Search

Objectives: Early interventions improve outcomes for people at high risk of psychosis and are likely to be cost saving. This group tends to seek help for emotional problems - depression and anxiety - via primary care services, where early detection methods are poor. We sought to determine prevalence rates of high risk for psychosis in UK primary care mental health services and clinical outcomes following routinely delivered psychological therapies., Methods: We used a brief screen designed for settings with low base rates and significant time constraints to determine prevalence of high risk for psychosis in UK 'Talking Therapies' services. We examined socio-demographic characteristics, presenting problems and recovery trajectories for this group, compared with people not at risk of psychosis., Results: A 2-item screen selected for specificity yielded a prevalence rate of 3% in primary care mental health services. People at elevated risk of psychosis were younger and more likely to report at least one long-term physical condition. This group presented with higher levels of depression, anxiety and trauma symptoms at assessment and were less likely to have recovered at the end of treatment, compared to people not at risk., Conclusions: Very brief screening tools can be implemented in busy health care settings. The 3% of referrals to UK primary care psychological therapies services at elevated risk of psychosis typically present with more severe symptoms and greater levels of comorbidity and may require augmented interventions to recover fully., (© 2024 The Author(s). British Journal of Clinical Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Aim: Integrated youth services (IYS) have been identified as a national priority in response to the youth mental health and substance use (MHSU) crisis in Canada. In British Columbia (BC), an IYS initiative called Foundry expanded to 11 physical centres and launched a virtual service. The aim of the study was to describe the demographics of Foundry clients and patterns of service utilization during this expansion, along with the impact of the COVID-19 pandemic., Methods: Data were analysed for all youth (ages 12-24) accessing both in-person (April 27th, 2018-March 31st, 2021) and virtual (May 1st, 2020-March 31st, 2021) services. Cohorts containing all clients from before (April 27th, 2018-March 16th, 2020) and during (March 17th, 2020-March 31st, 2021) the COVID-19 pandemic were also examined., Results: A total of 23 749 unique youth accessed Foundry during the study period, with 110 145 services provided. Mean client age was 19.54 years (SD = 3.45) and 62% identified as female. Over 60% of youth scored 'high' or 'very high' for distress and 29% had a self-rated mental health of 'poor', with similar percentages seen for all services and virtual services. These ratings stayed consistent before and during the COVID-19 pandemic., Conclusions: Foundry has continued to reach the target age group, with a 65% increase in number of clients during the study period compared with the pilot stage. This study highlights lessons learned and next steps to promote youth-centred data capture practices over time within an integrated youth services context., (© 2024 The Authors. Early Intervention in Psychiatry published by John Wiley & Sons Australia, Ltd.)

Introduction: The suicide crisis syndrome (SCS) has demonstrated efficacy in predicting suicide attempts, showing potential utility in detecting at-risk individuals who may not be willing to disclose suicidal ideation (SI). The present international study examined differences in intentions to utilize mental health and suicide prevention resources among community-based adults with varying suicide risk (i.e., presence/absence of SCS and/or SI)., Methods: A sample of 16,934 community-based adults from 13 countries completed measures about the SCS and SI. Mental health and suicide prevention resources were provided to all participants, who indicated their intentions to use these resources., Results: Individuals with SCS (55.7%) were just as likely as those with SI alone (54.0%), and more likely than those with no suicide-related symptoms (45.7%), to report willingness to utilize mental health resources. Those with SI (both with and without SCS) were more likely to seek suicide prevention resources (52.6% and 50.5%, respectively) than those without SI (41.7% and 41.8%); however, when examining endorsements for personal use, those with SCS (21.6%) were more likely to use resources than individuals not at risk (15.1%)., Conclusions: These findings provide insight into individuals' willingness to use resources across configurations of explicitly disclosed (SI) and indirect (SCS) suicide risk., (© 2024 The Authors. Suicide and Life‐Threatening Behavior published by Wiley Periodicals LLC on behalf of American Association of Suicidology.)

Aim: Timely help-seeking and pathways to care (PtC) have been linked to positive outcomes in suicidal adolescents. While the importance of formal contacts is recognized, caregivers also play a significant role in these pathways. Caregiver's familiarity with mental health issues may influence an adolescent's PtC. This study explores the relationship between a caregiver's prior suicidality and mental health treatment on their children's pathways to entering a specialist suicide prevention treatment program., Method: Caregivers (n = 118, 35 males and 83 females) of young individuals (12-25 years) who were admitted into an outpatient suicide prevention service, completed a self-report questionnaire describing their child's onset of symptoms, help-seeking, PtC and the caregiver's prior suicidality and mental health treatment., Results: Parents were the source most likely to recognize the onset of suicidality, with general practitioners and psychologists the most common first contacts. Significant delays were identified for onset duration averaging 48.0 weeks, and it was observed that shorter delays in treatment were related to fewer number of contacts. Caregiver prior suicidality was associated with longer delays in treatment but had no relationship with onset duration., Conclusion: Caregivers and professional contacts are vital agents in improving the PtC of suicidal adolescents. Results highlight the significant delays in treatment and the added complexity of a caregiver's prior experience of suicidality to these pathways. These complexities warrant further exploration to minimize obstacles that hinder help-seeking and lengthen PtC, as this may improve interventions and outcomes for suicidal adolescents and their caregivers., (© 2024 The Authors. Early Intervention in Psychiatry published by John Wiley & Sons Australia, Ltd.)

Aim: People living with mental illness are more likely than the general population to experience adverse housing outcomes, including homelessness. The aim of the current study is to examine residential status when participants have their first contact with mental health services, and the correlates of residential status at that moment., Methods: First-time mental health service users were recruited from seven clinical sites across Québec. Data on residential status at entry in the project, as well as demographic, clinical and social variables, were collected using self-report and interviewer-rated questionnaires. Participants were classified as 'Homeless', 'At risk of homelessness' and 'Stably Housed', and correlates of residential status were identified through multivariate logistic regression and unbiased recursive partitioning., Results: Among the 478 participants, 206 (43.1%) were in stable housing, 171 (35.8%) were at risk of homelessness and 101 (21.1%) were classified as homeless. Placement in a youth protection facility was strongly associated with adverse housing outcomes, while having a high school diploma and more social support were associated with more stable housing situations., Conclusions: First-time mental health service users are likely to experience a range of adverse housing situations, indicating the potential for clinical sites to implement homelessness primary prevention strategies. Factors related to family, foster care and schooling seem to be particularly salient in understanding risk of homelessness in first-time mental health service users, calling for intersectoral action to prevent adverse psychosocial outcomes in this population., (© 2024 The Authors. Early Intervention in Psychiatry published by John Wiley & Sons Australia, Ltd.)

Aim: Increasing rates of mental illness among young people, exacerbated by the negative impacts of COVID-19, has resulted in growing pressure on available psychiatric resources to meet increasing demand. Inpatient units provide specialist care for young people with the most severe and complex mental disorders but are one of the most expensive models of psychiatric care. The aim of this review is to provide an update on the effectiveness of adolescent and youth mental health inpatient units in improving outcomes to inform the most efficacious use of psychiatric resources., Methods: Systematic searches of PubMed, The Cochrane Library, PsycINFO, EMBASE, and Web of Science were conducted for studies published in English between January 2011 to May 2022. Criteria for selection included participants aged 12-25 years who had been admitted to amental health inpatient unit. Studies were excluded if set in substance abuse or disability specific units, outpatient or forensic settings, or assessed novel interventions., Results: 23 studies were identified as meeting inclusion criteria, with most (n = 19) utilizing a pre-post observational design and reporting improvement across various domains following inpatient treatment. A total of 24 different outcome measures or methods were used meaning a meta-analysis of results was not possible. There was also a lack of consistency across models of care, lengths of stay, admission policies, and interventions provided., Conclusion: Inpatient units provide positive outcomes for consumers however a clear understanding of clinical significance and comparison to other treatment settings is lacking., (© 2024 The Authors. Early Intervention in Psychiatry published by John Wiley & Sons Australia, Ltd.)

Objectives: Therapists have long observed a phenomenon referred to as the 'revolving door' of mental health services, in which individuals often develop, seek treatment for, and recover from multiple mental illnesses across their life. However, this has not been systematically examined. If this phenomenon is widespread, one would expect that the number of lifetime disorders would exceed that of current disorders. The aim of this meta-analysis was to test this hypothesis., Methods: A search was conducted of the following databases: MEDLINE, PsycINFO and Web of Science. In total, 38 studies were included in the current review; 27 of these contained sufficient quantitative data to be included in the meta-analysis, addressing the primary research aim. The remaining 11 studies were included in the systematic review only., Results: Meta-analyses of the 27 studies indicated that the average number of lifetime disorders was 1.84 times that of current disorders. Previous treatment significantly moderated this relationship, while the clinical nature of the sample did not. Examination of the remaining studies revealed common temporal sequences, indicating disorders which typically develop first or consequently to other disorders., Conclusions: These findings provide support for the revolving door of mental illness, suggesting a need for transdiagnostic treatments and broader conceptualisation of relapse prevention., (© 2024 The Authors. British Journal of Clinical Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Aim: A growing number of quantitative studies have investigated the utility of neuropsychological assessment in mental health settings. However, to the best of our knowledge, no previous study has qualitatively explored youth mental health providers' perceptions of neuropsychological assessment services. A more in-depth understanding of the perceived advantages and barriers associated with neuropsychological assessment in youth mental health settings is critical to better inform policy, practice and service uptake. Thus, the aim of this study was to qualitatively explore clinicians' views about neuropsychological assessments for youth with mental health concerns., Methods: A single open-ended qualitative question, included as part of an anonymous cross-sectional online survey, was completed by clinicians (N = 206) treating or assessing adolescents and young adults within Australian primary care mental health centres (headspace). Responses were analysed using an inductive approach to thematic analysis., Results: Five main themes were identified. Clinicians (a) identified barriers to accessing neuropsychological assessments (53%), (b) indicated a range of mixed outcomes following neuropsychological assessment (39%), (c) highlighted a need for neuropsychological assessments (22%), (d) reported a lack of awareness about this resource (10%) and (e) described practice issues associated with neuropsychological services (4%)., Conclusion: This study uncovered perceived factors contributing to reduced access to neuropsychological assessment in Australian youth mental health settings. Given potential adverse outcomes resulting from this clinical service gap, efforts should be made to address factors contributing to poorer access, thereby mitigating the impact of poor access on the management of mental illness in youth. Several strategies, including funding neuropsychological assessments, are discussed., (© 2019 John Wiley & Sons Australia, Ltd.)

Introduction: The use of restrictive interventions is one of the most controversial practices in medicine. They are utilized in an inpatient setting to manage agitated or aggressive behaviour or to ensure that an individual receives the necessary treatments. However, restrictive interventions remove autonomy and adverse events can be associated with their practice. Youth-specific inpatient units (IPUs) are now being established and it is imperative that the use of restrictive interventions is reduced. In order to inform and facilitate prevention and reduction strategies, this study aimed to determine the prevalence and determinants of restrictive interventions (restraint, seclusion and medication without consent) in a youth specialist mental health IPU., Methods: This study was set at a 16-bed youth specialist acute IPU of Orygen Youth Health, a specialist youth mental health service that provides inpatient care for those aged 18 to 25 years within a catchment area of west and north-western regions of Melbourne, Australia. A retrospective file audit was conducted of all the admissions to the unit from 01 January 2015 to 30 June 2015., Results: Over the 6-month study period, 159 young people were admitted and this accounted for 188 admissions. Over half (54.3%) of admissions were involuntary and restrictive intervention were used in 17.6% of admissions. Specifically, 15.7% (N = 25) of young people experienced restraint, 10.1% (N = 16) were secluded, and 8.1% (N = 12) experienced medication without consent. Absent insight and involuntary status on admission were associated with restrictive interventions., Conclusion: As youth mental health services develop, interventions aimed at reducing restrictive interventions are needed., (© 2018 John Wiley & Sons Australia, Ltd.)

Aim: Many school districts in the United States employ mental health professionals to provide assessment, counselling and crisis interventions within the school setting; however, little is known about actual clinical practices of psychosis screening in schools. The aim of the present study is to examine attitudes and practices regarding psychosis screening among school mental health providers in metropolitan Boston, Massachusetts., Methods: School-based mental health clinicians (N = 100) completed an anonymous survey assessing familiarity, screening, and involvement with psychosis and psychosis risk prior to attending trainings on psychosis., Results: Providers reported screening for psychosis less often than other mental health problems and rated themselves as less confident treating psychosis relative to other mental health concerns. Frequency of screening for psychosis was significantly associated with familiarity with psychosis assessment and case management, confidence providing treatment for individuals experiencing psychosis, and the number of students with or at risk for psychosis with whom providers had been involved. Frequency of screening for psychosis was not associated with years of practice, suggesting that both novice and experienced school-based providers may benefit from training on this issue., Conclusions: Community outreach via school-based provider training on assessment and management of psychosis may help to increase providers' understanding of psychosis and increase the practice of verbal or written screening for psychosis and psychosis risk within schools., (© 2018 John Wiley & Sons Australia, Ltd.)

Aim: This study aimed to determine the prevalence of high-risk sexual behaviours, sequelae and associated factors in young people attending a youth mental health service., Methods: The study design was a cross-sectional survey of 103 young people aged between 15-25 years carried out across four specialist mental health clinics. A questionnaire on the sexual health of secondary level students was adapted for this study. Mental health symptomatology was assessed through the Brief Psychiatric Rating Scale (BPRS)., Results: The mean age was 20.9 (SD ±2.8) years, with 50.5% being female, 41.7% male and 7.7% transgender. A total of 52.4% (N = 54) attended the psychosis [EPPIC] clinic; 15.6% (N = 16) attended the ultra-high risk for psychosis [PACE] clinic; 19.4% (N = 20) attended the personality disorders [HYPE] clinic; and 12.6% (N = 13) attended the mood clinic [YMC]. The mean BPRS score was 47.7 (SD ±12.2). A total of 77.7% of young people had previously been sexually active and of these, 37.5% did not use consistent contraception; 26.3% had been pregnant, of which 95.2% were unplanned. A total of 68.8% reported having been tested for sexually transmitted infections and 25.5% tested positive. The severity of symptoms or clinical characteristics were not associated with engagement in high-risk sexual behaviours., Conclusions: These results indicate that young people with mental health disorders have high needs in regard to their sexual health, which could be addressed by incorporating sexual health referral pathways into early intervention services., (© 2018 John Wiley & Sons Australia, Ltd.)

