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1. Adaptation and validation of the On Your Own Feet – Transition Experiences Scale evaluating transitions to adult services among adolescent mental health service users in Europe

Author

Gerritsen, Suzanne E, van Bodegom, Larissa S, Overbeek, Mathilde M, van Staa, AnneLoes, Maras, Athanasios, van Amelsvoort, Therese AMJ, Wolke, Dieter, de Girolamo, Giovanni, Franić, Tomislav, McNicholas, Fiona, Paul, Moli, Purper-Ouakil, Diane, Santosh, Paramala, Schulze, Ulrike ME, Singh, Swaran P, Street, Cathy, Tremmery, Sabine, Tuomainen, Helena, and Dieleman, Gwendolyn C

Published
2024
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3. Qualitative study to explore the perspectives and mental health experiences of first episode psychosis patients and their caregivers in North India

Author

Sood, Mamta, Chadda, Rakesh K., Chawla, Nishtha, Shukla, Tulika, Patil, Vaibhav, Ratra, Dhriti, Rajhans, Pallavi, Padmavati, R., Thara, Rangaswamy, Raghavan, Vijaya, Mohan, Mohapradeep, Iyer, Srividya, Shah, Jai, Madan, Jason, Birchwood, Max, Meyer, Caroline, Lilford, RJ, Furtado, Vivek, Currie, Graeme, and Singh, Swaran P.

Published
2024
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6. Protocol-based assessment and management of first episode psychosis: Comparison of short and medium-term outcomes in psychopathology, quality of life, functioning and family burden across two sites in India

Author

Chadda, Rakesh K., Sood, Mamta, Chawla, Nishtha, Padmavati, R., Thara, Rangaswamy, Raghavan, Vijaya, Shukla, Tulika, Patil, Vaibhav, Sen, Mahadev Singh, Mohan, Mohapradeep, Iyer, Srividya, Shah, Jai, Madan, Jason, Birchwood, Max, Meyer, Caroline, Lilford, R.J., Furtado, Vivek, Currie, Graeme, and Singh, Swaran P.

Published
2024
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10. The importance of clinicians' and parents' awareness of suicidal behaviour in adolescents reaching the upper age limit of their mental health services in Europe

Author

van Bodegom, Larissa S., Gerritsen, Suzanne E., Dieleman, Gwendolyn C., Overbeek, Mathilde M., de Girolamo, Giovanni, Scocco, Paolo, Hillegers, Manon H.J., Wolke, Dieter, Rizopoulos, Dimitris, Appleton, Rebecca, Conti, Patrizia, Franić, Tomislav, Margari, Francesco, Madan, Jason, McNicholas, Fiona, Nacinovich, Renata, Pastore, Adriana, Paul, Moli, Purper-Ouakil, Diane, Saam, Melanie C., Santosh, Paramala J., Sartor, Anne, Schulze, Ulrike M.E., Signorini, Giulia, Singh, Swaran P., Street, Cathy, Tah, Priya, Tanase, Elena, Tremmery, Sabine, Tuomainen, Helena, and Maras, Athanasios

Published
2023
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12. Leaving child and adolescent mental health services in the MILESTONE cohort: a longitudinal cohort study on young people's mental health indicators, care pathways, and outcomes in Europe

Author

Appleton, Rebecca, Davidović, Nikolina, Ferrari, Sabrina, Fiori, Federico, Gatherer, Charlotte, Hendrickx, Gaëlle, Holme, Ingrid, Jardri, Renaud, Kolozsvari, Alfred, Lievesley, Kate, Mastroianni, Mathilde, Maurice, Virginie, Morini, Giorgia, Parenti, Aesa, Russet, Frédérick, Saam, Melanie, Sagar-Ouriaghli, Ilyas, Sartor, Anne, Signorini, Giulia, Singh, Jatinder, Tah, Priya, Tuffrey, Amanda, van Amelsvoort, Therese AMJ, Varvara, Pamela, Vicari, Stefano, Walker, Leanne, Wilson, Anna, Jerkovic, Helena, Gerritsen, Suzanne E, van Bodegom, Larissa S, Overbeek, Mathilde M, Maras, Athanasios, Verhulst, Frank C, Wolke, Dieter, Rizopoulos, Dimitris, de Girolamo, Giovanni, Franić, Tomislav, Madan, Jason, McNicholas, Fiona, Paul, Moli, Purper-Ouakil, Diane, Santosh, Paramala J, Schulze, Ulrike M E, Singh, Swaran P, Street, Cathy, Tremmery, Sabine, Tuomainen, Helena, and Dieleman, Gwendolyn C

Published
2022
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14. The EMPOWER blended digital intervention for relapse prevention in schizophrenia: a feasibility cluster randomised controlled trial in Scotland and Australia

Author

Gumley, Andrew I, Bradstreet, Simon, Ainsworth, John, Allan, Stephanie, Alvarez-Jimenez, Mario, Aucott, Lorna, Birchwood, Maximillian, Briggs, Andrew, Bucci, Sandra, Cotton, Sue M, Engel, Lidia, French, Paul, Lederman, Reeva, Lewis, Shôn, Machin, Matthew, MacLennan, Graeme, McLeod, Hamish, McMeekin, Nicola, Mihalopoulos, Cathy, Morton, Emma, Norrie, John, Schwannauer, Matthias, Singh, Swaran P, Sundram, Suresh, Thompson, Andrew, Williams, Chris, Yung, Alison R, Farhall, John, and Gleeson, John

Published
2022
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15. Practitioner Review: Continuity of mental health care from childhood to adulthood for youths with ADHD – who, how and when?

Author

Adamo, Nicoletta, Singh, Swaran P., Bölte, Sven, Coghill, David, Newcorn, Jeffrey H., Parlatini, Valeria, Purper‐Ouakil, Diane, Rausch, Juliane, Rohde, Luis, Santosh, Paramala, Banaschewski, Tobias, and Buitelaar, Jan K.

Abstract

Many youths with attention‐deficit/hyperactivity disorder (ADHD) experience significant long‐term impairment and may develop concurrent mental and somatic health difficulties as adults. This is associated with burden and costs for the individual and society which could be prevented through continued support in youth. Yet, only few young people transition to adult mental health services for ongoing care in different countries worldwide. We provide an overview on current transition practices, highlighting the gaps in knowledge and the barriers to effective service transitioning, while considering the large geographical variation in available guidelines and service provision. For ease of use, this review is organized in a question‐and‐answer format covering different aspects of the transition process and considering both service users' and clinicians' perspectives. Consensus is needed to identify those that require continued care, the optimal timing to arrange transition, and the most suitable services. Finally, we discuss cost‐effectiveness of transition practices, consider examples of best practice, and propose recommendations on how to improve transitional care, including the importance of service users' input into transition planning. [ABSTRACT FROM AUTHOR]

Published
2024
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17. Care Transition from Child/Adolescents to Adult Services

Author

Tuomainen, Helena, Appleton, Rebecca, Singh, Swaran P., Taylor, Eric, Section editor, Wong, John CM, Section editor, Sartorius, Norman, Series Editor, Kua, Ee Heok, Series Editor, Taylor, Eric, editor, Verhulst, Frank, editor, Wong, John Chee Meng, editor, and Yoshida, Keiko, editor

Published
2020
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19. The Lancet PsychiatryCommission on youth mental health

Author

McGorry, Patrick D, Mei, Cristina, Dalal, Naeem, Alvarez-Jimenez, Mario, Blakemore, Sarah-Jayne, Browne, Vivienne, Dooley, Barbara, Hickie, Ian B, Jones, Peter B, McDaid, David, Mihalopoulos, Cathrine, Wood, Stephen J, El Azzouzi, Fatima Azzahra, Fazio, Jessica, Gow, Ella, Hanjabam, Sadam, Hayes, Alan, Morris, Amelia, Pang, Elina, Paramasivam, Keerthana, Quagliato Nogueira, Isabella, Tan, Jimmy, Adelsheim, Steven, Broome, Matthew R, Cannon, Mary, Chanen, Andrew M, Chen, Eric Y H, Danese, Andrea, Davis, Maryann, Ford, Tamsin, Gonsalves, Pattie P, Hamilton, Matthew P, Henderson, Jo, John, Ann, Kay-Lambkin, Frances, Le, Long K-D, Kieling, Christian, Mac Dhonnagáin, Niall, Malla, Ashok, Nieman, Dorien H, Rickwood, Debra, Robinson, Jo, Shah, Jai L, Singh, Swaran, Soosay, Ian, Tee, Karen, Twenge, Jean, Valmaggia, Lucia, van Amelsvoort, Therese, Verma, Swapna, Wilson, Jon, Yung, Alison, Iyer, Srividya N, and Killackey, Eóin

Published
2024
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23. Thoracic epidural analgesia in a patient with von Hippel‐Lindau disease

Author

Amanda Yap, Satoshi Hanada, Sapna Ravindranath, Tejinder Singh Swaran Singh, and Yatish Siddapura Ranganath

Subjects
anesthesia, epidural, spinal hemangioblastoma, von Hippel‐Lindau disease, Medicine, Medicine (General), R5-920
Abstract

Abstract von Hippel‐Lindau disease (VHLD) is an autosomal dominant disorder characterized by central nervous system hemangioblastomas and renal tumors. Here, we report a case of thoracic epidural placement in a 35‐year‐old woman with VHLD presenting for left open heminephrectomy for renal masses. We also reviewed the literature on this topic.

Published
2022
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30. Development and validation of multivariable prediction models of remission, recovery, and quality of life outcomes in people with first episode psychosis: a machine learning approach

Author

Leighton, Samuel P, Upthegrove, Rachel, Krishnadas, Rajeev, Benros, Michael E, Broome, Matthew R, Gkoutos, Georgios V, Liddle, Peter F, Singh, Swaran P, Everard, Linda, Jones, Peter B, Fowler, David, Sharma, Vimal, Freemantle, Nicholas, Christensen, Rune H B, Albert, Nikolai, Nordentoft, Merete, Schwannauer, Matthias, Cavanagh, Jonathan, Gumley, Andrew I, Birchwood, Max, and Mallikarjun, Pavan K

Published
2019
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32. The impact of reduced routine community mental healthcare on people from minority ethnic groups during the COVID-19 pandemic: qualitative study of stakeholder perspectives.

Author

Winsper, Catherine, Bhattacharya, Rahul, Bhui, Kamaldeep, Currie, Graeme, Edge, Dawn, Ellard, David, Franklin, Donna, Gill, Paramjit, Gilbert, Steve, Khan, Noreen, Miller, Robin, Motala, Zahra, Pinfold, Vanessa, Sandhu, Harbinder, Singh, Swaran P., Weich, Scott, and Giacco, Domenico

Subjects
COVID-19 pandemic, ETHNIC groups, MINORITIES, CULTURAL pluralism, MENTAL health personnel, ETHNIC differences, PSYCHOLOGICAL resilience
Abstract

Background: Enduring ethnic inequalities exist in mental healthcare. The COVID-19 pandemic has widened these. Aims: To explore stakeholder perspectives on how the COVID-19 pandemic has increased ethnic inequalities in mental healthcare. Method: A qualitative interview study of four areas in England with 34 patients, 15 carers and 39 mental health professionals from National Health Service (NHS) and community organisations (July 2021 to July 2022). Framework analysis was used to develop a logic model of inter-relationships between pre-pandemic barriers and COVID-19 impacts. Results: Impacts were largely similar across sites, with some small variations (e.g. positive service impacts of higher ethnic diversity in area 2). Pre-pandemic barriers at individual level included mistrust and thus avoidance of services and at a service level included the dominance of a monocultural model, leading to poor communication, disengagement and alienation. During the pandemic remote service delivery, closure of community organisations and media scapegoating exacerbated existing barriers by worsening alienation and communication barriers, fuelling prejudice and division, and increasing mistrust in services. Some minority ethnic patients reported positive developments, experiencing empowerment through self-determination and creative activities. Conclusions: During the COVID-19 pandemic some patients showed resilience and developed adaptations that could be nurtured by services. However, there has been a reduction in the availability of group-specific NHS and third-sector services in the community, exacerbating pre-existing barriers. As these developments are likely to have long-term consequences for minority ethnic groups' engagement with mental healthcare, they need to be addressed as a priority by the NHS and its partners. [ABSTRACT FROM AUTHOR]

Published
2024
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33. Transition from Child and Adolescent to Adult Mental Health Services in Young People with Depression: On What Do Clinicians Base their Recommendation?

