Mental Disorders In Young People Research Articles

Digital mental health interventions for treating mental disorders in young people based in low-and middle-income countries: A systematic review of the literature

Abstract Young people (YP) (between 10 and 24 years) are disproportionally vulnerable to developing and being affected by mental health conditions due to physical, social and emotional risk factors. YP in low-and middle-income countries (LMICs) have poorer access to, and quality of, mental health services compared to those in high-income countries. Digital mental health interventions (DMHIs) have been proposed as tools to address this burden of disease and reduce the global treatment gap in youth mental health outcomes. This study aimed to examine the evidence for DMHIs for treating mental disorders in YP based in LMICs. To do this, the author searched academic databases (MEDLINE, PsycINFO, Embase and Web of Science) for primary studies on DMHIs targeting YP in LMICs. Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria were followed. The quality of the studies was assessed using the Critical Appraisal Skills Programme) framework. A narrative synthesis methodology was used to summarise and explain the findings. The authors identified 287 studies of which 7 were eligible in the final review. The authors found evidence of the effectiveness of multiple forms of DMHI (especially internet-based cognitive behavioural therapy) on anxiety and depression outcomes. Studies reported a lack of long-term benefits of treatment, high dropout rates, and did not include key geographical settings or data on cost-effectiveness. No studies were judged to be of high quality. This review highlights the available evidence showing that DMHIs can improve mental health outcomes for YP in LMICs, but due to the limited number of studies and lack of high-quality data, increased adoption and scaling up of digital interventions require more rigorous studies showing clinical effectiveness and ability to provide return on investment.

The most common mental disorders in young people and middle-aged people in the modern world

The relevance of the study is due to the fact that in the modern world, young and middle-aged people are exposed to numerous negative factors that can lead to mental disorders. Since these groups are the foundation of any society, maintaining their mental health is a very important task. In this regard, the article is aimed at reviewing and analysing mental disorders that are most common among young and middle-aged people. The main research methods used were analysis, synthesis, induction, deduction and comparison, which helped to identify a wide range of mental disorders typical of young and middle-aged people. The empirical part of the study is represented by a questionnaire conducted to assess the psychological state and causes of mental disorders among young and middle-aged people. The article defines the concept of “mental disorder”; analyses the relationship between genetic, psychological, social factors and their impact on the onset of disorders; analyses the work of psychologists, psychiatrists, and physicians who deal with the issue of helping people with mental problems; the types of mental disorders are considered; the most common types of classification of mental disorders are compared; the mental disorders that are most common among young and middle-aged people are identified; various methods and ways of diagnosing disorders are described; current types of treatment of mental disorders are presented. The article makes a contribution to the psychological science of the general mental health of modern society in the face of negative external influences. The work is of theoretical and practical value for psychologists, psychoanalysts, physicians, and sociologists who can help people with existing mental disorders

A new Algorithm for Detecting Clinical High Risk of Psychosis in Adolescents.

The delimitation of the clinical high risk of psychosis (CHRp) is characterized by the wide variety of symptoms assessed from different approaches from the onset of psychosis. This study aimed to create a systematic procedure for an effective and accurate earlydetection of CHRp in educational settings. A representative sample of 1,824 adolescents (average age, 15.79; 53.8%, women) was used to develop an online assessment system and a new 3-track, 3-level algorithm that combines symptoms of the main risk approaches: ultra-high risk (UHR), basic symptoms (BS), and anomalies in the subjective self-experience (ASE) with functional deficit. The acceptability and feasibility of the online screening system were confirmed by the data. Of the total participants, 68 (3.7%) were identified as high-risk and 417 (22.9%) were identified as moderate, which also supports the functionality of the proposed algorithm. The system indicates a dynamic model of progression of the different symptoms in the early stages of psychosis, and it may constitute a first line of identification for severe mental disorders in young people in the earliest stages, allowing application of initial preventive measures.