Aim: Early detection/early intervention (ED/EI) programmes have been inconsistently implemented throughout Europe. We evaluated the ED/EI service distribution in European Psychiatric Association (EPA) member countries, considering indicators of socio-economic development, human and financial resources allocated in mental health (MH) as well as presence of a national branch of the Early Intervention in MH (IEPA). Contextually, we evaluated the duration of untreated psychosis (DUP) in relation to ED/EI service implementation., Methods: EPA section "Prevention of Mental Disorders" conducted the cross-sectional survey administering the 16-item questionnaire to the representatives of its National Psychiatric Associations (NPAs). The survey addressed the Service status and profile, national guidelines, education and policy, DUP and IEPA national branch status. The data were analysed in relation to the indices of economic parameters and MH resources., Results: Neither the national economic parameters, nor indices of MH financial resources were significantly associated with variables related to ED/EI implementation. However, more MH human resources per country were associated with shorter DUP. In comparison to countries without a national branch of IEPA, all of these with the branch had more MH human resources, ED/EI chapters in the national guidelines and services involving both adolescents and adults., Conclusions: An unequal development of ED/EI services and related academic activities appears throughout Europe. The current results, besides providing a useful starting point to set the agenda for harmonizing ED/EI services, reveal that their implementation was more likely to be influenced by the IEPA membership status, rather than by country-specific financial and human resources allocated to MH., (© 2018 John Wiley & Sons Australia, Ltd.)

Aim: In order to strengthen specialized early intervention in psychosis (EIP) services, a contextually nuanced understanding of psychosocial forces driving suboptimal treatment response is critical. This study sought to examine factors driving poor outcomes through a systematic emic coding of psychosocial assessments for discharged EIP clients categorized as leaving with all treatment goals met (AG) or no treatment goals met (NG)., Methods: Psychosocial assessments at baseline, 1 year, 2 years and discharge were extracted from an EIP research registry and systematically coded. One hundred and thirty clients met the study's inclusion criteria (72 NG, 58 AG) from a larger pool of 278. Assessments were coded, quantized and analysed using a combination of basic inferential statistics and thematic analysis., Results: Structural adversity, individual trauma, history of aggression/violence, limited insight and long treatment histories prior to EIP, were strong and significant predictors of poor client outcomes (NG), while motivation for treatment, college goals or preparedness at baseline, baseline engagement in constructive activities, social strengths, individual strengths, talents and family support strongly predicted better outcomes (AG). Race/ethnicity also significantly predicted outcome group. Analyses underscore the powerful impact of multiple converging forms of structural disadvantage, on the one hand, and individual, family and social strengths and supports on the other, in shaping clients' response to EIP treatment., Conclusions: Findings emphasize the importance of greater empirical attention to background structural and socio-economic conditions among early psychosis clients and their multifaceted impacts and underscore the potential value of programmatic components explicitly designed to support clients from multiply disadvantaged backgrounds., (© 2017 John Wiley & Sons Australia, Ltd.)

The aim of this study was to examine variation in suicide ideation and its relationship to risk of suicide attempt in the subsequent 90 days by race and ethnicity. Participants were adults who completed the Patient Health Questionnaire depression module (PHQ9) during an outpatient encounter between January 10, 2010, and December 12, 2012 (N = 509,945 patients; N = 1,228,308 completed PHQ9). Data came from the Virtual Data Warehouse from four health care systems in the Mental Health Research Network. The sample was majority female (73.7%), primarily 30-64 years old (60.1%), healthy (64.5% comorbidity index = 0), and over half were non-Hispanic White (52.9%). Only Asian patients (OR: 1.31; 95% CI: 1.24, 1.39) had higher odds of reporting suicide ideation when compared to non-Hispanic White people. All racial and ethnic groups had increased risk for suicide attempt with increased frequency of suicide ideation. The PHQ9 item 9 can be used as an indicator of suicide ideation and risk for suicide attempt up to 90 days after the reported ideation in racial and ethnic minority patients during routine clinical care., (© 2018 The American Association of Suicidology.)

Aim: Social media holds promise for expanding the reach of mental health services, especially for young people who frequently use these popular platforms. We surveyed social media users who self-identified as having a mental illness to learn about their use of social media for mental health and to identify opportunities to augment existing mental health services., Methods: We asked 240 Twitter users who self-identified in their profile as having a mental illness to participate in an online survey. The survey was in English and inquired about participants' mental health condition, use of social media for mental health and interest in accessing mental health programs delivered through social media., Results: Respondents from 10 countries completed 135 surveys. Most respondents were from the United States (54%), Canada (22%) and the United Kingdom (17%) and reported a psychiatric diagnosis of either schizophrenia spectrum disorder (27%), bipolar disorder (25%), major depressive disorder (16%) or depression (20%). Young adults age ≤35 (46%) were more likely to use Instagram (P = .002), Snapchat (P < .001) and their mobile phone for accessing social media (P < .001) compared to adults age 36 and older (53%). Most participants (85%) expressed interest in mental health programs delivered through social media, especially to promote overall health and wellbeing (72%) and for coping with mental health symptoms (90%)., Conclusions: This exploratory study demonstrates the feasibility of reaching social media users with mental illness and can inform efforts to leverage social media to make evidence-based mental health services more widely available to those in need., (© 2017 John Wiley & Sons Australia, Ltd.)

Aim: Negative symptoms (NS) have been associated with poor outcome and remain difficult to treat in patients with psychosis. This study examined the association of NS with clinical features at first presentation to mental health services for psychosis and with outcomes at 1-year follow-up., Methods: Clinical data were utilized from five London Early Intervention Services (EIS) included in the MiData audit database. The sample comprised 484 first-episode psychosis patients with complete Positive and Negative Syndrome Scale data at baseline and 1-year follow-up. Multiple imputation (N = 50) was conducted to account for missing follow-up data., Results: Baseline NS were associated with male gender (B = -1.63, P < .05), younger age at onset (B = -.15, P <. 05), a higher level of impairment on the Global Assessment of Functioning (disability) Scale at baseline (B = -.19, P <. 010), an absence of reported substance misuse prior to baseline assessment (B = -3.05, P <. 001) and unemployment at baseline (B = -.93, P <. 01). At 1-year follow-up, NS at presentation were associated with worse Global Assessment of Functioning Scale for symptom (B = -.28, P < .01) and disability (B = -.27, P <. 05) and with hospital admission (OR = 1.06, P < .01)., Conclusions: Negative symptoms at presentation to EIS were associated with worse functioning at entry and poorer outcomes 1 year later. Future research is required to better understand the aetiology and trajectories of NS in early psychosis and propose novel targeted interventions., (© 2017 John Wiley & Sons Australia, Ltd.)

Background: Maternal prenatal psychiatric disease has been identified as a possible risk factor for atopic dermatitis development in her children. We quantified the associations between maternal and paternal psychiatric disease and the development of atopic dermatitis in their offspring using nationwide registries., Methods: All children in Denmark born between 1 January 1996 and 31 December 2011 who developed atopic dermatitis prior to their fifth birthday were identified and individually matched 1:10 with controls from the general population and with children receiving care in a similar ambulatory/hospital setting. Conditional logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals., Results: A total of 8602 children with atopic dermatitis were matched with controls. Rates of parental psychiatric care were similar in the atopic dermatitis and control groups. When compared to the general population, weak associations were found between childhood atopic dermatitis and maternal history of depression [OR 1.18 (95% confidence interval: 1.12-1.26)], alcohol abuse [OR 1.37 (1.17-1.60)] and illicit drug use [OR 1.34 (1.14-1.60)]. However, associations became insignificant when the paediatric ambulatory/hospital control group was used [OR 1.05 (0.99-1.13)], [OR 1.14 (0.98-1.34)] and [OR 1.03 (0.88-1.22)], respectively. No paternal psychiatric disease or prenatal maternal psychiatric disease associated with the AD development in the offspring., Conclusions: While we found no consistent associations between maternal or paternal psychiatric disease and the subsequent development of atopic dermatitis in their offspring, children of parents with substance abuse issues may be more likely to receive an atopic dermatitis diagnosis., (© 2018 European Academy of Dermatology and Venereology.)

