Key Points
Question
Does preemptive intervention compared with usual care reduce the severity of autism symptoms and the likelihood of an autism spectrum disorder (ASD) diagnosis in infants showing early signs of ASD?
Findings
In this randomized clinical trial of 103 infants showing early behavioral signs of ASD, preemptive intervention led to a statistically significant reduction in the severity of ASD behaviors across early childhood. Infants who received the preemptive intervention had lower odds of meeting diagnostic criteria for ASD (7%) than those who received usual care (21%) at age 3 years, with a number needed to treat of 7 participants.
Meaning
This study found that a preemptive intervention reduced ASD diagnostic behaviors when used at the time atypical development first emerges during infancy.
Purpose
To assess the quality of the research about how employment conditions and psychosocial workplace exposures impact the mental health of young workers, and to summarize the available evidence.
Methods
We undertook a systematic search of three databases using a tiered search strategy. Studies were included if they: (a) assessed employment conditions such as working hours, precarious employment, contract type, insecurity, and flexible work, or psychosocial workplace exposures such as violence, harassment and bullying, social support, job demand and control, effort-reward imbalance, and organizational justice; (b) included a validated mental health measure; and (c) presented results specific to young people aged ≤ 30 years or were stratified by age group to provide an estimate for young people aged ≤ 30 years. The quality of included studies was assessed using the Risk of Bias in Non-randomized Studies of Exposures (ROBINS-E) tool.
Results
Nine studies were included in the review. Four were related to employment conditions, capturing contract type and working hours. Five studies captured concepts relevant to psychosocial workplace exposures including workplace sexual harassment, psychosocial job quality, work stressors, and job control. The quality of the included studies was generally low, with six of the nine at serious risk of bias. Three studies at moderate risk of bias were included in the qualitative synthesis, and results of these showed contemporaneous exposure to sexual harassment and poor psychosocial job quality was associated with poorer mental health outcomes among young workers. Longitudinal evidence showed that exposure to low job control was associated with incident depression diagnosis among young workers.
Conclusions
The findings of this review illustrate that even better studies are at moderate risk of bias. Addressing issues related to confounding, selection of participants, measurement of exposures and outcomes, and missing data will improve the quality of future research in this area and lead to a clearer understanding of how employment conditions and psychosocial workplace exposures impact the mental health of young people. Generating high-quality evidence is particularly critical given the disproportionate impact of COVID-19 on young people’s employment. In preparing for a post-pandemic world where poor-quality employment conditions and exposure to psychosocial workplace exposures may become more prevalent, rigorous research must exist to inform policy to protect the mental health of young workers.
Supplementary Information
The online version contains supplementary material available at 10.1007/s00127-021-02077-x.
Background: Employment is recognised as facilitating the personal and clinical recovery of people with psychosocial disability. Yet this group continue to experience considerable barriers to work, and, constitute a significant proportion of individuals engaged with Disability Employment Services (DES). Recognition of the role of recovery-oriented practice within DES remains limited, despite these approaches being widely promoted as bestpractice within the field of mental health. Methods: The Improving Disability Employment Study (IDES) aims to gather evidence on factors influencing employment outcomes for Australians with disability. Descriptive analysis and linear regression of IDES survey data from 369 DES participants, alongside narrative analysis of data collected through 56 in-depth interviews with 30 DES participants with psychosocial disability, allowed us to explore factors influencing mental health, well-being and personal recovery within the context of DES. Results: Psychosocial disability was reported as the main disability by 48% of IDES respondents. These individuals had significantly lower scores on measures of mental health and well-being (44.9, 48.4 respectively, p ≤ 0.01), compared with respondents with other disability types (52.2, 54.3 p ≤ 0.01). Within this group, individuals currently employed had higher mental health and well-being scores than those not employed (47.5 vs 36.9, 55.5 vs 45.4 respectively, p ≤ 0.01). Building on these findings, our qualitative analysis identified five personal recovery narratives: 1) Recovery in spite of DES; 2) DES as a key actor in recovery; 3) DES playing a supporting role in fluctuating journeys of recovery; 4) Recovery undermined by DES; and, 5) Just surviving regardless of DES. Narratives were strongly influenced by participants' mental health and employment status, alongside the relationship with their DES worker, and, participants' perspectives on the effectiveness of services provided.
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