Prevalence of psychiatric conditions in people with intellectual disability: A record linkage study in New South Wales, Australia

OBJECTIVE

To compare the prevalence of psychiatric conditions in a population-based cohort of people with intellectual disability and matched comparators in New South Wales, Australia.

METHOD

The study cohort included 97,644 people with intellectual disability and 451,502 comparators aged ⩾ 5 between 1 July 2001 to 30 June 2018. We used linked records of hospital admissions, emergency department presentations, ambulatory mental health service contacts, and Medicare rebates to identify any, serious, and specific psychiatric conditions.

RESULTS

People with intellectual disability showed greatly elevated period prevalence of any psychiatric condition (76.0% vs 38.3%), serious mental illness (16.2% vs 5.1%), and all specific psychiatric conditions compared to comparators. Among people with intellectual disability and congenital/developmental conditions, people with Down syndrome showed reduced risk of most psychiatric conditions while people with attention-deficit hyperactivity disorder and people with learning disorders showed increased risk. Age-specific analysis showed earlier onset of dementia and heightened prevalence of self-injury/suicidality in adulthood among people with intellectual disability. Annualised prevalence trends showed increases in 2006-2007 for most psychiatric conditions and decreases in 2014-2015 to 2017-2018.

CONCLUSIONS

The higher prevalence of psychiatric conditions in people with intellectual disability indicates the importance of systemic responses to address the mental health needs of this population. Our findings highlight the importance of considering the psychiatric profiles of specific congenital/developmental conditions among people with intellectual disability, and the need to provide targeted services to high-risk groups such as those with co-occurring attention-deficit hyperactivity disorder.

Adults with Intellectual Disability and Autism Spectrum Disorder: What Is the Evidence around the Use of Polypharmacy

A review on the mental health needs of adults with intellectual disability (ID) and autism spectrum disorder (ASD) published just over 10 years ago found a limited evidence base for pharmacological intervention in this group. The aim of this paper was therefore to review the evidence in the subsequent 10 years, with a focus on polypharmacy use in adults who have both ID and ASD. A critical literature review of key papers published from 2009 to 2021 was undertaken on adults with both ID and ASD and related to psychopharmacology, polypharmacy, antipsychotics, antidepressants, mood stabilisers and anxiolytics interventions in improving symptoms. After excluding articles for lack of relevance, a review with a focus on the use of polypharmacy was carried out on the retrieved results. Four papers were identified as relevant to adults with both ID and ASD. Three main themes were identified in the review, including the application of pharmacogenetics, the influence of national policy on prescribing practices and safety concerns in a population with multiple health comorbidities. The past decade has produced a small increase in the evidence base on psychopharmacology use in adults with ID and ASD. However, more evidence on the effectiveness and impact of long-term polypharmacy use is required.

Defining quality of life for individuals with neurodevelopmental disorders: Challenges within an inpatient population

PURPOSE

The concept of Quality of Life (QoL) for people with neurodevelopmental disorders primarily focuses on deinstitutionalisation and community inclusion. This population, however, often presents with comorbid diagnoses and is sectioned to treatment facilities under the Mental Health Act. The aim of this paper is to review the existing literature on QoL and discuss the consideration of this specialised population and the environment when measuring QoL.

METHODS

Databases were searched using specific inclusion and exclusion criteria to ensure literature reviewed was relevant to the defined population. The challenges identified from the literature were categorised into interpersonal and intrapersonal factors.

RESULTS

A total of 30 articles were retrieved and considered in this review.

CONCLUSIONS

This paper discusses how these individuals present with different behaviours and opportunities, which subsequently make it difficult to apply existing knowledge of QoL. The need to further examine the QoL in this specific population is discussed.

Translation and validation of the Spanish version of the Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS-LD)

INTRODUCTION

The Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS-LD) is a brief instrument that assesses functioning in people with intellectual development disorder and mental health problems/behaviour disorders. The aim of the present study was to examine the evidence on the validity of the scores based on the Spanish version of the HoNOS-LD.

MATERIAL AND METHODS

The study included 111 participants that were assessed by the Spanish version of the HoNOS-LD and other questionnaires that measured different variables related to the scale. Thirty-three participants were assessed by 2 examiners, and retested 7 days later, in order to study inter-examiner reliability and test-retest reliabilities.

RESULTS

Based on clinical and conceptual criteria, and on the results of the parallel analysis, a factorial solution with one factor was selected. Internal consistency was good (Omega coefficient of 0.87). Inter-examiner and test-retest reliabilities were excellent (intraclass correlation coefficients of 0.95 and 0.98, respectively). Correlations between sections of the HoNOS-LD and the related instruments showed the expected direction, and were highly significant (P<.001), and the HoNOS-LD score increased with the intensity of the support required by the participants. These results showed evidence of the validity of association with other external variables.

CONCLUSIONS

The Spanish version of the HoNOS-LD is a brief, valid and reliable instrument, which will enable a routine assessment of functioning for different uses, including diagnosis and intervention.

Social Effectiveness

The ability to effectively manage social interactions is key to achieving many life goals. A substantial amount of research has been conducted in rehabilitation counseling and rehabilitation psychology that includes a consideration of some aspect of social effectiveness. The purpose of this study was to collect and synthesize the past 30 years of rehabilitation counseling and rehabilitation psychology research addressing aspects of social effectiveness. A total of 13 terms (e.g., interpersonal skills, social competence, social functioning, and soft skills) were used to search six of the most prominent rehabilitation counseling and rehabilitation psychology journals from the period January 1982 to May 2013. A total of 608 articles were identified as including at least one of the search terms, with 175 using a search term prominently and the other 433 only passively. Social skills, social functioning, and social competence were among the most frequently used search terms, accounting for almost 90% of all used terms. It was found that social effectiveness constructs were rarely defined and often used interchangeably. Twenty-nine interventions studies had been published in the 30-year period. Results reflect a substantial and useful body of literature in this area of research while also conveying an opportunity for the development of a more systematic, unified, and theory-driven approach to understanding and addressing aspects of social effectiveness.

Carer-led health interventions to monitor, promote and improve the health of adults with intellectual disabilities in the community: a systematic review

Using carers to help assess, monitor, or promote health in people with intellectual disabilities (ID) may be one way of improving health outcomes in a population that experiences significant health inequalities. This paper provides a review of carer-led health interventions in various populations and healthcare settings, in order to investigate potential roles for carers in ID health care. We used rapid review methodology, using the Scopus database, citation tracking and input from ID healthcare professionals to identify relevant research. 24 studies were included in the final review. For people with ID, the only existing interventions found were carer-completed health diaries which, while being well received, failed to improve health outcomes. Studies in non-ID populations show that carers can successfully deliver screening procedures, health promotion interventions and interventions to improve coping skills, pain management and cognitive functioning. While such examples provide a useful starting point for the development of future carer-led health interventions for people with ID, the paucity of research in this area means that the most appropriate means of engaging carers in a way that will reliably impact on health outcomes in this population remains, as yet, unknown.