Clinical staging and the differential risks for clinical and functional outcomes in young people presenting for youth mental health care.

Autor: Capon W; Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia., Hickie IB; Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia., Varidel M; Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia., Prodan A; 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., Crouse JJ; Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia., Carpenter JS; Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia., Cross SP; School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, 2109, Australia., Nichles A; Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia., Zmicerevska N; Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia., Guastella AJ; Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia., Scott EM; Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia., Scott J; Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK., Shah J; Department of Psychiatry, McGill University, Montreal, H3A 0G4, Canada., Iorfino F; Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia. frank.iorfino@sydney.edu.au.
Jazyk: angličtina
Zdroj: BMC medicine [BMC Med] 2022 Dec 14; Vol. 20 (1), pp. 479. Date of Electronic Publication: 2022 Dec 14.
DOI: 10.1186/s12916-022-02666-w
Abstrakt: 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.
(© 2022. The Author(s).)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje