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We are developing an economic model to explore multiple topics in Australian youth mental health policy. To help make that model more readily transferable to other jurisdictions, we developed a software framework for authoring modular computational health economic models (CHEMs) (the software files that implement health economic models). We specified framework user requirements for: a simple programming syntax; a template CHEM module; tools for authoring new CHEM modules; search tools for finding existing CHEM modules; tools for supplying CHEM modules with data; reproducible analysis and reporting tools; and tools to help maintain a CHEM project website. We implemented the framework as six development version code libraries in the programming language R that integrate with online services for software development and research data archiving. We used the framework to author five development version R libraries of CHEM modules focussed on utility mapping in youth mental health. These modules provide tools for variable validation, dataset description, multi-attribute instrument scoring, construction of mapping models, reporting of mapping studies and making out of sample predictions. We assessed these CHEM module libraries as mostly meeting transparency, reusability and updatability criteria that we have previously developed, but requiring more detailed documentation and unit testing of individual modules. Our software framework has potential value as a prototype for future tools to support the development of transferable CHEMs.Code: Visit https://www.ready4-dev.com for more information about how to find, install and apply the prototype software framework., (© 2024. The Author(s).)

Cluster analyzes have been widely used in mental health research to decompose inter-individual heterogeneity by identifying more homogeneous subgroups of individuals. However, despite advances in new algorithms and increasing popularity, there is little guidance on model choice, analytical framework and reporting requirements. In this paper, we aimed to address this gap by introducing the philosophy, design, advantages/disadvantages and implementation of major algorithms that are particularly relevant in mental health research. Extensions of basic models, such as kernel methods, deep learning, semi-supervised clustering, and clustering ensembles are subsequently introduced. How to choose algorithms to address common issues as well as methods for pre-clustering data processing, clustering evaluation and validation are then discussed. Importantly, we also provide general guidance on clustering workflow and reporting requirements. To facilitate the implementation of different algorithms, we provide information on R functions and libraries., Competing Interests: Declaration of Competing Interest This study was not funded. The author(s) declare that there were no conflicts of interest with respect to the authorship or the publication of this article., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Subjective cognitive symptoms are common in young people receiving mental health treatment and are associated with poorer outcomes. The aim of this study was to determine the psychometric properties of the Neuropsychological Symptoms Self-Report (NSSR), an eight-item measure recently developed to provide a snapshot of young people's perceived change in cognitive functioning in relation to mental health treatment., Method: The sample included 633 youth aged 12-25 years (M age  = 18.2, 66.5% female, 88.6% Australian-born) who had sought mental health treatment in primary headspace services. At three-month follow-up, participants completed the NSSR and self-report measures of depression and anxiety., Results: Excellent internal consistency was found: Cronbach's alpha = 0.93. The NSSR had negative correlations with self-reported anxiety (r = -.33, p < .001) and depression (r = -.48, p < .001) symptoms, suggesting a link with affective symptoms, but still independence of constructs. Exploratory and confirmatory factor analyses supported a single-factor model. Item response theory (IRT) analysis suggested good model fit (homogeneity, data integrity, scalability, local independence and monotonicity) for all items. There was some evidence of measurement noninvariance (for item thresholds) by sex and age, but not diagnosis. IRT models also supported briefer six- and three-item versions of the NSSR., Conclusion: In busy clinical practice, clinicians need a rapid and reliable method for determining whether cognitive symptoms are of concern and in need of further assessment and treatment. Study findings support the NSSR as a brief, psychometrically sound measure for assessing subjective cognitive functioning in adolescents and young adults receiving mental health treatment., (© 2021 Association for Child and Adolescent Mental Health.)

