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Gunasinghe C, Bergou N, MacCrimmon S, Rhead R, Woodhead C, Jones Nielsen JD, Hatch SL. Co-production of an online research and resource platform for improving the health of young people-The hype project. PLoS One 2024; 19:e0277734. [PMID: 38848378 PMCID: PMC11161015 DOI: 10.1371/journal.pone.0277734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/29/2024] [Indexed: 06/09/2024] Open
Abstract
Mental health conditions tend to go unrecognised and untreated in adolescence, and therefore it is crucial to improve the health and social outcomes for these individuals through age and culturally appropriate interventions. This paper aims firstly to describe the development and implementation of the HYPE project platform (a research and resource platform co-designed and co-produced with young people). The second aim is to describe the characteristics of participants who engaged with the platform and an embedded pilot online survey. Participatory action research approach was used to address objectives of the HYPE project. Data were analysed to: (1) help improve access to health and social services, (2) guide provision of information of online resources and (3) deliver complementary community-based events/activities to promote mental health and to ultimately prevent mental health issues. Pilot and main phases of the HYPE project demonstrated the capacity and feasibility for such a platform to reach local, national, and international populations. Analyses demonstrated that the platform was particularly relevant for young females with pre-existing health difficulties. Some of the barriers to involving young people in research and help-seeking are discussed.
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Affiliation(s)
- Cerisse Gunasinghe
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Department of Psychology, School of Health & Psychological Sciences, City, University of London, London, United Kingdom
| | - Nicol Bergou
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Shirlee MacCrimmon
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Rebecca Rhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Charlotte Woodhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, King’s College London, London, United Kingdom
| | - Jessica D. Jones Nielsen
- Department of Psychology, School of Health & Psychological Sciences, City, University of London, London, United Kingdom
| | - Stephani L. Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, King’s College London, London, United Kingdom
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Quinlan-Davidson M, Dixon M, Chinnery G, Hawke LD, Iyer S, Moxness K, Prebeg M, Thabane L, Henderson JL. Youth not engaged in education, employment, or training: a discrete choice experiment of service preferences in Canada. BMC Public Health 2024; 24:1402. [PMID: 38797845 PMCID: PMC11129463 DOI: 10.1186/s12889-024-18877-0] [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: 11/29/2023] [Accepted: 05/17/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Prior research has showed the importance of providing integrated support services to prevent and reduce youth not in education, employment, or training (NEET) related challenges. There is limited evidence on NEET youth's perspectives and preferences for employment, education, and training services. The objective of this study was to identify employment, education and training service preferences of NEET youth. We acknowledge the deficit-based lens associated with the term NEET and use 'upcoming youth' to refer to this population group. METHODS Canadian youth (14-29 years) who reported Upcoming status or at-risk of Upcoming status were recruited to the study. We used a discrete choice experiment (DCE) survey, which included ten attributes with three levels each indicating service characteristics. Sawtooth software was used to design and administer the DCE. Participants also provided demographic information and completed the Global Appraisal of Individual Needs-Short Screener. We analyzed the data using hierarchical Bayesian methods to determine service attribute importance and latent class analyses to identify groups of participants with similar service preferences. RESULTS A total of n=503 youth participated in the study. 51% of participants were 24-29 years of age; 18.7% identified as having Upcoming status; 41.1% were from rural areas; and 36.0% of youth stated that they met basic needs with a little left. Participants strongly preferred services that promoted life skills, mentorship, basic income, and securing a work or educational placement. Three latent classes were identified and included: (i) job and educational services (38.9%), or services that include career counseling and securing a work or educational placement; (ii) mental health and wellness services (34.9%), or services that offer support for mental health and wellness in the workplace and free mental health and substance use services; and (iii) holistic skills building services (26.1%), or services that endorsed skills for school and job success, and life skills. CONCLUSIONS This study identified employment, education, and training service preferences among Upcoming youth. The findings indicate a need to create a service model that supports holistic skills building, mental health and wellness, and long-term school and job opportunities.
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Affiliation(s)
- Meaghen Quinlan-Davidson
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mahalia Dixon
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
| | | | - Lisa D Hawke
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Srividya Iyer
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Research Centre, Montreal, QC, Canada
| | | | - Matthew Prebeg
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - J L Henderson
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Dowell A, Stubbe M, Dunlop A, Fedchuck D, Gardiner T, Garrett S, Gordon S, Hilder J, Mathieson F, Tester R. Evaluating Success and Challenges of a Primary Care Youth Mental Health Programme Using Complexity, Implementation Science, and Appreciative Inquiry. Cureus 2024; 16:e58870. [PMID: 38800160 PMCID: PMC11116841 DOI: 10.7759/cureus.58870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Background Using an innovative framework of complexity and implementation science, with underpinning core values of appreciative inquiry (CIS-A), this paper describes the evaluation of a pilot service in New Zealand aiming to deliver integrated psychological therapy services within primary care, to young people (aged 18-24) experiencing mild to moderate mental distress. Method Using mixed quantitative and qualitative methods and multiple data sources, there was a strong focus on local innovation and co-design with service users, young people and multiple care providers. Data is drawn from service users, stakeholders and providers of the service in three areas of the lower North Island of New Zealand. Results The Piki pilot provided a significant and innovative enhancement of mental health care to this population. The service supported 5307 individuals with a range of therapy options, with the majority having between one and three therapy sessions. From 730 service users who completed a survey, 591 (81%) were 'very satisfied' with the service provided. The CIS-A framework was used successfully to provide rapid feedback and encourage adaptation to evolving issues. These included unexpected workload pressures, changes to therapy delivery, the integration of co-design and prioritising the needs of vulnerable groups. There was a successful incorporation of youth/service user input to co-design the programme, introduction of a peer-to-peer support service, and integration of a digital resource platform. The framework was also used to address challenges encountered and to support necessary adaptations in response to the COVID-19 pandemic. Conclusions We describe the use of an embedded evaluation to support and inform the implementation of a novel and innovative youth mental health programme. Complexity and implementation science, underpinned by the core values of appreciative inquiry (CIS-A), were successfully utilised providing potential learning that can be applied locally, nationally and internationally. This study has a focus on youth mental health but the principles and utility of applying a complexity and implementation science approach have application in many different health care settings. The use of a framework such as CIS-A can support complex innovation and implementation and can be used to enable rapid course correction and turn 'hindsight to foresight'.
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Affiliation(s)
- Anthony Dowell
- Primary Health Care and General Practice, University of Otago, Wellington, NZL
| | - Maria Stubbe
- Primary Health Care and General Practice, University of Otago, Wellington, NZL
| | - Abigail Dunlop
- Primary Health Care and General Practice, University of Otago, Wellington, NZL
| | - Dasha Fedchuck
- Psychological Medicine, University of Otago, Wellington, NZL
| | - Tracey Gardiner
- Psychological Medicine, University of Otago, Wellington, NZL
| | - Sue Garrett
- Primary Health Care and General Practice, University of Otago, Wellington, NZL
| | - Sarah Gordon
- Psychological Medicine, University of Otago, Wellington, NZL
| | - Jo Hilder
- Primary Health Care and General Practice, University of Otago, Wellington, NZL
| | - Fiona Mathieson
- Psychological Medicine, University of Otago, Wellington, NZL
| | - Rachel Tester
- Primary Health Care and General Practice, University of Otago, Wellington, NZL
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Quinlan-Davidson M, Shan D, Courtney D, Barbic S, Cleverley K, Hawke LD, Ma C, Prebeg M, Relihan J, Szatmari P, Henderson JL. Associations over the COVID-19 pandemic period and the mental health and substance use of youth not in employment, education or training in Ontario, Canada: a longitudinal, cohort study. Child Adolesc Psychiatry Ment Health 2023; 17:105. [PMID: 37679811 PMCID: PMC10486040 DOI: 10.1186/s13034-023-00653-4] [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: 05/05/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND The economic shutdown and school closures associated with the COVID-19 pandemic have negatively influenced many young people's educational and training opportunities, leading to an increase in youth not in education, employment, or training (NEET) globally and in Canada. NEET youth have a greater vulnerability to mental health and substance use problems, compared to their counterparts who are in school and/or employed. There is limited evidence on the association between COVID-19 and NEET youth. The objectives of this exploratory study included investigating: longitudinal associations between the COVID-19 pandemic and the mental health and substance use (MHSU) of NEET youth; and MHSU among subgroups of NEET and non-NEET youth. METHODS 618 youth (14-28 years old) participated in this longitudinal, cohort study. Youth were recruited from four pre-existing studies at the Centre for Addiction and Mental Health. Data on MHSU were collected across 11 time points during the COVID-19 pandemic (April 2020-August 2022). MHSU were measured using the CoRonavIruS Health Impact Survey Youth Self-Report, the Global Appraisal of Individual Needs Short Screener, and the PTSD Checklist for DSM-5. Linear Mixed Models and Generalized Estimating Equations were used to analyze associations of NEET status and time on mental health and substance use. Exploratory analyses were conducted to investigate interactions between sociodemographic characteristics and NEET status and time. RESULTS At baseline, NEET youth were significantly more likely to screen positive for an internalizing disorder compared to non-NEET youth (OR = 1.92; 95%CI=[1.26-2.91] p = 0.002). No significant differences were found between youth with, and without, NEET in MHSU symptoms across the study time frame. Youth who had significantly higher odds of screening positive for an internalizing disorder included younger youth (OR = 1.06, 95%CI=[1.00-1.11]); youth who identify as Trans, non-binary or gender diverse (OR = 8.33, 95%CI=[4.17-16.17]); and those living in urban areas (OR = 1.35, 95%CI=[1.03-1.76]), compared to their counterparts. Youth who identify as White had significantly higher odds of screening positive for substance use problems (OR = 2.38, 95%CI=[1.72-3.23]) compared to racialized youth. CONCLUSIONS Our findings indicate that sociodemographic factors such as age, gender identity, ethnicity and area of residence impacted youth MHSU symptoms over the course of the study and during the pandemic. Overall, NEET status was not consistently associated with MHSU symptoms over and above these factors. The study contributes to evidence on MHSU symptoms of NEET youth.
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Affiliation(s)
| | - Di Shan
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Darren Courtney
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Skye Barbic
- Faculty of Medicine, Department of Occupational Science and Occupational Therapy, the University of British Columbia, Vancouver, Canada
- Foundry British Columbia, Vancouver, BC, Canada
| | - Kristin Cleverley
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Lisa D Hawke
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Clement Ma
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Matthew Prebeg
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Peter Szatmari
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
| | - J L Henderson
- Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Harmanci D, Edelman N, Richardson D, Lunt A, Llewellyn C. How are young people's mental health related to their sexual health and substance use? A systematic review of UK literature. Int J Adolesc Med Health 2023; 35:131-158. [PMID: 36636992 DOI: 10.1515/ijamh-2022-0090] [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: 10/11/2022] [Accepted: 12/15/2022] [Indexed: 01/14/2023]
Abstract
OBJECTIVES The transition from childhood to adulthood is complex and presents challenges to young people's mental health. Mental health impacts and is impacted by a range of contextual and personal factors. Adolescence and young adulthood also coincide with increased experimentation with sex, sexuality and substance use. Addressing the mental health, sexual health and substance-use challenges experienced by young people therefore necessitates an understanding of how these elements relate to one another. By collecting and analysing existing literature, this review aims to identify associations between young people's mental health and sexual health, their mental health and substance use and any resulting gaps-in-knowledge. CONTENT Seven electronic databases were searched between March and May 2021 and updated in May 2022 with terms collated under the categories of "young people", "mental health", "sexual health" and "substance use". English-language articles, presenting data from the UK & Ireland, on young people aged 16-24 years inclusive were screened and subjected to a selection process in accordance with PRISMA guidelines (preregistered on PROSPERO, ref. number CRD42021245096). The quality of the resulting articles were assessed using the Mixed Methods Appraisal Tool (MMAT) and findings were tabulated through a data extraction process. SUMMARY 27 articles were included in the review. Various mental health indices such as depression, anxiety, self-harm, psychotic-like experiences, hypomanic symptoms and binge-purge type eating disorders were found to be associated with higher use of substances such as alcohol, cannabis, ecstasy and generalised drug use. Additionally, mental health indices such as depression, anxiety and self-harm were found to be associated with sex before age 16 and/or unprotected sex at age 16, positive Chlamydia infection and higher levels of sexual activity at a younger age. Overall, cross-sectional associations were stronger than the longitudinal associations presented in the articles. OUTLOOK This review into the specific relations between young people's mental health, sexual health and substance use has revealed the complex and bi-directional nature of these associations, with some conditions and substances having been more extensively investigated (e.g., alcohol and depression/anxiety) as opposed to the relations between young people's sexual health and mental health which is lacking in the UK and Irish context. The findings can help inform mental health related policies and service provisions targeted at young people in the UK and Ireland. Areas for future work are suggested.
