Process Evaluation of a Treatment Program for Mood and Anxiety Disorders Among Emerging Adults: Preentry Factors, Engagement, and Outcomes.

OBJECTIVE: Effective mental health services for emerging adults are needed. This work evaluated the logic model of one such program and assessed participation and medium-term outcomes. METHODS: Baseline data were collected from 398 emerging adults attending an intake appointment at a mood and anxiety disorders treatment program in Canada for persons ages 16-25. Questionnaires about demographic characteristics, prior help seeking, symptoms, functional impairment, and health satisfaction were completed at baseline and at follow-up, approximately 2 to 10 months later (mean=6 months), depending on participants' availability and willingness. Program satisfaction was also assessed. Preentry characteristics and disengagement were evaluated. Repeated-measures analyses were used to evaluate outcomes. RESULTS: The program did not require physician referral; however, emerging adults who contacted the program had extensive prior help seeking: 73% had seen a family doctor and 32% had visited an emergency department. Among 370 individuals for whom full intake data were available, scores indicated moderate depression, moderate anxiety, and low satisfaction with quality of health. They reported either not functioning or underfunctioning for a mean of 4.3 days per week. Follow-up data indicated significant improvement on all measures, including clinically significant improvement in both depression and functioning. Patient satisfaction was high, and quality of health improved significantly. CONCLUSIONS: Results indicate that the model studied, which emphasizes early-stage intervention for mood and anxiety disorders among emerging adults, was associated with statistical and clinical improvement at intermediate follow-up. Outputs and medium-term outcomes of the model were satisfied.

Expectations vs reality: The expectations and experiences of psychiatric treatment reported by young adults at a mood and anxiety outpatient mental health program.

AIM: To compare young adults' expectations of psychiatric treatment to their actual experiences and identify myths and assumptions that youth might hold prior to receiving care. METHODS: We interviewed youth who engaged in at least 4 months of treatment at the First Episode Mood and Anxiety Program to theme saturation (N = 20). They were asked about their experience of treatment and the expectations they had prior to care. Transcribed interviews were analysed for themes. RESULTS: Results indicated that participants often expected a cold, serious atmosphere, a "quick fix," and a directive therapeutic relationship. Although most patients had a negative experience at some point in their care, they overall described a welcoming environment with engaged providers and a collaborative therapeutic relationship. Participants found treatment more complex than they had anticipated, but ultimately experienced strengthening of agency and a change in perspective. CONCLUSIONS: These results identify a need to recognize assumptions held by young adults seeking treatment for mental health symptoms. Addressing these preconceptions might reduce apprehension and improve readiness for treatment. This research provides direction on how to dispel myths and better prepare youth for the work involved in effective psychiatric care.

Youth Perspectives on the Mental Health Treatment Process: What Helps, What Hinders?

In this study we explored adolescent perceptions of what was most helpful and most challenging about mental health treatment for mood and/or anxiety disorders. Youth seeking treatment at the First Episode Mood and Anxiety Program were recruited to participate in a follow-up survey about their experiences of mental health care services. Responses to two open-ended questions were analyzed for emerging themes and differences between age groups and gender. Males were more likely to report therapy as being helpful than females, 16-18 year olds were more likely to report medication as a challenge to treatment and 19-26 year olds were more likely to report accessing services as a challenge to treatment. Understanding what helps and what hinders treatment-seeking youth can guide both clinical treatment and service delivery models for this population.

Presenting concerns of emerging adults seeking treatment at an early intervention outpatient mood and anxiety program.

This study examined presenting concerns and characteristics of emerging adults (EAs) seeking treatment at an early intervention program for mood and anxiety disorders to better understand presenting concerns when treatment is needed. During an intake assessment conducted by a social worker or clinical psychologist, participants (N = 548; 62% female, 38% male) reported their top three current life concerns, which were analyzed qualitatively using thematic analysis. Participants completed a battery of questionnaires assessing demographic information, symptomatology, and daily functioning. Females presented with significantly higher levels of anxiety, and both females and younger individuals (age 16-18) presented with significantly higher levels of depression compared to males and older individuals (age 19-26), respectively. The two most commonly reported presenting concerns were problems in interpersonal relationships and academics, and females were more likely to report academic concerns than males. The majority of participants reported seeking help for a wide range of problems commonly faced by EAs (83.7%), and participants rarely expressed concerns about particular symptoms of mood and/or anxiety disorders (16.3%). EAs and those supporting EAs may benefit from learning when psychosocial concerns are indicative of mental health challenges warranting professional attention.

Early Intervention in Mood and Anxiety Disorders: The First Episode Mood and Anxiety Program (FEMAP).

The First Episode Mood and Anxiety Program (FEMAP) was developed for youth with mood and/or anxiety concerns in London, Ontario, to provide early intervention for these disorders, similar to the first-episode psychosis programs across Ontario and Canada. The logic and causal models of the pathway to and through FEMAP are described and inclusion/exclusion criteria are delineated. Results of the process evaluation of the model and preliminary data from a treatment-effectiveness evaluation and ongoing cost-comparison evaluation are provided. Several characteristic quotes from youth utilizing the service are included, as is an overview of utilization statistics. Challenges and lessons learned are conveyed.

Process Evaluation of an Early-Intervention Program for Mood and Anxiety Disorders Among Older Adolescents and Young Adults.

OBJECTIVE: Research to determine the best approach for providing early intervention for mood and anxiety disorders is imperative. The authors describe a process evaluation of an early-intervention program for transition-age youths with mood or anxiety disorders. METHODS: Causal and logic models for pathways to care for the program, as well as descriptive data from 548 participating youths, are presented. Follow-up measures of functional improvement are reported. RESULTS: Diagnostic characterization, symptom severity, and functional impairment of participants indicated that the model selected an appropriate catchment population without creating excessive overinclusion. Self-referred youths reported greater anxiety and substance use. Acceptance by the program was predictive of greater follow-through with treatment. Several variables, including frequent lifetime marijuana use, predicted loss to follow-up. At follow-up, youths were significantly functionally improved. CONCLUSIONS: This process evaluation indicated that the model provided appropriate early intervention for youths with mood or anxiety disorders without causing excessive overinclusion.

Cannabis use, addiction risk and functional impairment in youth seeking treatment for primary mood or anxiety concerns.

Cannabis use is common in youth and there is evidence that the co-occurrence of cannabis use (and other substance use) with mental illnesses predicts poorer outcomes, including suicide. The main purposes of this study were to: (i) identify rates of cannabis use and substance use disorder risk, and (ii) predictors for cannabis use among youth seeking help for mood and/or anxiety concerns in a sample population prescreened to exclude primary substance use disorders; and (iii) to determine if there was an association between cannabis use and functional impairment in this sample. We investigated substance use risk as well as hypothesized predictors of cannabis use and functional impairment including demographic characteristics, socioeconomic status, trait coping style, age of onset of several risk behaviors, current use of common addictive substances, level of functional impairment, and current psychiatric symptom severity. Results showed that approximately half of the participants were at moderate to high risk for a substance use disorder, and just over 4% appeared to have a primary substance use disorder. They also suggested an association between cannabis use and gender (male), age of first cannabis use, recent cigarette use, and functional impairment. Independently, functional impairment was predicted by inattentive coping style, depression severity, and total cannabis use score. These results confirm a high risk for addictive disorders and an association between cannabis use and functional impairment in this sample. These results support the need for substance use treatment programs to optimize care wherever youth with primary mood and/or anxiety concerns are seen.