Abstract
Improving our understanding of the causes of functional impairment in young people is a major global challenge. Here, we investigated the relationships between self-reported days out of role and the total quantity and different patterns of self-reported somatic, anxious-depressive, psychotic-like, and hypomanic symptoms in a community-based cohort of young adults. We examined self-ratings of 23 symptoms ranging across the four dimensions and days out of role in >1900 young adult twins and non-twin siblings participating in the “19Up” wave of the Brisbane Longitudinal Twin Study. Adjusted prevalence ratios (APR) and 95% confidence intervals (95% CI) quantified associations between impairment and different symptom patterns. Three individual symptoms showed significant associations with days out of role, with the largest association for impaired concentration. When impairment was assessed according to each symptom dimension, there was a clear stepwise relationship between the total number of somatic symptoms and the likelihood of impairment, while individuals reporting ≥4 anxious-depressive symptoms or five hypomanic symptoms had greater likelihood of reporting days out of role. Furthermore, there was a stepwise relationship between the total number of undifferentiated symptoms and the likelihood of reporting days out of role. There was some suggestion of differences in the magnitude and significance of associations when the cohort was stratified according to sex, but not for age or twin status. Our findings reinforce the development of early intervention mental health frameworks and, if confirmed, support the need to consider interventions for subthreshold and/or undifferentiated syndromes for reducing disability among young people.
Highlights
The increasing number of young adults who are not in employment, education, and training is a major global challenge[1]
Two partially overlapping studies of high school and university students demonstrated that several subtypes of self-reported psychotic-like experiences were each associated with impaired self-reported functioning[12,13], and clinical studies of non-psychotic help-seeking young people accessing youth mental health services have reported similar relationships between self- and clinician-rated impairment and self-reported bizarre experiences and persecutory ideas[14]
There was some suggestion of sex differences (Fig. 3B). In this community-based cohort of young adults, we identified both general and specific relationships between the likelihood of having ≥1 day out of role and experiencing symptoms associated with mental ill-health
Summary
The increasing number of young adults who are not in employment, education, and training is a major global challenge[1]. A study of adults in the Epidemiological Catchment Area study showed that people experiencing minor depression with mood disturbance (based on the Diagnostic Interview Schedule) had a 1.6-fold greater risk of self-reported disability days compared to asymptomatic individuals, while those with major depression had a 4.8-fold greater risk of disability days[8]. Two partially overlapping studies of high school and university students demonstrated that several subtypes of self-reported psychotic-like experiences (bizarre experiences, perceptual abnormalities, persecutory ideas, and grandiosity) were each associated with impaired self-reported functioning[12,13], and clinical studies of non-psychotic help-seeking young people accessing youth mental health services have reported similar relationships between self- and clinician-rated impairment and self-reported bizarre experiences and persecutory ideas[14]. A re-analysis of five sites of the Epidemiological Catchment Area study showed that Diagnostic Interview Schedule ascertained “subthreshold manic/hypomanic symptoms”
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