Capon William, Hickie Ian B, Fetanat Masoud, Varidel Mathew, LaMonica Haley M, Prodan Ante, Piper Sarah, Davenport Tracey A, Mughal Sarah, Shah Jai L, Scott Elizabeth M, Iorfino Frank
Brain and Mind Centre, The University of Sydney, Australia.
Brain and Mind Centre, The University of Sydney, Australia; Translational Health Research Institute, Western Sydney University, Australia; School of Computer, Data and Mathematical Sciences, Western Sydney University, Australia.
Compr Psychiatry. 2023 Oct;126:152404. doi: 10.1016/j.comppsych.2023.152404. Epub 2023 Jul 22.
There is an ongoing necessity to match clinical interventions with the multidimensional needs of young people. A key step toward better service planning and the design of optimal models of care is to use multidimensional assessment to understand the clinical needs of those presenting to primary mental health care.
1284 people aged 12-25 years presenting to primary youth mental health services completed an online assessment at service entry. Latent class analysis was conducted for seven scales assessing anxiety, depression, psychosis, mania, functioning (indexed by Work and Social Adjustment Scale), and suicidality.
A three-class solution was identified as the optimal solution. Class 1 (n = 305, 23.75%), an early illness stage group, had low and mixed symptomatology with limited functional impairment, class 2 (n = 353, 27.49%) was made up of older persons with established depression and functional impairment, and class 3 (n = 626, 48.75%) had very high and complex needs, with functional impairment, suicidality, and at-risk mental states (psychosis or mania). Additional differentiating characteristics included psychological distress, circadian disturbances, social support, mental health history, eating disorder behaviours, and symptoms of post-traumatic stress disorder.
A large proportion of help-seeking young people present with symptoms and functional impairment that may exceed the levels of care available from basic primary care or brief intervention services. These subgroups highlight the importance of multidimensional assessments to determine appropriate service pathways and care options.
持续需要使临床干预措施与年轻人的多维度需求相匹配。朝着更好的服务规划和设计最佳护理模式迈出的关键一步是使用多维度评估来了解前来接受初级心理健康护理者的临床需求。
1284名年龄在12至25岁之间、前来接受初级青少年心理健康服务的人在服务开始时完成了一项在线评估。对评估焦虑、抑郁、精神病、躁狂、功能（以工作和社会适应量表为指标）和自杀倾向的七个量表进行了潜在类别分析。
确定了三类解决方案为最佳方案。第1类（n = 305，23.75%）为疾病早期阶段组，症状轻微且混合，功能损害有限；第2类（n = 353，27.49%）由患有已确诊抑郁症和功能损害的年长者组成；第3类（n = 626，48.75%）有非常高且复杂的需求，伴有功能损害、自杀倾向和处于风险中的精神状态（精神病或躁狂）。其他区分特征包括心理困扰、昼夜节律紊乱、社会支持、心理健康史、饮食失调行为和创伤后应激障碍症状。
很大一部分寻求帮助的年轻人出现的症状和功能损害可能超过基本初级护理或简短干预服务所能提供的护理水平。这些亚组凸显了多维度评估对于确定适当服务途径和护理选择的重要性。
