Prior suicide attempts predict worse clinical and functional outcomes in young people attending a mental health service

Iorfino, Frank; Hermens, Daniel F.; Cross, Shane; Zmicerevska, Natalia; Nichles, Alissa; Groot, Josine; Guastella, Adam J.; Scott, Elizabeth; Hickie, Ian B.

doi:10.1016/j.jad.2018.06.032

Cited by 27 publications

(47 citation statements)

References 40 publications

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“…Similarly, among young people with early‐stage disorders, these behaviours are not only a determinant of immediate distress and additional impairment but also a predictor of later onset of more severe illness (bipolar‐type or mood instability) and greater functional impairment . Importantly, at entry to services, up to one‐third of young people already experience suicidal thoughts, and they are not restricted to those with more severe illness types .…”

Section: Evidence For a Multidimensional Outcomes Frameworkmentioning

confidence: 83%

“…This contrasts with data from an Australian survey which showed that 8% of teenagers had expressed suicidal ideation and 2% had attempted suicide in the previous 12 months . While engagement with care is associated with a reduction in repeated suicidal behaviours, new experiences of suicidal thoughts and behaviours emerge during care, particularly among those whose illness course and trajectory is worsening and in association with alcohol or other substance misuse . These findings have important implications for an enhanced focus on reducing self‐harm, suicidal thoughts and behaviours throughout the course of clinical care for all of those who present to such services, not just those who are perceived as higher risk.…”

Section: Evidence For a Multidimensional Outcomes Frameworkmentioning

confidence: 99%

“…These factors perpetuate poor experiences of care and suboptimal outcomes for individuals . For young people, additional challenges include: presentations of subthreshold disorders; high rates of deterioration and illness progression; high rates of self‐harm and suicidality; impacts on social, educational or vocational participation; comorbid physical health problems; and alcohol or other substance misuse . Consequently, there is a need to create person‐centred and transdiagnostic youth mental health models of care that respond directly to these challenges …”

Section: A Service Delivery Model To Support Highly Personalised and mentioning

confidence: 99%

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Right care, first time: a highly personalised and measurement‐based care model to manage youth mental health

Hickie

Scott

Cross

et al. 2019

Medical Journal of Australia

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137

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Section: Evidence For a Multidimensional Outcomes Frameworkmentioning

confidence: 83%

Section: Evidence For a Multidimensional Outcomes Frameworkmentioning

confidence: 99%

Section: A Service Delivery Model To Support Highly Personalised and mentioning

confidence: 99%

See 1 more Smart Citation

Right care, first time: a highly personalised and measurement‐based care model to manage youth mental health

Hickie

Scott

Cross

et al. 2019

Medical Journal of Australia

Self Cite

114

137

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show abstract

“…Concerns have been raised, however, about the quality of these services in terms of outcomes, variability between centres and appropriateness of care provided . Specifically, ongoing challenges persist with excessive wait times, lack of timely intervention for illness acuity and suicidal thoughts and behaviours, appropriate treatment provision for those with complex needs, premature treatment drop‐out, and ongoing functional impairment after treatment …”

Section: Discussionmentioning

confidence: 99%

Project Synergy: co‐designing technology‐enabled solutions for Australian mental health services reform

Hickie

Davenport

Burns

et al. 2019

Medical Journal of Australia

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109

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Summary Project Synergy aims to test the potential of new and emerging technologies to enhance the quality of mental health care provided by traditional face‐to‐face services. Specifically, it seeks to ensure that consumers get the right care, first time (delivery of effective mental health care early in the course of illness). Using co‐design with affected individuals, Project Synergy has built, implemented and evaluated an online platform to assist the assessment, feedback, management and monitoring of people with mental disorders. It also promotes the maintenance of wellbeing by collating health and social information from consumers, their supportive others and health professionals. This information is reported back openly to consumers and their service providers to promote genuine collaborative care. The online platform does not provide stand‐alone medical or health advice, risk assessment, clinical diagnosis or treatment; instead, it supports users to decide what may be suitable care options. Using an iterative cycle of research and development, the first four studies of Project Synergy (2014–2016) involved the development of different types of online prototypes for young people (i) attending university; (ii) in three disadvantaged communities in New South Wales; (iii) at risk of suicide; and (iv) attending five headspace centres. These contributed valuable information concerning the co‐design, build, user testing and evaluation of prototypes, as well as staff experiences during development and service quality improvements following implementation. Through ongoing research and development (2017–2020), these prototypes underpin one online platform that aims to support better multidimensional mental health outcomes for consumers; more efficient, effective and appropriate use of health professional knowledge and clinical skills; and quality improvements in mental health service delivery.

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“…The presence of such high rates of deliberate self-harm and suicidal thoughts and behaviour early in the course of care highlights the specific need for risk reduction strategies and ongoing management of these thoughts and behaviours during care and treatment. A report on suicide attempts in this cohort79 found that the presence of a prior suicide attempt at baseline increases not only the risk for subsequent deliberate self-harm and suicidal thoughts and behaviours but also other negative outcomes including onset of alcohol or substance use disorder and bipolar disorder. This demonstrates the utility of this dataset in assessing prospective risk for multiple outcome domains in relation to baseline features.…”

Section: Findings To Datementioning

confidence: 85%

Cohort profile: the Brain and Mind CentreOptymisecohort: tracking multidimensional outcomes in young people presenting for mental healthcare

et al. 2020

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PurposeThe Brain and Mind Centre (BMC)Optymisecohort assesses multiple clinical and functional domains longitudinally in young people presenting for mental health care and treatment. Longitudinal tracking of this cohort will allow investigation of the relationships between multiple outcome domains across the course of care. Subsets ofOptymisehave completed detailed neuropsychological and neurobiological assessments, permitting investigation of associations between these measures and longitudinal course.ParticipantsYoung people (aged 12–30) presenting to clinics coordinated by the BMC were recruited to a research register (n=6743) progressively between June 2008 and July 2018. To date, 2767 individuals have been included inOptymisebased on the availability of at least one detailed clinical assessment.MeasuresTrained researchers use a clinical research proforma to extract key data from clinical files to detail social and occupational functioning, clinical presentation, self-harm and suicidal thoughts and behaviours, alcohol and other substance use, physical health comorbidities, personal and family history of mental illness, and treatment utilisation at the following time points: baseline, 3, 6, 12, 24, 36, 48, and 60 months, and time last seen.Findings to dateThere is moderate to substantial agreement between raters for data collected via the proforma. While wide variations in individual illness course are clear, social and occupational outcomes suggest that the majority of cohort members show no improvement in functioning over time. Differential rates of longitudinal transition are reported between early and late stages of illness, with a number of baseline factors associated with these transitions. Furthermore, there are longitudinal associations between prior suicide attempts and inferior clinical and functional outcomes.Future plansFuture reports will detail the longitudinal course of each outcome domain and examine multidirectional relationships between these domains both cross-sectionally and longitudinally, and explore in subsets the associations between detailed neurobiological measures and clinical, social and functional outcomes.

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Prior suicide attempts predict worse clinical and functional outcomes in young people attending a mental health service

Cited by 27 publications

References 40 publications

Right care, first time: a highly personalised and measurement‐based care model to manage youth mental health

Right care, first time: a highly personalised and measurement‐based care model to manage youth mental health

Project Synergy: co‐designing technology‐enabled solutions for Australian mental health services reform

Cohort profile: the Brain and Mind CentreOptymisecohort: tracking multidimensional outcomes in young people presenting for mental healthcare

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