Author

van Bodegom, Larissa S., primary, Overbeek, Mathilde M., additional, Gerritsen, Suzanne E., additional, Maras, Athanasios, additional, Hillegers, Manon H. J., additional, Wolke, Dieter, additional, Rizopoulos, Dimitris, additional, Allibrio, Giovanni, additional, van Amelsvoort, Therese A. M. J., additional, Appleton, Rebecca, additional, Armando, Marco, additional, Franić, Tomislav, additional, de Girolamo, Giovanni, additional, Madan, Jason, additional, Manenti, Lidia, additional, Margari, Francesco, additional, McNicholas, Fiona, additional, Pastore, Adriana, additional, Paul, Moli, additional, Purper-Ouakil, Diane, additional, Rinaldi, Francesco, additional, Saam, Melanie C., additional, Santosh, Paramala J., additional, Sartor, Anne, additional, Schulze, Ulrike M. E., additional, Signorini, Giulia, additional, Singh, Swaran P., additional, Street, Cathy, additional, Tah, Priya, additional, Tanase, Elena, additional, Tremmery, Sabine, additional, Tuomainen, Helena, additional, and Dieleman, Gwendolyn C., additional

Published
2023
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34. Predictors of transitioning to adult mental health services and associated costs: a cross-country comparison

Author

Appleton, Rebecca, primary, Canaway, Alastair, additional, Tuomainen, Helena, additional, Dieleman, Gwen, additional, Gerritsen, Suzanne, additional, Overbeek, Mathilde, additional, Maras, Athanasios, additional, van Bodegom, Larissa, additional, Franić, Tomislav, additional, de Girolamo, Giovanni, additional, Madan, Jason, additional, McNicholas, Fiona, additional, Purper-Ouakil, Diane, additional, Schulze, Ulrike M E, additional, Tremmery, Sabine, additional, and Singh, Swaran P, additional

Published
2023
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39. Early Signs Monitoring to Prevent Relapse in Psychosis and Promote Well-Being, Engagement, and Recovery: Protocol for a Feasibility Cluster Randomized Controlled Trial Harnessing Mobile Phone Technology Blended With Peer Support

Author

Gumley, Andrew, Bradstreet, Simon, Ainsworth, John, Allan, Stephanie, Alvarez-Jimenez, Mario, Beattie, Louise, Bell, Imogen, Birchwood, Max, Briggs, Andrew, Bucci, Sandra, Castagnini, Emily, Clark, Andrea, Cotton, Sue M, Engel, Lidia, French, Paul, Lederman, Reeva, Lewis, Shon, Machin, Matthew, MacLennan, Graeme, Matrunola, Claire, McLeod, Hamish, McMeekin, Nicola, Mihalopoulos, Cathrine, Morton, Emma, Norrie, John, Reilly, Frank, Schwannauer, Matthias, Singh, Swaran P, Smith, Lesley, Sundram, Suresh, Thomson, David, Thompson, Andrew, Whitehill, Helen, Wilson-Kay, Alison, Williams, Christopher, Yung, Alison, Farhall, John, and Gleeson, John

Subjects
Medicine, Computer applications to medicine. Medical informatics, R858-859.7
Abstract

BackgroundRelapse in schizophrenia is a major cause of distress and disability and is predicted by changes in symptoms such as anxiety, depression, and suspiciousness (early warning signs [EWSs]). These can be used as the basis for timely interventions to prevent relapse. However, there is considerable uncertainty regarding the implementation of EWS interventions. ObjectiveThis study was designed to establish the feasibility of conducting a definitive cluster randomized controlled trial comparing Early signs Monitoring to Prevent relapse in psychosis and prOmote Well-being, Engagement, and Recovery (EMPOWER) against treatment as usual (TAU). Our primary outcomes are establishing parameters of feasibility, acceptability, usability, safety, and outcome signals of a digital health intervention as an adjunct to usual care that is deliverable in the UK National Health Service and Australian community mental health service (CMHS) settings. We will assess the feasibility of candidate primary outcomes, candidate secondary outcomes, and candidate mechanisms for a definitive trial. MethodsWe will randomize CMHSs to EMPOWER or TAU. We aim to recruit up to 120 service user participants from 8 CMHSs and follow them for 12 months. Eligible service users will (1) be aged 16 years and above, (2) be in contact with local CMHSs, (3) have either been admitted to a psychiatric inpatient service or received crisis intervention at least once in the previous 2 years for a relapse, and (4) have an International Classification of Diseases-10 diagnosis of a schizophrenia-related disorder. Service users will also be invited to nominate a carer to participate. We will identify the feasibility of the main trial in terms of recruitment and retention to the study and the acceptability, usability, safety, and outcome signals of the EMPOWER intervention. EMPOWER is a mobile phone app that enables the monitoring of well-being and possible EWSs of relapse on a daily basis. An algorithm calculates changes in well-being based on participants’ own baseline to enable tailoring of well-being messaging and clinical triage of possible EWSs. Use of the app is blended with ongoing peer support. ResultsRecruitment to the trial began September 2018, and follow-up of participants was completed in July 2019. Data collection is continuing. The database was locked in July 2019, followed by analysis and disclosing of group allocation. ConclusionsThe knowledge gained from the study will inform the design of a definitive trial including finalizing the delivery of our digital health intervention, sample size estimation, methods to ensure successful identification, consent, randomization, and follow-up of participants, and the primary and secondary outcomes. The trial will also inform the final health economic model to be applied in the main trial. Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN): 99559262; http://isrctn.com/ISRCTN99559262 International Registered Report Identifier (IRRID)DERR1-10.2196/15058

