Dehn LB, Micheel S, Beblo T, Driessen M. Evaluation of a supported education and employment program for adolescents and young adults with mental health problems: A study protocol of the StAB project. PLoS One 2022; 17:e0271803. [PMID: 35905081 PMCID: PMC9337640 DOI: 10.1371/journal.pone.0271803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 11/19/2022] Open
Abstract
The majority of mental illnesses begins in childhood, adolescence and young adulthood before the age of 25. The transition from adolescence to adulthood is a particularly vulnerable time for adolescents with mental illness, affecting psychosocial functioning and participation in work life. Therefore, they need—in contrast to classic standard vocational interventions—a long-term, holistic and individually oriented vocational rehabilitation program. With the innovative model project "Start in education and employment (StAB)”, adolescents and young adults with mental illnesses are to be supported with regard to their vocational perspectives and participation by a new type of individualized, holistic, long-term job coaching. It follows the Individual Placement and Support (IPS) concept, as a manualized form of the Supported Employment Approach and is based on the "first place–then train" principle. In order to evaluate the effectiveness and feasibility of the StAB program, a double-centre prospective single arm evaluation study in a mixed-methods design will be conducted. The focus is on quantitative research analysing pre-post-effects of the StAB intervention in a two-year observational study. Young people between 15 and 25 years with a psychiatric diagnosis who are currently in receipt of means-tested benefits or are entitled to them will be recruited. The study will take place in two major cities in the north-western part of Germany, Bielefeld and Dortmund. We expect to contribute to gain more empirical data about the implementation of Supported Employment and Education to severely mentally ill adolescents and young adults in German settings. Moreover, these results may also provide the scientific foundation for future measures focusing the improvement of vocational rehabilitation for young people with mental illness. The study was registered in the German Clinical Trials Register (DRKS00027576) on March 10, 2022.
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Affiliation(s)
- Ina Schniedermann
- Department of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
| | - Lorenz B. Dehn
- Department of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
- Department of Psychology, Bielefeld University, Bielefeld, Germany
- * E-mail:
| | - Sabrina Micheel
- Department of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
| | - Thomas Beblo
- Department of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Martin Driessen
- Department of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
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12
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Bowman S, McKinstry C, Howie L, Hepworth G, McGorry P. Perceptions of rural high school teachers - on the frontline of youth suicide. Aust J Rural Health 2022; 30:608-618. [PMID: 35767662 DOI: 10.1111/ajr.12894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 01/28/2022] [Accepted: 05/26/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the perceptions and beliefs of rural high school teachers about student suicide completion in their school and their perceived self-efficacy in identification of suicidality in students (suicidal ideation, plans and behaviours). DESIGN A cross-sectional survey methodology. SETTING Gippsland and the Loddon Mallee regions of Victoria, Australia. PARTICIPANTS Rural high school teachers. OUTCOME MEASURE A survey that aimed to obtain participants' perceptions and self-reports about students who had died by suicide in their school within the last 5 years, their perceived self-efficacy in identifying suicidal students and barriers to helping students at risk. RESULTS Two hundred and seventy-seven rural high school teachers participated and 86% reported that a student from their school had died by suicide within the last 5 years. Sixty-five per cent believed that more than one student had died by suicide and 70% perceived they were currently aware of students experiencing suicidality in their class. Receiving professional development about suicide and obtaining help from mental health clinicians predicted perceived self-efficacy in identification of suicidality in students. Participants perceived the barriers to help students at risk included insufficient numbers of school-based mental health professionals and community mental health services. CONCLUSIONS Many rural high school teachers perceive they are at the front line of the youth suicide crisis due to unmet service need in youth mental ill health. Increased access to effective services immediately after teachers become aware of suicidality may assist in reducing youth suicide in rural areas.
