Mental Health Problems In Young People Research Articles

An integrated model of care for young people with liver disease and transplant

Rationale, aims and objectives: Young people (YP) with chronic illness have increased risk of mental health problems. This paper evaluates the feasibility, acceptability and effectiveness of incorporating routine electronic mental health screening into the standard multidisciplinary healthcare of YP with chronic liver disease and liver transplant.Methods: One hundred and eighty-seven YP (mean age 18 years, 53% female) attending routine appointments in a tertiary service in the UK completed mental health screening prior to their clinic appointment. These standardized measures (the 9-item Patient Health Questionnaire [PHQ9] and the 7-item Generalised Anxiety questionnaire [GAD7]) were completed using an informatics system that facilitates routine collection of patient-reported outcomes, with real-time feedback to guide clinical care. Responses are immediately uploaded to medical notes and evaluated by the clinical team. Fifty-three YP completed an additional feasibility measure. YP screening positive were assessed by the clinical team, with appropriate support offered. Level of clinician agreement with screening programme was ascertained by the team’s clinical psychologist.Results: YP reported that completing the electronic screening was acceptable, a positive experience and that routine mental health screening in this manner would not affect the way they felt about coming to clinic. Clinician judgement corroborated 31 of the 33 YP who screened as positive for anxiety/depression. Screening did not effectively identify all YP warranting psychosocial input.Conclusions: Screening using electronic measures, with responses uploaded in real-time to medical notes for consultant review, can facilitate the rapid identification of mental health problems in YP with physical health problems, in an acceptable and time/cost-effective way. This should be combined with the support of embedded mental health practitioners within physical healthcare environments.

Liver transplantation and adolescence: The role of mental health.

Young people (YP) with chronic illness have higher rates of mental health problems than the general population, with psychosocial complexity associated with nonadherence and poorer health outcomes. This study aimed to describe the prevalence of anxiety and depression in YP after liver transplantation, with autoimmune liver disease and other chronic liver diseases, identify the factors YP attribute their distress to and the relationship between anxiety/depression, and describe YP's beliefs about their illness and treatment. An electronically administered questionnaire battery was given routinely to YP attending an outpatient liver transition clinic; 187 YP participated, of which 17.7% screened positive for anxiety or depression. There were no significant differences between disease groups. This is significantly higher than the prevalence of common mental health problems in the general adolescent population. Patients most frequently attributed their distress to fatigue, sleep difficulties, financial concerns, problems at work/school, worry, and low self-esteem. Higher levels of depression and anxiety were significantly associated with specific illness and treatment beliefs but not with perceived understanding of illness or treatment control. In conclusion, the increased prevalence of mental health problems in YP and the intertwined nature of these with their physical health outcomes provide evidence that holistic care should be delivered as standard for this age group. Liver Transplantation 22 1544-1553 2016 AASLD.