Early intervention for depression in young people: a blind spot in mental health care – Authors' reply

Abstract

We thank Benjamin Janaway and Mukesh Kripalani for their interest in our Personal View. We agree that subthreshold depression might not be an accurate term, both because it can refer to the isolated experience of low mood and because no clear demarcation exists between subthreshold and full-threshold depression. We also agree that early intervention should focus on culturally sensitive interventions that include psychoeducation and address disengagement from education and work. One of our motivations for writing our Personal View is our belief that early intervention for depression needs to expand beyond its narrow focus on subthreshold depression to include early episodes of depression, which can be uncomplicated or marked by severe symptoms and complex comorbidity. The lines of division between these subgroups are less important than the availability of a range of interventions that are appropriate to the young person's clinical stage.1McGorry PD Hickie IB Yung AR Pantelis C Jackson HJ Clinical staging of psychiatric disorders: a heuristic framework for choosing earlier, safer and more effective interventions.Aust N Z J Psychiatry. 2006; 40: 616-622Crossref PubMed Scopus (0) Google Scholar In general, we support the notion of providing care to young people who are experiencing distress, irrespective of whether they meet formal criteria for a diagnosis. Mild symptoms will often respond to interventions of lower intensity, which might include psychoeducation, reassurance, and watchful waiting. Young people with moderate symptoms should be offered evidence-based psychotherapy and other psychosocial supports. And when the symptoms are particularly severe and accompanied by poor psychosocial functioning, we argue that more specialist care is required, which is best delivered by a multidisciplinary team. Janaway and Kripalani also suggest that targeting early evidence of symptoms with clinical and psychosocial support might be an inefficient use of resources, and that perhaps we should target aetiological factors rather than directly intervening to help manage the young person's symptoms. We do not disagree that focusing on the social determinants of mental disorders is important, but believe that we can make progress on both aspects—addressing the social determinants and providing clinical care—at the same time. Addressing the social determinants requires concerted political effort, with results often not manifesting for many years. But psychological distress is frequent among young people right now, and while we push for political reforms and await their implementation, young people need more urgent care. We declare no competing interests. Early intervention for depression in young people: a blind spot in mental health careIt was with a great anticipation we read the Personal View by Christopher Davy and Patrick McGorry.1 We would like to raise some points that might be worth considering. Full-Text PDF Early intervention for depression in young people: a blind spot in mental health careDepression is a major contributor to disability across the lifespan. As a disorder that commonly has its onset in adolescence and early adulthood, and high recurrence and persistence, it is a prime candidate for early intervention. Most of the early intervention focus, however, has been confined to indicated prevention efforts. In this Personal View, we argue that early intervention for depression must expand beyond this narrow focus to include young people (aged 12–25 years old) who present with early episodes of full-threshold major depressive disorder. Full-Text PDF