Internalizing symptoms in adolescence are modestly affected by symptoms of anxiety, depression, and neurodevelopmental disorders in childhood

BackgroundInternalizing disorders, such as anxiety and depressive disorders, are common mental disorders in young people, but a detailed understanding of the symptom continuity from childhood to adolescence that additionally includes a variety of neurodevelopmental disorder (NDD) symptoms is lacking. We therefore aimed to assess the extent to which parent-reported anxiety, depression, and NDD symptoms in childhood predict parent-reported internalizing symptoms in adolescence.MethodsWe used the nation-wide population-based Child and Adolescent Twin Study in Sweden, comprising 4492 twins born in Sweden between 1998 and 2003 that were assessed at age 9, and then again at age 15. Linear regression in a structural equation modelling framework was used to analyze the data.ResultsOverall, our results indicate that 15.9% of the variance in internalizing symptoms at age 15 can be predicted by anxiety, depression, and NDD symptoms at age 9. Anxiety and NDD symptoms in childhood predicted the largest amount of internalizing symptoms in adolescence.ConclusionsAdolescent internalizing symptoms are modestly affected by childhood symptoms of anxiety, depression, and NDDs, suggesting that they may represent different constructs across age. Future studies should further empirically investigate differences in etiology and trajectories of childhood versus adolescent internalizing symptoms.

Prevalence and factors associated with common mental disorders in young people living with HIV in sub-Saharan Africa: a systematic review.

IntroductionCommon mental disorders (CMDs) particularly depression and anxiety, are highly comorbid with HIV also in young people living with HIV (YLWH). In sub‐Saharan Africa (SSA) where most YLWH reside, there are limited summary data on CMDs among these youths, yet there are previous systematic reviews summarizing data on CMDs among adults living with HIV. We conducted a systematic literature review on the prevalence and correlates of CMDs among YLWH, aged 10 to 24 years, from SSA.MethodsWe searched African Index Medicus, African Journals Online and five other electronic databases (from database inception up to 31 December 2020) for relevant studies published in English. The key search terms applied were as follows: “Depression OR Anxiety”, “Young people”, “HIV infections” and “sub‐Saharan Africa”.Results and discussionOut of 3989 articles, 31 studies were included in the review. The prevalence of CMDs in YLWH widely varied ranging between 16.0% and 40.8% for major depression, 4.4% and 52.6% for depressive symptoms and 2.2% and 25.0% for anxiety symptoms. Anxiety disorder was estimated at 45.6%. Four of the five included studies with a comparison group of HIV‐negative young people reported significantly higher prevalence estimates of depressive disorders among YLWH. Several sociodemographic, psychosocial and HIV‐related correlates of CMDs were reported but most lacked consensus across studies. Nevertheless, female sex, older age, fewer schooling years, HIV‐positive status, bullying, sexual abuse, HIV‐related stigma, social support and poor antiretroviral therapy adherence were frequently reported (in ≥2 studies) as significant correlates of depressive symptoms among YLWH. Higher social support was the only frequent significant correlate of anxiety symptoms.ConclusionsThe burden of CMDs among YLWH from SSA is substantial and appears to be significantly higher when compared with HIV‐negative peers, particularly for depressive disorders. However, more comparative research is needed. Importantly, screening for CMDs at the youth HIV‐clinics should be prioritized especially for YLWH at high risk of CMDs, to facilitate early management or referral for treatment. Furthermore, youth‐friendly psychological interventions addressing CMDs in YLWH should urgently be piloted in SSA, incorporating contextual components that may directly or indirectly reduce symptoms of CMDs among YLWH, such as social support.

Public health psychiatry: an idea whose time has come

Public health psychiatry: an idea whose time has come

Establishing a Theory-Based Multi-Level Approach for Primary Prevention of Mental Disorders in Young People.

