Youth Mental Health. Mary Cannon

Transcription

1 RCSI March 2011 Youth Mental Health Mary Cannon Associate Professor, Department of Psychiatry,Royal College of Surgeons in Ireland, Consultant Psychiatrist Beaumont Hospital, Dublin HRB Clinician Scientist

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3 Mental Capital

4 The Importance of Youth Mental Health Incidence rates Slide courtesy of Pat McGorry

5 Ten leading causes of burden of disease, world, 2004 and 2030

6 Youth Depression and Anxiety England Collishaw et al, 2010

7 The case for early detection Cancer - Don t try to cure it. Just find it Wired magazine Jan 09

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9 Dunedin Multidisciplinary Health and Development Study Total birth cohort born 1972/73 in Dunedin (N=1037) North Island South Island Dunedin

10 Numbers of Dunedin Study members all over the world at age

11 Subject Retention Dunedin Multidisciplinary Health and Development Study Age % Assessed

12 Age 3 Age 11 Age 26

13 Prior Juvenile diagnoses in Adults with Mental Disorder: a follow-back study (Kim Cohen, Caspi, Moffitt et al, Arch Gen Psychiatry, 2003) Age Diagnostic Instrument 11 DISC (DSM-III) 13 DISC (DSM-III) 15 DISC (DSM-III) 18 DIS (DSM III-R) 21 DIS (DSM III-R) 26 DIS (DSM-IV) DIS = Diagnostic Interview Schedule

14 Psychiatric diagnoses in childhood and adulthood Adult disorder Childhood disorders Anxiety Anxiety Depression Depression Substance Use ADHD Antisocial personality disorder CD/ODD Mania Subs Use (18) Schizophreniform disorder Eating Disorder

15 Age at first diagnosis among persons meeting criteria for DSM-IV mental disorders at age yrs 18 yrs 21 yrs 26 yrs 75% 50% 80% 60% DSM-IV mental disorder Intensive use of mental health services (Kim-Cohen et al, Arch Gen Psychiatry, 2003)

16 The association between juvenile diagnoses at yrs and adult disorders at 26 years Anxiety AOR Depression Subs Use ASPD Scz'form Mania Eating disorder Anxiety Depression ADHD CD/ODD

17 Proportion of adult disorders attributable to any psychiatric disorder in childhood Adult disorder % AFP Anxiety 26 Depression 23 Substance Use 24 ASPD 41 Mania 32 Schizophreniform disorder 25 Eating Disorder 46

18 The importance of youth mental health Most adult disorders have their roots in childhood and adolescence 75% of adults with psychiatric disorder had a disorder before 18 yrs and 50% had a disorder before 15 yrs Up to half of adult cases in the population could be prevented by effective treatment of youth with psychiatric disorders.

19 The case of Schizophrenia

20 The Challenges Brain changes Life transitions Peer pressures Hormonal changes

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22 The Teenage Brain

23 The Adult Brain

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25 Synaptic Pruning

26 The Neuron Neurons are the cells in the brain that interact with one another and tell the brain what to do The brain contains 100 billion neurons!

27 The Changing Teen Brain The brain develops from back to front The Frontal Area of the brain grows last and changes a lot through ages 11 or 12 The brain doesn t stop developing until age 25

28 Functions of the Frontal lobe Abstract thinking Attention shifting Information manipulation Planning and foresight Monitoring and error correction Decision making Inhibition Social functioning

29 The Challenging Times study

30 Challenging Times (2004) School screening results 723 children aged years in 12 secondary schools in North Dublin 19% met criteria for possible mental disorder Risk factors:not living with 2 biological parents; 5 or more in sibship and Coeducation school (girls)

31 Challenging Times: Interview Results year olds interviewed 15.6% met criteria for a mental disorder on interview (Lynch et al, 2006) 4.5% depression 3.7% anxiety 1.5% deliberate self-harm 34% victims of bullying Bullying was associated with risk of depression, and suicidal thoughts or behaviour (Mills et al, 2004)

32 Childhood trauma and mental health

33 Childhood Trauma No psychotic symptoms Psychotic symptoms Child Sexual Abuse Domestic Violence Victim of bullying Bully or bully/victim * = p<0.05 Type of trauma (Kelleher et al, Br J Psychiatry, 2008) Child Physical Abuse

34 Is Cannabis use a risk factor for adult psychosis? Arseneault, Cannon, Moffitt et al, (2002) BMJ, 325:

35 Age at onset of cannabis use (Ireland) HRB (2005)

36 Predicting Psychotic Disorder at Age Odds ratio * Users by age 15 Users by age 18 (Arseneault, Cannon, Poulton et al, BMJ, 2002, 325, )

37 Predicting Depressive Disorder at Age 26 3 Odds ratio * Users by age 15 Users by age 18

38 Interactive effects / Synergy

39 Risk Factors for Psychotic Sx Risk Factor N Psy. Sx. (%) OR (95% CI) Cannabis Use 18 4 (21) 5.2 ( ) Trauma 24 5(22) 5.2 ( ) Harley et al (Psychological Med 2010)

40 Percentage of adolescents reporting psychotic symptoms in each risk category No Trauma or Cannabis Use Cannabis Use only Trauma only Trauma AND Cannabis Use 3-D Column 1 (Harley et al,2010)

