Psychological disability presents early in affective disorders
MedWire News: Functional disability is already pronounced in young people in the early stages of affective and anxiety disorders, and deteriorates with advancing clinical stage, study results show.
The researchers used data from headspace - a novel mental health clinic for young people at risk for psychiatric disorders, in Campbelltown, New South Wales, Australia.
"The obtained results highlight the need for interventions that specifically target disability, rather than just symptoms of mental health problems," say study researcher Ian Hickie (University of Sydney) and colleagues in the Journal of Affective Disorders.
The team assessed 330 individuals, aged between 12 and 25 years (average 16.8 years), who were referred to headspace by general practitioners, pediatricians, schools, welfare agencies, family, friends, or themselves after experiencing mental health problems.
Patients were assessed using the Social and Occupational Function Assessment Scale (SOFAS), the Work and Social Adjustment Scale (WSAS), the Brief Disability Questionnaire (BDQ), and the Kessler-10 questionnaire (K-10) for psychological distress.
In addition patients were placed in one of seven illness stages: stage 1 for subsyndromal disorders; 1a for mild or non-specific symptoms; 1b, high risk for development of a full syndrome; 2 for an episode of a DSM-IV based syndrome; 3a, incomplete remission of a DSM-IV syndrome; 3b, recurrence or relapse of a DSM-IV syndrome; 3c, multiple relapses; and 4, severe, persistent, or unremitting symptoms.
Over a third (37.3%) of the sample presented with symptoms indicative of an affective disorder, while 15.8% presented with anxiety disorders. A composite "behavioral/developmental" diagnostic category, accounted for 37.0% of the sample, while 10% of the sample was yet to be determined.
Data from clinical staging placed 38.2% of the sample in category 1b, with 33.3% at stage 1a, 14.2% stage 2, and 7.3% stage 3 and above (7% of participants could not be staged properly).
Overall, there were high levels of psychological distress and disability in the group across the various scales, for example 69.4% of the sample was in the "high to "very high" category for psychological distress on the K-10. In addition, individuals spent on average 3.9 days in bed in the past month.
Higher levels of self-reported psychological distress and disability were associated with affective disorder diagnosis and increased with advancing clinical stage.
Discussing the findings, the researchers say that the clinical staging model effectively captures the increasing disability associated with illness progression.
The next stage will be to develop "specific interventions that target disability and the development of health service models that permit the delivery of such interventions prior to the onset of major syndromes," Hickie et al comment.
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By Andrew Czyzewski