A prototype software framework for transparent, reusable and updatable computational health economic models

Most health economic analyses are undertaken with the aid of computers. However, the ethical dimensions of implementing health economic models as software (or computational health economic models (CHEMs)) are poorly understood. We propose that developers and funders of CHEMs share ethical responsibilities to (i) establish socially acceptable user requirements and design specifications; (ii) ensure fitness for purpose; and (iii) support socially beneficial use. We further propose that a transparent (T), reusable (R) and updatable (U) CHEM is suggestive of a project team that has largely fulfilled these responsibilities. We propose six criteria for assessing CHEMs: (T1) software files are open access; (T2) project team contributions and judgments are easily identified; (R1) programming practices promote generalisability and transferability; (R2) licenses restrict only unethical reuse; (U1) maintenance infrastructure is in place; and (U2) new releases are systematically retested and appropriately deprecated. To facilitate CHEMs that meet TRU criteria, we have developed a prototype software framework in the open-source programming language R. The framework comprises six code libraries for authoring CHEMs, supplying CHEMs with data and undertaking analyses with CHEMs. The prototype software framework integrates with services for software development and research data archiving. We determine that an initial set of youth mental health CHEMs we developed with the prototype software framework wholly meet criteria T1-2, R1-2 and U1 and partially meet criterion U2. Our assessment criteria and prototype software framework can help inform and improve ethical implementation of CHEMs. Resource barriers to ethical CHEM practice should be addressed by research funders.Comment: 17 pages, 4 tables, 1 figur

Heterogeneity of quality of life in young people attending primary mental health services

AIMS: The utility of quality of life (QoL) as an outcome measure in youth-specific primary mental health care settings has yet to be determined. We aimed to determine: (i) whether heterogeneity on individual items of a QoL measure could be used to identify distinct groups of help-seeking young people; and (ii) the validity of these groups based on having clinically meaningful differences in demographic and clinical characteristics. METHODS: Young people, at their first presentation to one of five primary mental health services, completed a range of questionnaires, including the Assessment of Quality of Life–6 dimensions adolescent version (AQoL-6D). Latent class analysis (LCA) and multivariate multinomial logistic regression were used to define classes based on AQoL-6D and determine demographic and clinical characteristics associated with class membership. RESULTS: 1107 young people (12–25 years) participated. Four groups were identified: (i) no-to-mild impairment in QoL; (ii) moderate impairment across dimensions but especially mental health and coping; (iii) moderate impairment across dimensions but especially on the pain dimension; and (iv) poor QoL across all dimensions along with a greater likelihood of complex and severe clinical presentations. Differences between groups were observed with respect to demographic and clinical features. CONCLUSIONS: Adding multi-attribute utility instruments such as the AQoL-6D to routine data collection in mental health services might generate insights into the care needs of young people beyond reducing psychological distress and promoting symptom recovery. In young people with impairments across all QoL dimensions, the need for a holistic and personalised approach to treatment and recovery is heightened

Climate change concerns impact on young Australians’ psychological distress and outlook for the future

Aims: Climate change is escalating and will disproportionately affect young people. Research on the mental health consequences of worry or concerns related to climate change are so far limited. This study aims to evaluate the extent of climate change concern in young people aged 15–19, its association with various demographic factors and its impact on psychological distress and future outlook. Understanding the impact of climate concerns on young people's mental wellbeing is crucial for identifying effective measures and building resilience. Methods: Climate concerns, psychological distress, and future outlook were measured in the 2022 Mission Australia Youth Survey, Australia's largest annual population-wide survey of young people aged 15 to 19 (N = 18,800). Multinomial logistic regression models were used to map factors associated with climate concerns and assess whether climate concerns are associated with psychological distress and future outlook. Results: One in four young people reported feeling very or extremely concerned about climate change. Climate concerns were higher among individuals identifying as female or gender diverse, or who self-reported a mental health condition. After controlling for confounding factors, we found those who were very or extremely concerned about climate change to be more likely to have high psychological distress than those not at all concerned (Relative risk ratio (RRR) = 1.81; 95% CI: 1.56–2.11), and more likely to have a negative future outlook (RRR = 1.52; 95% CI: 1.27–1.81). These associations were stronger among participants who reported to be gender diverse, Indigenous or from outer-regional/remote areas. Conclusion: This study identified associations between climate concerns, psychological distress, and future outlook among young people. Immediate attention from research and policy sectors to support climate change education, communication strategies and targeted interventions is urgently required to mitigate long-term impacts on young people's wellbeing.</p

Treatment and outcomes of an Australian cohort of outpatients with bipolar 1 or schizoaffective disorder over twenty-four months : implications for clinical practice