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Affiliation(s)
- Siann Bowman
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Vic., Australia
| | - Carol McKinstry
- La Trobe Rural Health School, La Trobe University, Bendigo, Vic., Australia
| | - Linsey Howie
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Vic., Australia
| | - Graham Hepworth
- Statistical Consulting Centre, The University of Melbourne, Melbourne, Vic., Australia
| | - Patrick McGorry
- Orygen, Centre for Youth Mental Health, University of Melbourne, Melbourne, Vic., Australia
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Thomson S, Galletly C, Prener C, Garverich S, Liu D, Lincoln A. Associations between health literacy, cognitive function and general literacy in people with schizophrenia attending community mental health clinics in Australia. BMC Psychiatry 2022; 22:245. [PMID: 35392852 PMCID: PMC8986965 DOI: 10.1186/s12888-022-03901-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/24/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Health literacy (HL) has been defined as the ability of individuals to access, understand, and utilise basic health information. HL is crucial to patient engagement in treatment through supporting patient autonomy, informed consent and collaborative care. In people with physical disorders, poor HL is associated with poor health outcomes, but less is known about HL in people with severe mental illness. This study aimed to assess HL and investigate the associations between education, cognitive function, general literacy, and HL in participants with schizophrenia attending community mental health clinics. METHOD Fifty-two outpatients with schizophrenia attending a public community mental health clinic in Adelaide, Australia completed the Test of Functional Health Literacy in Adults-Short Form (S-TOFHLA) along with tests of cognition, aural and reading literacy and numeracy including Digit Symbol Coding (DSC), verbal fluency, the Wechsler Adult Intelligence Scale (WAIS-IV), Woodcock-Johnson III (Part 4 and 9) and the Lipkus numeracy scale. Sixty-one percent of participants were male. Participants had a mean age of 41.2 (SD 9.9) years and a mean of 11.02 (SD 1.5) years of education. RESULTS The majority of participants had very poor aural and verbal literacy and poorer literacy correlated with fewer years of education. On the S-TOFHLA, 81% of participants had adequate HL; 6% were marginal and 13% were inadequate. There was a positive correlation between education and HL, with those with more years of education scoring higher for HL. There was also a significant association between better HL and better working memory and attention. CONCLUSIONS Consistent with previous research in schizophrenia, our participants had reduced educational attainment, aural and reading literacy and cognitive function compared to population norms. However, HL was better than expected given that previous research has found that people with psychiatric disorders tend to have lower HL, compared to the general population. This may reflect effective case management of our participants whilst attending the community clinics and supports ongoing research and intervention regarding HL in people living with mental illness.
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Affiliation(s)
- Sumana Thomson
- Northern Adelaide Local Health Network, Adelaide, South, Australia. .,Adelaide Medical School, The University of Adelaide, Adelaide, South, Australia.
| | - Cherrie Galletly
- Northern Adelaide Local Health Network, Adelaide, South Australia ,grid.1010.00000 0004 1936 7304Adelaide Medical School, The University of Adelaide, Adelaide, South Australia ,Ramsay Health Care (SA) Mental Health Services, Adelaide, South Australia
| | - Christopher Prener
- grid.262962.b0000 0004 1936 9342 Department of Sociology and Anthropology, Saint Louis University, St. Louis, MO USA
| | - Suzanne Garverich
- grid.261112.70000 0001 2173 3359Institute for Health Equity and Social Justice Research, Northeastern University, Boston, MA USA
| | - Dennis Liu
- Northern Adelaide Local Health Network, Adelaide, South Australia ,grid.1010.00000 0004 1936 7304Adelaide Medical School, The University of Adelaide, Adelaide, South Australia
| | - Alisa Lincoln
- grid.261112.70000 0001 2173 3359Institute for Health Equity and Social Justice Research, Northeastern University, Boston, MA USA
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14
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The mental health of young people who are not in education, employment, or training: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1107-1121. [PMID: 34931257 PMCID: PMC8687877 DOI: 10.1007/s00127-021-02212-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 12/05/2021] [Indexed: 11/06/2022]
Abstract