Aims: A disproportionate number of people with mental ill-health experience social exclusion. Appropriate measurement tools are required to progress opportunities to improve social inclusion. We have developed a novel measure, the Filia Social Inclusion Measure (F-SIM). Here we aimed to present a more concise, easy-to-use form, while retaining its measurement integrity by (i) refining the F-SIM using traditional and contemporary item-reduction techniques; and (ii) testing the psychometric properties of the reduced measure., Methods: Five hundred and six participants completed the F-SIM, younger and older groups of people with serious mental illness (including psychosis, mood, anxiety disorders) and same-aged community counterparts. The F-SIM was completed at baseline and 2-week follow-up, alongside other measures (including social inclusion, loneliness). The F-SIM was refined using multidimensional scaling network analysis, confirmatory factor analysis and item response theory. The psychometric evaluation included assessment of dimensionality, internal consistency, test-retest reliability, discriminant ability and construct validity., Results: The F-SIM was reduced from 135-items to 16; with 4-items in each domain of housing and neighbourhood, finances, employment and education and social participation and relationships. Psychometric properties were sound, including strong internal consistency within domains (all α > 0.85) and excellent overall (α = 0.92). Test-retest reliability was also high (γ = 0.90). Differences between groups were observed; clinical subgroups consistently reported lower levels of social inclusion compared to community counterparts., Conclusions: The F-SIM16 is a sound, reliable, brief self-report measure of social inclusion suitable for use in clinical and research settings. It has the potential to evaluate the effectiveness of interventions, and aid in fostering targeted and personalised needs-based care.

Objectives: To determine the effects of gender on mental health literacy in young people between 12 and 25 years of age., Design: Computer-Assisted Telephone Interviewing was employed to conduct a cross-sectional structured interview focusing on young people's awareness of depression and psychosis., Participants: The sample comprised 1207 young Australians (539 males and 668 females) between the ages of 12-25 recruited from two metropolitan and two regional areas within Victoria. Six hundred and six respondents were presented a depression vignette and 601 were presented a psychosis vignette., Results: Female respondents (60.7%) were significantly more likely to correctly identify depression in the vignette as compared to male respondents (34.5%). No significant gender differences were noted for the psychosis vignette. Males were less significantly likely to endorse seeing a doctor or psychologist/counsellor for the treatment of psychosis. Males were also significantly more likely than females to endorse alcohol as a way of dealing with depression and antibiotics as useful for dealing with psychosis., Conclusion: Gender differences in mental health literacy are striking. Males showed significantly lower recognition of symptoms associated with mental illness and were more likely endorse the use alcohol to deal with mental health problems. Such factors may contribute to the delays in help seeking seen in young males. Further research is needed to delineate how these gender differences in young people may obstruct help seeking, early intervention and other aspects of mental health service delivery.

Background: Adolescence is a critical period for mental health and social exclusion, a key social determinant of mental health. Early intervention approaches are key to mitigating the impact of mental ill-health during adolescence, however social exclusion can create additional barriers to accessing care. Aim: We aimed to better understand help-seeking experiences of adolescents facing co-occurring social exclusion and mental ill-health, including sources of support, barriers and preferences for service provision. Method: Cross-sectional data were analysed, from the 2022 Mission Australia Youth Survey (N = 18,800). Adolescents aged 15 to 19 years were recruited from around Australia, through schools, community organisations and digital platforms. Indices of four domains of social exclusion (housing, finances, relational and education/employment) were created using existing Youth Survey variables, and supplemented with demographic characteristics, psychological distress and help-seeking behaviours (perceived need, mental health supports, barriers to access and preferences). Relationships between social exclusion domains, mental health concerns and help-seeking behaviours were explored using logistic regression models. Results: A total of 9,743 young people reported having needed mental health support, yet only 58.1% reportedly sought support (n = 5,565). Social exclusion domains were associated with different help-seeking behaviours: housing challenges with higher help-seeking (OR = 1.28; 95% CI [1.15, 1.42]); relational difficulties and edu-employment issues with lower (OR = 0.75; 95% CI [0.68, 0.83] and OR = 0.82; 95% CI [0.75, 0.89]). Stigma, confidentiality concerns, cost and not knowing where to seek help were common barriers to help-seeking; those experiencing social exclusion more likely to report these. Participants reported a strong preference for face-to-face support. Conclusions: This study highlights the additional needs and challenges faced by adolescents dealing with both social exclusion and mental ill-health. With greater barriers to help-seeking, concerted efforts are needed to reduce stigma, improve mental health literacy and increase access to trusted information sources. Further initiatives should focus on structural factors that socially exclude young people and exacerbate inequitable access to mental healthcare. [ABSTRACT FROM AUTHOR]