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Affiliation(s)
- Damla Harmanci
- Department of Primary Care & Public Health, Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - Natalie Edelman
- Department of Primary Care & Public Health, Brighton and Sussex Medical School, Falmer, Brighton, UK.,School of Sport & Health Sciences, University of Brighton, Falmer, Brighton, UK
| | - Daniel Richardson
- Department of Primary Care & Public Health, Brighton and Sussex Medical School, Falmer, Brighton, UK.,University Hospitals Sussex NHS foundation Trust, Brighton, UK
| | - Alexandria Lunt
- Department of Primary Care & Public Health, Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - Carrie Llewellyn
- Department of Primary Care & Public Health, Brighton and Sussex Medical School, Falmer, Brighton, UK
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Capon W, Hickie IB, Varidel M, Prodan A, Crouse JJ, Carpenter JS, Cross SP, Nichles A, Zmicerevska N, Guastella AJ, Scott EM, Scott J, Shah J, Iorfino F. Clinical staging and the differential risks for clinical and functional outcomes in young people presenting for youth mental health care. BMC Med 2022; 20:479. [PMID: 36514113 PMCID: PMC9749194 DOI: 10.1186/s12916-022-02666-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Clinical staging proposes that youth-onset mental disorders develop progressively, and that active treatment of earlier stages should prevent progression to more severe disorders. This retrospective cohort study examined the longitudinal relationships between clinical stages and multiple clinical and functional outcomes within the first 12 months of care. METHODS Demographic and clinical information of 2901 young people who accessed mental health care at age 12-25 years was collected at predetermined timepoints (baseline, 3 months, 6 months, 12 months). Initial clinical stage was used to define three fixed groups for analyses (stage 1a: 'non-specific anxious or depressive symptoms', 1b: 'attenuated mood or psychotic syndromes', 2+: 'full-threshold mood or psychotic syndromes'). Logistic regression models, which controlled for age and follow-up time, were used to compare clinical and functional outcomes (role and social function, suicidal ideation, alcohol and substance misuse, physical health comorbidity, circadian disturbances) between staging groups within the initial 12 months of care. RESULTS Of the entire cohort, 2093 young people aged 12-25 years were followed up at least once over the first 12 months of care, with 60.4% female and a baseline mean age of 18.16 years. Longitudinally, young people at stage 2+ were more likely to develop circadian disturbances (odds ratio [OR]=2.58; CI 1.60-4.17), compared with individuals at stage 1b. Additionally, stage 1b individuals were more likely to become disengaged from education/employment (OR=2.11, CI 1.36-3.28), develop suicidal ideations (OR=1.92; CI 1.30-2.84) and circadian disturbances (OR=1.94, CI 1.31-2.86), compared to stage 1a. By contrast, we found no relationship between clinical stage and the emergence of alcohol or substance misuse and physical comorbidity. CONCLUSIONS The differential rates of emergence of poor clinical and functional outcomes between early versus late clinical stages support the clinical staging model's assumptions about illness trajectories for mood and psychotic syndromes. The greater risk of progression to poor outcomes in those who present with more severe syndromes may be used to guide specific intervention packages.
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Affiliation(s)
- William Capon
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia
| | - Mathew Varidel
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia
| | - Ante Prodan
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia.,Translational Health Research Institute, Western Sydney University, Sydney, 2751, Australia.,School of Computer, Data and Mathematical Sciences, Western Sydney University, Sydney, 2751, Australia
| | - Jacob J Crouse
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia
| | - Joanne S Carpenter
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia
| | - Shane P Cross
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, 2109, Australia
| | - Alissa Nichles
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia
| | | | - Adam J Guastella
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - Jai Shah
- Department of Psychiatry, McGill University, Montreal, H3A 0G4, Canada
| | - Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia.
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Remes H, Palma Carvajal M, Peltonen R, Martikainen P, Goisis A. The Well-Being of Adolescents Conceived Through Medically Assisted Reproduction: A Population-Level and Within-Family Analysis. EUROPEAN JOURNAL OF POPULATION = REVUE EUROPEENNE DE DEMOGRAPHIE 2022; 38:915-949. [PMID: 36507233 PMCID: PMC9727010 DOI: 10.1007/s10680-022-09623-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 05/03/2022] [Indexed: 12/15/2022]
Abstract
Medically assisted reproduction (MAR) plays an increasingly important role in the realization of fertility intentions in advanced societies, yet the evidence regarding MAR-conceived children's longer-term well-being remains inconclusive. Using register data on all Finnish children born in 1995-2000, we compared a range of social and mental health outcomes among MAR- and naturally conceived adolescents in population-averaged estimates, and within families who have conceived both through MAR and naturally. In baseline models, MAR-conceived adolescents had better school performance and the likelihood of school dropout, not being in education or employment, and early home-leaving were lower than among naturally conceived adolescents. No major differences were found in mental health and high-risk health behaviours. Adjustment for family sociodemographic characteristics attenuated MAR adolescents' advantage in social outcomes, while increasing the risk of mental disorders. The higher probability of mental disorders persisted when comparing MAR adolescents to their naturally conceived siblings. On average, MAR adolescents had similar or better outcomes than naturally conceived adolescents, largely due to their more advantaged family backgrounds, which underscores the importance of integrating a sociodemographic perspective in studies of MAR and its consequences.
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Affiliation(s)
- Hanna Remes
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, P.O. Box 18, 00014 Helsinki, Finland
| | | | - Riina Peltonen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, P.O. Box 18, 00014 Helsinki, Finland
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, P.O. Box 18, 00014 Helsinki, Finland
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Laboratory of Population Health, Max Planck Institute for Demographic Research, Rostock, Germany
| | - Alice Goisis
- University College London, Social Research Institute, London, UK
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Haugland SH, Stea TH. Risky Lives? Self-Directed Violence and Violence From Others Among Young People Not in Education, Employment, or Training (NEET). Front Public Health 2022; 10:904458. [PMID: 35875022 PMCID: PMC9301122 DOI: 10.3389/fpubh.2022.904458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/16/2022] [Indexed: 12/02/2022] Open
Abstract
Self-directed violence and violence from others comprise a major public health concern in youth. However, we lack knowledge about the prevalence of violent experiences among young people that are not in education, employment, or training (NEET), whether violent occurrences are similar among girls and boys, and whether violence differs between NEET youths and young students. This cross-sectional study compared the occurrences of self-directed violence (suicide attempts and self-harm) and exposure to violence from others (violent threats, beaten without visible marks, or injured due to violent events) between 96 NEET youth and 384 age- and sex-matched upper secondary school students (16–21 years). Suicide attempts were reported by 45.2% of NEET girls and 18.8% of schoolgirls (p < 0.001), but no significant difference was found between NEET boys (17.6%) and schoolboys (13.1%). Self-harm was reported by 78.9% of NEET girls and 33.9% of schoolgirls (p < 0.001). Self-harm was less prevalent among boys; it was reported by 34.6% of NEET boys and 21.8% of schoolboys (p = 0.056). A multivariable logistic regression analysis, adjusted for parental education, showed that, compared to schoolgirls, NEET girls had much higher odds ratios (ORs) for both self-directed violence and violence from others with OR ranging from 4.39; CI 1.96–9.85 to 7.68; CI 3.20–18.41. The risk of injury due to violent events was higher among NEET boys (OR: 3.23, 95%CI: 1.21–8.62) compared to schoolboys. Our findings highlighted the importance of including NEET individuals in studies on violence and emphasized the importance of psychosocial health services for young people marginalized from education and the labor market.
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Affiliation(s)
- Siri Havas Haugland
- Department of Psychosocial Health, University of Agder, Kristiansand, Norway
- *Correspondence: Siri Havas Haugland
| | - Tonje Holte Stea
- Department of Health and Nursing Science, University of Agder, Kristiansand, Norway
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9
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Cotton SM, Filia KM, Lambert M, Berk M, Ratheesh A, Schimmelmann BG, Macneil C, Hasty M, McGorry PD, Conus P. Not in education, employment and training status in the early stages of bipolar I disorder with psychotic features. Early Interv Psychiatry 2022; 16:609-617. [PMID: 34313390 DOI: 10.1111/eip.13203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/30/2021] [Accepted: 07/15/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE There is a lack of existing research regarding young people with bipolar I disorder (BD-I) and psychotic features, who are not in education, employment, and training (NEET). Thus, the aims of the study were to: (a) establish rates of NEET at service entry to a specialist early intervention service; (b) delineate premorbid and current variables associated with NEET status at service entry and (c) examine correlates of NEET status at discharge. METHOD Medical file audit methodology was utilized to collect information on 118 patients with first episode psychotic mania treated at the Early Psychosis Prevention and Intervention Centre (EPPIC), Melbourne, Australia. NEET status was determined using the modified vocation status index (MVCI). Bivariate and multivariable logistic variables were used to examine relationships between premorbid, service entry and treatment variables, and NEET status at service entry and discharge. RESULTS The NEET rate was 33.9% at service entry, and 39.2% at discharge. Variables associated with NEET status at service entry were premorbid functioning and polysubstance use. NEET status at service entry was the only significant correlate of NEET status at discharge. When service entry NEET was taken out of the model, substance use during treatment was predictive of NEET status at discharge. CONCLUSIONS NEET status at service entry was related to a history of premorbid decline, and risk factors such as substance use and forensic issues. NEET status can decline during treatment, and utility of vocational intervention programs specifically for BD, in addition to specialist early intervention, needs to be examined.
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Affiliation(s)
- Sue M Cotton
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen, Parkville, Victoria, Australia
| | - Kate M Filia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen, Parkville, Victoria, Australia
| | - Martin Lambert
- Psychosis Early Detection and Intervention Centre (PEDIC), Department for Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Berk
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen, Parkville, Victoria, Australia.,IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Aswin Ratheesh
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen, Parkville, Victoria, Australia
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg, Germany.,University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
| | - Craig Macneil
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen, Parkville, Victoria, Australia
| | - Melissa Hasty
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen, Parkville, Victoria, Australia
| | - Patrick D McGorry
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen, Parkville, Victoria, Australia
| | - Philippe Conus
- Treatment and Early Intervention in Psychosis Program (TIPP), Departement de Psychiatrie CHUV, Université de Lausanne, Prilly, Switzerland
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10
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Optimizing Strategies for Improving Mental Health in Victoria, Australia during the COVID-19 Era: A System Dynamics Modelling Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116470. [PMID: 35682058 PMCID: PMC9180267 DOI: 10.3390/ijerph19116470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/17/2022] [Accepted: 05/24/2022] [Indexed: 11/17/2022]
Abstract
The ongoing COVID-19 pandemic has impacted the mental health of populations and highlighted the limitations of mental health care systems. As the trajectory of the pandemic and the economic recovery are still uncertain, decision tools are needed to help evaluate the best interventions to improve mental health outcomes. We developed a system dynamics model that captures causal relationships among population, demographics, post-secondary education, health services, COVID-19 impact, and mental health outcomes. The study was conducted in the Australian state of Victoria. The model was calibrated using historical data and was stratified by age group and by geographic remoteness. Findings demonstrate that the most effective intervention combination includes economic, social, and health sector initiatives. Assertive post-suicide attempt care is the most impactful health sector intervention, but delaying implementation reduces the potency of its impact. Some evidence-based interventions, such as population-wide community awareness campaigns, are projected to worsen mental health outcomes when implemented on their own. Systems modelling offers a powerful decision-support tool to test alternative strategies for improving mental health outcomes in the Victorian context.
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Lindhardt L, Storebø OJ, Bruun LS, Simonsen E, Mortensen OS. “ Psychosis among the disconnected youth: a systematic review.”. COGENT PSYCHOLOGY 2022. [DOI: 10.1080/23311908.2022.2056306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Line Lindhardt
- Early Psychosis Intervention Center, Mental Health Services East, Region Zealand Denmark
| | - Ole Jakob Storebø
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
- Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Laura Staxen Bruun
- Early Psychosis Intervention Center, Mental Health Services East, Region Zealand Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ole Steen Mortensen
- Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Occupational and Social Medicine, Holbaek Hospital, Denmark
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12
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Multicomponent Intervention Associated with Improved Emotional and Cognitive Outcomes of Marginalized Unemployed Youth of Latin America. SOCIAL SCIENCES-BASEL 2022. [DOI: 10.3390/socsci11040155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mass migration and people seeking political refuge are critical social issues facing Latin America. Ecuador has the largest population of recognized refugees in the region. Youths from a migration background have an increased risk of becoming NEET (Young people not in employment, education, or training). Such youths struggle more with mental health problems than non-NEET peers. Being a refugee, NEET further increases the risk of having mental health problems and may be linked to lower cognitive functioning, which could maintain exclusion and unemployment. This intervention study was performed with a group of young people of different nationalities who were refugees or belonged to other vulnerable groups attending a six-week employability-support intervention in Ecuador. In order to assess the impact of the intervention, a range of measures of executive cognitive function, mental health, and the potential for positive change were used. We found that post-intervention, the group reported significantly less psychological distress and better self-esteem, self-efficacy, and cognitive response inhibition than before the intervention. We conclude that multicomponent interventions may effectively improve the psychological functioning of vulnerable NEET groups in the Latin American context.