Published
2020
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40. Improving mental healthcare access and experience for people from minority ethnic groups: an England-wide multisite experience-based codesign (EBCD) study

Author

Winsper, Catherine, primary, Bhattacharya, Rahul, additional, Bhui, Kamaldeep, additional, Currie, Graeme, additional, Edge, Dawn, additional, Ellard, David R, additional, Franklin, Donna, additional, Gill, Paramjit S, additional, Gilbert, Steve, additional, Miller, Robin, additional, Motala, Zahra, additional, Pinfold, Vanessa, additional, Sandhu, Harbinder, additional, Singh, Swaran P, additional, Weich, Scott, additional, and Giacco, Domenico, additional

Published
2023
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43. Neurological injury following peripheral nerve blocks: a narrative review of estimates of risks and the influence of ultrasound guidance.

Author

Lemke, Ethan, Johnston, David F., Behrens, Matthew B., Seering, Melinda S., McConnell, Brie M., Singh, Tejinder Singh Swaran, and Sondekoppam, Rakesh V.

Abstract

Background Peripheral nerve injury or post-block neurological dysfunction (PBND) are uncommon but a recognized complications of peripheral nerve blocks (PNB). A broad range of its incidence is noted in the literature and hence a critical appraisal of its occurrence is needed. Objective In this review, we wanted to know the pooled estimates of PBND and further, determine its pooled estimates following various PNB over time. Additionally, we also sought to estimate the incidence of PBND with or without US guidance. Evidence review A literature search was conducted in six databases. For the purposes of the review, we defined PBND as any new-onset sensorimotor disturbances in the distribution of the performed PNB either attributable to the PNB (when reported) or reported in the context of the PNB (when association with a PNB was not mentioned). Both prospective and retrospective studies which provided incidence of PBND at timepoints of interest (>48 hours to <2 weeks; >2 weeks to 6 weeks, 7 weeks to 5 months, 6 months to 1 year and >1 year durations) were included for review. Incidence data were used to provide pooled estimates (with 95% CI) of PBND at these time periods. Similar estimates were obtained to know the incidence of PBND with or without the use of US guidance. Additionally, PBND associated with individual PNB were obtained in a similar fashion with upper and lower limb PNB classified based on the anatomical location of needle insertion. Findings The overall incidence of PBND decreased with time, with the incidence being approximately 1% at <2 weeks' time (Incidence per thousand (95% CI)= 9 (8; to 11)) to approximately 3/10 000 at 1 year (Incidence per thousand (95% CI)= 0. 3 (0.1; to 0.5)). Incidence of PBND differed for individual PNB with the highest incidence noted for interscalene block. Conclusions Our review adds information to existing literature that the neurological complications are rarer but seem to display a higher incidence for some blocks more than others. Use of US guidance may be associated with a lower incidence of PBND especially in those PNBs reporting a higher pooled estimates. Future studies need to standardize the reporting of PBND at various timepoints and its association to PNB. [ABSTRACT FROM AUTHOR]

Published
2024
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45. The interface between child/adolescent and adult mental health services: results from a European 28-country survey

