Abstract
BackgroundIt is increasingly acknowledged that clinical interventions for young persons with mental disorders need to optimize social, vocational and physical functioning, and take into account developmental needs, rather than focusing only on the traditional target of psychiatric symptom change. However, few interventions for youth presenting to mental health services offer a coherent rationale for multi-faceted approaches that efficiently address all these targets.This trial uses two facilitated group therapy modules (social and physical activity) as a vehicle for promoting clinical, cognitive, social and vocational change. The modules are an adjunct to usual treatments offered to youth attending mental health services in Sydney, Australia.Methods/DesignThe design is a 2-arm, parallel group cross-over, randomized clinical trial (RCT) that examines the efficacy of this adjunctive youth early intervention program (called “YES”) for improving social, vocational, mental and physical health functioning in a trans-diagnostic sample of 120 young persons aged 14–25 years who are currently receiving a range of “usual treatments” for clinically diagnosed anxiety, affective and/or psychotic disorders.Individuals who provide written informed consent are offered 2 group therapy modules (each comprising 4 hours per week for 8 weeks) with a 3-week “pause” between modules. Randomization determines whether individuals commence with module A or module B. The sample will be assessed pre-randomization, and at week 1 and week 8 (after completion of the first module), and at week 11 (commencement of second module) and week 19 (completion of second module). Final follow–up is 1-year post trial entry.DiscussionIf the findings of this exploratory trial demonstrate benefits in the target domains, then it will be important to extend the research by undertaking: (a) a comparison of the YES program to a control intervention in a randomized controlled trial, (b) an explanatory study of putative mediators of change, and (c) a multi-center trial with a number of trained therapists offering the group modules combined with a longer follow-up period.Trial registrationAustralian New Zealand Controlled Trial Registration: ACTRN1262400175673, Date: 16 July 2015
Highlights
It is increasingly acknowledged that clinical interventions for young persons with mental disorders need to optimize social, vocational and physical functioning, and take into account developmental needs, rather than focusing only on the traditional target of psychiatric symptom change
A depressive episode may herald the beginning of a lifetime of recurrent depression, but it may be a precursor of a future bipolar disorder or of psychosis
The design will allow us to answer questions about the benefits of each module, and whether benefits from or engagement with either module can be predicted by week 1 measures
Summary
This trial examines the YES program which comprises two group modules that address mental health, developmental and physical health issues that are common features of the clinical presentations seen in young people attending youth mental health services. Competing interests Ian Hickie is the executive director of the Brain and Mind Research Institute. He has previously been a member of the Federal Minister for Mental Health and Aging Mental Health Expert Working Group and a member of the Federal Minister’s National Advisory Council on Mental Health. IH assisted with the design of the study and is the sponsor of the paper. JS helped with modifications to the design of the study and with drafting of the paper.
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