Simple Summary: Including therapy dogs in adolescent mental health is increasingly popular; however, there is poor guidance to assist providers in developing high-quality interventions. This study recruited global experts in the field to agree on a set of minimum standards for health, safety, and welfare. A panel of 40 experts agreed that 32 items out of a possible 49 were important or essential to the minimum standards, including risk assessments, veterinary screening and preventative healthcare for dogs, and training in infection control and first aid for providers. Welfare measures included training providers to assess, document, and respond to dog (and human) wellbeing. Strict measures, including fecal testing, prohibiting raw food diets, and one-hour work schedules, were not included in the minimum standards, despite their common use in hospital/acute settings. Recommendations for providers are made. As interest in animal-assisted therapy (AAT) and canine-assisted psychotherapy (CAP) grows, there are increasing calls for the management of related health, safety, and welfare concerns for canines, providers, and clients. Existing health and safety guidelines lack empirical support and are, at times, contradictory. Welfare is increasingly prioritized; however, tools to monitor and manage welfare are underutilized and under-reported. The aim of this study was to provide expert consensus on the minimum health, safety, and welfare standards required to develop and deliver a CAP group program to adolescents experiencing common mental health disorders. Diverse AAT experts were recruited globally. Using Delphi methodology, over two rounds, 40 panelists reached a consensus agreement to include 32 items from a possible 49 into the minimum standards. Health and safety measures included risk assessment, veterinary screening, preventative medicine, training in infection control, and first aid. Welfare measures included training in welfare assessment, documentation of welfare, and flexible, individualized responses to promote wellbeing. Intestinal screening for parasites and the prohibition of raw food were not supported. Flexible and individualized assessment and management of canine welfare were supported over fixed and time-limited work schedules. Clinical practice implications are discussed, and recommendations are made. [ABSTRACT FROM AUTHOR]

Purpose: Use of alcohol and other substances is a multifaceted issue impacting young people across multiple life domains. This paper aims to elucidate patterns of substance use and associated demographic and clinical factors among young people seeking treatment for their mental health. Methods: Young people (12–25 years old) were recruited from five youth-specific primary mental health ("headspace") services in Australia. Self-reported substance use and harms in the past 3 months were measured using WHO-ASSIST. Network analyses were conducted to evaluate interrelationships between use and harms associated with different substances. Subgroups were then identified based on whether participants reported using high centrality substances, and associated demographic and clinical factors were assessed with multinomial logistic regression. Results: 1107 youth participated. 70% reported use of at least one substance in the past 3 months, with around 30% of those reporting related health, social, legal or financial problems. Network analysis highlighted substantial interconnections between use and harm indicators for all substances, with amphetamine-type stimulants (ATS) and cannabis being high central substances. Higher levels of substance use and harms were reported in subgroups with ATS or cannabis use and different risk factors were associated with these subgroups. Conclusions: Findings highlight the importance of screening for substance use in youth primary mental healthcare settings, offering a key opportunity for early intervention. Clinicians should be aware of the inner connections of use and harms of different drugs and the role of cannabis and amphetamine use as a marker for more substance use profiles. [ABSTRACT FROM AUTHOR]

The authors aimed to evaluate changes in use of government-subsidized primary mental health services, through the Medicare Benefits Schedule (MBS), by young people during the first year of the COVID-19 pandemic in Australia and whether changes were associated with age, sex, socioeconomic status, and residence in particular geographical areas. Interrupted time-series analyses were conducted by using quarterly mental health MBS service data (all young people ages 12–25 years, 2015–2020) for individual Statistical Area Level 3 areas across Australia. The data captured >22.4 million service records. Meta-analysis and meta-regression models estimated the pandemic interruption effect at the national level and delineated factors influencing these estimates. Compared with expected prepandemic trends, a 6.2% (95% CI=5.3%–7.2%) increase was noted for all young people in use of MBS mental health services in 2020. Substantial differences were found between age and sex subgroups, with a higher increase among females and young people ages 18–25. A decreasing trend was observed for males ages 18–25 (3.5% reduction, 95% CI=2.5%–4.5%). The interruption effect was strongly associated with socioeconomic status. Service uptake increased in areas of high socioeconomic status, with smaller or limited uptake in areas of low socioeconomic status. During 2020, young people's use of primary mental health services increased overall. However, increases were inequitably distributed and relatively low, compared with increases in population-level mental health burden. Policy makers should address barriers to primary care access for young people, particularly for young males and those from socioeconomically disadvantaged backgrounds. [ABSTRACT FROM AUTHOR]