Author

Signorini, Giulia, Singh, Swaran P., Marsanic, Vlatka Boricevic, Dieleman, Gwen, Dodig-Ćurković, Katarina, Franic, Tomislav, Gerritsen, Suzanne E., Griffin, James, Maras, Athanasios, McNicholas, Fiona, O’Hara, Lesley, Purper-Ouakil, Diane, Paul, Moli, Russet, Frederick, Santosh, Paramala, Schulze, Ulrike, Street, Cathy, Tremmery, Sabine, Tuomainen, Helena, Verhulst, Frank, Warwick, Jane, de Girolamo, Giovanni, and for the MILESTONEConsortium

Published
2018
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46. Predictors of transitioning to adult mental health services and associated costs:a cross-country comparison

Author

Appleton, Rebecca, Canaway, Alastair, Tuomainen, Helena, Dieleman, Gwen, Gerritsen, Suzanne, Overbeek, Mathilde, Maras, Athanasios, van Bodegom, Larissa, Franić, Tomislav, de Girolamo, Giovanni, Madan, Jason, McNicholas, Fiona, Purper-Ouakil, Diane, Schulze, Ulrike M.E., Tremmery, Sabine, Singh, Swaran P., Appleton, Rebecca, Canaway, Alastair, Tuomainen, Helena, Dieleman, Gwen, Gerritsen, Suzanne, Overbeek, Mathilde, Maras, Athanasios, van Bodegom, Larissa, Franić, Tomislav, de Girolamo, Giovanni, Madan, Jason, McNicholas, Fiona, Purper-Ouakil, Diane, Schulze, Ulrike M.E., Tremmery, Sabine, and Singh, Swaran P.

Abstract

BACKGROUND: Young people are at risk of falling through the care gap after leaving child and adolescent mental health services (CAMHS) despite an ongoing need for mental health support. Currently, little is known about the predictors of transitioning to adult mental health services (AMHS), and associated healthcare and societal costs as young people cross the transition boundary. OBJECTIVE: To conduct a secondary data analysis exploring predictors of transitioning or falling through the gap and associated costs. METHODS: Data were used from a longitudinal study, which followed young people from seven European countries for 2 years after reaching their CAMHS boundary. Predictors of transitioning (including sociodemographic and clinical variables) and longitudinal resource use were compared for 488 young people who transitioned to AMHS versus those who fell through the gap. FINDINGS: Young people were more likely to transition to AMHS if they were severely ill. Those from Italy, the Netherlands and the UK were more likely to fall through the gap than transition to AMHS. Healthcare costs fell for all young people over the study, with a sharper decrease for those who fell through the gap. CONCLUSIONS: Total healthcare costs fell for all participants, indicating that the intensity of mental health support reduces for all young people as they cross the CAMHS boundary, regardless of clinical need. CLINICAL IMPLICATIONS: It is important that alternative forms of mental health support are available for young people who do not meet the AMHS care threshold but still have mental health needs after leaving CAMHS.

Published
2023

47. Transition from Child and Adolescent to Adult Mental Health Services in Young People with Depression:On What Do Clinicians Base their Recommendation?

Author

Van Bodegom, Larissa S., Overbeek, Mathilde M., Gerritsen, Suzanne E., Maras, Athanasios, Hillegers, Manon H.J., Wolke, Dieter, Rizopoulos, Dimitris, Allibrio, Giovanni, Van Amelsvoort, Therese A.M.J., Appleton, Rebecca, Armando, Marco, Franić, Tomislav, De Girolamo, Giovanni, Madan, Jason, Manenti, Lidia, Margari, Francesco, McNicholas, Fiona, Pastore, Adriana, Paul, Moli, Purper-Ouakil, Diane, Rinaldi, Francesco, Saam, Melanie C., Santosh, Paramala J., Sartor, Anne, Schulze, Ulrike M.E., Signorini, Giulia, Singh, Swaran P., Street, Cathy, Tah, Priya, Tanase, Elena, Tremmery, Sabine, Tuomainen, Helena, Dieleman, Gwendolyn C., Van Bodegom, Larissa S., Overbeek, Mathilde M., Gerritsen, Suzanne E., Maras, Athanasios, Hillegers, Manon H.J., Wolke, Dieter, Rizopoulos, Dimitris, Allibrio, Giovanni, Van Amelsvoort, Therese A.M.J., Appleton, Rebecca, Armando, Marco, Franić, Tomislav, De Girolamo, Giovanni, Madan, Jason, Manenti, Lidia, Margari, Francesco, McNicholas, Fiona, Pastore, Adriana, Paul, Moli, Purper-Ouakil, Diane, Rinaldi, Francesco, Saam, Melanie C., Santosh, Paramala J., Sartor, Anne, Schulze, Ulrike M.E., Signorini, Giulia, Singh, Swaran P., Street, Cathy, Tah, Priya, Tanase, Elena, Tremmery, Sabine, Tuomainen, Helena, and Dieleman, Gwendolyn C.