PURPOSE There are increasing concerns about the intersection between NEET (not in education, employment, or training) status and youth mental ill-health and substance use. However, findings are inconsistent and differ across types of problems. This is the first systematic review and meta-analysis (PROSPERO-CRD42018087446) on the association between NEET status and youth mental health and substance use problems. METHODS We searched Medline, EMBASE, Web of Science, ERIC, PsycINFO, and ProQuest Dissertations and Theses (1999-2020). Two reviewers extracted data and appraised study quality using a modified Newcastle-Ottawa Scale. We ran robust variance estimation random-effects models for associations between NEET and aggregate groups of mental ill-health and substance use measures; conventional random-effects models for associations with individual mental/substance use problems; and subgroup analyses to explore heterogeneity. RESULTS We identified 24 studies from 6,120 references. NEET status was associated with aggregate groups of mental ill-health (OR 1.28, CI 1.06-1.54), substance use problems (OR 1.43, CI 1.08-1.89), and combined mental ill-health and substance use measures (OR 1.38, CI 1.15-1.64). Each disaggregated measure was associated with NEET status [mood (OR 1.43, CI 1.21-1.70), anxiety (OR 1.55, CI 1.07-2.24), behaviour problems (OR 1.49, CI 1.21-1.85), alcohol use (OR 1.28, CI 1.24-1.46), cannabis use (OR 1.62, CI 1.07-2.46), drug use (OR 1.99, CI 1.19-3.31), suicidality (OR 2.84, CI 2.04-3.95); and psychological distress (OR 1.10, CI 1.01-1.21)]. Longitudinal data indicated that aggregate measures of mental health problems and of mental health and substance use problems (combined) predicted being NEET later, while evidence for the inverse relationship was equivocal and sparse. CONCLUSION Our review provides evidence for meaningful, significant associations between youth mental health and substance use problems and being NEET. We, therefore, advocate for mental ill-health prevention and early intervention and integrating vocational supports in youth mental healthcare.
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Lindstrom G, Sofija E, Riley T. "Getting better at getting better": How Sharing Mental Health Stories Can Shape Young People's Wellbeing. Community Ment Health J 2021; 57:1604-1613. [PMID: 33580469 DOI: 10.1007/s10597-021-00786-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 01/29/2021] [Indexed: 10/22/2022]
Abstract
Sharing lived-experience of mental ill-health is increasingly recognised as a promising youth mental health intervention. batyr is a preventative mental health organization that trains young people to share their story of mental ill-health safely through a speaker development program. This qualitative study aimed to understand how the role of batyr speakers shapes individual wellbeing, help-seeking behaviour, and stigma as well as how young people talk about mental health within their social circles. Data was collected using in-depth semi-structured interviews with 18 batyr speakers (age 18-35 years). Thematic analysis revealed five themes: Getting better at getting better, Growing towards self-acceptance, Breaking the wall by talking about mental health, Increasing connectedness and Reaching out for support. The participants reported overall improved wellbeing, as a result of increased confidence, greater self-awareness, and an increased ability to talk safely about their mental illness. Findings suggested that the program led to a reduction of self-stigma and stigma.
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Affiliation(s)
- Genesis Lindstrom
- School of Medicine, Griffith University, Parklands drive, Southport, QLD 4222, Australia.
| | - Ernesta Sofija
- School of Medicine, Griffith University, Parklands drive, Southport, QLD 4222, Australia
| | - Tom Riley
- batyr, The Dax Centre, Kenneth Myer Building, 30 Royal Parade, Parkville, VIC 3010, Australia
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16
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Henson A, Ruglis J, Sinacore A, Fitzpatrick M, Lanteigne D. Self‐compassion for youth in small city centres: A school‐based pilot project. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Alisha Henson
- Department of Educational & Counselling Psychology Faculty of Education McGill University Montreal QC Canada
- Pembroke Psychological Services Pembroke ON Canada
| | - Jessica Ruglis
- Department of Educational & Counselling Psychology Faculty of Education McGill University Montreal QC Canada
| | - Ada Sinacore
- Department of Educational & Counselling Psychology Faculty of Education McGill University Montreal QC Canada
| | - Marilyn Fitzpatrick
- Department of Educational & Counselling Psychology Faculty of Education McGill University Montreal QC Canada
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Salvador-Carulla L, Fernandez A, Sarma H, Mendoza J, Wands M, Gandre C, Chevreul K, Lukersmith S. Impact of Ed-LinQ: A Public Policy Strategy to Facilitate Engagement between Schools and the Mental Health Care System in Queensland, Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157924. [PMID: 34360229 PMCID: PMC8345643 DOI: 10.3390/ijerph18157924] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022]