Background The Bipolar Comprehensive Outcomes Study (BCOS) is a 2-year, prospective, non-interventional, observational study designed to explore the clinical and functional outcomes associated with &lsquo;real-world&rsquo; treatment of participants with bipolar I or schizoaffective disorder. All participants received treatment as usual. There was no study medication.Methods Participants prescribed either conventional mood stabilizers (CMS; n&thinsp;=&thinsp;155) alone, or olanzapine with, or without, CMS (olanzapine&thinsp;&plusmn;&thinsp;CMS; n&thinsp;=&thinsp;84) were assessed every 3&thinsp;months using several measures, including the Young Mania Rating Scale, 21-item Hamilton Depression Rating Scale, Clinical Global Impressions Scale &ndash; Bipolar Version, and the EuroQol Instrument. This paper reports 24-month longitudinal clinical, pharmacological, functional, and socioeconomic data.Results On average, participants were 42 (range 18 to 79) years of age, 58%; were female, and 73%; had a diagnosis of bipolar I. Polypharmacy was the usual approach to pharmacological treatment; participants took a median of 5 different psychotropic medications over the course of the study, and spent a median proportion of time of 100%; of the study on mood stabilizers, 90%; on antipsychotics, 9%; on antidepressants, and 5%; on benzodiazepines/hypnotics. By 24&thinsp;months, the majority of participants had achieved both symptomatic and syndromal remission of both mania and depression. Symptomatic relapse rates were similar for both the CMS alone (65%;) and the olanzapine&thinsp;&plusmn;&thinsp;CMS (61%;) cohorts.Conclusions Participants with bipolar I or schizoaffective disorder in this study were receiving complex medication treatments that were often discordant with recommendations made in contemporary major treatment guidelines. The majority of study participants demonstrated some clinical and functional improvements, but not all achieved remission of symptoms or syndrome.<br /

Interrelationships between social exclusion, mental health and wellbeing in adolescents: insights from a national Youth Survey

Utilising the most recent data from the largest annual survey of young people in Australia, the 2022 Mission Australia Youth Survey (n=18,800), the aims of the current study were twofold: (i) to obtain a better understanding of the relationships between social exclusion domains, mental health and wellbeing of young people aged 15-19 years; and (ii) identify potentially modifiable targets, or population groups requiring greater or targeted supports

Guidance on Minimum Standards for Canine-Assisted Psychotherapy in Adolescent Mental Health: Delphi Expert Consensus on Health, Safety, and Canine Welfare

As interest in animal-assisted therapy (AAT) and canine-assisted psychotherapy (CAP) grows, there are increasing calls for the management of related health, safety, and welfare concerns for canines, providers, and clients. Existing health and safety guidelines lack empirical support and are, at times, contradictory. Welfare is increasingly prioritized; however, tools to monitor and manage welfare are underutilized and under-reported. The aim of this study was to provide expert consensus on the minimum health, safety, and welfare standards required to develop and deliver a CAP group program to adolescents experiencing common mental health disorders. Diverse AAT experts were recruited globally. Using Delphi methodology, over two rounds, 40 panelists reached a consensus agreement to include 32 items from a possible 49 into the minimum standards. Health and safety measures included risk assessment, veterinary screening, preventative medicine, training in infection control, and first aid. Welfare measures included training in welfare assessment, documentation of welfare, and flexible, individualized responses to promote wellbeing. Intestinal screening for parasites and the prohibition of raw food were not supported. Flexible and individualized assessment and management of canine welfare were supported over fixed and time-limited work schedules. Clinical practice implications are discussed, and recommendations are made

Who are the ‘Missing Middle’? Obtaining a consensus definition of the ‘Missing Middle’ from experts in youth mental health

Background: As highlighted in Australia’s Royal and Productivity Commissions into mental health, significant subgroups of individuals are failing to have their needs met, or are ‘falling through the cracks’ in the current system - a phenomenon increasingly referred to as the missing middle. A barrier to devising solutions is that the term missing middle is not clearly defined. Using the Delphi method, we aimed to define the term and explore the acceptability of the proposed definition. Method: Three expert groups were recruited through advertisements and targeted email invitations. Experts included: carers and young people with a lived experience of mental ill-health; researchers and policy makers; clinicians, and service providers. Using a three-stage Delphi process, we elicited definitions, refined, and developed a consensus definition. Results: Ten subthemes describing the missing middle were identified, with four of these endorsed across all expert groups from the outset: service gap, inflexibility, inadequate service quality and duration, and social disadvantage. Additional subthemes were later endorsed. Feedback was sought on a consensus-driven definition that encompassed the original four endorsed subthemes. Conclusion: A broad definition of the missing middle was developed, repositioning the term to a systems lens, referring to a missing middle service gap. The newly formulated definition represents the missing middle as a term to describe a gap in care where existing mental health services are not meeting the needs of individuals in a meaningful way. The study also demonstrated the utility of the Delphi approach in capturing and unifying viewpoints from diverse expert groups

The sick role, illness cognitions and outcomes in bipolar disorder

C1 - Journal Articles Referee