Abstract

Background: Clinicians in Child and Adolescent Mental Healthcare Services (CAMHS) face the challenge to determine who is at risk of persistence of depressive problems into adulthood and requires continued treatment after reaching the CAMHS upper age limit of care-provision. We assessed whether risk factors for persistence were related to CAMHS clinicians' transition recommendations. Methods:Within the wider MILESTONE cohort study, 203 CAMHS users were classified with unipolar depressive disorder by their clinician, and 185 reported clinical levels of depressive problems on the DSM-oriented Depressive Problems scale of the Achenbach Youth Self Report. Logistic regression models were fitted to both subsamples to assess the relationship between clinicians' transition recommendations and risk factors for persistent depression. Results:Only clinician-rated severity of psychopathology was related to a recommendation to continue treatment for those classified with unipolar depressive disorder (N=203; OR=1.45, 95% CI (1.03-2.03), p=.044) and for those with self-reported depressive problems on the Achenbach DSM-oriented Depressive Problems scale (N=185; OR=1.62, 95% CI (1.12-2.34), p=.012). Conclusion:Transition recommendations and need for continued treatment are based on clinical expertise, rather than self-reported problems and needs.

Published
2023

48. The importance of clinicians' and parents' awareness of suicidal behaviour in adolescents reaching the upper age limit of their mental health services in Europe

Author

van Bodegom, L, Gerritsen, S, Dieleman, G, Overbeek, M, de Girolamo, G, Scocco, P, Hillegers, M, Wolke, D, Rizopoulos, D, Appleton, R, Conti, P, Franić, T, Margari, F, Madan, J, Mcnicholas, F, Nacinovich, R, Pastore, A, Paul, M, Purper-Ouakil, D, Saam, M, Santosh, P, Sartor, A, Schulze, U, Signorini, G, Singh, S, Street, C, Tah, P, Tanase, E, Tremmery, S, Tuomainen, H, Maras, A, van Bodegom, Larissa S, Gerritsen, Suzanne E, Dieleman, Gwendolyn C, Overbeek, Mathilde M, de Girolamo, Giovanni, Scocco, Paolo, Hillegers, Manon H J, Wolke, Dieter, Rizopoulos, Dimitris, Appleton, Rebecca, Conti, Patrizia, Franić, Tomislav, Margari, Francesco, Madan, Jason, McNicholas, Fiona, Nacinovich, Renata, Pastore, Adriana, Paul, Moli, Purper-Ouakil, Diane, Saam, Melanie C, Santosh, Paramala J, Sartor, Anne, Schulze, Ulrike M E, Signorini, Giulia, Singh, Swaran P, Street, Cathy, Tah, Priya, Tanase, Elena, Tremmery, Sabine, Tuomainen, Helena, Maras, Athanasios, van Bodegom, L, Gerritsen, S, Dieleman, G, Overbeek, M, de Girolamo, G, Scocco, P, Hillegers, M, Wolke, D, Rizopoulos, D, Appleton, R, Conti, P, Franić, T, Margari, F, Madan, J, Mcnicholas, F, Nacinovich, R, Pastore, A, Paul, M, Purper-Ouakil, D, Saam, M, Santosh, P, Sartor, A, Schulze, U, Signorini, G, Singh, S, Street, C, Tah, P, Tanase, E, Tremmery, S, Tuomainen, H, Maras, A, van Bodegom, Larissa S, Gerritsen, Suzanne E, Dieleman, Gwendolyn C, Overbeek, Mathilde M, de Girolamo, Giovanni, Scocco, Paolo, Hillegers, Manon H J, Wolke, Dieter, Rizopoulos, Dimitris, Appleton, Rebecca, Conti, Patrizia, Franić, Tomislav, Margari, Francesco, Madan, Jason, McNicholas, Fiona, Nacinovich, Renata, Pastore, Adriana, Paul, Moli, Purper-Ouakil, Diane, Saam, Melanie C, Santosh, Paramala J, Sartor, Anne, Schulze, Ulrike M E, Signorini, Giulia, Singh, Swaran P, Street, Cathy, Tah, Priya, Tanase, Elena, Tremmery, Sabine, Tuomainen, Helena, and Maras, Athanasios