Abstract
Ed-LinQ is a mental health policy initiative to enhance the early detection and treatment of children with mental illness by improving the liaison between schools and health services in Queensland, Australia. We measured its impact from policy to practice to inform further program developments and public strategies. We followed a mixed quantitative/qualitative approach. The Adoption Impact Ladder (AIL) was used to analyse the adoption of this initiative by end-users (decision makers both in the health and education sectors) and the penetration of the initiative in the school sector. Survey respondents included representatives of schools (n = 186) and mental health providers (n = 78). In total, 63% of the school representative respondents were at least aware of the existence of the Ed-LinQ initiative, 74% were satisfied with the initiative and 28% of the respondent schools adopted the initiative to a significant extent. Adoption was higher in urban districts and in the health sector. The overall level of penetration in the school sector of Queensland was low (3%). The qualitative analysis indicated an improvement in the referral and communication processes between schools and the health sectors and the importance of funding in the implementation of the initiative. Mapping of existing programs is needed to assess the implementation of a new one as well as the design of different implementation strategies for urban and rural areas. Assessing the adoption of health policy strategies and their penetration in a target audience is critical to understand their proportional impacts across a defined ecosystem and constitutes a necessary preliminary step for the evaluation of their quality and efficiency.
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Affiliation(s)
- Luis Salvador-Carulla
- Centre for Mental Health Research, Australian National University, Canberra 2601, Australia; (L.S.-C.); (H.S.)
- Menzies Centre for Health Policy, The University of Sydney, Sydney 2006, Australia;
| | - Ana Fernandez
- Menzies Centre for Health Policy, The University of Sydney, Sydney 2006, Australia;
- Agencia de Salut Publica, 08023 Barcelona, Spain
| | - Haribondhu Sarma
- Centre for Mental Health Research, Australian National University, Canberra 2601, Australia; (L.S.-C.); (H.S.)
| | - John Mendoza
- ConNectica Consulting, Caloundra 4551, Australia; (J.M.); (M.W.)
| | - Marion Wands
- ConNectica Consulting, Caloundra 4551, Australia; (J.M.); (M.W.)
| | - Coralie Gandre
- IRDES, Institut de Recherche et Documentation en Économie de La Santé, 75019 Paris, France;
| | | | - Sue Lukersmith
- Centre for Mental Health Research, Australian National University, Canberra 2601, Australia; (L.S.-C.); (H.S.)
- Menzies Centre for Health Policy, The University of Sydney, Sydney 2006, Australia;
- Correspondence:
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18
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Bowman S, McKinstry C, Howie L, McGorry P. Expanding the search for emerging mental ill health to safeguard student potential and vocational success in high school: A narrative review. Early Interv Psychiatry 2020; 14:655-676. [PMID: 32026624 DOI: 10.1111/eip.12928] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/29/2022]
Abstract
AIM Young people experiencing mental ill health are more likely than their healthy aged peers to drop out of high school. This can result in social exclusion and vocational derailment. Identifying young people at risk and taking action before an illness is established or school dropout occurs is an important goal. This study aimed to examine evidence for the risk markers and at risk mental states of the clinical staging model (stage 0-1b) and whether these risk states and early symptoms impact school participation and academic attainment. METHOD This narrative review assembles research from both the psychiatry and education literature. It examines stage 0 to stage 1b of the clinical staging model and links the risk states and early symptoms to evidence about the academic success of young people in high school. RESULTS In accordance with the clinical staging model and evidence from education literature, childhood trauma and parental mental illness can impact school engagement and academic progress. Sleep disturbance can result in academic failure. Undifferentiated depression and anxiety can increase the risk for school dropout. Subthreshold psychosis and hypomanic states are associated with functional impairment and high rates of Not in Employment, Education, or Training (NEET) but are not recognized in the education literature. CONCLUSION Risk markers for emerging mental ill health can be identified in education research and demonstrate an impact on a student's success in high school. Clear referral protocols need to be embedded into school life to reduce risk of progression to later stages of illness and support school participation and success.
