Social disadvantage in early psychosis and its effect on clinical presentation and service access, engagement and use

Incidence of psychosis varies geographically due to factors such as social disadvantage. Whether this influences the clinical presentation and/or engagement of those experiencing psychosis remains relatively understudied. This study analysed data from young people across Australia accessing ultra-high risk (UHR) or first episode psychosis (FEP) services delivered through the headspace Early Psychosis (hEP) program between June 2017 and March 2021. The cohort was categorised into low, middle, and high tertiles of social disadvantage using the Index of Relative Socioeconomic Disadvantage (IRSD). Data from 3089 participants aged 15–25 were included (1515 UHR, 1574 FEP). The low and middle tertiles for both cohorts had greater percentages of those not in education or employment (NEET), with First Nations or culturally and linguistically diverse backgrounds. Clinical presentations to services were similar across all tertiles in both cohorts, however, functioning at presentation varied significantly within the FEP cohort. Significantly lower numbers of direct services were provided in the low tertile of both cohorts, with significantly poorer engagement in the initial three-months also occurring for these young people. This variation in early psychosis service patterns associated with geographical variation in social deprivation demonstrates the need for further research and fine tuning of national early psychosis services.</p

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 /

Social inclusion and mental illness

© 2014 Dr. Kate Maree FiliaBackground: Social inclusion is increasingly recognised as an important contributor to good mental health and greater mental health outcomes, in particular for people with mental illness. Despite increased understanding of the positive impact that social inclusion can have, the potential to make progress has been slowed by some key limitations. The key, underlying problem regarding social inclusion, is the lack of a specific operationalised definition, with only some consensus regarding what it means to be socially included. This lack of specificity has made it difficult to accurately measure the impact of initiatives designed to improve social inclusion. Nonetheless, several attempts at developing measures of social inclusion have been made, in particular for use with people with mental illness. Psychometric testing has been conducted on some, but not all of the measures, and has not been completed on any of them. The overall aim of this thesis was to develop a measure of social inclusion for use with people with mental illness. The measure was designed in a series of studies ensuring the representative input of people with a lived experience of mental illness. The measure was titled the SIMI-LE, an abbreviation of a measure of Social Inclusion for people with Mental Illness – Long Edition. Method: The development of the SIMI-LE took place over three sequential studies. The first study involved a thematic analysis of literature regarding social inclusion to obtain the opinions of professionals regarding key contributors of social inclusion. Seventy-one pieces of literature were reviewed (academic literature regarding social inclusion in general n=25, academic literature regarding social inclusion and mental illness n=26, and organisational reports n=20). The second was a Delphi study, conducted to obtain a consensus between three groups regarding the importance or relevance of contributors identified in the first study. Participants included 32 consumers of a mental health service, 32 carers of a person with mental illness and 40 community members. The third study involved the construction of the measure, and preliminary testing with a sample of ninety participants (30 consumers, 30 family members of a person with mental illness and 30 community members). Results: A comprehensive list of contributors was compiled during the first study. A consensus across three groups regarding how important or relevant each of these contributors were, was obtained during the second study. Finally, the SIMI-LE was constructed and preliminary testing conducted. The measure was seen to have good face validity and was highly acceptable to participants. Preliminary findings demonstrated poorer outcomes for people with mental illness as compared to those without, with differences seen in each of the five categories. Discussion: Overall, the aim of developing a measure of social inclusion for use with people with mental illness was achieved. In the process of developing the measure, a greater understanding of social inclusion from the perspective of people with mental illness was obtained. The measure has demonstrated excellent preliminary psychometric properties and has displayed the ability to differentiate between groups, as expected. Implications for use and suggestions for future research are detailed

Guidance on minimum standards for canine-assisted psychotherapy in adolescent mental health: Delphi expert consensus on terminology, qualifications and training

Abstract Introduction: Canine-assisted psychotherapy (CAP) is an emerging field that is largely unregulated and at times fragmented. Despite this, CAP shows promise as an innovative intervention for improving adolescent mental health. To ensure safe, ethical interventions incorporating dogs, providers need minimum standards to guide intervention development and subsequent research. Initially, standards should guide the preliminary steps required to prepare for and set up CAP interventions. These should include consensus agreement on the specific training and qualifications of providers, and training/assessment standards for canines to deliver such interventions. Also crucial is establishing clear expectations about treatment goals via use of clinically accurate terminology. Methods: Using Delphi methodology, experts in animal-assisted therapy (AAT) were recruited globally to complete questionnaires in an iterative process designed to establish consensus. Consensus was met when 80% or more experts agreed that an item was either ‘important’ or ‘essential’ and therefore included or ‘unimportant’ or ‘irrelevant’ and therefore excluded from the minimum standards required to develop a CAP group intervention for adolescents experiencing common mental health disorders including depression, anxiety, and adjustment disorder. Results: Over two rounds, consensus was reached to include 34 items and exclude none; 45 items remained unresolved. Standardized terminology was identified that clearly defined the type and scope of the service being provided, delineating psychotherapeutic treatments from informal dog-related interactions. To deliver the CAP intervention, providers must have formal qualifications and licensure/registration in mental health, training and supervision in AAT, and canine-specific training and experience. Important temperament characteristics of working dogs were identified including absence of aggression, and enjoyment working in CAP. Dogs should be formally assessed in obedience and AAT applications, in partnership with a bonded handler. Assessors of dog-handler teams should be independent and have expertise in both canine ethology and AAT. Discussion: These results reinforce the importance of accurate and standardized terminology, and the need for further community education on the role of ‘therapy’ and ‘therapy dogs’. Consensus on the essential content for provider training was not achieved, highlighting the diversity of practice globally. Nevertheless, there was recognition of the need for breadth and depth of knowledge across the domains of mental health, AAT, canine training, and handling dogs for AAT applications. Dogs working independently of a bonded handler were not supported, nor were mental health providers working with an ‘assessed’ dog in the absence of AAT and CAP training. Implications for clinical practice are explored

'More than just numbers on a page?' : A qualitative exploration of the use of data collection and feedback in youth mental health services

Funding: The authors received no specific funding for this work. Acknowledgments We would like to thank the participants who generously shared their time and experience for the purposes of this study.Peer reviewedPublisher PD