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Changes in psychological distress and psychosocial functioning in young people visiting headspace centres for mental health problems

Debra J Rickwood, Kelly R Mazzer, Nic R Telford, Alexandra G Parker, Chris J Tanti and Patrick D McGorry
Med J Aust 2015; 202 (10): 537-542. || doi: 10.5694/mja14.01696

Summary

Objectives: To examine changes in psychological distress and psychosocial functioning in young people presenting to headspace centres across Australia for mental health problems.

Design: Analysis of routine data collected from headspace clients who had commenced an episode of care between 1 April 2013 and 31 March 2014, and at 90-day follow-up.

Participants: A total of 24 034 people aged 12–25 years who had first presented to one of the 55 fully established headspace centres for mental health problems during the data collection period.

Main outcome measures: Main reason for presentation, types of therapeutic services provided, Kessler Psychological Distress Scale (K10) scores, and Social and Occupational Functioning Assessment Scale (SOFAS) scores.

Results: Most headspace mental health clients presented with symptoms of depression and anxiety and were likely to receive cognitive behaviour therapy (CBT). Younger males were more likely than other age- and sex-defined groups to present for anger and behavioural problems, while younger females were more likely to present for deliberate self-harm. From presentation to last assessment, over one-third of clients had significant improvements in psychological distress (K10) and a similar proportion in psychosocial functioning (SOFAS). Sixty per cent of clients showed significant improvement on one or both measures.

Conclusions: Data regarding outcomes for young people using mental health care services similar to headspace centres are scarce, but the current results compare favourably with those reported overseas, and show positive outcomes for young people using headspace centres.

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  • Debra J Rickwood1,2
  • Kelly R Mazzer2
  • Nic R Telford2
  • Alexandra G Parker2
  • Chris J Tanti2
  • Patrick D McGorry3

  • 1 University of Canberra, Canberra, ACT.
  • 2 headspace. The National Youth Mental Health Foundation, Melbourne, VIC.
  • 3 Orygen Youth Health Research Centre, University of Melbourne, Melbourne, VIC.


Acknowledgements: 

headspace, the National Youth Mental Health Foundation is funded by the Australian Government.

Competing interests:

We are all employed by or directly involved with headspace, the National Youth Mental Health Foundation.

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access_time 05:18, 10 June 2015
Anthony Jorm

As Rickwood and colleagues note, “the absence of a control group…means that changes in scores reported cannot be attributed to headspace care”. It is well known that people with depression and anxiety disorders tend to improve even without intervention, so some or all of the improvements they describe could be due to spontaneous remission. In this regard, it is instructive to compare the changes they report to data from 2 meta-analyses of improvement in depressed patients who were untreated.

The first meta-analysis involved 10 studies, including 2 with adolescents, and found a standardized mean difference of 0.5 over a mean duration of 10 weeks.1 For headspace clients, by comparison, the standardized mean difference on the K10 was approximately 0.33 at last assessment and 0.67 at 3-month follow-up.

The second meta-analysis examined ‘remission’ in untreated depression, with the remission criteria being similar to Rickwood and colleagues’ definition of ‘clinically significant improvement’.2 This meta-analysis found 23% remission at 3 months for adults, with a higher rate (not given in the paper) in children and adolescents. By comparison, 21% of headspace clients showed clinically significant improvement after a mean of 4.4 sessions.

My conclusion is that the improvements reported in the headspace clients could plausibly be accounted for by the natural history of depression and anxiety disorders. It is unfortunate that headspace centres have continued to be rolled out without any adequate data on benefits. A randomized controlled trial is required.

1. Rutherford BR, Mori S, Sneed JR, Pimontel MA, Roose SP. Contribution of spontaneous improvement to placebo response in depression: a meta-analytic review. J Psychiatr Res 2012; 46: 697-702.
2. Whiteford HA, Harris MG, McKeon G, Baxter A, Pennell, Barendregt JJ, et al. Estimating remission from untreated major depression: a systematic review and meta-analysis. Psychol Med 2013;43:1569-1585.

Competing Interests: I have published and held grants with some of the authors.

Prof Anthony Jorm
University of Melbourne

access_time 02:37, 14 June 2015
Klaus Stelter

I commented previously on lack of hard data in McGorry et al's. previous paper - in this Paper one has got to have issues with their "primary presenting concern" under Measures:- "The primary presenting concern was categorised according to the clinical presentation features as determined by the clinicians. These did not comprise diagnoses...(but) were indicative of mental health problems".
I wonder if the average GP could stand up in court and say: "the patient presented with cough - which I thought was indicative of a respiratory problem"!
I am not trying to "knock" headspace but I wish they would come clean on what we can or cannot expect of them and some hard outcome data.
.

Competing Interests: Work as MO in Mission Australia's Triple Care Farm rehab facility

Dr Klaus Stelter
St George Division of General Practice Inc.

access_time 11:46, 9 July 2015
Robert Goldney

The outcome report of the effectiveness of the headspace initiative was disappointing (1). We can only agree with Jorm (2) that the result of only 21% having ‘clinically significant’ improvement on the K10 psychological distress measure in terms of the ‘presenting concern’ , rather than clinical diagnosis, is plausibly explained by the natural history of such distress.

In addition the authors stated that 31% had ‘reliably improved’ ‘psychosocial functioning’ using the Social and Occupational Functioning Assessment Scale (SOFAS). However, according to the DSM IV-TR (3), in which it is described in the section devoted to ‘Criteria sets and Axes provided for further study’, that scale ‘focuses exclusively on the individual’s level of social and occupational functioning and is not directly influenced by the overall severity of the individual’s psychological symptoms’. Not only is it an inappropriate scale for measuring psychological function, thereby rendering invalid any comparisons with other studies which have used conventional instruments, but it also has questionable reliability (4).

It was also noted that their outcomes were ‘similar to the child and adolescent results’ of the National Outcomes and Casemix Collection (NOCC) relating to the broader public mental health services, hardly a convincing endorsement of a supposedly better service.

The question must be posed: are these outcomes sufficiently encouraging to warrant continuation of the implementation of what is essentially a duplication of traditional services, or, if not always duplication, a significant expenditure which has not bolstered existing evidence based services? With increasing demands on new funding, it is a question which must be addressed.

Competing interests: No relevant disclosures.

References
1. Jorm A http://.mja.com.au/journal/2015/202/10/changes-psychological-distress-and-psychosocial-functioning-young-people
2. Rickwood DJ, Mazzer KR, Telford NR et al. Changes in psychological distress and psychosocial functioning in young people accessing headspace centres for mental health problems. Medical Journal of Australia, 2015, 202: 537-542.
3. American Psychiatric Association. Diagnostic and Statistical manual of Mental Disorders, Fourth Edition, Text Revision. APA, Washington DC, 814-816.
4. Morosini PL, Magliano L, Brambilla L, et al. Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatrica Scandinavia 2000, 101: 323-329.

Competing Interests: No relevant disclosures

Prof Robert Goldney
University of Adelaide

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