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Applying clinical staging to young people who present for mental health care
Author(s) -
Hickie Ian B.,
Scott Elizabeth M.,
Hermens Daniel F.,
Naismith Sharon L.,
Guastella Adam J.,
Kaur Manreena,
Sidis Anna,
Whitwell Bradley,
Glozier Nicholas,
Davenport Tracey,
Pantelis Christos,
Wood Stephen J.,
McGorry Patrick D.
Publication year - 2013
Publication title -
early intervention in psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.087
H-Index - 45
eISSN - 1751-7893
pISSN - 1751-7885
DOI - 10.1111/j.1751-7893.2012.00366.x
Subject(s) - cohort , mental health , medicine , psychiatry , young adult , longitudinal study , stage (stratigraphy) , inter rater reliability , mental illness , health care , pediatrics , psychology , gerontology , rating scale , developmental psychology , paleontology , pathology , biology , economics , economic growth
Aim: The study aims to apply clinical staging to young people who present for mental health care; to describe the demographic features, patterns of psychological symptoms, disability correlates and clinical stages of those young people; and to report longitudinal estimates of progression from less to more severe stages. Methods: The study uses cross‐sectional and longitudinal assessments of young people managed in specialized youth clinics. On the basis of clinical records, subjects were assigned to a specific clinical ‘stage’ (i.e. ‘help‐seeking’, ‘attenuated syndrome’, ‘discrete disorder’ or ‘persistent or recurrent illness’). Results: Young people ( n = 209, mean age = 19.9 years (range = 12–30 years), 48% female) were selected from a broader cohort of n = 1483 subjects. Ten percent were assigned to the earliest ‘help‐seeking’ stage, 54% to the ‘attenuated syndrome’ stage, 25% to the ‘discrete disorder’ stage and 11% to the later ‘persistent or recurrent illness’ stage. The interrater reliability of independent ratings at baseline was acceptable (κ = 0.71). Subjects assigned to the ‘attenuated syndrome’ stage reported symptom and disability scores that were similar to those assigned to later stages. Longitudinally (median = 48 weeks), transition to later clinical stages were 11% of the ‘help‐seeking’, 19% of the ‘attenuated syndrome’ and 33% of the ‘discrete disorder’ groups. Conclusion: Among young people presenting for mental health care, most are clinically staged as having ‘attenuated syndromes’. Despite access to specialized treatment, a significant number progress to more severe or persistent disorders.