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13
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Filia K, Menssink J, Gao CX, Rickwood D, Hamilton M, Hetrick SE, Parker AG, Herrman H, Hickie I, Sharmin S, McGorry PD, Cotton SM. Social inclusion, intersectionality, and profiles of vulnerable groups of young people seeking mental health support. Soc Psychiatry Psychiatr Epidemiol 2022; 57:245-254. [PMID: 34091699 DOI: 10.1007/s00127-021-02123-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 06/02/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND headspace centres provide enhanced primary mental healthcare for young people. A priority is to provide services for all young people irrespective of a range of social disadvantages or social exclusion. The aims of this study were to: (i) delineate extent of social inclusion across domains of housing, studying/employment, functioning, alcohol, and other drug use; and (ii) map profiles of young people deemed vulnerable to experiencing additional barriers to accessing services based on their social inclusion domains (e.g., those living in unstable housing, not in employment/education, and/or experiencing intersecting or multiple forms of disadvantage or difficulties), including detailing their clinical characteristics. METHODS Young people were recruited from five headspace centres. Data relevant to social inclusion were examined. Multivariate logistic regression models were used to determine overlap between vulnerable groups, functional, social, clinical, and behavioural factors. RESULTS 1107 young people participated, aged 12-25 years (M = 18.1 years, SD = 3.3), most living in stable housing (96.5%) and engaged in studying/employment (84.8%). Specific vulnerabilities were evident in young people with NEET status (15.2%); in unstable accommodation (3.5%); of culturally diverse backgrounds (CALD) (12.2%); living in regional areas (36.1%); and identifying as lesbian, gay, bisexual, transgender, intersex, queer/questioning, and asexual plus (LGBTIQA+; 28.2%). Higher levels of distress, substance use, functional impairment, and lower social support were reported by those who were NEET and/or in unstable housing. LGBTIQA+ status was associated with high distress, depressive symptoms, and suicidal ideation. CONCLUSIONS Most participants reported good social support, stable housing, and engagement in work or education. Those deemed vulnerable were likely to experience social exclusion across multiple domains and reported more mental health problems. The co-occurrence of mental ill-health and social exclusion highlights the importance of integrated mental healthcare.
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Affiliation(s)
- K Filia
- Orygen, Locked Bag 10, 35 Poplar Road, Parkville, VIC, 3052, Australia.
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia.
| | - J Menssink
- Orygen, Locked Bag 10, 35 Poplar Road, Parkville, VIC, 3052, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - C X Gao
- Orygen, Locked Bag 10, 35 Poplar Road, Parkville, VIC, 3052, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - D Rickwood
- headspace National Youth Mental Health Foundation, Melbourne, VIC, Australia
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - M Hamilton
- Orygen, Locked Bag 10, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - S E Hetrick
- Orygen, Locked Bag 10, 35 Poplar Road, Parkville, VIC, 3052, Australia
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - A G Parker
- Orygen, Locked Bag 10, 35 Poplar Road, Parkville, VIC, 3052, Australia
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
| | - H Herrman
- Orygen, Locked Bag 10, 35 Poplar Road, Parkville, VIC, 3052, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - I Hickie
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
| | - S Sharmin
- Orygen, Locked Bag 10, 35 Poplar Road, Parkville, VIC, 3052, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - P D McGorry
- Orygen, Locked Bag 10, 35 Poplar Road, Parkville, VIC, 3052, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - S M Cotton
- Orygen, Locked Bag 10, 35 Poplar Road, Parkville, VIC, 3052, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
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14
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McGorry PD, Mei C, Chanen A, Hodges C, Alvarez-Jimenez M, Killackey E. Designing and scaling up integrated youth mental health care. World Psychiatry 2022; 21:61-76. [PMID: 35015367 PMCID: PMC8751571 DOI: 10.1002/wps.20938] [Citation(s) in RCA: 95] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Mental ill-health represents the main threat to the health, survival and future potential of young people around the world. There are indications that this is a rising tide of vulnerability and need for care, a trend that has been augmented by the COVID-19 pandemic. It represents a global public health crisis, which not only demands a deep and sophisticated understanding of possible targets for prevention, but also urgent reform and investment in the provision of developmentally appropriate clinical care. Despite having the greatest level of need, and potential to benefit, adolescents and emerging adults have the worst access to timely and quality mental health care. How is this global crisis to be addressed? Since the start of the century, a range of co-designed youth mental health strategies and innovations have emerged. These range from digital platforms, through to new models of primary care to new services for potentially severe mental illness, which must be locally adapted according to the availability of resources, workforce, cultural factors and health financing patterns. The fulcrum of this progress is the advent of broad-spectrum, integrated primary youth mental health care services. They represent a blueprint and beach-head for an overdue global system reform. While resources will vary across settings, the mental health needs of young people are largely universal, and underpin a set of fundamental principles and design features. These include establishing an accessible, "soft entry" youth primary care platform with digital support, where young people are valued and essential partners in the design, operation, management and evaluation of the service. Global progress achieved to date in implementing integrated youth mental health care has highlighted that these services are being accessed by young people with genuine and substantial mental health needs, that they are benefiting from them, and that both these young people and their families are highly satisfied with the services they receive. However, we are still at base camp and these primary care platforms need to be scaled up across the globe, complemented by prevention, digital platforms and, crucially, more specialized care for complex and persistent conditions, aligned to this transitional age range (from approximately 12 to 25 years). The rising tide of mental ill-health in young people globally demands that this focus be elevated to a top priority in global health.
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Affiliation(s)
- Patrick D McGorry
- Orygen, National Centre of Excellence in Youth Mental Health; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Cristina Mei
- Orygen, National Centre of Excellence in Youth Mental Health; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Andrew Chanen
- Orygen, National Centre of Excellence in Youth Mental Health; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Craig Hodges
- Orygen, National Centre of Excellence in Youth Mental Health; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Mario Alvarez-Jimenez
- Orygen, National Centre of Excellence in Youth Mental Health; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Eóin Killackey
- Orygen, National Centre of Excellence in Youth Mental Health; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
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15
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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: 7] [Impact Index Per Article: 3.5] [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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16
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Iorfino F, Cheng VWS, Cross SP, Yee HF, Davenport TA, Scott EM, Hickie IB. Right Care, First Time: Developing a Theory-Based Automated Protocol to Help Clinically Stage Young People Based on Severity and Persistence of Mental Illness. Front Public Health 2021; 9:621862. [PMID: 34513775 PMCID: PMC8429786 DOI: 10.3389/fpubh.2021.621862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 07/31/2021] [Indexed: 11/21/2022] Open
Abstract
Most mental disorders emerge before the age of 25 years and, if left untreated, have the potential to lead to considerable lifetime burden of disease. Many services struggle to manage high demand and have difficulty matching individuals to timely interventions due to the heterogeneity of disorders. The technological implementation of clinical staging for youth mental health may assist the early detection and treatment of mental disorders. We describe the development of a theory-based automated protocol to facilitate the initial clinical staging process, its intended use, and strategies for protocol validation and refinement. The automated clinical staging protocol leverages the clinical validation and evidence base of the staging model to improve its standardization, scalability, and utility by deploying it using Health Information Technologies (HIT). Its use has the potential to enhance clinical decision-making and transform existing care pathways, but further validation and evaluation of the tool in real-world settings is needed.
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Affiliation(s)
- Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | | | - Shane P Cross
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Hannah F Yee
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | | | - Elizabeth M Scott
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
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17
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Hawke LD, Hayes E, Iyer S, Killackey E, Chinnery G, Gariépy G, Thabane L, Darnay K, Alagaratnam A, Tucker-Kilfoil S, Moxness K, Hachimi-Idrissi N, Winkelmann I, Henderson J. Youth-oriented outcomes of education, employment and training interventions for upcoming youth: Protocol for a discrete choice experiment. Early Interv Psychiatry 2021; 15:942-948. [PMID: 32945127 DOI: 10.1111/eip.13039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/06/2020] [Accepted: 08/30/2020] [Indexed: 11/29/2022]
Abstract
AIM The issue of youth who are not engaged in education, employment or training has been a focus of policymakers for decades. Although interventions exist for these youth, they often measure success in ways that fail to capture what youth seek to gain. The project aims to address this gap by assessing youth-oriented outcomes for interventions targeting upcoming youth. Acknowledging the stigma attached to the deficit-based notion of not engaged in education, employment or training, hereafter we refer to 'upcoming youth', a term coined by youth partners on the project. This study asks what youth want to achieve by participating in an intervention for upcoming youth, with a view to guiding service and research design. METHODS A mixed-methods discrete choice experiment will be conducted with youth engaged as partners. A qualitative (focus group) stage will be conducted to design discrete-choice experiment attributes and levels. The experiment will be piloted and administered online to approx. 500 youth (aged 14-29) across Canada to identify the outcomes that youth prioritize for interventions. Latent class analyses will then be conducted to explore clusters of outcomes that different groups of youth prioritize. CONCLUSIONS From a strengths-based recovery-oriented framework, hearing the voices of the target population is important in designing and evaluating services. This youth-oriented research project will identify the intervention outcomes that are the highest priority for upcoming youth. Findings will inform the development, implementation and testing of interventions targeting relevant outcomes for youth who are not engaged in education, employment or training.
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Affiliation(s)
- Lisa D Hawke
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Em Hayes
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | | | | | | | | | - Karleigh Darnay
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | | | | | | | | | - Joanna Henderson
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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18
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Iorfino F, Occhipinti JA, Skinner A, Davenport T, Rowe S, Prodan A, Sturgess J, Hickie IB. The Impact of Technology-Enabled Care Coordination in a Complex Mental Health System: A Local System Dynamics Model. J Med Internet Res 2021; 23:e25331. [PMID: 34077384 PMCID: PMC8274674 DOI: 10.2196/25331] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/20/2020] [Accepted: 04/15/2021] [Indexed: 12/16/2022] Open
Abstract
Background Prior to the COVID-19 pandemic, major shortcomings in the way mental health care systems were organized were impairing the delivery of effective care. The mental health impacts of the pandemic, the recession, and the resulting social dislocation will depend on the extent to which care systems will become overwhelmed and on the strategic investments made across the system to effectively respond. Objective This study aimed to explore the impact of strengthening the mental health system through technology-enabled care coordination on mental health and suicide outcomes. Methods A system dynamics model for the regional population catchment of North Coast New South Wales, Australia, was developed that incorporated defined pathways from social determinants of mental health to psychological distress, mental health care, and suicidal behavior. The model reproduced historic time series data across a range of outcomes and was used to evaluate the relative impact of a set of scenarios on attempted suicide (ie, self-harm hospitalizations), suicide deaths, mental health–related emergency department (ED) presentations, and psychological distress over the period from 2021 to 2030. These scenarios include (1) business as usual, (2) increase in service capacity growth rate by 20%, (3) standard telehealth, and (4) technology-enabled care coordination. Each scenario was tested using both pre– and post–COVID-19 social and economic conditions. Results Technology-enabled care coordination was forecast to deliver a reduction in self-harm hospitalizations and suicide deaths by 6.71% (95% interval 5.63%-7.87%), mental health–related ED presentations by 10.33% (95% interval 8.58%-12.19%), and the prevalence of high psychological distress by 1.76 percentage points (95% interval 1.35-2.32 percentage points). Scenario testing demonstrated that increasing service capacity growth rate by 20% or standard telehealth had substantially lower impacts. This pattern of results was replicated under post–COVID-19 conditions with technology-enabled care coordination being the only tested scenario, which was forecast to reduce the negative impact of the pandemic on mental health and suicide. Conclusions The use of technology-enabled care coordination is likely to improve mental health and suicide outcomes. The substantially lower effectiveness of targeting individual components of the mental health system (ie, increasing service capacity growth rate by 20% or standard telehealth) reiterates that strengthening the whole system has the greatest impact on patient outcomes. Investments into more of the same types of programs and services alone will not be enough to improve outcomes; instead, new models of care and the digital infrastructure to support them and their integration are needed.
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Affiliation(s)
- Frank Iorfino
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | | | - Adam Skinner
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | | | - Shelley Rowe
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Ante Prodan
- Translational Health Research Institute, Western Sydney University, Sydney, Australia
| | - Julie Sturgess
- North Coast Primary Health Network, Coffs Harbour, Australia
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, Australia
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19
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Gehue LJ, Crouse JJ, Battisti RA, Yim M, Carpenter JS, Scott EM, Hickie IB. Piloting the 'Youth Early-intervention Study' ('YES'): Preliminary functional outcomes of a randomized controlled trial targeting social participation and physical well-being in young people with emerging mental disorders. J Affect Disord 2021; 280:180-188. [PMID: 33217700 DOI: 10.1016/j.jad.2020.10.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 09/07/2020] [Accepted: 10/31/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Young people with mental disorders present with diverse social, vocational, physical, and developmental needs. However, multifaceted interventions are rare. We examine the effectiveness of a clinical trial targeting social participation and physical well-being in young people accessing clinical services. METHODS The 'Youth Early-intervention Study' ('YES') was an unblinded, two-phase, pilot randomized controlled trial offered as an adjunct to standard clinical care, consisting of group activities. Mixed effects models were used to examine functional outcomes over time measured by the 'Social and Occupational Functioning Assessment Scale', 'Functioning Assessment Short Test', and 'Brief Disability Questionnaire' (items 7 and 8). RESULTS 133 participants aged 14-25 were recruited. 87 participants completed both arms and 83 participants completed a 12-month post-trial assessment. Functioning improved across all outcomes. While diagnoses differed in functioning at baseline (lower functioning in psychotic and bipolar disorders compared to depression), they did not differ in the rate of improvement across any measure. Randomization groups did not differ in baseline functioning or the rate of improvement, suggesting a non-specific impact of the intervention. Engagement with education increased from 11% at baseline to 51% at 12-months post-trial and full-time employment increased from 8% at baseline to 20% at 12-months post-trial. LIMITATIONS Small sample, no control group, and unmeasured potential moderators (e.g. neurocognitive impairment). CONCLUSIONS 'YES' was effective and preliminary positive outcomes were observed across all functional outcomes. Future studies should compare the 'YES' intervention to a treatment-as-usual control condition and conduct a multi-centre trial across early intervention service sites.