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Affiliation(s)
- Siann Bowman
- Department of Occupational Therapy, School of Allied Health, LaTrobe University, Melbourne, Australia
| | - Carol McKinstry
- Department of Occupational Therapy, LaTrobe Rural Health School, LaTrobe University, Melbourne, Australia
| | - Linsey Howie
- Department of Occupational Therapy, School of Clinical and Community Allied Health, LaTrobe University, Melbourne, Australia
| | - Patrick McGorry
- The National Centre of Excellence in Youth Mental Health, Orygen, The University of Melbourne, Melbourne, Australia
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Hynek KA, Straiton M, Hauge LJ, Corbett K, Abebe DS. Use of outpatient mental healthcare services and upper-secondary school completion in young women with migrant background – A population-based study. SSM Popul Health 2020; 11:100631. [PMID: 32715079 PMCID: PMC7369604 DOI: 10.1016/j.ssmph.2020.100631] [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: 03/02/2020] [Revised: 07/07/2020] [Accepted: 07/07/2020] [Indexed: 11/28/2022] Open
Abstract
Mental disorders typically develop during adolescence, with young women being particularly at risk. Mental disorders during this period can negatively affect both current and future life prospects such as school completion. Migrants are at increased risk of developing mental disorders as a result of their experiences prior to, during and after migration. Additionally, they are less likely to complete upper-secondary school when compared to the majority population. Thus, being a young migrant woman with a mental disorder may have adverse consequences for school completion, which in turn can affect socioeconomic status later in life. In this study, we aimed to investigate the association between mental disorders, defined as having used outpatient mental healthcare services (OPMH), and completion of upper-secondary school among young women living in Norway, using national registry data. Additionally, we examined differences in probability of school completion between Norwegian majority, migrants and migrant descendants between those who used and did not use OPMH. The sample consisted of women born between 1990 and 1993 (N = 122,777). We conducted hierarchical, multivariable logistic regression analysis. In unadjusted analysis, we found that young women who used OPMH services had lower odds of school completion than those who did not, even after adjustment for migrant background and parental education. However, by calculating predictive margins, we found that descendant women, who had used OPMH services, had significantly higher probability of completing upper-secondary education than Norwegian majority women who had used services. None of the four migrant groups differed significantly from majority women. Use of OPMH services, had most adverse effect on majority, migrants from Nordic and Western countries and descendants, when compared to non-users. Future interventions should aim to increase school completion among young women with mental disorders. This is a cohort study of young women in Norway, using national registry data. Mental health service use reduces the odds of upper-secondary school completion. Migrant women using services do not have lower rates of completion than majority. School noncompletion have lasting socioeconomic consequences.
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20
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Rakhshan Rouhakhtar P, Schiffman J. Community Rehabilitation for Youth with Psychosis Spectrum Disorders. Child Adolesc Psychiatr Clin N Am 2020; 29:225-239. [PMID: 31708049 DOI: 10.1016/j.chc.2019.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Recovery-oriented treatment for youth with psychosis goes beyond a symptom and deficit-amelioration model, promoting engagement and functioning within the community. Given the challenges young people with psychosis face, early psychosis treatment programs often integrate rehabilitative components targeting functional outcomes. The current article reviews 4 community rehabilitation programs in early psychosis: care coordination, cognitive rehabilitation, supported education and employment, and peer support. For each of these rehabilitative intervention programs, we discuss challenges faced by youth with psychosis, clinical intervention practices, the current state of evidence, and clinical and/or research considerations.
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Affiliation(s)
- Pamela Rakhshan Rouhakhtar
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA.