Abstract

Background: To study clinicians' and parents' awareness of suicidal behaviour in adolescents reaching the upper age limit of their Child and Adolescent Mental Health Service (CAMHS) and its association with mental health indicators, transition recommendations and mental health service (MHS) use. Methods: 763 CAMHS users from eight European countries were assessed using multi-informant and standardised assessment tools at baseline and nine months follow-up. Separate ANCOVA's and pairwise comparisons were conducted to assess whether clinicians' and parents' awareness of young people's suicidal behaviour were associated with mental health indicators, clinician's recommendations to continue treatment and MHS use at nine months follow-up. Results: 53.5 % of clinicians and 56.9 % of parents were unaware of young people's self-reported suicidal behaviour at baseline. Compared to those whose clinicians/parents were aware, unawareness was associated with a 72–80 % lower proportion of being recommended to continue treatment. Self-reported mental health problems at baseline were comparable for young people whose clinicians and parents were aware and unaware of suicidal behaviour. Clinicians' and parents' unawareness were not associated with MHS use at follow-up. Limitations: Aspects of suicidal behaviour, such as suicide ideation, -plans and -attempts, could not be distinguished. Few young people transitioned to Adult Mental Health Services (AMHS), therefore power to study factors associated with AMHS use was limited. Conclusion: Clinicians and parents are often unaware of suicidal behaviour, which decreases the likelihood of a recommendation to continue treatment, but does not seem to affect young people's MHS use or their mental health problems.

Published
2023

49. Healthcare costs for young people transitioning the boundary between child/adolescent and adult mental health services in seven European countries:results from the MILESTONE study

Author

Canaway, Alastair, Appleton, Rebecca, van Bodegom, Larissa, Dieleman, Gwen, Franic, Tomislav, Gerritsen, Suzanne, de Girolamo, Giovanni, Maras, Athanasios, McNicholas, Fiona, Overbeek, Mathilde, Paul, Moli, Purper-Ouakil, Diane, Santosh, Paramala, Schulze, Ulrike, Singh, Swaran P., Street, Cathy, Tah, Priya, Tremmery, Bie, Tuomainen, Helena, Verhulst, Frank C., Wolke, Dieter, Madan, Jason, Canaway, Alastair, Appleton, Rebecca, van Bodegom, Larissa, Dieleman, Gwen, Franic, Tomislav, Gerritsen, Suzanne, de Girolamo, Giovanni, Maras, Athanasios, McNicholas, Fiona, Overbeek, Mathilde, Paul, Moli, Purper-Ouakil, Diane, Santosh, Paramala, Schulze, Ulrike, Singh, Swaran P., Street, Cathy, Tah, Priya, Tremmery, Bie, Tuomainen, Helena, Verhulst, Frank C., Wolke, Dieter, and Madan, Jason

Abstract

Background The boundary between services for children and adolescents and adults has been identified as problematic for young people with mental health problems. Aims To examine the use and cost of healthcare for young people engaged in mental healthcare before and after the child/adolescent and adult service boundary. Method Data from 772 young people in seven European countries participating in the MILESTONE trial were analysed. We analysed and costed healthcare resources used in the 6-month period before and after the service boundary. Results The proportion of young people engaging with healthcare services fell substantially after crossing the service boundary (associated costs €7761 pre-boundary v. €3376 post-boundary). Pre-boundary, the main cost driver was in-patient care (approximately 50%), whereas post-boundary costs were more evenly spread between services; cost reductions were correlated with pre-boundary in-patient care. Severity was associated with substantially higher costs pre- and post-boundary, and those who were engaged specifically with mental health services after the service boundary accrued the greatest healthcare costs post-service boundary. Conclusions Costs of healthcare are large in this population, but fall considerably after transition, particularly for those who were most severely ill. In part, this is likely to reflect improvement in the mental health of young people. However, qualitative evidence from the MILESTONE study suggests that lack of capacity in adult services and young people's disengagement with formal mental health services post-transition are contributing factors. Long-term data are needed to assess the adverse long-term effects on costs and health of this unmet need and disengagement.

Published
2023

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