The increasing prevalence of mental health disorders and psychosocial distress among young people exceeds the capacity of mental health services. Social and systemic factors determine mental health as much as individual factors. To determine how best to address multi-level risk factors, we must first understand the distribution of risk. Previously, we have used psychometric methods applied to two epidemiologically-principled samples of people aged 14–24 to establish a robust, latent common mental distress (CMD) factor of depression and anxiety normally distributed across the population. This was linearly associated with suicidal thoughts and non-suicidal self-harm such that effective interventions to reduce CMD across the whole population could have a greater total benefit than those that focus on the minority with the most severe scores. In a randomised trial of mindfulness interventions in university students (the Mindful Student Study), we demonstrated a population-shift effect whereby the intervention group appeared resilient to a universal stressor. Given these findings, and in light of the COVID-19 pandemic, we argue that population-based interventions to reduce CMD are urgently required. To target all types of mental health determinants, these interventions must be multi-level. Careful design and evaluation, interdisciplinary work, and extensive local stakeholder involvement are crucial for these interventions to be effective.

The impact of psychotic experiences in the early stages of mental health problems in young people

BackgroundAnxiety and depressive symptoms and psychotic experiences constitute common features of emerging mental disorders in young people. Psychotic experiences and the ultra-high risk (UHR) state for psychosis appear to have a particular importance for clinical presentation, progression of symptomatology, quality of life and functioning, but the impact of psychotic experiences in individuals seeking help at non-UHR services, compared to UHR services, is under-researched.MethodsSixty-nine young people (Mage ± SD at baseline = 20.8 ± 2.6, range 16–26 years, 48 females) presenting to mental health services were grouped according to UHR and non-UHR status. They were assessed at baseline for anxiety and depressive symptoms, psychological distress, psychosocial functioning and quality of life. They were followed up at three, six, and 12 months. Data were analysed using mixed linear modelling.ResultsUHR individuals reported higher levels of depressive symptoms and psychological distress, and lower levels of role functioning and quality of life compared to non-UHR individuals. No differences were reported for anxiety symptoms or social functioning. Decline in psychosocial functioning was not associated with clinical deterioration or reduction of quality of life.ConclusionsPsychotic experiences appear to be particularly associated with depressive symptoms and psychological distress, impaired role functioning and quality of life in help-seeking young people in the medium-term. It is therefore important to pay special attention to psychotic experiences in the early stages of mental health problems even if psychotic symptoms are not the main motivation for help-seeking.

Beyond the "at risk mental state" concept: transitioning to transdiagnostic psychiatry.

The "at risk mental state" for psychosis approach has been a catalytic, highly productive research paradigm over the last 25 years. In this paper we review that paradigm and summarize its key lessons, which include the valence of this phenotype for future psychosis outcomes, but also for comorbid, persistent or incident non-psychotic disorders; and the evidence that onset of psychotic disorder can at least be delayed in ultra high risk (UHR) patients, and that some full-threshold psychotic disorder may emerge from risk states not captured by UHR criteria. The paradigm has also illuminated risk factors and mechanisms involved in psychosis onset. However, findings from this and related paradigms indicate the need to develop new identification and diagnostic strategies. These findings include the high prevalence and impact of mental disorders in young people, the limitations of current diagnostic systems and risk identification approaches, the diffuse and unstable symptom patterns in early stages, and their pluripotent, transdiagnostic trajectories. The approach we have recently adopted has been guided by the clinical staging model and adapts the original "at risk mental state" approach to encompass a broader range of inputs and output target syndromes. This approach is supported by a number of novel modelling and prediction strategies that acknowledge and reflect the dynamic nature of psychopathology, such as dynamical systems theory, network theory, and joint modelling. Importantly, a broader transdiagnostic approach and enhancing specific prediction (profiling or increasing precision) can be achieved concurrently. A holistic strategy can be developed that applies these new prediction approaches, as well as machine learning and iterative probabilistic multimodal models, to a blend of subjective psychological data, physical disturbances (e.g., EEG measures) and biomarkers (e.g., neuroinflammation, neural network abnormalities) acquired through fine-grained sequential or longitudinal assessments. This strategy could ultimately enhance our understanding and ability to predict the onset, early course and evolution of mental ill health, further opening pathways for preventive interventions.