Background: This study explored engagement with psychology on a specialist early intervention psychosis inpatient unit, with a focus on whether demographics or admission factors impacted on engagement., Method: This was a retrospective cohort study using data extracted from patient notes for all service users who were admitted to an Early Intervention ward during a specified 6-month period. One hundred and one records were identified., Results: Sixty-eight (67.3%) of the service users engaged in psychological therapy, 45.6% (n = 47) attended psychology groups and 58.4% (n = 59) engaged in individual psychology sessions. Service users admitted to the ward voluntarily were more likely to engage in individual psychology sessions in comparison to those admitted under section of the mental health act (β = -0.270, P < .005). Length of admission predicted engagement with groups (β = 0.38, P < .001) and individual psychology sessions (β = 0.408, P < .001). Ethnicity, gender and number of admissions did not predict engagement in psychology., Conclusions: Psychological interventions are acceptable on a specialist early intervention psychosis inpatient ward and offer an opportunity to engage service users. Engagement was not predicted by demographic factors typically seen in community settings. Implications arising from these differences are discussed., (© 2017 John Wiley & Sons Australia, Ltd.)

Aim: Improving timely access to evidence-based treatment for people aged 14-65 years experiencing a first episode psychosis (FEP) or an at-risk mental state (ARMS) for psychosis is a national priority within the United Kingdom. An early intervention in psychosis (EIP) access and waiting time standard has been set which has extended the age range and acceptance criteria for services., Methods: This descriptive evaluation reports upon the referrals and access to treatment times within an EIP service over the first year of operating in line with the access and waiting time standard. Patient pathways and post-assessment status are also described., Results: The service received 406 referrals, of which 88% (n = 357) were assessed. The mean length of time to treatment was 1.5 weeks, with 88% being seen within 2 weeks. Of those who engaged in an assessment, 34% (n = 138) were identified as ARMS cases and 30% (n = 123) were identified as FEP. Over 35 year olds accounted for 22% (n = 80) of the total accepted cases., Conclusions: The findings indicate clinical and operational issues, which will need careful consideration in the future planning of services. The high number of ARMS cases highlights the importance of clear treatment pathways and targeted interventions and may suggest a need to commission distinct ARMS services. The number of people who met the extended age and service acceptance criteria may suggest a need to adapt or redesign clinical services to meet the age-specific needs of over 35 year olds and those with an ARMS. It is unclear how changes to the remit of EIP services will impact upon future clinical outcomes., (© 2018 John Wiley & Sons Australia, Ltd.)

The aim of this pilot study was to evaluate the utilisation and experience of an exercise physiology programme, known as Bod Squad at a youth mental health service. Individual sessions were offered in an outpatient setting, while both group and individual sessions occurred in an inpatient unit. This pilot study used a mixed methodology to collect data from young people who attended Bod Squad. A database of exercise physiology records for 47 young people were analysed for attendance and physiological indicators. In addition, 7 semi-structured interviews were conducted with young people to explore their experience of Bod Squad. Young people attended a total of 169 sessions during the programmes tenure, with an overall mean of 3.6 sessions. Pre-post measures for 10 young people (who had attended at least 4 sessions) showed modest average reductions for body mass index, waist circumference, chest circumference and resting heart rate. Five themes emerged from the interviews-(1) My reasons for attending, (2) The social aspect, (3) An individualized approach, (4) Outcomes from Bod Squad and (5) My experience of the service. All of these themes included positive experiences of Bod Squad, which young people perceived as relevant to their needs and helpful to their recovery. These findings are congruent with previous studies that have concluded that exercise physiology may be an effective, acceptable and valued intervention for addressing physical and metabolic health issues for young people., (© 2017 John Wiley & Sons Australia, Ltd.)

Aim: The timely identification and treatment of psychosis are increasingly the focus of early interventions, with research targeting the initial high-risk period in the months following first-episode hospitalization. Ongoing treatment after stabilization is also essential in the years following a first-episode psychosis (FEP), but has received less research attention. In this study, variables that could impact continued psychiatric service utilization by adolescents following their FEP and temporal patterns in service utilization are examined., Methods: Families of 52 adolescents (aged 14.4 ± 2.5 years) discharged following a hospitalization for FEP were contacted two or more years following the adolescents' discharge. A chart review (Time 1) of hospital records provided clinical data on each adolescent's psychiatric diagnosis, symptoms, illness course, medications and family history. Follow-up (Time 2) data were collected from parents/caregivers using a questionnaire enquiring about post-discharge treatment history and service utilization., Results: Bivariate analyses were conducted to identify Time 1 variables associated with psychiatric service utilization at Time 2. Significant variables were included in a logistic regression model and three variables were independently associated with continued service utilization: having a primary diagnosis of schizophrenia (odds ratio (OR) = 24.0; P = 0.02), not having a first-degree relative with depression (OR = 0.12; P = 0.05) and fewer months since the last inpatient discharge (OR = 0.92; P = 0.02)., Conclusions: Findings suggest: (1) the importance of early diagnosis, (2) that a relative with depression may negatively influence the adolescent's ongoing service utilization, and (3) that 18 months post-discharge may be a critical time to review treatment strategies and collaborate with youth and families to ensure appropriateness of services., (© 2016 John Wiley & Sons Australia, Ltd.)

Aim: This investigation aims to identify if correlates of not working or studying were also correlated with part-time vocational participation., Methods: Demographic and vocational engagement information was collected from 226 participant clinical charts aged 15 to 25 years accessing a primary youth health clinic. Multinomial logistic regressions were used to examine potential correlates no and part-time vocational engagement compared to those full-time., Results: A total of 33% were not working or studying and 19% were part-time. Not working or studying was associated with secondary school dropout and a history of drug use. These associations were not observed in those participating part-time., Conclusions: This result suggests that the markers of disadvantage observed in those not working or studying do not carry over to those who are part-time. Potentially, those who are part-time are less vulnerable to long-term disadvantage compared to their unemployed counterparts as they do not share the same indicators of disadvantage., (© 2017 John Wiley & Sons Australia, Ltd.)

Objectives: To investigate the acceptability and utility of a newly developed computerized cognitive behavioural therapy (cCBT) programme, MindWise (2.0), for adults attending Irish primary care psychology services., Method: Adult primary care psychology service users across four rural locations in Ireland were invited to participate in this study. A total of 60 service users participated in the MindWise (2.0) treatment group and compared to 22 people in a comparison waiting list control group. Participants completed pre- and post-intervention outcome measures of anxiety, depression, and work/social functioning., Results: At post-intervention, 25 of 60 people in the MindWise (2.0) condition had fully completed the programme and 19 of 22 people in the waiting list condition provided time 2 data. Relative to those in the control group, the MindWise (2.0) participants reported significantly reduced symptoms of anxiety and no change in depression or work/social functioning., Conclusions: The newly developed cCBT programme, MindWise (2.0), resulted in significant improvements on a measure of anxiety and may address some barriers to accessing more traditional face-to-face mental health services for adults in a primary care setting. Further programme development and related research appears both warranted and needed to lower programme drop-out, establish if gains in anxiety management are maintained over time, and support people in a primary care context with depression., Practitioner Points: There is a growing evidence base that computerized self-help programmes can assist in a stepped-care approach to adult mental health service provision. These programmes require further development to address issues such as high dropout, the development of equally effective transdiagnostic content, and greater effectiveness in the country of origin. This study evaluated the acceptability and utility of a brief online CBT programme for adults referred due to anxiety or low mood to primary care psychology services in the national health service in Ireland. Results indicate that 42% of people completed the programme and experienced a significant reduction in anxiety but not depression and no improvement in work or social adjustment compared to similar adults on a waiting list for services. This study suggests the programme warrants further development and research and may in time become a useful and suitable intervention within the national health service in Ireland., (© 2017 The British Psychological Society.)