41 Clonmel Study (Martin and Carr, 2004) All school children aged <18 in Clonmel in completed questionnaire 17% met criteria for possible mental disorder 9% for clinically significant disorder 4% of 6-11 yr olds and 13.5% of yr olds

42 Growing Up in Ireland Study year olds and their parents surveyed. Government funded study Lives of Irish children will be better understood 19% Mental and behavioural conditions Further follow-up at age 13

43 Adolescent Brain Development Study 1131 children filled out questionnaires years old Strengths and Difficulties Questionnaire 7% Abnormal score 14% Borderline score

44 212 children interviewed Adolescent Brain Development Study Interview Results 15% current mental disorder (1 in 6) 37% lifetime mental disorder (1 in 3) Commonest diagnosis was anxiety disorder (25% ) followed by mood disorder (16%) Suicidal thoughts in 7% Risk factors: Depression and psychotic symptoms Unmet need for assessment and treatment

45 Irish yr-old suicide rate, Male Female Rate per 100, Slide courtesy of Paul Corcoran (NSRF)

46 Is suicide a major cause of death in Ireland? Suicide accounted for 460 (1.6%) of the 28,488 deaths that occurred in , 2% 1,008 4% 4,591 16% 10,666 37% Circulatory system Malignant neoplasms Respiratory system 4,079 14% 7,828 27% Digestive system Suicide Other Slide courtesy of Paul Corcoran NSRF

47 Is suicide a major cause of death among young adults in Ireland? Suicide accounted for 204 (24.0%) of the 850 deaths of year-olds that occurred in % 8% 18% 9% 10% 2% 2% 24% Circulatory system Malignant neoplasms Respiratory system Digestive system Suicide Transport accidents Drug dependence Other Slide courtesy of Paul Corcoran NSRF

48 Suicide in Ireland and in other EU Suicide in Ireland and in other EU 35 countries Age-standardised rate per 100,000 Lithuania Slovenia Hungary Latvia Belgium Estonia Finland France Austria Czech Republic Poland Denmark Sweden Bulgaria Slovakia Germany Romania Portugal Luxembourg Netherlands Ireland Spain Italy UK Malta Greece Slide courtesy of Paul Corcoran NSRF

49 10-14yrs 15-19yrs 20-24yrs 25-29yrs 30-34yrs 35-39yrs 40-44yrs 45-49yrs 50-54yrs 55-59yrs 60-64yrs 65-69yrs 70-74yrs 75-79yrs 80-84yrs 85yrs Suicide in Europe by age Male Female Average annual rate per 100,000

50 10-14yrs 15-19yrs 20-24yrs 25-29yrs 30-34yrs 35-39yrs 40-44yrs 45-49yrs 50-54yrs 55-59yrs 60-64yrs 65-69yrs 70-74yrs 75-79yrs 80-84yrs 85yrs Suicide in Ireland by age Men Women Annual rate per 100,000

51 Youth Suicide and Freedom An international comparison Eckersley and Dear (2002)

52 Peak rate of Deliberate Self Harm among years old girls

53 The Facts 1 in 6 Irish children meet criteria for a mental disorder 75% of adult mental disorders evident in adulthood have already started by age 18 The peak rate for Deliberate Self Harm among Irish females is years of age Suicide accounts for 24% of deaths in the year age group

54 Building Bridges

55 Professor Pat McGorry :Australian of the Year 2010

56 headspace Western Melbourne

57 Young Person phone or walk-in External Referral Not within headspace charter Community GPs & Other Services o Engagement o Case management o Specialist services eg autism o Forensic o PDSS o recreational Brief intervention Comorbid substance use & mental health Simple Intervention Depression / anxiety No previous treatment Family Referral Agencies School - based Health Nurses Youth Support agencies TAFE & Other Education orgs. Welfare org. Phone or in person Brief assessment carried out Information provided Referral to external agency if more appropriate Access Team Headspace assessment: Psych registrar Clinical staff Case Review Case reviewed & interventions recommended Integrated & Co-ordinated Care GP o Primary care o Mental health plan Allied Health (private & DoHA) o Clinical work o Group Program Vocational and educational management REVIEW & EXIT State Funded MHS o Job search External Referral External Referral Not within headspace charter o Psychiatric services o Assessment o Engagement o Clinical services o Access team o Supportive counseling o Referral and linking

58 Where to get help

59 Get on Board for Youth Mental Health

60 On Board for Youth Mental Health

61 A New Hope? Leaders Debate Tues 22 nd Feb 2011 'IF THERE WAS one key social justice issue you would pursue in government, what would it be?'' This question, posed in the dying minutes of last week's final leaders' debate, forced the would-be taoisigh to pin their colours to the mast. All eyes were on Enda Kenny, king of the polls. "I feel the priority should be the 300,000 people who suffer from mental illness," said Kenny, "the 75,000 people who attempt self-harm and those who have the tragedy of suicide visit their families." Irish Times Mar 1 st 2011

62 Acknowledgements Dept Psychiatry, RCSI and Beaumont Hospital Ian Kelleher Mary Clarke Dearbhla Connor Nina Devlin Sarah Roddy National Suicide Research Foundation Paul Corcoran Helen Keally Institute of Psychiatry, London Robin Murray Louise Arseneault Temi Moffitt Avshalom Caspi Dept Child and Adolescent Psychiatry, Mater Hospital and UCD Prof Carol Fitzpatrick Dr Fionnuala Lynch Dr Michelle Harley