S116. THE IMPACT OF PSYCHOTIC EXPERIENCES IN THE EARLY STAGES OF MENTAL HEALTH PROBLEMS IN YOUNG PEOPLE

BackgroundAnxiety and depressive symptoms and psychotic experiences constitute common features of emerging mental disorders in young people. Psychotic experiences and the ultra-high risk (UHR) state for psychosis appear to have a particular importance for clinical presentation, progression of symptomatology, quality of life and functioning, but the impact of psychotic experiences in individuals seeking help at non-UHR services, compared to UHR services, is under-researched.Methods69 young people (Mage ± SD at baseline = 20.8 ± 2.6, range 16–26 years, 48 females) presenting to mental health services were grouped according to UHR and non-UHR status. They were assessed at baseline for psychotic experiences, anxiety and depressive symptoms, psychological distress, psychosocial functioning and quality of life. They were followed up at three, six, and 12 months. Data were analysed using mixed and general linear modelling.ResultsUHR individuals reported higher levels of depressive symptoms and lower levels of role functioning at baseline compared to non-UHR individuals. Significant differences were evident over time for psychological distress and quality of life, with greater impairment developing in those at UHR. No robust differences were reported for anxiety symptoms or social functioning.DiscussionPsychotic experiences appear to be particularly associated with depressive symptoms and psychological distress, impaired role functioning and quality of life in help-seeking young people in the medium-term. It is therefore important to pay special attention to psychotic experiences in the early stages of mental health problems even if psychotic symptoms are not the main motivation for help-seeking.

Training General Practitioners to Detect Probable Mental Disorders in Young People During Health Risk Screening

PurposeThe purpose of the study is to investigate whether a training intervention increases general practitioners' (GPs) detection sensitivity for probable mental disorders in young people. MethodsForty general practices were randomized to an intervention (29 GPs) or comparison arm (49 GPs). Intervention GPs participated in 9 hours of interactive training on youth-friendly care, psychosocial health risk screening, and responding to risk-taking behavior with motivational interviewing approaches, followed by practice visits assisting with integration of screening processes and tools. Youth aged 14–24 years attending GPs underwent a computer-assisted telephone interview about their consultation and psychosocial health risks. Having a “probable mental disorder” was defined as either scoring high on Kessler's scale of psychological distress (K10) or self-perceived mental illness. Other definitions tested were high K10; self-perceived mental illness; and high K10 and self-perceived mental illness. Psychosocial health risk screening rates, detection sensitivity, and other accuracy parameters (specificity, positive predictive value, and negative predictive value) were estimated. ResultsGPs' detection sensitivity improved after the intervention if having probable mental disorder was defined as high K10 score and self-perceived mental illness (odds ratio: 2.81; 95% confidence interval: 1.23–6.42). There was no significant difference in sensitivity of GPs' detection for our preferred definition, high K10 or self-perceived mental illness (.37 in both; odds ratio: .93; 95% confidence interval: .47–1.83), and detection accuracy was comparable (specificity: .84 vs. .87, positive predictive values: .54 vs. .60, and negative predictive values: .72 vs. .72). ConclusionsImproving recognition of mental disorder among young people attending primary care is likely to require a multifaceted approach targeting young people and GPs.

Current CAPE-15: a measure of recent psychotic-like experiences and associated distress.

Psychotic-like experiences (PLEs) are common in young people and are associated with both distress and adverse outcomes. The Community Assessment of Psychic Experiences-Positive Scale (CAPE-P) provides a 20-item measure of lifetime PLEs. A 15-item revision of this scale was recently published (CAPE-P15). Although the CAPE-P has been used to assess PLEs in the last 12 months, there is no version of the CAPE for assessing more recent PLEs (e.g. 3 months). This study aimed to determine the reliability and validity of the current CAPE-P15 and assess its relationship with current distress. A cross-sectional online survey of 489 university students (17-25 years) assessed lifetime and current substance use, current distress, and lifetime and 3-month PLEs on the CAPE-P15. Confirmatory factor analysis indicated that the current CAPE-P15 retained the same three-factor structure as the lifetime version consisting of persecutory ideation, bizarre experiences and perceptual abnormalities. The total score of the current version was lower than the lifetime version, but the two were strongly correlated (r = .64). The current version was highly predictive of generalized distress (r = .52) and indices that combined symptom frequency with associated distress did not confer greater predictive power than frequency alone. This study provided preliminary data that the current CAPE-P15 provides a valid and reliable measure of current PLEs. The current CAPE-P15 is likely to have substantial practical utility if it is later shown to be sensitive to change, especially in prevention and early intervention for mental disorders in young people.