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Affiliation(s)
- Lillian J Gehue
- Youth Mental Health and Technology Team, Brain and Mind Centre, University of Sydney, NSW, Australia
| | - Jacob J Crouse
- Youth Mental Health and Technology Team, Brain and Mind Centre, University of Sydney, NSW, Australia.
| | - Robert A Battisti
- Cancer Centre for Children, The Children's Hospital at Westmead, NSW, Australia
| | - Mark Yim
- St Vincent's Private Hospital, Sydney, NSW, Australia
| | - Joanne S Carpenter
- Youth Mental Health and Technology Team, Brain and Mind Centre, University of Sydney, NSW, Australia
| | - Elizabeth M Scott
- Youth Mental Health and Technology Team, Brain and Mind Centre, University of Sydney, NSW, Australia; St Vincent's and Mater Clinical School, The University of Notre Dame, NSW, Australia
| | - Ian B Hickie
- Youth Mental Health and Technology Team, Brain and Mind Centre, University of Sydney, NSW, Australia
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20
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Allott K, Van‐der‐el K, Bryce S, Hamilton M, Adams S, Burgat L, Killackey E, Rickwood D. Need for clinical neuropsychological assessment in headspace youth mental health services: A national survey of providers. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/ajpy.12225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Kelly Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia,
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia,
| | - Kristi Van‐der‐el
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia,
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia,
| | - Shayden Bryce
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia,
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia,
| | - Matthew Hamilton
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia,
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia,
| | - Sophie Adams
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia,
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia,
- Orygen Youth Health, Parkville, Victoria, Australia,
| | - Liz Burgat
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia,
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia,
| | - Eoin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia,
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia,
| | - Debra Rickwood
- Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia,
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21
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Fakunle AG, Jafta N, Okekunle AP, Naidoo RN. Indoor microbiome and risk of lower respiratory tract infections among children under-five years: A meta-analysis. INDOOR AIR 2020; 30:795-804. [PMID: 32462684 DOI: 10.1111/ina.12698] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 04/03/2020] [Accepted: 05/15/2020] [Indexed: 06/11/2023]
Abstract
We investigated whether exposure to microbiome within the indoor environment is associated with risk of lower respiratory tract infections (LRTI) among children under 5 years of age. Electronic scientific repositories; PubMed, Scopus, Web of Science, GreenFILE, EMBASE, and Cochrane library were searched and screened through July 2019 for published reports for inclusion in the meta-analysis. Studies were eligible for inclusion if they reported an adjusted measure of risk for LRTI associated with IM exposure, including the relative risk (RR) or odds ratio (OR) and confidence interval (CI). The pooled OR was computed using the inverse of variance method for weighting. Sensitivity analysis was used to evaluate the effect of individual studies, while heterogeneity was evaluated by I2 statistics using RevMan 5.3. Seven studies were eligible for inclusion in our meta-analysis. Exposure to a higher concentration of IM was associated with an increased risk of LRTI [OR:1.20 (1.11, 1.33), P < .0001]. The risk was stronger with exposure to total fungal concentration [OR:1.27 (1.13, 1.44), P < .0001] than visible molds [OR:1.20 (1.07, 1.34, P = .001]. Under-five children exposed to higher IM concentration are likely at increased risk of LRTI. Interventions addressing IM exposure should be considered in the management of LRTI among under-five children.
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Affiliation(s)
- Adekunle G Fakunle
- Discipline of Occupational and Environmental Health, University of KwaZulu-Natal, Durban, South Africa
- Department of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Nkosana Jafta
- Discipline of Occupational and Environmental Health, University of KwaZulu-Natal, Durban, South Africa
| | - Akinkunmi P Okekunle
- Department of Epidemiology and Medical Statistics, College of Medicine, Ibadan, Nigeria
- The Postgraduate College, University of Ibadan, Ibadan, Nigeria
| | - Rajen N Naidoo
- Discipline of Occupational and Environmental Health, University of KwaZulu-Natal, Durban, South Africa
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Hickie IB, Scott EM, Cross SP, Iorfino F, Davenport TA, Guastella AJ, Naismith SL, Carpenter JS, Rohleder C, Crouse JJ, Hermens DF, Koethe D, Markus Leweke F, Tickell AM, Sawrikar V, Scott J. Right care, first time: a highly personalised and measurement-based care model to manage youth mental health. Med J Aust 2020; 211 Suppl 9:S3-S46. [PMID: 31679171 DOI: 10.5694/mja2.50383] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Mood and psychotic syndromes most often emerge during adolescence and young adulthood, a period characterised by major physical and social change. Consequently, the effects of adolescent-onset mood and psychotic syndromes can have long term consequences. A key clinical challenge for youth mental health is to develop and test new systems that align with current evidence for comorbid presentations and underlying neurobiology, and are useful for predicting outcomes and guiding decisions regarding the provision of appropriate and effective care. Our highly personalised and measurement-based care model includes three core concepts: ▶ A multidimensional assessment and outcomes framework that includes: social and occupational function; self-harm, suicidal thoughts and behaviour; alcohol or other substance misuse; physical health; and illness trajectory. ▶ Clinical stage. ▶ Three common illness subtypes (psychosis, anxious depression, bipolar spectrum) based on proposed pathophysiological mechanisms (neurodevelopmental, hyperarousal, circadian). The model explicitly aims to prevent progression to more complex and severe forms of illness and is better aligned to contemporary models of the patterns of emergence of psychopathology. Inherent within this highly personalised approach is the incorporation of other evidence-based processes, including real-time measurement-based care as well as utilisation of multidisciplinary teams of health professionals. Data-driven local system modelling and personalised health information technologies provide crucial infrastructure support to these processes for better access to, and higher quality, mental health care for young people. CHAPTER 1: MULTIDIMENSIONAL OUTCOMES IN YOUTH MENTAL HEALTH CARE: WHAT MATTERS AND WHY?: Mood and psychotic syndromes present one of the most serious public health challenges that we face in the 21st century. Factors including prevalence, age of onset, and chronicity contribute to substantial burden and secondary risks such as alcohol or other substance misuse. Mood and psychotic syndromes most often emerge during adolescence and young adulthood, a period characterised by major physical and social change; thus, effects can have long term consequences. We propose five key domains which make up a multidimensional outcomes framework that aims to address the specific needs of young people presenting to health services with emerging mental illness. These include social and occupational function; self-harm, suicidal thoughts and behaviours; alcohol or other substance misuse; physical health; and illness type, stage and trajectory. Impairment and concurrent morbidity are well established in young people by the time they present for mental health care. Despite this, services and health professionals tend to focus on only one aspect of the presentation - illness type, stage and trajectory - and are often at odds with the preferences of young people and their families. There is a need to address the disconnect between mental health, physical health and social services and interventions, to ensure that youth mental health care focuses on the outcomes that matter to young people. CHAPTER 2: COMBINING CLINICAL STAGE AND PATHOPHYSIOLOGICAL MECHANISMS TO UNDERSTAND ILLNESS TRAJECTORIES IN YOUNG PEOPLE WITH EMERGING MOOD AND PSYCHOTIC SYNDROMES: Traditional diagnostic classification systems for mental disorders map poorly onto the early stages of illness experienced by young people, and purport categorical distinctions that are not readily supported by research into genetic, environmental and neurobiological risk factors. Consequently, a key clinical challenge in youth mental health is to develop and test new classification systems that align with current evidence on comorbid presentations, are consistent with current understanding of underlying neurobiology, and provide utility for predicting outcomes and guiding decisions regarding the provision of appropriate and effective care. This chapter outlines a transdiagnostic framework for classifying common adolescent-onset mood and psychotic syndromes, combining two independent but complementary dimensions: clinical staging, and three proposed pathophysiological mechanisms. Clinical staging reflects the progression of mental disorders and is in line with the concept used in general medicine, where more advanced stages are associated with a poorer prognosis and a need for more intensive interventions with a higher risk-to-benefit ratio. The three proposed pathophysiological mechanisms are neurodevelopmental abnormalities, hyperarousal and circadian dysfunction, which, over time, have illness trajectories (or pathways) to psychosis, anxious depression and bipolar spectrum disorders, respectively. The transdiagnostic framework has been evaluated in young people presenting to youth mental health clinics of the University of Sydney's Brain and Mind Centre, alongside a range of clinical and objective measures. Our research to date provides support for this framework, and we are now exploring its application to the development of more personalised models of care. CHAPTER 3: A COMPREHENSIVE ASSESSMENT FRAMEWORK FOR YOUTH MENTAL HEALTH: GUIDING HIGHLY PERSONALISED AND MEASUREMENT-BASED CARE USING MULTIDIMENSIONAL AND OBJECTIVE MEASURES: There is an urgent need for improved care for young people with mental health problems, in particular those with subthreshold mental disorders that are not sufficiently severe to meet traditional diagnostic criteria. New comprehensive assessment frameworks are needed to capture the biopsychosocial profile of a young person to drive highly personalised and measurement-based mental health care. We present a range of multidimensional measures involving five key domains: social and occupational function; self-harm, suicidal thoughts and behaviours; alcohol or other substance misuse; physical health; and illness type, stage and trajectory. Objective measures include: neuropsychological function; sleep-wake behaviours and circadian rhythms; metabolic and immune markers; and brain structure and function. The recommended multidimensional measures facilitate the development of a comprehensive clinical picture. The objective measures help to further develop informative and novel insights into underlying pathophysiological mechanisms and illness trajectories to guide personalised care plans. A panel of specific multidimensional and objective measures are recommended as standard clinical practice, while others are recommended secondarily to provide deeper insights with the aim of revealing alternative clinical paths for targeted interventions and treatments matched to the clinical stage and proposed pathophysiological mechanisms of the young person. CHAPTER 4: PERSONALISING CARE OPTIONS IN YOUTH MENTAL HEALTH: USING MULTIDIMENSIONAL ASSESSMENT, CLINICAL STAGE, PATHOPHYSIOLOGICAL MECHANISMS, AND INDIVIDUAL ILLNESS TRAJECTORIES TO GUIDE TREATMENT SELECTION: New models of mental health care for young people require that interventions be matched to illness type, clinical stage, underlying pathophysiological mechanisms and individual illness trajectories. Narrow syndrome-focused classifications often direct clinical attention away from other key factors such as functional impairment, self-harm and suicidality, alcohol or other substance misuse, and poor physical health. By contrast, we outline a treatment selection guide for early intervention for adolescent-onset mood and psychotic syndromes (ie, active treatments and indicated and more specific secondary prevention strategies). This guide is based on experiences with the Brain and Mind Centre's highly personalised and measurement-based care model to manage youth mental health. The model incorporates three complementary core concepts: ▶A multidimensional assessment and outcomes framework including: social and occupational function; self-harm, suicidal thoughts and behaviours; alcohol or other substance misuse; physical health; and illness trajectory. ▶Clinical stage. ▶Three common illness subtypes (psychosis, anxious depression, bipolar spectrum) based on three underlying pathophysiological mechanisms (neurodevelopmental, hyperarousal, circadian). These core concepts are not mutually exclusive and together may facilitate improved outcomes through a clinical stage-appropriate and transdiagnostic framework that helps guide decisions regarding the provision of appropriate and effective care options. Given its emphasis on adolescent-onset mood and psychotic syndromes, the Brain and Mind Centre's model of care also respects a fundamental developmental perspective - categorising childhood problems (eg, anxiety and neurodevelopmental difficulties) as risk factors and respecting the fact that young people are in a period of major biological and social transition. Based on these factors, a range of social, psychological and pharmacological interventions are recommended, with an emphasis on balancing the personal benefit-to-cost ratio. CHAPTER 5: A SERVICE DELIVERY MODEL TO SUPPORT HIGHLY PERSONALISED AND MEASUREMENT-BASED CARE IN YOUTH MENTAL HEALTH: Over the past decade, we have seen a growing focus on creating mental health service delivery models that better meet the unique needs of young Australians. Recent policy directives from the Australian Government recommend the adoption of stepped-care services to improve the appropriateness of care, determined by severity of need. Here, we propose that a highly personalised approach enhances stepped-care models by incorporating clinical staging and a young person's current and multidimensional needs. It explicitly aims to prevent progression to more complex and severe forms of illness and is better aligned to contemporary models of the patterns of emergence of psychopathology. Inherent within a highly personalised approach is the incorporation of other evidence-based processes, including real-time measurement-based care and use of multidisciplinary teams of health professionals. Data-driven local system modelling and personalised health information technologies provide crucial infrastructure support to these processes for better access to, and higher quality of, mental health care for young people.
