Self-referral psychological treatment centre for young adults: a 2-year observational evaluation of routine practice before and after treatment.
OBJECTIVE
To examine a self-referral psychological service provided to young adults with regard to effects on anxiety, depression and psychological distress and to explore client factors predicting non-adherence and non-response.


METHODS
Observational study over a 2-year period.


METHODS
Young Adults Centre providing psychological services by self-referral (preprimary care) to Linköping, Åtvidaberg, and Kinda municipalities (combined population 145,000) in Östergötland county, Sweden.


METHODS
607 young adults (16-25 years of age); 71% females (n=429).


METHODS
Individually scheduled cognitive behavioural therapy delivered in up to six 45 min sessions structured according to an assessment of the client's mental health problems: anxiety, depression, anxiety and depression combined, or decreased distress without specific anxiety or depression.


METHODS
Pre-post intervention changes in psychological distress (General Health Questionnaire-12, GHQ-12), Hospital Anxiety and Depression Scale Anxiety/Depression (HADS-A/D).


RESULTS
192 clients (32.5%) discontinued the intervention on their own initiative and 39 clients (6.6%) were referred to a psychiatric clinic during the course of the intervention. Intention-to-treat analyses including all clients showed a medium treatment effect size (d=0.64) with regard to psychological distress, and small effect sizes were observed with regard to anxiety (d=0.58) and depression (d=0.57). Restricting the analyses to clients who adhered to the agreed programme, a large effect size (d=1.26) was observed with regard to psychological distress, and medium effect sizes were observed with regard to anxiety (d=1.18) and depression (d=1.19). Lower age and a high initial HADS-A score were the strongest risk factors for non-adherence, and inability to concentrate and thinking of oneself as a worthless person increased the risk for discontinuation.


CONCLUSIONS
We conclude that provision of psychological services to young people through a self-referral centre has potential to improve long-term mental health in communities, but management of non-adherence remains a central challenge.
Young Adults Centre, Region Östergötland, Linköping, Sweden.
Karin
K
Halje
Department of Medical and Health Sciences, Linköping University, Linköping, Sweden Unit for Health Analysis, Centre for Healthcare Development, Region Östergötland, Linköping, Sweden.
Toomas
T
Timpka
Young Adults Centre, Region Östergötland, Linköping, Sweden.
Petra
P
Tylestedt
Young Adults Centre, Region Östergötland, Linköping, Sweden.
Anna-Karin
AK
Adler
Young Adults Centre, Region Östergötland, Linköping, Sweden.
Lena
L
Fröberg
Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Tommy
T
Schyman
Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Kristoffer
K
Johansson
Young Adults Centre, Region Östergötland, Linköping, Sweden.
Katarina
K
Dahl
D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000175:diagnosis / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008603:Mental Health; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012017:Referral and Consultation; D013315:Stress, Psychological / Q000175:diagnosis / Q000628:therapy*; D013548:Sweden; D055815:Young Adult
MENTAL HEALTH; PRIMARY CARE