Dysregulated sleep-wake cycles in young people are associated with emerging stages of major mental disorders.

To determine if disturbed sleep-wake cycle patterns in young people with evolving mental disorder are associated with stages of illness. The sleep-wake cycle was monitored using actigraphy across 4 to 22 days. Participants (21 healthy controls and 154 persons seeking help for mental health problems) were aged between 12 and 30 years. Those persons seeking mental health care were categorized as having mild symptoms (stage 1a), an 'attenuated syndrome' (stage 1b) or an 'established mental disorder' (stage 2+). The proportions of individuals with a delayed weekdays sleep schedule increased progressively across illness stages: 9.5% of controls, 11.1% of stage 1a, 25.6% of stage 1b, and 50.0% of stage 2+ (χ(2) (3 d.f.) = 18.4, P < 0.001). A similar pattern was found for weekends (χ(2) (3 d.f.) = 7.6, P = 0.048). Compared with controls, stage 1b participants had later sleep onset on weekends (P = 0.015), and participants at stages 1b and 2+ had later sleep offset on both weekdays and weekends (P < 0.020). Compared with controls, all participants with mental disorders had more wake after sleep onset (P < 0.029) and those at stages 1a and 2+ had lower sleep efficiency (P < 0.040). Older age, medicated status and later weekdays sleep offset were found to be the three strongest correlates of later versus earlier clinical stages. In relation to clinical staging of common mental disorders in young people, the extent of delayed sleep phase is associated with more severe or persistent phases of illness.

EPA-1119 - What students from high school think and know about mental disorders

Introduction Stigma still represents one of the main obstacles to effective treatment of mental disorders and to social integration of those with mental illness. Studies exploring the levels of knowledge and the attitudes of young people toward mental disorder may help to reduce stigma by improving integration of people with mental disorders. Objectives to describe opinions and attitudes of high school students toward mental disorders. Aims to assess:1)the level of knowledge on mental disorders;2)the opinions about people affected by mental disorders in a sample of high school students. Methods This study, promoted by the Department of Psychiatry of the University of NaplesSUN within the collaboration with the World Health Organization, was carried out in a secondary school located in the catchment area of Naples. The level of knowledge and the opinions on mental disorder were evaluated using the Questionnaire on Opinions, previously validated. Results 177 students attending the last two years of secondary school were recruited. Fifty-four percent of the sample were female, with age of 17.5(±0.6) years. About 40% of students identified the main clinical characteristics of affective disorders. Half of the sample stated that mental disorders should not be treated by psychiatrists, but by other health professionals (psychologists, 32%; neurologists, 18%; general practitioners, 4%). As regards opinions on civil rights, about 50% of students affirmed that patients should not vote and 41% that they should not get married. Conclusions The results show that the level of knowledge about mental disorders in young people is still very poor and the levels of stigma are still very high. Informative seminars dedicated to target population may be helpful to improve knowledge and reduce stigma.

The associations between psychiatric label use and young people's help-seeking preferences: results from an Australian national survey

Aims. Emerging evidence suggests that psychiatric labels may facilitate help seeking in young people. This study examined whether young people's use of accurate labels for five disorders would predict their help-seeking preferences. Methods. Young people's help-seeking intentions were assessed by a national telephone survey of 3021 Australian youths aged 15-25. Respondents were presented with a vignette of a young person portraying depression, depression with suicidal thoughts, psychosis, social phobia or post-traumatic stress disorder (PTSD). They were then asked what they thought was wrong with the person, and where they would go for help if they had a similar problem. Results. Accurate psychiatric label use was associated with a preference to seek help from a general practitioner or mental health specialist. Accurately labelling the psychosis vignette was also associated with a preference to not seek help from family or friends. Conclusions. Findings add to the emerging evidence that accurate psychiatric labelling may facilitate help seeking for various mental disorders in young people, and support the promise of community awareness campaigns designed to improve young people's ability to accurately identify mental disorders.