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Affiliation(s)
- Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, NSW
| | - Elizabeth M Scott
- Brain and Mind Centre, University of Sydney, Sydney, NSW.,University of Notre Dame Australia, Sydney, NSW
| | - Shane P Cross
- Brain and Mind Centre, University of Sydney, Sydney, NSW
| | - Frank Iorfino
- Brain and Mind Centre, University of Sydney, Sydney, NSW
| | | | | | | | | | | | - Jacob J Crouse
- Brain and Mind Centre, University of Sydney, Sydney, NSW
| | - Daniel F Hermens
- Brain and Mind Centre, University of Sydney, Sydney, NSW.,Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Birtinya, QLD
| | - Dagmar Koethe
- Brain and Mind Centre, University of Sydney, Sydney, NSW
| | | | | | - Vilas Sawrikar
- Brain and Mind Centre, University of Sydney, Sydney, NSW.,University of Edinburgh, Edinburgh, UK
| | - Jan Scott
- Brain and Mind Centre, University of Sydney, Sydney, NSW.,Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
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Berry C, Easterbrook MJ, Empson L, Fowler D. Structured activity and multiple group memberships as mechanisms of increased depression amongst young people not in employment, education or training. Early Interv Psychiatry 2019; 13:1480-1487. [PMID: 30924324 DOI: 10.1111/eip.12798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 01/03/2019] [Accepted: 02/17/2019] [Indexed: 11/30/2022]
Abstract
AIMS Young people Not in Employment, Education and Training (NEET) are at increased risk of depression, yet mechanisms of this association are poorly understood. We hypothesised that being NEET has both behavioural and social identity consequences and that reductions in structured activity and multiple group memberships underlie increased depression in this group. Our purpose was to assess first whether depression was greater for NEET compared to non-NEET young people from the same geographical locality, and secondly, whether a loss of structured activity leading to a reduction in multiple group memberships explains the NEET-depression association. METHODS The present study was a cross-sectional between-groups design using convenience sampling. Measures of depression, structured activity and multiple group memberships were obtained from 45 NEET young people and 190 university students (non-NEET). RESULTS The NEET group reported significantly more depression symptoms compared to the non-NEET student control group. A path model specifying NEET status as a predictor of depression, with this association mediated by a reduction in structured activity and fewer multiple group memberships (standardised indirect = 0.03, unstandardised indirect = 0.62, P = 0.052, 95% bias corrected confidence intervals [0.21,1.44]), provided excellent fit to our data: χ2 (3) = 0.26, P = 0.968, comparative fit index (CFI) = 1.00, root mean square error of approximation (RMSEA)<0.01, standardized root mean square residual (SRMR) = 0.01). CONCLUSIONS Our findings suggest that depression is elevated amongst NEET young people compared to non-NEET students from the same locality. The association between NEET status and depression was partially mediated by reduced structured activity and its association with reduced multiple group memberships. Although using cross-sectional data, our findings suggest social interventions may be a key resource in ameliorating depression amongst NEET young people; through preserving engagement in structured activity and the wellbeing benefits derived from arising multiple group memberships.
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Affiliation(s)
- Clio Berry
- School of Psychology, University of Sussex, Brighton, UK.,Research and Development, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Hove, UK
| | | | - Liza Empson
- School of Psychology, University of Sussex, Brighton, UK
| | - David Fowler
- School of Psychology, University of Sussex, Brighton, UK
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24
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Manhica H, Lundin A, Danielsson AK. Not in education, employment, or training (NEET) and risk of alcohol use disorder: a nationwide register-linkage study with 485 839 Swedish youths. BMJ Open 2019; 9:e032888. [PMID: 31615804 PMCID: PMC6797427 DOI: 10.1136/bmjopen-2019-032888] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To investigate to what extent being outside education, employment or training after completed secondary education in Sweden might affect the risk of subsequent alcohol use disorders (AUDs), with sociodemographic indicators, such as sex, domicile and origin, taken into account. DESIGN Population register-based cohort study with 485 839 Swedish youths. SETTING Sweden. PARTICIPANTS All youths who were born between 1982 and 1991 and were aged between 19 and 24 years when they completed secondary education in Sweden, between 2005 and 2009. PRIMARY OUTCOME MEASURE Cox regression models were used to estimate the HR of first record of entry into alcohol-related medical care with a diagnosis of an AUD, by level of labour market attachment, from 1 January 2009 to 31 December 2016. RESULTS About 4% of the youth population were outside education, employment or training and 25% were in insecure workforce after they completed secondary education. The risk of AUD was higher among youths in insecure workforce, HR 1.40 (95% CI 1.30 to 1.50), and among those outside education, employment or training, HR 1.30 (95% CI 1.11 to 1.51), compared with youths within the core workforce, also after adjusting for age, domicile, sex and origin. Being in education was associated with lower HR of AUD, HR=0.84 (95% CI 0.78 to 0.90). CONCLUSION Youths who are in insecure workforce and outside education, employment or training are at higher risk of AUD. Targeted policy actions are needed to support a successful school-work transition to secure equal opportunities for young people.
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Affiliation(s)
- Helio Manhica
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Andreas Lundin
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
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25
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Iorfino F, Cross SP, Davenport T, Carpenter JS, Scott E, Shiran S, Hickie IB. A Digital Platform Designed for Youth Mental Health Services to Deliver Personalized and Measurement-Based Care. Front Psychiatry 2019; 10:595. [PMID: 31507465 PMCID: PMC6716201 DOI: 10.3389/fpsyt.2019.00595] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 07/26/2019] [Indexed: 12/21/2022] Open
Abstract
Mental disorders that commonly emerge during adolescence and young adulthood are associated with substantial immediate burden and risks, as well as potentially imparting lifetime morbidity and premature mortality. While the development of health services that are youth focused and prioritize early intervention has been a critical step forward, an ongoing challenge is the heterogeneous nature of symptom profiles and illness trajectories. Consequently, it is often difficult to provide quality mental health care, at scale, that addresses the broad range of health, social, and functional needs of young people. Here, we describe a new digital platform designed to deliver personalized and measurement-based care. It provides health services and clinicians with the tools to directly address the multidimensional needs of young people. The term "personalized" describes the notion that the assessment of, and the sequence of interventions for, mental disorders are tailored to the young person-and their changing needs over time, while "measurement-based" describes the use of systematic and continuing assessment of a young person's outcomes over the entire course of clinical care. Together, these concepts support a framework for care that transcends a narrow focus on symptom reduction or risk reduction. Instead, it prioritizes a broader focus on enhancing social, health, and physical outcomes for young people and a commitment to tracking these outcomes throughout this key developmental period. Now, with twenty-first century technologies, it is possible to provide health services with the tools needed to deliver quality mental health care.
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Affiliation(s)
- Frank Iorfino
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
- Research and development, Innowell, Pty Ltd., Sydney, NSW, Australia
| | - Shane P. Cross
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Tracey Davenport
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
- Research and development, Innowell, Pty Ltd., Sydney, NSW, Australia
| | | | - Elizabeth Scott
- School of Medicine, University of Notre Dame, Sydney, NSW, Australia
| | - Sagit Shiran
- Research and development, Innowell, Pty Ltd., Sydney, NSW, Australia
| | - Ian B. Hickie
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
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26
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Settipani CA, Hawke LD, Cleverley K, Chaim G, Cheung A, Mehra K, Rice M, Szatmari P, Henderson J. Key attributes of integrated community-based youth service hubs for mental health: a scoping review. Int J Ment Health Syst 2019; 13:52. [PMID: 31367230 PMCID: PMC6651922 DOI: 10.1186/s13033-019-0306-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 07/10/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Community-based, integrated youth service hubs have the potential to address some of the longstanding issues with mental health services for youth, including problems with access and system fragmentation. Better understanding of these approaches, particularly efforts to create a single point of entry to comprehensive, evidence-based services through youth service hubs, is needed to help guide future implementation and evaluation. This scoping review identifies the key principles and characteristics of these models of care, as well as the state of the literature, particularly with regard to implementation and replicability. METHOD Electronic databases and grey literature sources were searched for material from 2001 to 2019, with diverse search terms capturing the concept of "integrated" or "one-stop shop" youth mental health services. Title/abstract and full text review were conducted, as well as additional focused searching. After screening 4891 texts at the title/abstract level and 496 at the full-text level, 110 documents were included for data extraction. RESULTS Several integrated care hub models for youth mental health services and related frameworks were identified internationally, largely in high-income countries. Common principles included an emphasis on rapid access to care and early intervention, youth and family engagement, youth-friendly settings and services, evidence-informed approaches, and partnerships and collaboration. Program characteristics also revealed similarities (e.g., providing evidence-informed or evidence-based services in youth-friendly spaces), with some differences (e.g., care coordination methods, types of service providers), potentially attributable to lack of available information about key ingredients. Outcome research was limited, with few rigorous evaluations of youth outcomes. Moreover, sufficient information for replication, community evaluation of feasibility or actual implementation was rarely provided. CONCLUSION Internationally, integrated youth service hubs were found to share common key principles, while providing comprehensive services to youth with mental health difficulties. There is a great need for common language and measurement framework to facilitate replication, rigorous evaluation of outcomes, knowledge exchange, and dissemination of findings.
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Affiliation(s)
- Cara A. Settipani
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Lisa D. Hawke
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Kristin Cleverley
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON Canada
| | - Gloria Chaim
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Amy Cheung
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON Canada
| | - Kamna Mehra
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON Canada
| | | | - Peter Szatmari
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON Canada
| | - Joanna Henderson
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
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Cairns AJ, Kavanagh DJ, Dark F, McPhail SM. Goal setting improves retention in youth mental health: a cross-sectional analysis. Child Adolesc Psychiatry Ment Health 2019; 13:31. [PMID: 31320924 PMCID: PMC6615268 DOI: 10.1186/s13034-019-0288-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 06/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study explored if a youth-specific mental health service routinely set goals with young people during initial intake/assessment and if goal setting and goal quality in this service was associated with patient retention. METHODS Consecutive initial assessments (n = 283) and administrative service data from two youth-specific health services in Australia were audited for evidence of goal setting, content and quality of the goal and number of therapy services provided after the intake/assessment process. Logistic regression was used to determine if goal setting was associated with disengagement after the assessment session, controlling for drug use, unemployment, age, gender, mental health diagnosis and service site. A consecutive sub-sample of 166 goals (74 participants), was analysed for goal quality. Each goal was assessed against three components of the SMART (specific, measurable, acceptable/achievable, realistic and timed goals) criteria; specific, measurable and timed; and assigned a goal quality score 1-3. A multiple regression explored whether goal quality was predictive of the number of sessions attended, controlling for the same variables as the logistic regression. RESULTS Goal setting was evident in the records of 187 participants (66%). Although most goals were for emotional management, 24% addressed improvements in function. Of the 166 goals analysed in depth, 95 were specific, 23 measurable, but none were timed. Not setting goals during initial assessments correlated with service disengagement (OR 0.30, p > 0.001). Goal setting was positively associated with more therapy sessions attended, regardless of goal quality rating. CONCLUSIONS Engagement and retention of young people within mental health services can be challenging. Clinical tools such as goal setting may keep young people engaged in services longer, potentially improving clinical outcomes. Further research exploring the effectiveness of current youth service models on client-specific goal based outcomes is recommended.
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Affiliation(s)
- Alice J. Cairns
- Centre for Rural and Remote Health, James Cook University, PO Box 341, Weipa, QLD 4874 Australia
| | - David J. Kavanagh
- Centre for Children’s Health Research, School of Psychology and Counselling and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Frances Dark
- Rehabilitation Academic Clinical Unit, Metro South Addiction and Mental Health Services, Metro South Health, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Steven M. McPhail
- Australian Centre for Health Services Innovation, School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
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Basta M, Karakonstantis S, Koutra K, Dafermos V, Papargiris A, Drakaki M, Tzagkarakis S, Vgontzas A, Simos P, Papadakis N. NEET status among young Greeks: Association with mental health and substance use. J Affect Disord 2019; 253:210-217. [PMID: 31054446 DOI: 10.1016/j.jad.2019.04.095] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 03/27/2019] [Accepted: 04/21/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Prior studies have shown that young people "not in education, employment or training" ("NEET") are at higher risk for psychopathology and substance abuse. Similar studies are lacking in Southern European populations. We aimed to examine the associations of anxiety and depressive symptoms, and substance use with NEET status in a large, randomized population-based sample in Greece. METHODS A telephone structured questionnaire was conducted in a representative sample of 2771 young Greeks aged 15-24 years. Anxiety and depressive symptoms were assessed with GAD-7 and PHQ-9 scales, respectively. Substances use and several sociodemographic parameters were also examined. RESULTS In our sample 16.4% were NEETs. In multivariate analyses, NEETs compared to non-NEETs were older, with lower family income, without insurance and more likely to be married and smoke. Furthermore, NEET status was associated with a higher GAD-7 score among older NEETs and long-term NEETs (NEETs unemployed for more than a year). Moreover, being NEET among older participants was associated with severe symptoms of anxiety and moderate/severe symptoms of depression. LIMITATIONS This was a telephone survey and a clinical evaluation of the patients was not performed. Furthermore, the structured interview was not designed to detect the level of substance use or the reasons for being NEET. CONCLUSIONS NEET status is frequent among young Greeks. Older, and long-term NEETs appear to be at higher risk for presenting anxiety/depression symptoms. Whether NEET status is associated with adverse outcomes later in life requires longitudinal studies.
