Applying clinical staging to young people who present for mental health care.
OBJECTIVE
The study aims to apply clinical staging to young people who present for mental health care; to describe the demographic features, patterns of psychological symptoms, disability correlates and clinical stages of those young people; and to report longitudinal estimates of progression from less to more severe stages.


METHODS
The study uses cross-sectional and longitudinal assessments of young people managed in specialized youth clinics. On the basis of clinical records, subjects were assigned to a specific clinical 'stage' (i.e. 'help-seeking', 'attenuated syndrome', 'discrete disorder' or 'persistent or recurrent illness').


RESULTS
Young people (n = 209, mean age = 19.9 years (range = 12-30 years), 48% female) were selected from a broader cohort of n = 1483 subjects. Ten percent were assigned to the earliest 'help-seeking' stage, 54% to the 'attenuated syndrome' stage, 25% to the 'discrete disorder' stage and 11% to the later 'persistent or recurrent illness' stage. The interrater reliability of independent ratings at baseline was acceptable (κ = 0.71). Subjects assigned to the 'attenuated syndrome' stage reported symptom and disability scores that were similar to those assigned to later stages. Longitudinally (median = 48 weeks), transition to later clinical stages were 11% of the 'help-seeking', 19% of the 'attenuated syndrome' and 33% of the 'discrete disorder' groups.


CONCLUSIONS
Among young people presenting for mental health care, most are clinically staged as having 'attenuated syndromes'. Despite access to specialized treatment, a significant number progress to more severe or persistent disorders.
Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, Sydney, New South Wales. ian.hickie@sydney.edu.au
Ian B
IB
Hickie
Elizabeth M
EM
Scott
Daniel F
DF
Hermens
Sharon L
SL
Naismith
Adam J
AJ
Guastella
Manreena
M
Kaur
Anna
A
Sidis
Bradley
B
Whitwell
Nicholas
N
Glozier
Tracey
T
Davenport
Christos
C
Pantelis
Stephen J
SJ
Wood
Patrick D
PD
McGorry
D000293:Adolescent; D000328:Adult; D001315:Australia; D002648:Child; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities / Q000523:psychology; D018450:Disease Progression; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis*; D008605:Mental Health Services; D015588:Observer Variation; D011569:Psychiatric Status Rating Scales; D063189:Symptom Assessment / Q000379:methods*