Delineating the trajectories of social and occupational functioning of young people attending early intervention mental health services in Australia: a longitudinal study

F Iorfino; Daniel F Hermens; Shane P M Cross; Natalia Zmicerevska; Alissa Nichles; Caro-Anne Badcock; Josine Groot; Elizabeth M Scott; Ian B Hickie

doi:10.1136/bmjopen-2017-020678

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Delineating the trajectories of social and occupational functioning of young people attending early intervention mental health services in Australia: a longitudinal study

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Delineating the trajectories of social and occupational functioning of young people attending early intervention mental health services in Australia: a longitudinal study

F Iorfino, Daniel F Hermens, Shane P M Cross, Natalia Zmicerevska, Alissa Nichles, Caro-Anne Badcock, Josine Groot, Elizabeth M Scott and Ian B Hickie

BMJ Open, Vol.8(3), pp.1-10

2018

DOI: https://doi.org/10.1136/bmjopen-2017-020678

PMCID: PMC5875606

PMID: 29588325

Appears in Thompson Institute Research Collection

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Abstract

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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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Title: Delineating the trajectories of social and occupational functioning of young people attending early intervention mental health services in Australia: a longitudinal study
Authors: F Iorfino (Author) - The University of Sydney
Daniel F Hermens (Author) - University of the Sunshine Coast
Shane P M Cross (Author) - The University of Sydney
Natalia Zmicerevska (Author) - The University of Sydney
Alissa Nichles (Author) - The University of Sydney
Caro-Anne Badcock (Author) - The University of Sydney
Josine Groot (Author) - The University of Sydney
Elizabeth M Scott (Author) - The University of Sydney
Ian B Hickie (Author) - The University of Sydney
Publication details: BMJ Open, Vol.8(3), pp.1-10
Publisher: B M J Group
Date published: 2018
DOI: 10.1136/bmjopen-2017-020678
ISSN: 2044-6055
PMID: 29588325; PMC5875606
Copyright note: Copyright © 2018 The Authors. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Grants: Optimising early interventions for young people with emerging mood disorder, 1061043, National Health and Medical Research Council (Australia, Canberra) - NHMRC
Optimising prevention and early intervention strategies for young people with emerging mood disorders, 1046899, National Health and Medical Research Council (Australia, Canberra) - NHMRC
Organisation Unit: Thompson Institute
Language: English
Record Identifier: 99450747602621
Output Type: Journal article

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Web Of Science research areas: Psychiatry

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