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Affiliation(s)
- Maria Basta
- Department of Psychiatry, University Hospital of Heraklion, Voutes, Heraklion, Crete Zip Code 71110, Greece..
| | - Stamatis Karakonstantis
- Department of Psychiatry, University Hospital of Heraklion, Voutes, Heraklion, Crete Zip Code 71110, Greece
| | - Katerina Koutra
- Department of Psychology, University of Crete, Rethymno, Greece
| | - Vassilis Dafermos
- Department of Political Science, University of Crete, Rethymno, Greece
| | | | - Maria Drakaki
- Department of Political Science, University of Crete, Rethymno, Greece
| | | | - Alexandros Vgontzas
- Department of Psychiatry, University Hospital of Heraklion, Voutes, Heraklion, Crete Zip Code 71110, Greece
| | - Panagiotis Simos
- Department of Psychiatry, University Hospital of Heraklion, Voutes, Heraklion, Crete Zip Code 71110, Greece
| | - Nikos Papadakis
- Department of Political Science, University of Crete, Rethymno, Greece
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Gariépy G, Iyer S. The Mental Health of Young Canadians Who Are Not Working or in School. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:338-344. [PMID: 30595044 PMCID: PMC6591889 DOI: 10.1177/0706743718815899] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Recent studies suggest that youth who have a mental health problem are more likely to be NEET-not in education, employment, or training-but findings remain mixed, and evidence from Canada is limited. We examined this association across a range of mental and substance disorders in a representative sample of Canadian youth. METHOD Data were from the 2012 Canadian Community Health Survey-Mental Health ( n = 5622; ages 15-29). The survey identified past-year mental (depression, bipolar, generalized anxiety) and substance (alcohol, cannabis, other drugs) disorders from a structured interview and included questions on suicidal ideation. We classified as NEET respondents who were not in school or employed in the past week. Logistic regression models tested the associations between mental and substance disorders and NEET status, adjusted for sociodemographic, health, and geographic variables. RESULTS About 10% of youth were NEET. Being NEET was associated with past-year depression (odds ratio [OR] = 1.67; 95% confidence interval [CI], 1.06 to 2.63); bipolar (OR = 2.31; 95% CI, 0.98 to 5.45), generalized anxiety (OR = 2.65; 95% CI, 1.37 to 5.12), and drug use (OR = 3.22; 95% CI, 1.33 to 7.76) disorders; and suicidal ideation (OR = 1.75; 95% CI, 0.99 to 3.09) but was not associated with alcohol (OR = 1.03; 95% CI, 0.63 to 1.69) or cannabis (OR = 0.97; 95% CI, 0.47 to 2.00) disorders. CONCLUSIONS Poor mental health was associated with being NEET in Canadian youth. Efforts targeting NEET should include provisions for mental health. Moreover, youth mental health initiatives should consider educational and employment outcomes. Further longitudinal and intervention studies are warranted.
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Affiliation(s)
- Geneviève Gariépy
- 1 Douglas Mental Health University Institute, McGill University, Montreal, Quebec.,2 Department of Psychiatry, McGill University, Montreal, Quebec
| | - Srividya Iyer
- 1 Douglas Mental Health University Institute, McGill University, Montreal, Quebec.,2 Department of Psychiatry, McGill University, Montreal, Quebec
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Gutiérrez-García RA, Benjet C, Borges G, Méndez Ríos E, Medina-Mora ME. Emerging adults not in education, employment or training (NEET): socio-demographic characteristics, mental health and reasons for being NEET. BMC Public Health 2018; 18:1201. [PMID: 30359227 PMCID: PMC6202842 DOI: 10.1186/s12889-018-6103-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 10/08/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND A growing group of emerging adults in many countries around the globe are not incorporated into the education system or the labor market; these have received the label "NEET: not in education, employment nor training". We describe the mental health and socio-demographic characteristics of emerging adults who are NEET from Mexico City (differentiating between NEET who are homemakers and NEET who are not) compared to their peers who are studying, working or both, in a city in which education and employment opportunities for youth are limited. A secondary objective, because of the often inconsistent inclusion criteria or definitions of NEET, was to evaluate the heterogeneity amongst NEET emerging adults in terms of their perceived reasons for being NEET and to evaluate whether different reasons for being NEET are associated with different mental health characteristics. METHODS The participants were 1071 emerging adults aged 19 to 26; they were interviewed in person by an interviewer in their homes as part of a follow-up study of the Mexican Adolescent Mental Health Survey. The Composite International Diagnostic Interview (WMH-CIDI) assessed psychiatric disorders, substance use and abuse, suicidal behavior and socio-demographic characteristics. RESULTS Of the total sample, 15.3% were NEET homemakers, 8.6% NEET non-homemakers, 41.6% worked only, 20.9% studied only and 13.5% worked and studied. Of those who were NEET, 12.6% were NEET by choice. NEET non-homemakers had overall greater odds of substance use, substance use disorders and some suicidal behaviors in comparison with all their peers, whereas NEET homemakers had reduced odds. Those who were NEET because they didn't know what to do with their life had greater odds of mood, behavioral, and substance disorders, use of all substances and of suicide behaviors compared to those who were NEET by choice. CONCLUSIONS Non-homemaker NEET who lack life goals require targeted mental health intervention. The demographic reality of emerging adults not in education or employment and the varying reasons they give for being NEET are not consistent with how NEET is often conceptualized in terms of a societal problem.
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Affiliation(s)
| | - Corina Benjet
- Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Guilherme Borges
- Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Enrique Méndez Ríos
- Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - María Elena Medina-Mora
- Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
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Prior suicide attempts predict worse clinical and functional outcomes in young people attending a mental health service. J Affect Disord 2018; 238:563-569. [PMID: 29940520 DOI: 10.1016/j.jad.2018.06.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 05/07/2018] [Accepted: 06/12/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Mental disorders and suicidal thoughts and behaviours are common in help-seeking youth. Few studies report the longitudinal associations between these phenomena and clinical and functional outcomes. This study examined whether prior suicide attempts predict poorer outcomes in mental health service attendees. METHODS Clinical and functional data from 1143 individuals (aged 12-30) attending a primary care-based mental health service in Australia were collected over 3-60 months (median = 21 months). Odds ratios (OR) with 95% confidence intervals for the effect of a prior suicide attempt on follow-up outcomes were estimated (adjusted for confounders). RESULTS Prior suicide attempts were common (n = 164; 14%) and prospectively associated with suicidal thoughts (OR = 1.71), suicide attempts (OR = 2.59), self-harm (OR = 1.71), an increased likelihood of being diagnosed with bipolar disorder (OR = 2.99), and the onset of an alcohol/substance use disorder (OR = 2.87). Over the course of care, no suicide attempts were reported in 1052 (92%) individuals, but 25 (2%) had recurrent attempts, and 66 (6%) had new onset of an attempt. New onset was associated with being female and previous suicidal ideation or self-harm; recurrent attempts were associated with being older and comorbid alcohol/substance use disorder. LIMITATIONS The cohort includes only individuals who remained in clinical contact, and the consistency of their documentation varied (across clinicians and over time). CONCLUSIONS Young people with prior suicide attempts are vulnerable to ongoing suicidal behaviours, and poorer clinical and functional outcomes. More intensive management strategies may be needed to directly address these behaviours and the long-term risks they confer. These behaviours also emerge over the course of care among those with no previous history, which has important implications for active service-level strategies that target these behaviours for all of those who present to such services.
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Cairns AJ, Kavanagh DJ, Dark F, McPhail SM. Comparing predictors of part-time and no vocational engagement in youth primary mental health services: A brief report. Early Interv Psychiatry 2018; 12:726-729. [PMID: 28524644 DOI: 10.1111/eip.12445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 12/20/2016] [Accepted: 03/18/2017] [Indexed: 11/30/2022]
Abstract
AIM This investigation aims to identify if correlates of not working or studying were also correlated with part-time vocational participation. METHODS Demographic and vocational engagement information was collected from 226 participant clinical charts aged 15 to 25 years accessing a primary youth health clinic. Multinomial logistic regressions were used to examine potential correlates no and part-time vocational engagement compared to those full-time. RESULTS A total of 33% were not working or studying and 19% were part-time. Not working or studying was associated with secondary school dropout and a history of drug use. These associations were not observed in those participating part-time. CONCLUSIONS This result suggests that the markers of disadvantage observed in those not working or studying do not carry over to those who are part-time. Potentially, those who are part-time are less vulnerable to long-term disadvantage compared to their unemployed counterparts as they do not share the same indicators of disadvantage.
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Affiliation(s)
- Alice J Cairns
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Brisbane, Queensland, Australia
| | - David J Kavanagh
- Centre for Children's Health Research, School of Psychology and Counselling, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Frances Dark
- Rehabilitation Academic Clinical Unit, Metro South Addiction and Mental Health Services and School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Steven M McPhail
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology & Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
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Leonardi M, Guido D, Quintas R, Silvaggi F, Guastafierro E, Martinuzzi A, Chatterji S, Koskinen S, Tobiasz-Adamczyk B, Haro JM, Cabello M, Raggi A. Factors Related to Unemployment in Europe. A Cross-Sectional Study from the COURAGE Survey in Finland, Poland and Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040722. [PMID: 29641485 PMCID: PMC5923764 DOI: 10.3390/ijerph15040722] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/05/2018] [Accepted: 04/08/2018] [Indexed: 01/08/2023]
Abstract
Background: Research addressing the impact of a large number of factors on unemployment is scarce. We aimed to comprehensively identify factors related to unemployment in a sample of persons aged 18-64 from Finland, Poland and Spain. Methods: In this cross-sectional study, factors from different areas were considered: socio-demographic indicators, health habits, chronic conditions, health state markers, vision and hearing indicators, and social networks and built environment scores. Results: Complete data were available for 5003 participants, mean age 48.1 (SD 11.5), 45.4% males. The most important factors connected to unemployment were health status indicators such as physical disability (OR = 2.944), self-rated health (OR = 2.629), inpatient care (OR = 1.980), and difficulties with getting to the toilet (OR = 2.040), while the most relevant factor related to employment were moderate alcohol consumption (OR = 0.732 for non-heavy drinkers; OR = 0.573 for infrequent heavy drinkers), and being married (OR = 0.734), or having been married (OR = 0.584). Other factors that played a significant role included presence of depression (OR = 1.384) and difficulties with near vision (OR = 1.584) and conversation hearing (OR = 1.597). Conclusions: Our results highlight the importance of selected factors related to unemployment, and suggest public health indications that could support concrete actions on modifiable factors, such as those aimed to promote physical activity and healthy behaviors, tackling depression or promoting education, in particular for the younger.
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Affiliation(s)
- Matilde Leonardi
- Neurological Institute C. Besta IRCCS Foundation, Neurology, Public Health and Disability Unit, 20133 Milan, Italy.
| | - Davide Guido
- Neurological Institute C. Besta IRCCS Foundation, Neurology, Public Health and Disability Unit, 20133 Milan, Italy.
| | - Rui Quintas
- Neurological Institute C. Besta IRCCS Foundation, Neurology, Public Health and Disability Unit, 20133 Milan, Italy.
- Neurological Institute C. Besta IRCCS Foundation, Clinical and Experimental Epileptology Unit, 20133 Milan, Italy.
| | - Fabiola Silvaggi
- Neurological Institute C. Besta IRCCS Foundation, Neurology, Public Health and Disability Unit, 20133 Milan, Italy.
| | - Erika Guastafierro
- Neurological Institute C. Besta IRCCS Foundation, Neurology, Public Health and Disability Unit, 20133 Milan, Italy.
| | - Andrea Martinuzzi
- E. Medea Scientific Institute, Conegliano-Pieve di Soligo Research Centre, 31015 Conegliano Veneto, Italy.
| | - Somnath Chatterji
- Information, Evidence and Research Unit, World Health Organization, 1211 Geneva, Switzerland.
| | - Seppo Koskinen
- Ageing, Disability and Functioning Unit, National Institute for Health and Welfare, 00271 Helsinki, Finland.
| | - Beata Tobiasz-Adamczyk
- Department of Medical Sociology, Jagiellonian University Medical College, 31-034 Krakow, Poland.
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, University of Barcelona, CIBERSAM, 08830 Barcelona, Spain.
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, 28029 Madrid, Spain.
| | - Maria Cabello
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, 28029 Madrid, Spain.
- Department of Psychiatry, Universidad Autonoma de Madrid, 28029 Madrid, Spain.
| | - Alberto Raggi
- Neurological Institute C. Besta IRCCS Foundation, Neurology, Public Health and Disability Unit, 20133 Milan, Italy.
