Using new and innovative technologies to assess clinical stage in early intervention youth mental health services: Evaluation study

Background: Globally there is increasing recognition that new strategies are required to reduce disability due to common mental health problems. As 75% of mental health and substance use disorders emerge during the teenage or early adulthood years, these strategies need to be readily accessible to young people. When considering how to provide such services at scale, new and innovative technologies show promise in augmenting traditional clinic-based services. Objective: The aim of this study was to test new and innovative technologies to assess clinical stage in early intervention youth mental health services using a prototypic online system known as the Mental Health eClinic (MHeC). Methods: The online assessment within the MHeC was compared directly against traditional clinician assessment within 2 Sydney-based youth-specific mental health services (headspace Camperdown and headspace Campbelltown). A total of 204 young people were recruited to the study. Eligible participants completed both face-to-face and online assessments, which were randomly allocated and counterbalanced at a 1-to-3 ratio. These assessments were (1) a traditional 45- to 60-minute headspace face-to-face assessment performed by a Youth Access Clinician and (2) an approximate 60-minute online assessment (including a self-report Web-based survey, immediate dashboard of results, and a video visit with a clinician). All assessments were completed within a 2-week timeframe from initial presentation. Results: Of the 72 participants who completed the study, 71% (51/72) were female and the mean age was 20.4 years (aged 16 to 25 years); 68% (49/72) of participants were recruited from headspace Camperdown and the remaining 32% (23/72) from headspace Campbelltown. Interrater agreement of participants’ stage, as determined after face-to-face assessment or online assessment, demonstrated fair agreement (kappa=.39, P\u3c.001) with concordance in 68% of cases (49/72). Among the discordant cases, those who were allocated to a higher stage by online raters were more likely to report a past history of mental health disorders (P=.001), previous suicide planning (P=.002), and current cannabis misuse (P=.03) compared to those allocated to a lower stage. Conclusions: The MHeC presents a new and innovative method for determining key clinical service parameters. It has the potential to be adapted to varied settings in which young people are connected with traditional clinical services and assist in providing the right care at the right tim

Transdiagnostic neurocognitive subgroups and functional course in young people with emerging mental disorders: a cohort study.

Background Neurocognitive impairments robustly predict functional outcome. However, heterogeneity in neurocognition is common within diagnostic groups, and data-driven analyses reveal homogeneous neurocognitive subgroups cutting across diagnostic boundaries. Aims To determine whether data-driven neurocognitive subgroups of young people with emerging mental disorders are associated with 3-year functional course. Method Model-based cluster analysis was applied to neurocognitive test scores across nine domains from 629 young people accessing mental health clinics. Cluster groups were compared on demographic, clinical and substance-use measures. Mixed-effects models explored associations between cluster-group membership and socio-occupational functioning (using the Social and Occupational Functioning Assessment Scale) over 3 years, adjusted for gender, premorbid IQ, level of education, depressive, positive, negative and manic symptoms, and diagnosis of a primary psychotic disorder. Results Cluster analysis of neurocognitive test scores derived three subgroups described as ‘normal range’ (n = 243, 38.6%), ‘intermediate impairment’ (n = 252, 40.1%), and ‘global impairment’ (n = 134, 21.3%). The major mental disorder categories (depressive, anxiety, bipolar, psychotic and other) were represented in each neurocognitive subgroup. The global impairment subgroup had lower functioning for 3 years of follow-up; however, neither the global impairment (B = 0.26, 95% CI −0.67 to 1.20; P = 0.581) or intermediate impairment (B = 0.46, 95% CI −0.26 to 1.19; P = 0.211) subgroups differed from the normal range subgroup in their rate of change in functioning over time. Conclusions Neurocognitive impairment may follow a continuum of severity across the major syndrome-based mental disorders, with data-driven neurocognitive subgroups predictive of functional course. Of note, the global impairment subgroup had longstanding functional impairment despite continuing engagement with clinical services

Developing the effectiveness of personalised interventions for young adults with affective disorders: Examination of neurocognitive screening and feedback

Neurocognitive dysfunction, including decreases in attention, executive function, and memory, are common symptoms experienced by people with affective disorders and are associated with educational/vocational/social consequences. Cognitive impairment is one of the most important predictors of long-term functioning in young adult patients with affective disorder; hence, assessing cognition and associated disability is a vital first step. There is mounting evidence that personalised intervention and feedback is an effective mode of treatment. Furthermore, advances in computerised technology may provide enhanced (more accessible, affordable, accurate) personalised, and patient-focused assessment. This thesis aims to address a gap in the literature through a series of studies in a young adult inpatient unit, investigating the clinical utility of an automated neurocognitive screening battery, and the introduction and implementation of a computerised self-reported assessment, and feedback as standard clinical care. Given the importance of neurocognitive performance in terms of predicting long-term outcomes, and the addition of technology in mental health services, this thesis will investigate the following: (i) the feasibility of neurocognitive screening in an inpatient unit and from an illness stage point of view; (ii) the patient response and utility to inpatient services of feedback; and (iii) changes to standard clinical care in an inpatient unit, as a result of the addition of cognitive screening, computerised assessment, and feedback. This thesis is made up of five empirical studies conducted as follows: (i) secondary analysis of neuropsychological profiles of an outpatient sample, based on clinical stage of illness; (iia) case study of three inpatient’s experiences in the neurocognitive screening and feedback protocol; (iib) qualitative analysis of inpatients subjective cognitive complaints; (iii) cluster analysis of inpatient pilot/feasibility, and confirmatory data, assessing neurocognitive profiles; and (iv) analysis of neurocognitive profiles and symptoms of community care outpatients compared to current inpatients. The respective findings were as follows: (i) neuropsychological functioning can be distinguished based on illness severity (clinical stage); (ii) subjective cognitive decline is often in line with objective test results; (iii) more severe neurocognitive profile clusters were associated with higher levels of distress, more impaired sustained attention, and more severe stage of illness; and, (iv) demarcation of clear neurocognitive cluster profiles are evident in both inpatient and outpatient cohorts. In conclusion, the series of studies presented in this thesis propose the clinical utility of neurocognitive screening as standard clinical care in a young adult inpatient unit. Critically, this thesis supports the current literature regarding the predictive qualities of neurocognitive assessment and thus supports the re-conceptualisation of personalised intervention (including feedback) for young adults with affective disorder

Youth Mental Health Tracker: protocol to establish a longitudinal cohort and research database for young people attending Australian mental health services

Introduction Mental disorders are a leading cause of long-term disability worldwide. Much of the burden of mental ill-health is mediated by early onset, comorbidities with physical health conditions and chronicity of the illnesses. This study aims to track the early period of mental disorders among young people presenting to Australian mental health services to facilitate more streamlined transdiagnostic processes, highly personalised and measurement-based care, secondary prevention and enhanced long-term outcomes. Methods and analysis Recruitment to this large-scale, multisite, prospective, transdiagnostic, longitudinal clinical cohort study (‘Youth Mental Health Tracker’) will be offered to all young people between the ages of 12 and 30 years presenting to participating services with proficiency in English and no history of intellectual disability. Young people will be tracked over 3 years with standardised assessments at baseline and 3, 6, 12, 24 and 36 months. Assessments will include self-report and clinician-administered measures, covering five key domains including: (1) social and occupational function; (2) self-harm, suicidal thoughts and behaviour; (3) alcohol or other substance misuse; (4) physical health; and (5) illness type, clinical stage and trajectory. Data collection will be facilitated by the use of health information technology. The data will be used to: (1) determine prospectively the course of multidimensional functional outcomes, based on the differential impact of demographics, medication, psychological interventions and other key potentially modifiable moderator variables and (2) map pathophysiological mechanisms and clinical illness trajectories to determine transition rates of young people to more severe illness forms