Background: First-episode psychosis most often has its onset during late adolescence. In caring for the young person, families endure high levels of stress and depression. Meanwhile, the social networks of families often erode. Our group has previously shown that family cognitive behaviour therapy (CBT) leads to significantly improved perceived stress compared with specialist first-episode treatment as usual; however, there are well-known barriers to the dissemination of effective family interventions. To address this, we have developed a novel online intervention entitled 'Altitudes' that fully integrates purpose-built online social networking, expert and peer moderation, and evidence-based psychoeducation within a single application. The primary aim of this trial is to evaluate the effectiveness of Altitudes in reducing stress in carers over a 6-month period.Methods/design: We describe here a single-blinded cluster randomised controlled trial (cRCT) with permutated blocks. The clusters comprise individual families. The two treatment conditions include Altitudes plus Specialist Treatment as Usual (STAU) and STAU alone. Altitudes involves participation in our novel online programme whereas STAU comprises specialist family work at the Early Psychosis Prevention and Intervention Centre (EPPIC), Melbourne, Australia. We aim to recruit 160 family members of young, 15-27 year-old, patients registered for treatment for first-episode psychosis (FEP) at EPPIC. The design includes two assessment time points, namely, baseline and 6-month follow-up. The study is due for completion within 2 years including an 18-month recruitment period and a 6-month treatment phase. The primary outcome is carers' perceived stress at 6 months. Secondary outcome measures include a biomarker of stress, depressive symptoms, worry, substance use, loneliness, social support, satisfaction with life, and a range of measures that tap into coping resources. We seek to gain a dynamic picture of carer stress through our Smartphone Ecological Momentary Assessment (SEMA) tool.Discussion: This is the first randomised controlled trial designed to evaluate an online intervention for carers of young people recovering from FEP. It has the potential to produce evidence in support of a highly novel, accessible, and cost-effective intervention to reduce stress in carers who are providing support to young people at a critical phase in their recovery from psychosis.Trial Registration: Australian New Zealand Clinical Trial Registry, identifier: ACTRN12616000968471 . Retrospectively registered on 22 July 2016. [ABSTRACT FROM AUTHOR]

Objectives There are no established tools to identify individuals at risk for developing bipolar disorder. We developed a set of ultra-high-risk criteria for bipolar disorder [bipolar at-risk ( BAR)]. The primary aim of the present study was to determine the predictive validity of the BAR criteria. Methods This was a 12-month prospective study that was conducted at Orygen Youth Health Clinical Program, a public mental health program for young people aged 15-24 years in metropolitan Melbourne, Australia. At intake, BAR screen-positive individuals and a matched group of individuals who did not meet BAR criteria were observed over a period of 12 months. The BAR criteria include general criteria such as being in the peak age range for the onset of the disorder, as well as sub-threshold mania, depression plus cyclothymic features, and depression plus genetic risk. Conversion to first-episode mania/hypomania was defined by the presence of DSM- IV manic symptoms for more than four days, in line with the DSM- IV definition of hypomania/mania. Results A total of 559 help-seeking patients were screened. Of the eligible participants, 59 (10.6%) met BAR criteria. Thirty-five participants were included in the BAR group and 35 matched participants were selected to be in the control group. During the follow-up, five BAR patients out of 35 (14.3%) converted to first-episode hypomania/mania as opposed to none in the non- BAR group [χ2(1) = 5.38, p = 0.020]. Four out of these five converters had a DSM- IV diagnosis of bipolar I or bipolar II disorder. Conclusions These findings support the possibility of identification of persons prior to the onset of mania/hypomania. The proposed criteria need further evaluation in larger, prospective studies with longer follow-up periods. [ABSTRACT FROM AUTHOR]