Background: Self-reported psychotic experiences (PEs) are associated with psychopathology of all kinds, not just psychoses. However, systematic reviews on the relevance of this for health services are unavailable. Furthermore, whether association with service use is confounded by other psychopathology is unknown, and is relevant to prevention and treatment., Objectives: Literature examining associations between PEs and service use was systematically reviewed. Study quality and the direction and extent of any associations were assessed, and meta-analysis conducted., Methods: Systematic review and meta-analysis was carried out as per PRISMA guidelines. A search of electronic databases was performed based on free-text and structured terms. Included studies were evaluated by two raters using a structured tool and estimates extracted for reporting., Results: Thirteen studies were returned. We found two prospective studies, and a minority of studies accounted for concurrent psychopathology, limiting our ability to test our main hypotheses. Five studies reported associations by different types of service use. Almost all studies assessed service use by self-report. Meta-analysis suggested that people who reported PEs were around twice as likely to report service use compared to those who did not (pooled OR for all included studies: 2.20,95% confidence intervals (95%CI): 1.66,2.91)., Conclusions: There was consistent evidence of association between PEs and mental health service use at the general population level. However, evidence for causation was poor due to a limited number of studies. Whether increased service use in this group is solely attributable to PEs, and therefore whether interventions aimed at limiting/preventing PEs might be effective, requires studies focusing on the relationships between PEs, psychopathology and service use., (© 2017 The Authors Early Intervention in Psychiatry Published by John Wiley & Sons Australia, Ltd.)

Aims: The primary aim of this pilot study was to determine the psychometric properties of the 18-item headspace Family and Friends Satisfaction Scale (hFAFSS)., Methods: During August 2015, staff from 22 headspace centres approached family members and friends of young people attending headspace to complete the hFAFSS. Principal components analysis with oblique Promin rotation and polychoric correlations were used to assess the factor structure of the hFAFSS., Results: There were 277 usable responses. Satisfaction was high, resulting in little variance. Parallel analyses suggested that the scale items tapped a single factor (68% of variance)., Conclusions: This study is one of the first attempts to measure the satisfaction of family and friends with primary care-based youth mental health services. Satisfaction of family members and friends was shown to be high, but limited variance restricts the usability of the hFAFSS as an evaluation measure, and revision and further testing is needed., (© 2017 John Wiley & Sons Australia, Ltd.)

Aim: This study explores a range of barriers that parents encountered in accessing mental health services. The study also explored whether parents experienced similar barriers to accessing services in 2003 and 2013., Methods: One hundred and thirty-four parents of young people attending an initial assessment at a Child and Adolescent Mental Health Service (CAMHS) or headspace centre completed a questionnaire assessing 10 general barriers to care. These data were compared to those collected from 129 participants at CAMHS in 2003., Results: The ranking of barriers to mental health care for their children was similar for both survey years, with 'wait time being too long' and 'help being too expensive' the two highest ranked barriers. Cost factors were related to not knowing that the services did not charge fees and having to take time off work to attend appointments. Multiple referral steps and uncertain wait times were the main concerns regarding wait times. The overall strength with which barriers were endorsed remained relatively low; however, at least 40% of the sample agreed they had experienced four of the barriers in both years., Conclusions: Despite relatively low endorsement of barriers, there are substantial proportions of parents who experienced some barriers to services, and services should continue working to reduce them to facilitate timely access. There is a particular need for more service-related information to clarify that public sector mental health services do not charge fees. Methods such as rapid initial assessment and actively managing wait lists may go some way to reducing perceived wait time barriers., (© 2015 Wiley Publishing Asia Pty Ltd.)

Aim: This is the first comprehensive, nationwide survey aimed at collecting evidence about the process of implementation and development of early intervention in psychosis (EIP) services (EIPs) in Italy, following the establishment of the pilot program 'Programma 2000' in 1999 and the publishing of the Italian National Guidelines in 2007. This survey covers all the Departments of Mental Health (DMHs) operating in Italy in 2013., Methods: Using a purpose-designed form to assess EIP implementation, all directors of public mental health services for adults throughout Italy (n = 216) were asked to provide information about the activities of EIP-relevant local services. The initial delivery was followed by a request for a prompt response., Results: Out of 216 enquired DMHs, 103 provided computable answers to the survey (response rate = 48%). Among responders, 45 (44%) reported the implementation of EIP (one out of five DMHs operating in Italy). About a half of the active EIPs also targeted patients at ultra-high risk of psychosis (n = 27). Strict application of guidelines related to drug prescription was reported in 35% of EIPs. Conversely, 90% provided some kind of structured psychotherapy and psychoeducation. Among EIPs, a minority reported willingness to provide initial assessment/contact at the patient's home., Conclusion: Albeit slowly, the implementation of EIP is spreading throughout the Italian public network of mental health. There is still a wide variability in the distribution of EIP services across the Italian territory. Further efforts are necessary to stimulate policy endorsement and resource allocation, as well as to support the poorest zones., (© 2015 Wiley Publishing Asia Pty Ltd.)

Freedom of Information Act requests sent to 51 NHS mental health providers in England showed an average of 20.5 suicides per organization. Only one provider, however, could report how many people that had killed themselves had been offered N.I.C.E. recommended psychological therapy. Information that might prevent suicides is being ignored., Practitioner Points: Mental health services need, urgently, to develop data systems that can inform clinical team leaders about gaps in their services to suicidal people in their care Clinical psychologists have a particular responsibility to pressure managers to effectively monitor the provision of evidence-based treatments to suicidal people Trusts and commissioners must be aware of, and rectify, any failings of their services in relation to the prevention of suicide., (© 2017 The British Psychological Society.)

Rationale, Aim, and Objective: The objective of the study is to assess the completeness and accuracy of medication records held by stakeholders (secondary care, general practice, and community pharmacy) for clozapine consumers managed in a shared care programme., Methods: This was an exploratory, descriptive study examining secondary and primary care medication records in a large, urban, public mental health service setting in Queensland, Australia. Consumers (18-65 years old) prescribed clozapine under shared care management with capacity to consent were eligible (n = 55) to participate. Information from medication and dispensing records was used by a pharmacist to compile a best possible medication history for each consumer. Discrepancies were identified through reconciliation of stakeholder records with the history. Discrepancies were defined as an omission, addition, or administration discrepancy (difference in dose, frequency, or clozapine brand)., Results: Thirty-five (63.6%) consumers consented for records to be reviewed. Overall, 32 (91.4%) consumers had at least 1 discrepancy in their records with a mean of 4.9 discrepancies per consumer. Of 172 discrepancies, 127 (73.8%) were omissions. Primarily, concomitant medicines were omitted in 19/35 (54%) of secondary care records while clozapine was omitted in 13/32 (40.6%) of community pharmacies records., Conclusions: Discrepancies were highly prevalent in the shared care medication records of clozapine consumers of this service. Where there is incomplete and inaccurate medication information, there is a risk of suboptimal clinical decision making, increasing the likelihood of adverse drug events. This study demonstrates a need for improved documentation and timely access to accurate and complete medication records for shared care stakeholders. Expanding the pharmacist's role in this setting could improve medication accuracy in documentation and related communication., (© 2017 John Wiley & Sons, Ltd.)

Aim: A decline in the rate of transition to psychosis in patients presenting with clinical high-risk has been reported in the literature. Several hypotheses have been put forward to explain this decline. In this brief report, we aimed to explore whether the demographic group presenting to clinical high-risk services differs from the 'end-point' population who present with first-episode psychosis (FEP), by focusing on gender., Method: Gender distribution was compared between clinical high-risk (CHR) and FEP using data extracted from published study samples and clinical data from corresponding cohorts within the same catchment area in South London., Results: The proportion of males was significantly higher in FEP compared to CHR services in the literature describing Europe, Australia and North America and in the clinical cohort from South London., Conclusion: Males are under-represented in existing CHR services in Europe, Australia and North America. This could reflect less willingness in males to seek help if experiencing low-level psychological distress and may be related to the declining transition., (© 2016 John Wiley & Sons Australia, Ltd.)