Early Clinical Phenotypes and Risk for Serious Mental Disorders in Young People: Need for Care Precedes Traditional Diagnoses in Mood and Psychotic Disorders

Potentially severe and persistent or recurrent mental disorders pose the major threat to the health, happiness, and productivity of young people as they emerge from childhood to approach the threshold of adult life. The World Economic Forum has recently revealed that mental disorders now equal cardiovascular diseases (CVDs) as the major threat among noncommunicable diseases to the gross domestic product of modern economies.1 This is due largely to the timing in the life cycle of the onset of mental ill health,2 with 75% of disorders emerging by age 25. Universal or primary prevention is the ultimate solution and must be actively researched and pursued where it works, though it is difficult to assemble solid evidence for this.3 Where primary prevention is still out of reach (and the severe mood and psychotic disorders is one such domain), given we have a range of effective treatment strategies in psychiatry, there are 2 alternative pathways to actively follow.First, we must substantially extend the coverage of current interventions so that the vast majority of people who can benefit from mental health care can gain access. Currently, even in wealthy developed nations, only a minority of people with a mental disorder and a consequent need for care actually receive it, and in developing countries access is minimal and quality of care poor. This is why we need to support the global campaign for mental health.4·5 Second, timing is crucial, and early intervention offers the best hope for disease modification and the reduction of the widespread psychological, social, and economic impacts of treatment delay and poor quality care.6 This strategy is a cornerstone of mainstream health care, in cancer, diabetes, and CVD, yet early intervention or pre-emptive psychiatry7·8 has only recently been extended, deployed, and now widely endorsed within the mental health field. Even so, and somewhat surprisingly, a small yet diverse band of critics have not only questioned but also actively campaigned against early intervention concepts and reforms. Obviously such questioning is, to a significant extent, healthy and quite justifiable, being derived from a blend of genuine scientific conservatism, the late adopter phenomenon, and a valid fear of exposing patients to harmful stigma and overtreatment within traditional and narrow models of care, which can often do more harm than good and is more widespread than we care to acknowledge. However, the more extreme commentary on early intervention is evidence-poor and polemical, fueled by vested interests, apologists for the status quo of a narrow brand of traditional psychiatry, and, ironically, unreconstructed antipsychiatry. Nevertheless, we can take it as a positive that the tone and intensity of the debate indicates that real change and a genuine paradigm shift may be occurring. To succeed, it is crucial that early intervention remains strongly evidence-based.The frontier for early intervention is the prodromal or subthreshold stage of illness when a need for care is demonstrable yet the diagnostically clear or pathognomonic features of a particular syndrome or illness have not yet revealed themselves.9 The observation that such subthreshold or warning signs of future more severe illness, often lasting months or years, could be retrospectively identified was made more than 80 years ago by Sullivan10 and countless clinicians since then. The latter have usually experienced a sense of frustration that had they come on the scene during this more subtle phase, which turned out to be a prodromal stage of illness, perhaps it would have been possible to avert much of the patients' suffering and functional disturbance that subsequently ensued.10,11Careful research reconstructing the prodromal stage of psychotic illnesses'215 enabled the creation of operational criteria that could be used prospectively to identify a group of patients who proved to be at incipient risk of transition to psychosis. …

Innovations in Practice: Child and adolescent psychiatrists and primary care - innovative models of consultation in the United States.