Background: The Mood and Anxiety Symptom Questionnaire (MASQ) was designed to specifically measure the Tripartite model of affect and is proposed to offer a delineation between the core components of anxiety and depression. Factor analytic data from adult clinical samples has shown mixed results; however no studies employing confirmatory factor analysis (CFA) have supported the predicted structure of distinct Depression, Anxiety and General Distress factors. The Tripartite model has not been validated in a clinical sample of older adolescents and young adults. The aim of the present study was to examine the validity of the Tripartite model using scale-level data from the MASQ and correlational and confirmatory factor analysis techniques. Methods: 137 young people (M = 17.78, SD = 2.63) referred to a specialist mental health service for adolescents and young adults completed the MASQ and diagnostic interview. Results: All MASQ scales were highly inter-correlated, with the lowest correlation between the depression- and anxiety-specific scales (r = .59). This pattern of correlations was observed for all participants rating for an Axis-I disorder but not for participants without a current disorder (r = .18). Confirmatory factor analyses were conducted to evaluate the model fit of a number of solutions. The predicted Tripartite structure was not supported. A 2-factor model demonstrated superior model fit and parsimony compared to 1- or 3-factor models. These broad factors represented Depression and Anxiety and were highly correlated (r = .88). Conclusion: The present data lend support to the notion that the Tripartite model does not adequately explain the relationship between anxiety and depression in all clinical populations. Indeed, in the present study this model was found to be inappropriate for a help-seeking community sample of older adolescents and young adults. [ABSTRACT FROM AUTHOR]

• An exciting new measure of social inclusion is presented here (the F-SIM). • Significant input was sought from consumers and carers in developing the F-SIM. • Excellent preliminary psychometric properties of the F-SIM were observed. • The F-SIM differentiated between those with and without severe mental illness. • The F-SIM will have useful applicability in both clinical and research settings. Social inclusion is an important contributor to good mental health and greater mental health outcomes for people with psychiatric disorders. A psychometrically-sound measure of social inclusion is required to facilitate progress in this area. The aim here was to report on preliminary findings from a novel, user-friendly measure of social inclusion that comprehensively assesses the construct. Preliminary testing of the Filia Social Inclusion Measure (F-SIM) was conducted with ninety participants (30 consumers; 30 family members/carers; 30 community members). Participants completed the self-report measure and a usability questionnaire. Preliminary findings demonstrated poorer social inclusion for people with mental illness compared to those without, with differences seen in each of five domains (housing and services, social functioning, occupational functioning, finances and health). Differences were also seen regarding family members or carers, with consistently poorer social inclusion than general community members observed. Participants reported the F-SIM as easy to use, and considered it to measure social inclusion well, indicating good face validity. The F-SIM demonstrates an ability to differentiate between groups. Implications for use and suggestions for future research are detailed. Following further psychometric assessment, the F-SIM will have wide applicability in clinical and research settings. [ABSTRACT FROM AUTHOR]

Background: Little is known about the trajectory of quality of life (QoL) following a first episode of psychotic mania in bipolar disorder (BD). This 18-month longitudinal study investigated the trajectory of QoL, and the influence of premorbid adjustment and symptoms on 18-month QoL in a cohort of young people experiencing a first episode of psychotic mania.Methods: As part of an overarching clinical trial, at baseline, sixty participants presenting with a first episode of psychotic mania (BD Type 1 - DSM-IV) completed symptomatic and functional assessments in addition to the Premorbid Adjustment Scale - General Subscale. Symptom measures were repeated at 18-month follow up. QoL was rated using the Quality of Life Scale (QLS) at designated time points.Results: Mean QLS scores at initial measurement (8 weeks) were 61% of the maximum possible score, increasing significantly to 70% at 12 months, and 71.2% at 18-month follow-up. Premorbid adjustment and 18-month depressive symptoms were significantly associated with QoL at 18-month follow-up.Limitations: Study limitations include the small sample size, inclusion of participants with psychotic mania only, use of measures originally designed for use with schizophrenia spectrum disorders, and lack of premorbid or baseline measurement of QoL.Conclusions: Results suggest that QoL can be maintained early in BD, and reinforce the importance of assertively treating depressive symptoms throughout the course of this disorder. The emergence of a link between premorbid adjustment and poorer QoL in this cohort highlights the importance of assessing facets of adjustment when planning psychological interventions. [ABSTRACT FROM AUTHOR]