Background and Objectives: Homeless women have shown high rates of substance use disorders (SUD), but many studies are more than a decade old, limited in geographic location, or focus only on women living outdoors or in shelters. The purpose of this study was to obtain a more current and representative sample of homeless women and the prevalence and predictors of substance use disorders among women seeking primary care at Health Care for the Homeless clinics across the US., Methods: Eleven Health Care for the Homeless (HCH) clinics in nine states contributed proportionally to a sample of n = 780 female patients who completed a self-administered survey including demographics, housing history, health, mental health, and drug and alcohol use., Results: Compared to the general population of women, rates were four times higher for an alcohol use disorder, and 12 times higher for a drug use disorder., Discussion and Conclusions: The findings indicate a significant need for SUD services, with an equally high need for mental health services. In addition, high rates of victimization and use of tobacco, and overall poor health status, indicate overall health disparities., Scientific Significance: Addressing barriers to full integration of substance use and mental health services, such as improving screening, reimbursement, clinician training, and addressing biases about motivation of this population to engage in treatment, are necessary to improve the health of women seeking care in HCH settings. (Am J Addict 2017;26:680-688)., (© 2017 American Academy of Addiction Psychiatry.)

Objective: Hardly any studies exist on the duration of major depressive disorder (MDD) and factors that explain variations in episode duration that lack biases. This limits clinical decision-making and leaves patients wondering when they will recover., Method: Data were used from the Netherlands Mental Health Survey and Incidence Study-2, a psychiatric epidemiological cohort study among a nationally representative adult population. Respondents with a newly originated depressive episode were selected: 286 MDD and 107 minor depressive disorder (MinDD) cases. DSM-IV diagnoses were assessed with the Composite International Diagnostic Interview 3.0 and episode duration with the Life Chart Interview., Results: Among MDD cases, median episode duration was 6 months, mean duration was 10.7 months, and 12% had not recovered at 36 months. Longer duration was associated with comorbid dysthymia, anxiety disorder, psychotropic medication use (i.e. antidepressants or benzodiazepines prescribed by a mental health professional), mental health care use and suicidal behaviour. Better physical and mental functioning before depression onset predicted shorter duration. Among MinDD cases, shorter median duration (3 months) but similar mean duration (8.7 months), risk of chronicity (10% not recovered at 36 months) and risk indicators for episode duration were found., Conclusion: As the risk of chronicity was similar for MDD and MinDD, MinDD cannot be dismissed as a merely brief mood state., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aims: This study aimed to determine the psychometric properties of the headspace youth (mental health) service satisfaction scale (YSSS), a 14-item purpose-designed scale for use with adolescents and young adults attending headspace centres, and to examine the level of satisfaction with headspace centre services and the client characteristics that predict this., Methods: There were 21 354 eligible headspace clients who had received more than one service over the 12-month data collection period during 2013-2014, and 12 436 (58%) completed a satisfaction scale. headspace clients could optionally self-complete the satisfaction scale at the beginning of visits 2, 5, 10 and 15. Clients' demographic and clinical characteristics were also recorded., Results: Factor analysis identified a four-factor solution for the scale and internal consistency of the subscales was acceptable to excellent. Satisfaction with headspace was high and increased over time for those who completed the scale multiple times. Several demographic and clinical characteristics predicted the likelihood of completion and level of satisfaction, with younger age shown to be a persistent predictor of lower satisfaction., Conclusions: Client satisfaction with headspace is high and increases with ongoing engagement. Development of the headspace YSSS contributes a new client satisfaction scale with tested psychometric properties for adolescents and young adults engaged in mental health services, providing an essential tool for youth mental health services to routinely evaluate the experiences of young people accessing their services., (© 2015 Wiley Publishing Asia Pty Ltd.)

Aim: Almost a quarter of young Australians experience a mental health issue that may become chronic if left untreated. Children and Young People's Mental Health (CYPMH) is a specialist tertiary service for young people with moderate to severe mental health problems on the Central Coast in Australia. This paper presents an overview of client data and service use collected over a 1 year period specific to the Youth Mental Health (YMH) component of the service., Method: Client data, including demographic characteristics, service usage, presenting issues and standardized outcome measures, were analysed using SPSS. Clinicians routinely collect MH-OAT (Mental Health Outcomes and Assessment Tools) measures at different points in a client's episode of care, and each of these measures was analysed separately. Wilcoxon Z and a series of McNemar's tests were used to report on the difference between admission and discharge scores., Results: During a designated 1 year period, 830 referrals to YMH were received. The most prevalent presenting issue was suicidal ideation followed by deliberate self-harm and depression. A comparison of admission and discharge outcome scores shows significant improvement by discharge on a range of measures. Specifically, analysis identified significant differences between admission and discharge HoNOSCA (Health of the Nation Outcomes Scales for Children and Adolescents) and CGAS (Children's Global Assessment Scale) scores for young people aged 12-17 and HONOS (Health of the Nation Outcomes Scale) scores for young people aged 18-24., Conclusion: The clinical outcomes for young people are positive with improvements seen on a range of measures., (© 2015 Wiley Publishing Asia Pty Ltd.)

Aim: To examine whether clinical stage of illness and current diagnosis influence appointment behaviour in a specialized primary-level youth mental health service., Methods: Factors associated with attendance at 8697 appointments made by 828 young people (females = 497) aged 12-25 years over a 1-year period were analysed., Results: The number of appointments made did not correlate with the rates of attendance. However, those with more severe psychiatric morbidity made significantly more appointments and missed significantly more appointments than those with less severe presentations. Impaired social functioning was the best predictor of female attendance rates, whereas age and clinical stage of illness best predicted male attendance rates. Current diagnosis rather than functional impairment appeared to influence the level of input offered by clinicians., Conclusions: Age, gender, severity of illness, functioning and psychological distress had differential associations with both planned treatment intensity and attendance rates. These differences are likely to have implications for service provision in this youth population., (© 2016 John Wiley & Sons Australia, Ltd.)

