Mental conditions in adolescence: stage at presentation predicts trajectory

  • Iorfino F & al.
  • JAMA Psychiatry
  • 28.08.2019

  • von Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • For anxiety, mood, and psychotic disorders, the stage at which an adolescent presents for care factors into their condition’s trajectory and progression.
  • This study identifies stage-to-stage transition points and factors that signal progression.

Why this matters

  • Awareness of red-flag factors marking progression, such as circadian disruption, can aid clinical recognition. 
  • Editorial: this framework holds potential for offering “substantial advances” in clinical understanding of how these conditions progress and appropriate treatment options. 

Key results

  • Stages: 
    • Ia: early subthreshold, nonspecific symptoms of, e.g., anxiety, depression;
    • Ib: attenuated syndromes that may meet diagnostic criteria, but with mild or short-term presentation; and
    • II: meet diagnostic criteria for a disorder that is persistent or recurrent.
  • Factors associated with stage-to-stage transition:
    • Ia to Ib: low social functioning; low engagement with education/employment; manic/psychotic-like episodes, self-harm, older age.
    • Ib to II: psychotic-like experiences, circadian disturbances, history of childhood psychiatric disorder, older age.

Study design

  • Longitudinal, observational study in Australia; 2254 people (59.0% female) ages 12-25 (baseline mean, 18.18) years who had contact with mental health care at 2 early-intervention centers.
  • Median follow-up, 14 (interquartile range, 5-33) months.
  • Outcome: transition from earlier to later stage.
  • Funding: National Health & Medical Research Council Center of Research Excellence; Australia Fellowship.

Limitations

  • Selected cohort; results not necessarily generalizable.