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Rodwell L, Romaniuk H, Nilsen W, Carlin JB, Lee KJ, Patton GC. Adolescent mental health and behavioural predictors of being NEET: a prospective study of young adults not in employment, education, or training. Psychol Med 2018; 48:861-871. [PMID: 28874224 DOI: 10.1017/s0033291717002434] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Young adults who are not in employment, education, or training (NEET) are at risk of long-term economic disadvantage and social exclusion. Knowledge about risk factors for being NEET largely comes from cross-sectional studies of vulnerable individuals. Using data collected over a 10-year period, we examined adolescent predictors of being NEET in young adulthood. METHODS We used data on 1938 participants from the Victorian Adolescent Health Cohort Study, a community-based longitudinal study of adolescents in Victoria, Australia. Associations between common mental disorders, disruptive behaviour, cannabis use and drinking behaviour in adolescence, and NEET status at two waves of follow-up in young adulthood (mean ages of 20.7 and 24.1 years) were investigated using logistic regression, with generalised estimating equations used to account for the repeated outcome measure. RESULTS Overall, 8.5% of the participants were NEET at age 20.7 years and 8.2% at 24.1 years. After adjusting for potential confounders, we found evidence of increased risk of being NEET among frequent adolescent cannabis users [adjusted odds ratio (ORadj) = 1.74; 95% confidence interval (CI) 1.10-2.75] and those who reported repeated disruptive behaviours (ORadj = 1.71; 95% CI 1.15-2.55) or persistent common mental disorders in adolescence (ORadj = 1.60; 95% CI 1.07-2.40). Similar associations were present when participants with children were included in the same category as those in employment, education, or training. CONCLUSIONS Young people with an early onset of mental health and behavioural problems are at risk of failing to make the transition from school to employment. This finding reinforces the importance of integrated employment and mental health support programmes.
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Affiliation(s)
- L Rodwell
- Clinical Epidemiology and Biostatistics Unit,Murdoch Childrens Research Institute,Parkville, VIC,Australia
| | - H Romaniuk
- Clinical Epidemiology and Biostatistics Unit,Murdoch Childrens Research Institute,Parkville, VIC,Australia
| | - W Nilsen
- Work Research Institute,Oslo and Akershus University College of Applied Sciences,Oslo,Norway
| | - J B Carlin
- Clinical Epidemiology and Biostatistics Unit,Murdoch Childrens Research Institute,Parkville, VIC,Australia
| | - K J Lee
- Clinical Epidemiology and Biostatistics Unit,Murdoch Childrens Research Institute,Parkville, VIC,Australia
| | - G C Patton
- Department of Paediatrics,Faculty of Medicine,Dentistry and Health Sciences,The University of Melbourne,Melbourne, VIC,Australia
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Iorfino F, Hermens DF, Cross SPM, Zmicerevska N, Nichles A, Badcock CA, Groot J, Scott EM, Hickie IB. Delineating the trajectories of social and occupational functioning of young people attending early intervention mental health services in Australia: a longitudinal study. BMJ Open 2018; 8:e020678. [PMID: 29588325 PMCID: PMC5875606 DOI: 10.1136/bmjopen-2017-020678] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/06/2018] [Accepted: 02/16/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Mental disorders typically emerge during adolescence and young adulthood and put young people at risk for prolonged socioeconomic difficulties. This study describes the longitudinal course of social and occupational functioning of young people attending primary care-based, early intervention services. DESIGN A longitudinal study of young people receiving mental healthcare. SETTING Data were collected between January 2005 and August 2017 from a designated primary care-based mental health service. PARTICIPANTS 554 young people (54% women) aged 12-32 years. MEASURES A systematic medical file audit collected clinical and functional information at predetermined time intervals (ie, 3 months to 5+ years) using a clinical pro forma. Group-based trajectory modelling (GBTM) was used to identify distinct trajectories of social and occupational functioning over time (median number of observations per person=4; median follow-up time=23 months). RESULTS Between first clinical contact and time last seen, 15% of young people had reliably deteriorated, 23% improved and 62% did not demonstrate substantive change in function. Of the whole cohort, 69% had functional scores less than 70 at time last seen, indicative of ongoing and substantive impairment. GBTM identified six distinct functional trajectories whereby over 60% had moderate-to-serious functional impairment at entry and remained chronically impaired over time; 7% entered with serious impairment and deteriorated further; a quarter were mildly impaired at entry and functionally recovered and only a small minority (4%) presented with serious impairments and functionally improved over time. Not being in education, employment or training, previous hospitalisation and a younger age at baseline emerged as significant predictors of these functional trajectories. CONCLUSION Young people with emerging mental disorders have significant functional impairment at presentation for care, and for the majority, it persists over the course of clinical care. In addition to providing clinical care earlier in the course of illness, these data suggest that more sophisticated and more intensive individual-level and organisational strategies may be required to achieve significant and sustained functional improvements.
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Affiliation(s)
- Frank Iorfino
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Daniel F Hermens
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Mind and Neuroscience Thompson Institute, University of the Sunshine Coast, Sunshine Coast, QLD, Australia
| | - Shane, PM Cross
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Natalia Zmicerevska
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Alissa Nichles
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Caro-Anne Badcock
- Statistical Consulting, The University of Sydney, Sydney, New South Wales, Australia
| | - Josine Groot
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Elizabeth M Scott
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Ian B Hickie
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
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A NEET distinction: youths not in employment, education or training follow different pathways to illness and care in psychosis. Soc Psychiatry Psychiatr Epidemiol 2018; 53:1401-1411. [PMID: 30094632 PMCID: PMC6267132 DOI: 10.1007/s00127-018-1565-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/24/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE The early phases of psychosis, including the prodrome, often feature educational/occupational difficulties and various symptoms and signs, that can render or keep youths "Not in Employment, Education or Training" (NEET). Conversely, NEET status itself may increase risk for illness progression and impaired functioning, and impede access to appropriate services for psychosis. As these issues have not been investigated, we aimed to examine differences in the illness and care pathways and characteristics of youths with psychosis who are NEET and non-NEET. METHODS Youths entering a catchment-based Canadian early intervention service for psychosis (N = 416) were assessed as being NEET or non-NEET and compared on symptomatology, premorbid adjustment, prodrome and duration of untreated psychosis (DUP). RESULTS Thirty-nine percent of the sample was NEET. Compared to non-NEET youths, NEET youths had 34% higher negative symptoms scores, longer prodromes (median of 52 weeks vs. 24 weeks), and were more often continuously ill after their first psychiatric change until the onset of psychosis (62% vs. 45%). Both groups had similar premorbid adjustment scores until late adolescence when scores were significantly worse for NEET youths. Accounting for other predictors, NEET youths had 23% longer DUPs on average, despite having made more help-seeking attempts. CONCLUSIONS Despite being more narrowly defined, NEET status was thrice as prevalent in our sample as in the Canadian population. The NEET group followed a distinct trajectory of persistent symptoms and functional decline before presenting with a psychotic disorder. The systemic delays that NEET youths encountered indicate a need for better-targeted early identification efforts.
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Mellifont D. DESperately Seeking Service: A narrative review informing a disability employment services reform framework for Australians with mental illness. Work 2017; 58:463-472. [DOI: 10.3233/wor-172643] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Damian Mellifont
- Centre for Disability Research and Policy, The University of Sydney, NSW, Australia. Tel.: +61 0434 956 400; E-mail:
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Gutiérrez-García RA, Benjet C, Borges G, Méndez Ríos E, Medina-Mora ME. NEET adolescents grown up: eight-year longitudinal follow-up of education, employment and mental health from adolescence to early adulthood in Mexico City. Eur Child Adolesc Psychiatry 2017; 26:1459-1469. [PMID: 28528425 DOI: 10.1007/s00787-017-1004-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 05/14/2017] [Indexed: 10/19/2022]
Abstract
The purpose is to examine the socio-demographic and mental health outcomes in early adulthood of those who as adolescents were not in education, employment or training, termed NEET, compared to their counterparts who studied, worked, or both. One thousand and seventy-one youth residing in Mexico City participated in a representative, prospective, longitudinal 8-year two-Wave cohort study. At Wave I the participants were aged 12-17 and at Wave II aged 19 and 26. The Composite International Diagnostic Interview assessed psychiatric disorders, substance use and abuse, suicidal behavior, interpersonal relationships, employment and education. The main finding of this study is that being NEET in adolescence was associated with several socio-demographic and mental health outcomes in early adulthood, above and beyond baseline socioeconomic disadvantage and mental health compared to their peers, particularly their peers who studied only or studied and worked. NEET youth were not that different from their peers who worked exclusively highlighting the protective value of keeping youth in school. The strongest differences between NEET youth and all their peer groups were their increased risks of incident suicidal behaviors. Social policies are needed for creating more educational opportunities, greater support for retention of students, and programs to facilitate the transition from school to the labor market considering cultural attitudes towards life trajectory expectations.
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Affiliation(s)
- Raúl A Gutiérrez-García
- Research, De La Salle Bajio University, Campus Salamanca, Guanajuato, Mexico.,Counseling Service, Universidad Politécnica de Aguascalientes, Aguascalientes, Mexico
| | - Corina Benjet
- Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico.
| | - Guilherme Borges
- Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Enrique Méndez Ríos
- Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - María Elena Medina-Mora
- Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
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Hetrick SE, Bailey AP, Smith KE, Malla A, Mathias S, Singh SP, O'Reilly A, Verma SK, Benoit L, Fleming TM, Moro MR, Rickwood DJ, Duffy J, Eriksen T, Illback R, Fisher CA, McGorry PD. Integrated (one-stop shop) youth health care: best available evidence and future directions. Med J Aust 2017; 207:S5-S18. [PMID: 29129182 DOI: 10.5694/mja17.00694] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 09/26/2017] [Indexed: 01/07/2023]
Abstract
Although mental health problems represent the largest burden of disease in young people, access to mental health care has been poor for this group. Integrated youth health care services have been proposed as an innovative solution. Integrated care joins up physical health, mental health and social care services, ideally in one location, so that a young person receives holistic care in a coordinated way. It can be implemented in a range of ways. A review of the available literature identified a range of studies reporting the results of evaluation research into integrated care services. The best available data indicate that many young people who may not otherwise have sought help are accessing these mental health services, and there are promising outcomes for most in terms of symptomatic and functional recovery. Where evaluated, young people report having benefited from and being highly satisfied with these services. Some young people, such as those with more severe presenting symptoms and those who received fewer treatment sessions, have failed to benefit, indicating a need for further integration with more specialist care. Efforts are underway to articulate the standards and core features to which integrated care services should adhere, as well as to further evaluate outcomes. This will guide the ongoing development of best practice models of service delivery.
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Affiliation(s)
- Sarah E Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health and The Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC
| | - Alan P Bailey
- Orygen, The National Centre of Excellence in Youth Mental Health and The Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC
| | | | - Ashok Malla
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Steve Mathias
- Foundry, Department of Psychiatry, University of British Columbia, and FRAYME/CADRE Knowledge Network, Vancouver, British Columbia, Canada
| | - Swaran P Singh
- Division of Health Sciences, University of Warwick, Coventry, UK
| | - Aileen O'Reilly
- Jigsaw, The National Centre for Youth Mental Health, Dublin, Ireland
| | - Swapna K Verma
- Department of Early Psychosis Intervention, Institute of Mental Health, Singapore, Singapore
| | - Laelia Benoit
- Sorbonne University and Maisons des Adolescents, Maison de Solenn, Cochin Hospital, Paris, France
| | - Theresa M Fleming
- Department of Psychological Medicine, University of Auckland, Auckland, and Te Wāhanga Tātai Hauora, Victoria University of Wellington, Wellington, New Zealand
| | - Marie Rose Moro
- Sorbonne University and Maisons des Adolescents, Maison de Solenn, Cochin Hospital, Paris, France
| | - Debra J Rickwood
- headspace, National Youth Mental Health Foundation, Melbourne, VIC
| | - Joseph Duffy
- Jigsaw, The National Centre for Youth Mental Health, Dublin, Ireland
| | - Trissel Eriksen
- Youth One Stop Shop, Network of Youth One Stop Shops, Palmerston North, New Zealand
| | | | - Caroline A Fisher
- Allied Health - Psychology, Royal Melbourne Hospital, Melbourne, VIC
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health and The Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC
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Cross SPM, Scott J, Hickie IB. Predicting early transition from sub-syndromal presentations to major mental disorders. BJPsych Open 2017; 3:223-227. [PMID: 28959452 PMCID: PMC5596309 DOI: 10.1192/bjpo.bp.117.004721] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 07/03/2017] [Accepted: 08/14/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Transition from at-risk state to full syndromal mental disorders is underexplored for unipolar and bipolar disorders compared with psychosis. AIMS Prospective, trans-diagnostic study of rates and predictors of early transition from sub-threshold to full syndromal mental disorder. METHOD One-year outcome of 243 consenting youth aged 15-25 years with a sub-syndromal presentation of a potentially severe mental disorder. Survival analysis and odds ratio (OR) for predictors of transition identified from baseline clinical and demographic ratings. RESULTS About 17% (n=36) experienced transition to a major mental disorder. Independent of syndromal diagnosis, transition was significantly more likely in individuals who were NEET (not in education, employment or training), in females and in those with more negative psychological symptoms (e.g. social withdrawal). CONCLUSIONS NEET status and negative symptoms are modifiable predictors of illness trajectory across diagnostic categories and are not specific to transition to psychosis. DECLARATION OF INTEREST I.B.H. has been a Commissioner in Australia's National Mental Health Commission since 2012. He was a board member of headspace: National Youth Mental Health Foundation until January 2012. He has led a range of community-based and pharmaceutical industry-supported depression awareness and education and training programmes. He has led projects for health professionals and the community supported by governmental, community agency and pharmaceutical industry partners (Wyeth, Eli Lilly, Servier, Pfizer, AstraZeneca) for the identification and management of depression and anxiety. He has received honoraria for presentations of his own work at educational seminars supported by a number of non-government organisations and the pharmaceutical industry (including Servier, Pfizer, AstraZeneca and Eli Lilly). He is a member of the Medical Advisory Panel for Medibank Private and also a board member of Psychosis Australia Trust. He leads an investigator-initiated study of the effects of agomelatine on circadian parameters (supported in part by Servier) and has participated in a multicentre clinical trial of the effects of agomelatine on sleep architecture in depression and a Servier-supported study of major depression and sleep disturbance in primary care settings. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
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Affiliation(s)
- Shane P M Cross
- , MPsych(Clinical), PhD, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Jan Scott
- , MBBS, MD, FRCPsych, Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Ian B Hickie
- , MD, MBBS, FRANZCP, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
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Lee RSC, Hermens DF, Scott J, O'Dea B, Glozier N, Scott EM, Hickie IB. A transdiagnostic study of education, employment, and training outcomes in young people with mental illness. Psychol Med 2017; 47:2061-2070. [PMID: 28393749 DOI: 10.1017/s0033291717000484] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Optimizing functional recovery in young individuals with severe mental illness constitutes a major healthcare priority. The current study sought to quantify the cognitive and clinical factors underpinning academic and vocational engagement in a transdiagnostic and prospective youth mental health cohort. The primary outcome measure was 'not in education, employment or training' ('NEET') status. METHOD A clinical sample of psychiatric out-patients aged 15-25 years (n = 163) was assessed at two time points, on average, 24 months apart. Functional status, and clinical and neuropsychological data were collected. Bayesian structural equation modelling was used to confirm the factor structure of predictors and cross-lagged effects at follow-up. RESULTS Individually, NEET status, cognitive dysfunction and negative symptoms at baseline were predictive of NEET status at follow-up (p < 0.05). Baseline cognitive functioning was the only predictor of follow-up NEET status in the multivariate Bayesian model, while controlling for baseline NEET status. For every 1 s.d. deficit in cognition, the probability of being disengaged at follow-up increased by 40% (95% credible interval 19-58%). Baseline NEET status predicted poorer negative symptoms at follow-up (β = 0.24, 95% credible interval 0.04-0.43). CONCLUSIONS Disengagement with education, employment or training (i.e. being NEET) was reported in about one in four members of this cohort. The initial level of cognitive functioning was the strongest determinant of future NEET status, whereas being academically or vocationally engaged had an impact on future negative symptomatology. If replicated, these findings support the need to develop early interventions that target cognitive phenotypes transdiagnostically.