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21
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Shinn AK, Cawkwell PB, Bolton K, Healy BC, Karmacharya R, Yip AG, Öngür D, Pinder-Amaker S. Return to College After a First Episode of Psychosis. SCHIZOPHRENIA BULLETIN OPEN 2020; 1:sgaa041. [PMID: 32984820 PMCID: PMC7503481 DOI: 10.1093/schizbullopen/sgaa041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
A first episode of psychosis (FEP) can derail a patient’s educational goals, including attainment of a college education, and this can have lasting ramifications for socioeconomic and health outcomes. Despite this, few studies have examined return to college, which is an important index of real-world educational success after a FEP. In this study, we conducted a longitudinal medical record review of patients in a transdiagnostic outpatient FEP program and performed survival analysis, setting return to college as the endpoint, among the subset of patients whose college education was interrupted. We found that 82% (93/114) of college-enrolled FEP individuals experienced disruptions to their education after FEP, but that return to college also occurred in a substantial proportion (49/88, 56%) among those on leave who had follow-up data. In this sample, the median time to college return was 18 months. When separated by baseline diagnostic category, FEP patients with affective psychotic disorders (FEAP, n = 45) showed faster time to college return than those with primary psychotic disorders (FEPP, n = 43) (median 12 vs 24 mo; P = .024, unadjusted). When adjusted for having no more than 1 psychiatric hospitalization at intake and absence of cannabis use in the 6 months prior to intake (which were also significant predictors), differences by diagnostic category were more significant (hazard ratio 2.66, 95% CI 1.43–4.94, P = .002). Participation in education is an important outcome for stakeholders, and students with FEP can be successful in accomplishing this goal.
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Affiliation(s)
- Ann K Shinn
- Psychotic Disorders Division, McLean Hospital, Belmont, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | | | - Kirsten Bolton
- Psychotic Disorders Division, McLean Hospital, Belmont, MA
| | - Brian C Healy
- Ann Romney Center for Neurologic Diseases, Brigham & Women’s Hospital, Boston, MA
- Department of Neurology, Harvard Medical School, Boston, MA
| | - Rakesh Karmacharya
- Psychotic Disorders Division, McLean Hospital, Belmont, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Agustin G Yip
- Psychotic Disorders Division, McLean Hospital, Belmont, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Dost Öngür
- Psychotic Disorders Division, McLean Hospital, Belmont, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Stephanie Pinder-Amaker
- Department of Psychiatry, Harvard Medical School, Boston, MA
- College Mental Health Program, McLean Hospital, Belmont, MA
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Boychuk C, Lysaght R, Stuart H. Career Decision-Making Processes of Young Adults With First-Episode Psychosis. QUALITATIVE HEALTH RESEARCH 2018; 28:1016-1031. [PMID: 29557298 DOI: 10.1177/1049732318761864] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The first episode of psychosis often emerges during young adulthood, when individuals are pursuing important educational and career goals that can become derailed because of the development of major impairments. Past research has neglected the developmental nature of employment and education decisions that young adults with first-episode psychosis make within the context of their lives. The purpose of this grounded theory study was to advance a model of the career decision-making processes of young adults with first-episode psychosis, and the influences that affect their career decision-making. The career decision-making of young adults with first-episode psychosis emerged as a multistaged, iterative process that unfolded over three phases of illness, and was affected by several internal and environmental influences. These findings suggest the phase of illness and career decision-making stage should be considered in future vocational programming for young adults with first-episode psychosis.
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23
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Vacheron MN, Veyrat-Masson H, Wehbe E. [What support of young presenting a first psychotic episode, when schooling is being challenged?]. L'ENCEPHALE 2017; 43:570-576. [PMID: 29128195 DOI: 10.1016/j.encep.2017.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 10/16/2017] [Indexed: 11/15/2022]
Abstract
Psychiatric disorders (more specifically mood disorders and psychosis) represent the 1st cause of disability among young people. Unemployment rate between 75 to 95% for the person with schizophrenia. It is correlated to poor social integration and bad economic status, worse symptomatology loss of autonomy as well as global bad functioning. It is responsible of more than half of the overall cost of psychosis. The onset of most of psychiatric disorders occur between the age of 25 and 35 years old, a critical time in young adult life when they should build their professional as well as social future. Without appropriate care, young adult are unable to build satisfactory emotional relationships, continue their studies, live independently or fit into life. They are frequently dependent on their environment. They also have an increased suicide rate and frequent comorbid substance abuse. Despite this context, their care pathway is often marked by a delay or premature stop of care, drug treatments not always suitable and a lack of specific relay post-hospitalization regarding continuity of professional training or studies. All factors impacting future employability of adolescents. Furthermore they spend most of their time in school and school plays a key part in an individual's