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Young Adults in General Psychiatry
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Mental illness is common, and usually starts early in life. However, the majority of those affected never seek mental health care. The overall aim of this thesis was to increase knowledge about help-seeking young adults with mental illness in order to improve diagnostic procedures in clinical psychiatry.

A group of young adult psychiatric out-patients (n=217) were consecutively invited to participate in the study between October 2002 and September 2003. Altogether 200 (92%) agreed to participate. Among them, there were 161 (80%) women and 39 (20%) men. Participants’ mean age was 22.4±1.9 years. All participants were carefully and comprehensively assessed with respect to axes I, II, IV and V in the DSM-IV. Psychiatric disorders and personality disorders were assessed using the Structured Clinical Interview for DSM-IV for axis I disorders and the Structured Clinical Interview for DSM-IV for axis II disorders. Psychosocial and environmental problems (axis IV) were evaluated through structured interviewing by a social worker and by self-assessment with a questionnaire. Professional and patient ratings on the Global Assessment of Functioning scale were compared before and after treatment. Patients also reported on the Swedish universities Scales of Personality, the Child and Adolescent Psychiatric Screening Inventory-Retrospect and the Coddington’s life event scale.

Taken together, the young adult, psychiatric outpatients were characterized by an early onset of their mental disorders, by co-morbidity, by being female and by having mood or anxiety disorders. There were no significant differences between self-referred and those referred by medical professionals according to either number of current or lifetime diagnoses. Childhood onset of depression was associated with more severe symptoms, more psychosocial risk factors, and more childhood developmental delays. Axis IV psychosocial stress categories were related to the presence of axis I disorders, personality disorders, co-morbidity, and impaired functioning. Agreement between patients’ and professionals’ ratings on the GAF scale was good before treatment and excellent after treatment.

In summary, the findings suggest that direct self-referral to specialized psychiatric care does not seem to be associated with overutilization of such care. Childhood onset of depression is associated with a more complex illness. The revised axis IV according to DSM-IV seems to have concurrent validity, but is still hampered by limited reliability. And finally, the results support the usefulness of the self-report GAF instrument for measuring outcome in psychiatric care.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2011. , 48 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 671
Keyword [en]
Young adults, multi-axial diagnostics, self-referred, help seeking, axis IV, axis V
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
URN: urn:nbn:se:uu:diva-151504ISBN: 978-91-554-8070-7OAI: oai:DiVA.org:uu-151504DiVA: diva2:410156
Public defence
2011-05-28, Sal IX, Universitetshuset, Biskopsgatan 3, Uppsala, 10:15 (Swedish)
Opponent
Supervisors
Available from: 2011-05-05 Created: 2011-04-12 Last updated: 2011-07-01Bibliographically approved
List of papers
1. Mental Disorders Among Young Adults Self-Referred and Referred by Professionals to Specialty Mental Health Care
Open this publication in new window or tab >>Mental Disorders Among Young Adults Self-Referred and Referred by Professionals to Specialty Mental Health Care
2009 (English)In: Psychiatric Services, ISSN 1075-2730, Vol. 60, no 12, 1649-1655 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Psychiatric disorders among young adults are prevalent, although a minority seek treatment. The option of direct self-referral to specialty mental health care may lower the help-seeking threshold but may also lead to self-referral by those with symptoms but no diagnosable disorders. This study examined whether differences exist in morbidity and in past use of mental health services between self-referrals to specialty care and those referred by nonpsychiatrist professionals. METHODS: Two hundred consecutive young adult outpatients from a medium-sized city in Sweden who visited a specialty psychiatric clinic were assessed with the Structured Clinical Interview for DSM-IV (axis I and II disorders). Previous mental health contacts were also assessed. RESULTS: A total of 49 patients (25%) were self-referred and 151 (75%) were referred by nonpsychiatrist professionals. Mood disorders and specific phobia were more common among self-referred patients (p<.05 for both), but no other significant between-group differences in axis I or II disorders were found. No differences were found in number of current axis I disorders (2.3 for self-referred and 2.2 for the comparison group), number of lifetime diagnoses (2.9 and 2.9), self-reported age at onset (13.6 and 13.5 years), and GAF ratings (54.5 and 54.7). The proportion of patients with no previous mental health contacts was larger in the self-referred group (35% and 18%, p<.05). CONCLUSIONS: No evidence was found that the option of direct self-referral to specialty mental health care increased help seeking or led to overuse of care, although the generalizability of findings to other settings is unknown.

National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-122829 (URN)10.1176/appi.ps.60.12.1649 (DOI)000272273300013 ()19952156 (PubMedID)
Available from: 2010-04-20 Created: 2010-04-20 Last updated: 2013-10-21Bibliographically approved
2. Depression in young adult psychiatric outpatients: delimiting early onset
Open this publication in new window or tab >>Depression in young adult psychiatric outpatients: delimiting early onset
2015 (English)In: Early Intervention in Psychiatry, ISSN 1751-7885, E-ISSN 1751-7893, Vol. 9, no 2, 108-117 p.Article in journal (Refereed) Published
Abstract [en]

Aim

The aim of this study was to examine differences in childhood, adolescent and adult onset of depression.