Objective: Insight on how different missions have impacted rates of mental health service (MHS) utilization is unexplored. We compared postdeployment MHS utilization in a national cohort of first-time deployed to missions in Balkan, Iraq, and Afghanistan respectively., Methods: A prospective national cohort study of 13 246 first-time deployed in the period 1996 through 2012 to missions in Balkan area, Iraq, or Afghanistan respectively. Soldiers 'MHS utilization was also compared with a 5:1 sex-, age-, and calendar year-matched never-deployed background population. Postdeployment utilization of MHS was retrieved from national coverage registers. Using Cox survival analyses, participants were followed and compared with regard to receiving three different types of psychiatric services: (i) admission to psychiatric hospital, (ii) psychiatric outpatient contact, and (iii) prescriptions of psychotropics., Results: Utilizing of psychiatric outpatient services and psychotropics was significantly higher in first-time deployed to Iraq and Afghanistan compared with deployed to Balkan. However, the rate of postdeployment admission to psychiatric hospital did not differ between missions. Postdeployment rates of psychiatric admission and psychiatric outpatient treatment were significantly higher in Afghanistan-deployed personnel compared with the background population., Conclusions: Utilization of MHS differed significantly between mission areas and was highest after the latest mission to Afghanistan., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Introduction and Aims: Research on perceived unmet need for care for mental health and substance use problems focuses on general populations to the detriment of hidden populations. This study describes prevalence and correlates of perceived unmet need for care in a community-based sample of street-involved people who use illicit drugs and identifies barriers to care., Design and Methods: A sample of 320 street-involved people who use drugs participated in a structured, interviewer-assisted survey in Edmonton, Canada. The survey included the Perceived Need for Care Questionnaire, which assessed unmet need for care for mental health and substance use problems across seven service types. Logistic regression examined the associations between perceived unmet need, extent of socioeconomic marginalisation and problem severity. Barriers underlying unmet service needs were also examined., Results: Most (82%) participants reported unmet need for one or more services during the past year. Odds of reporting one or more unmet needs were elevated amongst participants reporting substantial housing instability (adjusted odds ratio = 2.37; 95% confidence interval 1.19-4.28) and amongst participants meeting criteria for drug dependence (adjusted odds ratio = 1.22; 95% confidence interval 1.03-1.50), even after adjustment for sociodemographic covariates. Structural, rather than motivational barriers were the most commonly reported reasons underlying unmet service needs., Discussion and Conclusion: Street-involved people who use drugs experience very high rates of perceived unmet need for care for mental health and substance use problems. General population studies on perceived unmet need are insufficient for understanding needs and barriers to care in hidden populations.[Hyshka E, Anderson JT, Wild TC. Perceived unmet need and barriers to care amongst street-involved people who use illicit drugs. Drug Alcohol Rev 2017;36:295-304]., (© 2016 Australasian Professional Society on Alcohol and other Drugs.)

Objective: To investigate psychiatric outcomes after bariatric surgery, including suicide, self-harm, psychiatric service use and substance misuse., Method: Retrospective study on a Danish nationwide register-based cohort of 22 451 patients followed for 1 029 736 person-years. Data were analysed utilizing single- and multi-event Cox regression with non-operated controls with obesity and mirror-image analyses with the operated patient serving as their own controls., Results: We showed an increased ratio of self-harm (hazard ratio [HR] 3.23, P < 0.001; incidence rate ratio [IRR] 1.71, P < 0.001), psychiatric service use (admissions IRR 1.52, P < 0.001; emergency room visits IRR 1.70, P < 0.001), psychiatric diagnosis (organic psychiatric disorders HR 1.78, P < 0.001; substance use HR 2.06, P < 0.001; mood disorders HR 2.66, P < 0.001; neurotic, stress-related and somatoform disorders HR 2.48, P < 0.001; behavioural syndromes HR 3.15, P < 0.001; disorders of personality HR 2.68, P < 0.001; behavioural and emotional disorders HR 6.43, P < 0.001), as well as substance misuse utilizing Cox regression as well as mirror-image analyses, as compared to non-operated. We did not find an increased suicide rate (HR 1.35, P = 0.658) among operated as compared to non-operated., Conclusion: Our study shows that undergoing bariatric surgery is associated with increases in self-harm, psychiatric service use and occurrence of mental disorders., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Alaska Native and American Indian people (AN/AIs) are disproportionately affected by suicide. Within a large AN/AI health service organization, demographic, clinical, and service utilization factors were compared between those with a suicide-related health visit and those without. Cases had higher odds of a behavioral health diagnosis, treatment for an injury, behavioral health specialty care visits, and opioid medication dispensation in the year prior to a suicide-related visit compared to gender-, age-, and residence- (urban versus rural) matched controls. Odds of a suicide-related visit were lower among those with private insurance and those with non-primary care ambulatory clinic visits., (© 2016 The American Association of Suicidology.)

Aim: To assess demographic and clinical predictors of outpatient mental health clinic follow-up after inpatient psychiatric hospitalization among Medicaid-enrolled young adults., Methods: Using logistic regression and administrative claims data from the Maryland public mental health system and Maryland Medicaid for young adults ages 18-26 who were enrolled in Medicaid (N = 1127), the likelihood of outpatient mental health follow-up within 30 days after inpatient psychiatric hospitalization was estimated ., Results: Only 51% of the young adults had any outpatient mental health follow-up visits within 30 days of discharge. Being black and having a co-occurring substance use disorder diagnosis were associated with a lower probability of having a follow-up visit (OR = 0.60, P < 0.01 and OR = 0.36, P < 0.01, respectively). In addition, those who utilized any outpatient public mental health services during the 180 days prior to their index hospitalization (N = 625, 55.4%) were more likely to have a follow-up visit than those without prior outpatient use (OR = 2.45, P < 0.01). Prior Medicaid-reimbursed primary care visits were not significantly associated with follow-up., Conclusions: In this predominantly urban, low-income statewide sample of young adults hospitalized for serious psychiatric conditions, half did not connect with an outpatient mental healthcare provider following their discharge. Outpatient transition supports may be especially needed for young adults who were not receiving outpatient services prior to being admitted for psychiatric inpatient care, as well as for young adults with substance use disorders and African Americans., (© 2015 Wiley Publishing Asia Pty Ltd.)

Background and Aims: Drug abuse is a significant social and public health problem in Iran. The present study aimed to provide prevalence estimates and information on correlates of illicit drug use disorder and opioid dependence, as well as service use for these disorders in Iran., Design, Setting and Participants: This report is based on the Iranian household Mental Health Survey (IranMHS) conducted in 2011. A three-stage probability sampling was employed. Face-to-face interviews by trained psychologists were carried out with a nationally representative sample of 7841 individuals (3366 men and 4475 women) aged 15-64 years., Measurements: The Composite International Diagnostic Interview and questionnaires for socio-demographic correlates and service use., Findings: The prevalence of 12-month use disorders for any illicit drug according to DSM-IV and DSM-5 criteria were 2.09% [95% confidence interval (CI) = 1.70-2.47%] and 2.44% (95% CI = 2.03-2.85%), respectively. Opioid use disorders, and opium in particular, were the most common use disorder. The odds of drug use disorders were greater in men than in women, in previously married participants than in currently or never married participants, and in participants with lower socio-economic status than in those with higher socio-economic status (all P-values <0.05). Approximately half of those with drug use disorders and 40% with opioid dependence had a 12-month unmet need for treatment. Self-help groups were the most common type of service used, followed by obtaining medication from pharmacies directly and outpatient treatment services., Conclusions: Opioid use disorders are the most common type of drug use disorders in Iran, setting Iran apart from many other countries. Patterns of service use suggest a large unmet need for drug use disorder treatment in Iran., (© 2016 Society for the Study of Addiction.)

Objective: Discrimination reported by mental health service users in England is high. The study aims to determine changes in mental health-related discrimination from 2008 to 2014., Methods: Samples of mental health service users were interviewed from 2008 to 2014 using the Discrimination and Stigma Scale version 12. Social capital in terms of access to social resources is a marker of discrimination in terms of effects on social connections, and so from 2011, social capital also measured using the Resource Generator-UK., Results: Fewer participants reported discrimination in one or more life areas in 2014 compared to 2008 (OR: 0.58, 95% CI 0.36 to 0.94 P = 0.03). A weighted multiple regression model found a decrease in overall discrimination in 2014 compared to 2008 (mean difference: -13.55, 95% CI: -17.32 to -9.78, P < 0.001). There was not a consistent in discrimination decline between each year. No differences in access to social resources were found., Conclusions: Discrimination has fallen significantly over 2008-2014, although there was not a consistent decline between years. There is no evidence that social capital has increased., (© 2016 The Authors. Acta Psychiatrica Scandinavica Published by John Wiley & Sons Ltd.)