development including peer relationships, social interactions, academic attainment, cognitive progress, emotional control, behavioral expectations and physical and moral development. These areas are also reciprocally affected by mental illness. The initial phases of FEP are characterized by impaired academic performance, change in social behaviors and increasing absences from school, reflecting the prodrome of the illness that leads to disengagement from education. Functional decline often precedes onset of clinical symptoms and many adolescents and young adults are therefore isolated from school before their illness is recognized. School support staff may fail to recognize those who are functionally impaired because of evolving FEP although school is a key setting for promoting positive mental health, fostering resilience, detecting and responding to emerging mental ill health. So, people with psychotic illness have low levels of secondary school completion. School dropout has been defined as leaving education without obtaining a minimal credential, most often a higher secondary education diploma. In France, the school is compulsory up to the age of 16. Consequences are significant: among young people without a degree out of initial training for one to four years and present on the labour market, 47% are unemployed. School dropout depends on a number of factors, including grades, family and social environment and the relationship with the school, but also the emergence of psychiatric disorders. For first episode psychotic patients, age of onset, lack of family support, longer duration of psychosis, levels of premorbid global functioning and education, negative and cognitive symptoms, addictions, depressive comorbidities and stigma plays an important role in school dropout. However, young adults have historically received less treatment than expected considering prevalence of mental illness at that age. In the last few decades, early intervention programs for psychosis have been developed all around the world in order to promote rehabilitation and prevent long-term disabilities. Early intervention programs focus on the special needs of young people and their families and engage in some form of assertive community treatment, which attempts to treat patients in the community rather than using inpatient services. For early intervention in psychosis programs, the goal is to keep patients engaged with treatment, prevent them from further psychotic episodes and hospitalizations and promote rehabilitation. The additional services of an early intervention program include staff specialized in psychosis treatment, family/group/individual counseling sessions, assertive case management, and low-dose second generation anti-psychotics. In these programs, psychiatric rehabilitation practitioners already use individual counseling and supported education programs (SEd) to improve postsecondary educational outcomes. The goals of SEd are for individuals with serious mental illness to successfully be able to set and achieve an educational goal (e.g., training certificate or degree), to improve educational competencies (literacy, study skills, time management), to navigate the educational environment (e.g., applications, financial assistance), and to improve motivation toward completing educational goals. These approaches are often combined with efforts to support transitions to sustainable employment. Current evidence of these interventions are weak with limited information on specific difficulties experienced by young adults with FEP in educational tasks. Adaptive strategies are needed by young adults with FEP to succeed in educational settings but most studies do not explore it with rigorous methodology. However, common SEd components emerge: specialized and dedicated staffing, one-on-one and group skill-building activities, assistance with navigating the academic setting and coordinating different services, and linkages with mental health counseling. Continued specification, and testing of SEd core components are still needed. It is important that occupational therapy researchers and practitioners develop, and evaluate effective interventions to improve education outcomes for young adults with FEP. The objective of this work is to define school dropout, assess causes and consequences of FEP. How to help young people to maintain education? We will detail measures to support the academic re-insertion in France.
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Affiliation(s)
- M-N Vacheron
- Secteur 75G13, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France.
| | - H Veyrat-Masson
- Secteur 75G13, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France
| | - E Wehbe
- Secteur 75G13, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France
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Abstract
OBJECTIVES This paper reviews the importance of transition to adult services for young people with ADHD. METHOD Different models are described and evidence sought for their effectiveness in clinical practice. RESULTS Models of care for children with ADHD include specialised mental health services, individual paediatricians and child and adolescent psychiatrists. Although it might be expected that transition would be to equivalent adult teams or specialists, studies have shown that transition may not run smoothly, and the adult services are frequently inadequate. This may result in attrition from treatment or discharge to the general practitioner. CONCLUSIONS Adult mental health services for transitioning young people with ADHD are under-resourced. The way forward may be a generic ADHD specialist or service, treating ADHD across the lifespan and avoiding the need for transition.
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Affiliation(s)
- Alison S Poulton
- Sydney Medical School Nepean, The University of Sydney, Penrith, NSW, Australia
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