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Affiliation(s)
- R S C Lee
- Brain and Mind Centre, University of Sydney,Sydney, NSW,Australia
| | - D F Hermens
- Brain and Mind Centre, University of Sydney,Sydney, NSW,Australia
| | - J Scott
- Academic Psychiatry,Institute of Neuroscience, Newcastle University, Newcastle upon Tyne,UK
| | - B O'Dea
- Faculty of Medicine,Black Dog Institute, UNSW,Sydney, NSW,Australia
| | - N Glozier
- Brain and Mind Centre, University of Sydney,Sydney, NSW,Australia
| | - E M Scott
- Brain and Mind Centre, University of Sydney,Sydney, NSW,Australia
| | - I B Hickie
- Brain and Mind Centre, University of Sydney,Sydney, NSW,Australia
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Purcell R, Harrigan S. Lifetime rates and correlates of crime victimisation in young people with mental ill-health. Australas Psychiatry 2017; 25:135-139. [PMID: 27406928 DOI: 10.1177/1039856216658826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Research on crime victimisation in the mentally ill has focused on middle aged cohorts with long-standing illness and functional disability. The rates and correlates of victimisation in young cohorts is largely unknown. METHODS Participants ( n=776) were aged 12-25 years attending headspace centres in Australia, who consented to a clinical interview and provided self-reported data regarding lifetime victimisation. RESULTS A quarter of the sample (24.5%) reported crime victimisation, including 18.5% who experienced violent victimisation (mainly physical or sexual assault) and 14.1% non-violent crime. Both forms of victimisation were associated with illicit substance use, sexual orientation, and young adult age, while male gender was specifically associated with non-violent victimisation. Participants who reported violent victimisation were significantly more impaired both functionally and clinically than those reporting non-violent victimisation or no victimisation. CONCLUSIONS Young people with mental ill-health are vulnerable to criminal victimisation, particularly violent assaults, although the lifetime rates of victimisation are substantially lower than those observed in older cohorts with serious mental illness. Effective, early intervention to address modifiable factors may reduce the risk of further victimisation.
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Affiliation(s)
- Rosemary Purcell
- Principal Research Fellow and Psychologist, The Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, and; Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
| | - Susy Harrigan
- Research Fellow and Statistician, The Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
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Federici S, Bracalenti M, Meloni F, Luciano JV. World Health Organization disability assessment schedule 2.0: An international systematic review. Disabil Rehabil 2016; 39:2347-2380. [PMID: 27820966 DOI: 10.1080/09638288.2016.1223177] [Citation(s) in RCA: 218] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This systematic review examines research and practical applications of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a basis for establishing specific criteria for evaluating relevant international scientific literature. The aims were to establish the extent of international dissemination and use of WHODAS 2.0 and analyze psychometric research on its various translations and adaptations. In particular, we wanted to highlight which psychometric features have been investigated, focusing on the factor structure, reliability, and validity of this instrument. METHOD Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a search for publications focused on "whodas" using the ProQuest, PubMed, and Google Scholar electronic databases. RESULTS We identified 810 studies from 94 countries published between 1999 and 2015. WHODAS 2.0 has been translated into 47 languages and dialects and used in 27 areas of research (40% in psychiatry). CONCLUSIONS The growing number of studies indicates increasing interest in the WHODAS 2.0 for assessing individual functioning and disability in different settings and individual health conditions. The WHODAS 2.0 shows strong correlations with several other measures of activity limitations; probably due to the fact that it shares the same disability latent variable with them. Implications for Rehabilitation WHODAS 2.0 seems to be a valid, reliable self-report instrument for the assessment of disability. The increasing interest in use of the WHODAS 2.0 extends to rehabilitation and life sciences rather than being limited to psychiatry. WHODAS 2.0 is suitable for assessing health status and disability in a variety of settings and populations. A critical issue for rehabilitation is that a single "minimal clinically important .difference" score for the WHODAS 2.0 has not yet been established.
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Affiliation(s)
- Stefano Federici
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Marco Bracalenti
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Fabio Meloni
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Juan V Luciano
- b Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan De Déu , St. Boi De Llobregat , Spain.,c Primary Care Prevention and Health Promotion Research Network (RedIAPP) , Madrid , Spain
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Sahoo SS, Ramesh P, Welter E, Bukach A, Valdez J, Tatsuoka C, Bamps Y, Stoll S, Jobst BC, Sajatovic M. Insight: An ontology-based integrated database and analysis platform for epilepsy self-management research. Int J Med Inform 2016; 94:21-30. [PMID: 27573308 PMCID: PMC5010027 DOI: 10.1016/j.ijmedinf.2016.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 06/15/2016] [Accepted: 06/18/2016] [Indexed: 11/18/2022]
Abstract
We present Insight as an integrated database and analysis platform for epilepsy self-management research as part of the national Managing Epilepsy Well Network. Insight is the only available informatics platform for accessing and analyzing integrated data from multiple epilepsy self-management research studies with several new data management features and user-friendly functionalities. The features of Insight include, (1) use of Common Data Elements defined by members of the research community and an epilepsy domain ontology for data integration and querying, (2) visualization tools to support real time exploration of data distribution across research studies, and (3) an interactive visual query interface for provenance-enabled research cohort identification. The Insight platform contains data from five completed epilepsy self-management research studies covering various categories of data, including depression, quality of life, seizure frequency, and socioeconomic information. The data represents over 400 participants with 7552 data points. The Insight data exploration and cohort identification query interface has been developed using Ruby on Rails Web technology and open source Web Ontology Language Application Programming Interface to support ontology-based reasoning. We have developed an efficient ontology management module that automatically updates the ontology mappings each time a new version of the Epilepsy and Seizure Ontology is released. The Insight platform features a Role-based Access Control module to authenticate and effectively manage user access to different research studies. User access to Insight is managed by the Managing Epilepsy Well Network database steering committee consisting of representatives of all current collaborating centers of the Managing Epilepsy Well Network. New research studies are being continuously added to the Insight database and the size as well as the unique coverage of the dataset allows investigators to conduct aggregate data analysis that will inform the next generation of epilepsy self-management studies.
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Affiliation(s)
- Satya S Sahoo
- Division of Medical Informatics, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, United States; Electrical Engineering and Computer Science Department, School of Engineering, Case Western Reserve University, Cleveland, OH 44106, United States.
| | - Priya Ramesh
- Electrical Engineering and Computer Science Department, School of Engineering, Case Western Reserve University, Cleveland, OH 44106, United States
| | - Elisabeth Welter
- Neurological Institute, University Hospitals Case Medical Center, Cleveland, OH 44106, United States
| | - Ashley Bukach
- Neurological Institute, University Hospitals Case Medical Center, Cleveland, OH 44106, United States
| | - Joshua Valdez
- Division of Medical Informatics, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, United States
| | - Curtis Tatsuoka
- Neurological Institute, University Hospitals Case Medical Center, Cleveland, OH 44106, United States
| | - Yvan Bamps
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, United States
| | - Shelley Stoll
- Center for Managing Chronic Disease, University of Michigan, Ann Arbor, MI 48109, United States
| | - Barbara C Jobst
- Department of Neurology, Geisel School of Medicine, Dartmouth College, Lebanon, NH 03756, United States
| | - Martha Sajatovic
- Neurological Institute, University Hospitals Case Medical Center, Cleveland, OH 44106, United States
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O'Dea B, Lee RSC, McGorry PD, Hickie IB, Scott J, Hermens DF, Mykletun A, Purcell R, Killackey E, Pantelis C, Amminger GP, Glozier N. A prospective cohort study of depression course, functional disability, and NEET status in help-seeking young adults. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1395-1404. [PMID: 27498112 DOI: 10.1007/s00127-016-1272-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 08/01/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine the associations between depression course, functional disability, and Not in Education or Training (NEET) status in a clinical sample of young adults with mental health problems. METHODS Young adults aged 15-25 years seeking help from four primary mental health services were invited to participate in a prospective cohort study evaluating the course of psychiatric disorders in youth. Demographic and clinical characteristics, including depressive symptomatology and functioning, were evaluated through clinical interview and self-report at baseline and 12 month follow-up. RESULTS A total of 448 young adults participated (70 % female; M: 20.05 years, SD = 2.85). A significant interaction effect for time and depression course was found, such that those who became depressed reported an increase in functional disability and those whose depression remitted reported a significant reduction in functional disability. Developing depression was not a significant predictor of becoming NEET and vice versa: remitted depression did not make a person more likely to reengage in employment or education. CONCLUSIONS This is the first study to examine the course of depression, functional disability, and NEET rates among help-seeking young adults. This study confirms the importance of symptom reduction for improved functioning; however, functional disability remained greater than that seen in young people in the community and there was no association between a change in depression and a change in NEET status. These results argue that services need to address functional outcomes and reengagement with education and employment in addition to symptom reduction.
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Affiliation(s)
- Bridianne O'Dea
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia. .,Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
| | - Rico S C Lee
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Jan Scott
- Institute of Neuroscience, Newcastle University, Newcastle-upon-Tyne, UK
| | - Daniel F Hermens
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | | | - Rosemary Purcell
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.,Centre for Forensic Behavioural Science, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Eoin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, VIC, Australia
| | - G Paul Amminger
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Nicholas Glozier
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
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Abstract
Purpose
– The purpose of this paper is to evidence and better understand adolescent information behaviours in disadvantaged and disengaged circumstances, and explore issues of social integration.
Design/methodology/approach
– Interdisciplinary theoretical framework bringing together theories of information behaviour with theories of social capital. Mixed method design incorporating observation, interviews, and focus group conducted in areas of multiple deprivations. Participants’ young people aged 16-19 not in education, employment or training (NEET); and their support workers.
Findings
– Heightened access and internalised behavioural barriers found beyond those common to the general adolescent population, the former influenced by technology and literacy issues, the latter by social structures and norms. There is evidence suggestive of deception, risk-taking, secrecy, and situational relevance in information behaviours, and a reliance on bonding social capital characteristically exclusive and inward facing. Low levels of literacy and self-efficacy are significant interrelated issues, with NEET youth dependent upon support workers when seeking and processing information, and demonstrating passive non-motivated information behaviours often abandoned.
Research limitations/implications
– Highlights the need for further interdisciplinary research to explore complex relations between social and affective factors, and that seeks to both understand and influence information behaviours in disadvantaged and disengaged circumstances.
Practical implications
– Remedial literacy education recommended as an immediate priority for public and third sector agencies.
Originality/value
– First study of adolescent information behaviours in disadvantaged and disengaged circumstances. Novel interdisciplinary theoretical framework evidences and draws attention to understudied and enduring information poverty issues of significant societal concern, potentially consigning a significant proportion of the youth population to a stratified existence within an impoverished (small) information world. Sets a focused interdisciplinary research agenda.
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