Methods

Young psychiatric outpatients (n = 156) diagnosed with a lifetime depressive episode were divided into three groups according to age of onset of their first depressive episode: childhood (≤12 years, n = 21), adolescent (13–17 years, n = 58) and early adult onset (18–25 years,n = 77). Participants were assessed by diagnostic interviews and by questionnaires measuring previous life events and childhood developmental delays. Clinical characteristics and various risk factors were compared between groups.

Results

This clinical sample was dominated by women, with onset of their first depressive episode occurring during adolescence. Childhood onset was related to an increased number of depressive episodes, higher prevalence of personality disorders, more current social problems and more reported development delays during childhood regarding literacy learning, social skills and memory. They also reported more separation anxiety symptoms and neglect during childhood and more experiences of teenage pregnancies and abortions.

Conclusions

Childhood onset of depression is associated with more severe symptoms, more psychosocial risk factors and childhood developmental delays. Because all onset groups shared many features, the results are inconclusive if there are distinct subgroups according to age of onset.

National Category
Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:uu:diva-151489 (URN)10.1111/eip.12092 (DOI)000351164900004 ()24118989 (PubMedID)
Available from: 2011-04-12 Created: 2011-04-12 Last updated: 2015-07-24Bibliographically approved
3. Axis IV - psychosocial and environmental problems - in the DSM-IV
Open this publication in new window or tab >>Axis IV - psychosocial and environmental problems - in the DSM-IV
2013 (English)In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 20, no 9, 768-775 p.Article in journal (Refereed) Published
Abstract [en]

Accessible summary

  • The aim of this study was to extensively explore the properties of the revised axis IV of the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV).
  • Psychosocial and environmental problems, which are believed to exacerbate current mental disorders, were evaluated by using a questionnaire and through clinical interviews. The reliability between self-assessment and professional assessment was also examined.
  • The results showed that the revised axis IV according to DSM-IV seems to have concurrent validity, but is still hampered by limited reliability.
  • These findings could be useful for the upcoming DSM-V revision as well as help clinicians and patients to better identify mental health problems.

Abstract

The aim of this study was to further explore the properties of axis IV in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). In a naturalistic cross-sectional design, a group (n = 163) of young (18–25 years old) Swedish psychiatric outpatients was assessed according to DSM-IV. Psychosocial and environmental problems/axis IV were evaluated through structured interviewing by a social worker and by self-assessment on a questionnaire. Reliability between professional assessment and self-assessment of axis IV was examined. Concurrent validity of axis IV was also examined. Reliability between professional and self-assessed axis IV was fair to almost perfect, 0.31–0.83, according to prevalence and bias-adjusted kappa. Categories of psychosocial stress and environmental problems were related to the presence of axis I disorders, co-morbidity, personality disorders and decreasing Global Assessment of Functioning (GAF) values. The revised axis IV according to DSM-IV seems to have concurrent validity, but is still hampered by limited reliability.

Keyword
assessment, axis IV, concurrent validity, DSM-IV, psychosocial stress, young adults
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-151493 (URN)10.1111/jpm.12009 (DOI)000325371100002 ()
Available from: 2011-04-12 Created: 2011-04-12 Last updated: 2013-11-19Bibliographically approved
4. Axis V - Global Assessment of Functioning Scale (GAF), further evaluation of the self-report version
Open this publication in new window or tab >>Axis V - Global Assessment of Functioning Scale (GAF), further evaluation of the self-report version
2008 (English)In: European psychiatry, ISSN 0924-9338, Vol. 23, no 8, 575-579 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The study aimed to examine agreement between patients' and professional staff members' ratings on the Global Assessment of Functioning scale (GAF). METHODS: A total of 191 young adult psychiatric outpatients were included in a naturalistic, longitudinal study. Axis I and axis II disorders were assessed by means of the Structured Clinical Interview for DSM-IV. Before and after treatment, patients and trained staff members did a GAF rating. Agreement between GAF ratings was analyzed using the intra-class correlation coefficient (ICC). RESULTS: The overall intra-class correlation coefficients before and after treatment were 0.65 and 0.86, respectively. Agreement in different axis I diagnostic groups varied, but was generally lower before treatment as compared to after treatment (0.50-0.66 and 0.78-0.90, respectively). Excessive psychiatric co-morbidity was associated with the lowest inter-rater reliability. Agreement, with respect to change in GAF scores during treatment, was good to excellent in all groups. CONCLUSION: Overall, agreement between patients' and professionals' ratings on the GAF scale was good before and excellent after treatment. The results support the usefulness of the self-report GAF instrument for measuring outcome in psychiatric care. However, more research is needed about the difficulties in rating severely disordered patients.

Keyword
Axis V, Global assessment of functioning, GAF, Self-report instrument, Treatment outcomes
National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-102477 (URN)10.1016/j.eurpsy.2008.05.001 (DOI)000261634200006 ()18774271 (PubMedID)
Available from: 2009-05-07 Created: 2009-05-07 Last updated: 2013-10-21Bibliographically approved

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