Occhipinti Jo-An, Ho Nicholas, Crosland Paul, Huntley Sam, Hawkins Wendy, Connell Adam, Piccone Judith, Piper Sarah, Hosseini Seyed Hossein, Vacher Catherine, van Rosmalen Jordan, Morson Sophie, Milham Courtney, Burton Wendy, Andrade Kayla, Gosling Chloe, Tran Kristen, Song Yun Ju Christine, Loblay Victoria, Robinson Jo, Skinner Adam, Hickie Ian B
Brain and Mind Centre, Faculty of Medicine and Health, https://ror.org/0384j8v12University of Sydney, Sydney, Australia.
Computer Simulation & Advanced Research Technologies, Sydney, Australia.
Eur Psychiatry. 2025 Jun 27;68(1):e93. doi: 10.1192/j.eurpsy.2025.10053.
Rates of youth anxiety, depression, and self-harm have increased substantially in recent years. Expansion of clinical service capacity is constrained by workforce shortages and system fragmentation, and even substantial investment may not achieve the scale of growth required to address unmet need. Preventive strategies - such as strengthening social cohesion - are therefore essential to alleviate mounting pressures on the mental health system, yet their potential to compensate for these constraints remains unquantified.
This study employed a system dynamics model to explore the interplay between service capacity and social cohesion on youth mental health outcomes. The model was developed for a population catchment characterized by a mix of urban, suburban, and rural communities. Primary outcomes were prevalence of psychological distress and mental disorders, and incidence of mental health-related emergency department (ED) presentations among young people aged 15-24 years, projected over a 10-year time horizon. Two-way sensitivity analyses of services capacity and social cohesion were conducted.
Changes to specialized mental health services capacity growth had the greatest projected impact on youth mental health outcomes. Heatmaps revealed thresholds where improvements in social cohesion could offset negative impacts of constrained service capacity. For example, if services capacity growth was sustained at only 80% of baseline, improving social cohesion could still reduce years lived with symptomatic disorder by 6.3%. To achieve a similar scale of improvement without improvements in social cohesion, the current growth rate in services capacity would need to be more than double. Combining a doubling of service capacity growth with reversing the decline in social cohesion could reduce ED presentations by 25.6% and years with symptomatic mental disorder by 19.2%. A doubling of specialized, headspace, and GP services capacity growth could prevent 24,060 years lived with symptomatic mental disorder among youth aged 15-24.
This study provides a quantitative framework for understanding how social cohesion improvements can help mitigate workforce constraints in mental health systems, demonstrating the value of integrating service expansion with social cohesion enhancement strategies.
近年来，青少年焦虑、抑郁和自我伤害的发生率大幅上升。临床服务能力的扩大受到劳动力短缺和系统碎片化的限制，即使大量投资也可能无法实现满足未满足需求所需的增长规模。因此，诸如加强社会凝聚力等预防策略对于缓解心理健康系统日益增加的压力至关重要，但其弥补这些限制的潜力仍未得到量化。
本研究采用系统动力学模型来探索服务能力与社会凝聚力在青少年心理健康结果方面的相互作用。该模型是针对一个以城市、郊区和农村社区混合为特征的人口集水区开发的。主要结果是心理困扰和精神障碍的患病率，以及15至24岁年轻人中与心理健康相关的急诊科就诊率，预测时间跨度为10年。对服务能力和社会凝聚力进行了双向敏感性分析。
专业心理健康服务能力增长的变化对青少年心理健康结果的预测影响最大。热图显示了社会凝聚力改善可以抵消服务能力受限负面影响的阈值。例如，如果服务能力增长仅维持在基线的80%，提高社会凝聚力仍可将有症状障碍的生存年数减少6.3%。要在不改善社会凝聚力的情况下实现类似规模的改善，当前服务能力的增长率需要增加一倍以上。将服务能力增长翻倍与扭转社会凝聚力下降相结合，可以将急诊科就诊率降低25.6%，有症状精神障碍的生存年数降低19.2%。专业、青少年心理健康早期干预服务中心和全科医生服务能力增长翻倍可以预防15至24岁青少年中有症状精神障碍的生存年数达24,060年。
本研究提供了一个定量框架，用于理解社会凝聚力的改善如何有助于缓解心理健康系统中的劳动力限制，证明了将服务扩展与增强社会凝聚力战略相结合的价值。