There is a severe shortage of child and adolescent psychiatrists (CAPs) in the United States, an increasingly recognized high prevalence of mental disorders in young people, and widely supported goals to provide more mental health services in the primary care setting. A number of innovative, state-wide or more local, publically funded programs have been developed in the United States over the last several years to respond to these challenges and to provide CAP consultation to primary care physicians (PCPs) who wish to address the mental health disorders of their patients in the primary care setting. A number of these programs and their approaches to consultation are described. An example of a clinical scenario that might be addressed using this model of CAP/PCP collaboration is offered. An innovative model of consultation to PCPs from CAPs appears able to facilitate the treatment of many young people with mental health disorders in the primary care setting.

Profiles of family-focused adverse experiences through childhood and early adolescence: The ROOTS project a community investigation of adolescent mental health

BackgroundAdverse family experiences in early life are associated with subsequent psychopathology. This study adds to the growing body of work exploring the nature and associations between adverse experiences over the childhood years.MethodsPrimary carers of 1143 randomly recruited 14-year olds in Cambridgeshire and Suffolk, UK were interviewed using the Cambridge Early Experiences Interview (CAMEEI) to assess family-focused adversities. Adversities were recorded retrospectively in three time periods (early and later childhood and early adolescence). Latent Class Analysis (LCA) grouped individuals into adversity classes for each time period and longitudinally. Adolescents were interviewed to generate lifetime DSM-IV diagnoses using the K-SADS-PL. The associations between adversity class and diagnoses were explored.ResultsLCA generated a 4-class model for each time period and longitudinally. In early childhood 69% were allocated to a low adversity class; a moderate adversity class (19%) showed elevated rates of family loss, mild or moderate family discord, financial difficulties, maternal psychiatric illness and higher risk for paternal atypical parenting; a severe class (6%) experienced higher rates on all indicators and almost exclusively accounted for incidents of child abuse; a fourth class, characterised by atypical parenting from both parents, accounted for the remaining 7%. Class membership was fairly stable (~ 55%) over time with escape from any adversity by 14 years being uncommon. Compared to those in the low class, the odds ratio for reported psychopathology in adolescents in the severe class ranged from 8 for disruptive behaviour disorders through to 4.8 for depressions and 2.0 for anxiety disorders. Only in the low adversity class did significantly more females than males report psychopathology.ConclusionsFamily adversities in the early years occur as multiple rather than single experiences. Although some children escape adversity, for many this negative family environment persists over the first 15 years of life. Different profiles of family risk may be associated with specific mental disorders in young people. Sex differences in psychopathologies may be most pronounced in those exposed to low levels of family adversities.

Comorbidity: Coexisting substance use and mental disorders in young people

Young people with comorbid disorders (coexisting mental health and substance use disorders) present with particular issues that can be difficult for service providers, and for the community as a whole, to respond to. They tend to fall between the cracks of mental health services and substance use services, with the outcome often being ineffective treatment, or no treatment at all, for the young people concerned, and increasing conflict, ideological clashes and blame between agencies. There is urgent need for better communication and development of protocols between mental health services and substance use services for young people; both need to recognise and respect their differing expertise, develop coordinated treatment plans and convey this information to the wider helping services sector. Cross-training is necessary for professionals in the mental health and substance use fields.

The specialist youth mental health model: strengthening the weakest link in the public mental health system

Despite mental disorders being the dominant health issue confronting young people, youth mental health is yet to be recognised as a discrete, unified program area; responsibility for young people's mental health is currently split across multiple levels of government. Public specialist mental health services have followed a paediatric-adult split in service delivery, mirroring general and acute health care. The pattern of peak onset and the burden of mental disorders in young people means that the maximum weakness and discontinuity in the system occurs just when it should be at its strongest. Young people need youth-friendly services that recognise and respond to their special cultural and developmental needs. At the primary and community level, headspace: the National Youth Mental Health Foundation, is a national response to this and aims to provide better access, engagement and enhanced multidisciplinary care for young people across Australia. The specialist mental health service level should be complemented by youth-specific specialist mental health services for young people, aged 12-25 years, which would strengthen the existing system with a better targeted stream of care, providing access to integrated mental health, substance use, and vocational-recovery services. Alternative approaches to creating this capacity should be urgently developed and evaluated, and sustained reform informed by evidence as well as values.