Objective: To better understand mental health service users' experiences of stigma and discrimination in different settings., Method: An annual telephone survey of people with a mental health diagnosis conducted to evaluate the Time to Change antistigma campaign in England. Of 985 people who participated in 2013, 84 took part in a qualitative interview which was audio recorded. Of these, 50 interviews were transcribed and thematically analysed to explore accounts of discrimination. We analysed common types of behaviour; motivations ascribed to the discriminators; expectations of what fair treatment would have been; and the impact of discrimination on participants., Results: Discrimination was most common in five contexts: welfare benefits, mental health care, physical health care, family and friends. Participants often found it hard to assess whether a behaviour was discriminatory or not. Lack of support, whether by public services or by friends and family, was often experienced as discrimination, reflecting an expectation that positive behaviours and reasonable adjustments should be offered in response to mental health needs., Conclusion: The impact of discrimination across different settings was often perceived by participants as aggravating their mental health, and there is thus a need to treat discrimination as a health issue, not just a social justice issue., (© 2016 The Authors. Acta Psychiatrica Scandinavica Published by John Wiley & Sons Ltd.)

Aim: Functional somatic symptoms (FSS) are common in paediatric patients who are referred to Child and Adolescent Mental Health Service (CAMHS), but little is known about current referral practices. The aim of this study was to systematically investigate clinical features of paediatric inpatients with FSS referred to CAMHS and to describe why paediatricians referred them., Methods: The study population comprised 60 children with FSS admitted to a large Danish paediatric department during 2012. We compared medical record data on the clinical characteristics and paediatric management of 16 children who had been referred and 44 children who had not., Results: Most paediatric records lacked information on psychosocial factors and symptoms. Referred children were significantly more multisymptomatic of FSS (p < 0.01) than the controls, had longer symptom duration, underwent more clinical investigations, had longer paediatric admissions of at least two weeks and received more treatment elements before referral. The most frequently stated referral reason was inadequate treatment response., Conclusion: Paediatric inpatients with more severe FSS were more likely to be referred to CAMHS, but referral reasons were generally vague and psychosocial information was frequently missing. Clinical guidelines are needed to improve and systematise mental health referrals for children with FSS., (©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Aim: Early intervention mental health services tailored for young people are being developed across the world, yet reports on service use patterns and short-term clinical outcomes for the clinically diverse group accessing these services are very limited. The current study employed the clinical staging model to examine whether young people within the two clinical stages that precede full-threshold disorder (stage 1a and stage 1b) differed in terms of treatments received and short-term symptomatic and functional outcomes., Methods: Eight hundred ninety young people aged 12-25 years seeking mental healthcare within a 12-month period were analysed in this study., Results: Attenuated syndrome (stage 1b) patients used significantly more services than help-seeking (stage 1a) patients, including significantly higher rates of psychotropic medication prescription (9.3% vs. 43.6%). Stage 1a patients started with significantly lower levels of psychological distress and significantly higher levels of functioning at service entry and showed improvement only in psychological distress over 10 sessions. Despite using significantly more services, stage 1b patients remained impaired on both measures after 10 sessions; however, they showed some modest improvements in their levels of psychological distress and functioning over this time., Conclusion: Patients with attenuated syndromes have treatment patterns and clinical outcomes not dissimilar to those with more severe mental disorders and therefore require more intensive interventions provided over a longer time period in order to achieve recovery. The staging model allows services to selectively allocate their limited resources towards those patients with greater care needs. More research into the unique treatment needs and longer term outcomes of this diverse patient group is supported., (© 2014 Wiley Publishing Asia Pty Ltd.)

Aim: The Transitions Study was designed to establish a cohort of young people (12-25 years) seeking help for mental health problems, in order to longitudinally explore and refine a clinical staging model of the development and progression of mental disorders. This paper presents the baseline demographic and clinical characteristics of the cohort, particularly the nature and severity of psychopathology., Method: All eligible young people attending one of four headspace clinical services were invited to participate, and completed a battery of self-report and interviewer-administered measures of psychopathology and functional impairment at baseline, which will be repeated at the annual follow up., Results: Of 1615 eligible clients, 802 young people (66% women; mean age = 18.3 years) consented to participate and completed baseline assessments (participation rate = 50%). The severity of mental health problems varied, with 51% meeting the criteria for probable caseness related to generalized anxiety, 45% presenting with moderate to severe depressive symptoms and over a third experiencing subthreshold psychotic symptomatology. Disordered eating (32%) and problematic tobacco (56%), cannabis (30%) and alcohol (38%) use also affected a significant proportion. Overall, 39% of the cohort were classed as being functionally impaired at baseline., Conclusion: The Transitions Study recruited a heterogeneous cohort at baseline in relation to the nature and severity of mental health problems and levels of functional impairment. The variation in clinical presentations within the cohort, from mild, through moderate to severe levels of psychopathology and impairment, increases the likelihood of the Transitions Study ultimately being able to achieve its aims of empirically testing a clinical staging model for mental disorders., (© 2014 Wiley Publishing Asia Pty Ltd.)

Background and Objectives: This study assesses medical and psychiatric comorbidities, service utilization, and psychotropic medication prescriptions in veterans with comorbid major depressive disorder (MDD) and alcohol use disorder (AUD) relative to veterans with MDD alone., Methods: Using cross-sectional administrative data (fiscal year [FY]2012: October 1, 2011-September 30, 2012) from the Veterans Health Administration (VHA), we identified veterans with a diagnosis of current (12-month) MDD nationally (N = 309,374), 18.8% of whom were also diagnosed with current (12-month) AUD. Veterans with both MDD and AUD were compared to those with MDD alone on sociodemographic characteristics, current (12-month) medical and psychiatric disorders, service utilization, and psychotropic prescriptions. We then used logistic regression analyses to calculate odds ratio and 95% confidence interval of characteristics that were independently different between the groups., Results: Dually diagnosed veterans with MDD and AUD, relative to veterans with MDD alone, had a greater number of comorbid health conditions, such as liver disease, drug use disorders, and bipolar disorder as well as greater likelihood of homelessness and higher service utilization., Conclusions and Scientific Significance: Dually diagnosed veterans with MDD and AUD had more frequent medical and psychiatric comorbidities and more frequently had been homeless. These data suggest the importance of assessing the presence of comorbid medical/psychiatric disorders and potential homelessness in order to provide appropriately comprehensive treatment to dually diagnosed veterans with MDD and AUD and indicate a need to develop more effective treatments for combined disorders., (© American Academy of Addiction Psychiatry.)

Background and Objective: As the baby boomers age, the number of older adults with comorbid substance use and mental disorders is projected to grow. Little research has examined the potential impact of substance use on older adults' mental health treatment use and unmet treatment need. This study examined these associations among the rapidly growing population of baby boomers and their older counterparts., Methods: Data are from the 2008 to 2012 National Survey on Drug Use and Health (NSDUH) (N = 18,443 respondents aged 50-64 and 11,191 aged 65 +). Age-combined and age-stratified logistic regression analyses were used to examine relationships between alcohol, illicit drug, and tobacco use and mental health problems, treatment use, and perceived unmet treatment need, with sociodemographic characteristics and health status as covariates., Results: Heavy alcohol, illicit drug, and tobacco use increased the odds of having a mental health problem in both age groups. Compared to those who used alcohol on 1-99 days during the preceding year, lifetime abstainers had significantly lower odds of having received mental health treatment in both age groups. Poorer self-rated health and past-year mental health treatment use increased the odds of perceived unmet treatment need in both age groups, while lifetime abstention in the boomers decreased the odds., Conclusions and Scientific Significance: This study's key finding is the lower likelihood of mental health treatment use among lifetime abstainers in both age groups. Further research may identify barriers to treatment use and ways to promote use among both age groups., (© American Academy of Addiction Psychiatry.)