Unrecognized schizophrenia spectrum and other mental disorders in youth disconnected from education and work-life.

Background: Schizophrenia spectrum disorders typically emerge during adolescence or early adulthood. Often the symptomatology is vague initially, while a marked functional decline and social withdrawal can be seen. A group of young people with such social and functional impairments is the so-called "Not in Education, Employment or Training" (NEET), i.e., a youth population that is socially disconnected from education and work-life. Despite the NEET group's disconnection from important parts of social life and a rising concern of an intersection with mental health problems, a psychopathological perspective on the problems experienced by this group remains underexplored. Aim: To examine a NEET sample for psychopathology and if relevant allocate psychiatric diagnoses. Methods: We performed an interview study comprising 40 participants from youth job-counseling services. All underwent a comprehensive psychiatric evaluation. Inclusion criteria were 18-29 years of age and a welfare benefit history of minimum 6 months. Results: Diagnostic criteria of any mental disorder were fulfilled by 95% of the sample; half of whom were diagnosed with a schizophrenia spectrum disorder. The participants with schizophrenia spectrum disorders had lower global functioning, were more often in contact with the mental health services and had higher PANSS and Examination of Anomalous Self-Experiences (EASE) scores compared to those with non-schizophrenia spectrum disorders. The participants fulfilling the criteria for schizophrenia spectrum disorders had lower EASE and PANSS scores than usually reported in the literature, suggesting more "symptom-poor" presentations. Conclusion: Psychiatric illness and particularly schizophrenia spectrum disorders affecting social interaction and the ability to take part in educational and work-life were grossly overrepresented in the NEET sample. Our findings suggest that pronounced social disconnection in youth in and of itself should lead to suspect the presence of a severe mental disorder.

Self-reported mental health in adolescents attending school and its association with later school dropout: A prospective 2.5-year follow-up study.

AIMS: Mental health problems in young people are associated with educational outcomes. There are persistent difficulties in screening for these problems and mapping the trajectories of mental health in relation to academic and work outcomes. We investigated whether Strength and Difficulties Questionnaire (SDQ) scores in adolescents attending school were associated with school dropout in upper secondary school, both in adolescents with already recognised mental disorders and adolescents without known mental disorders. METHODS: The data consisted of a questionnaire targeting 13,100 adolescents attending the final year of compulsory school combined with data derived from a national register. SDQ scores were divided into normal, borderline and abnormal scores. School dropout in upper secondary school was identified during a 2.5-years follow-up period. We stratified the data by recognised mental disorders. Logistic regression was performed to examine the association between SDQ scores and later school dropout with adjustment for parents' mental disorders, parents' educational level, sex, suicidal thoughts, school absence and negative childhood events. RESULTS: During follow-up, 18.5% of adolescents experienced school dropout. Adolescents with abnormally high SDQ scores and borderline SDQ scores had higher odds for school dropout than adolescents with SDQ scores in the normal range. The association remained in the adjusted analysis, although more covariates showed independent contributions in association with school dropout. CONCLUSIONS: Self-reported SDQ scores in adolescents attending school were associated with later school dropout irrespective of recognised mental disorders, indicating that markers such as the SDQ might contribute to the identification of vulnerable adolescent groups, although the findings of multifactorial contributions suggest we should consider more indicators in a risk assessment for school dropout.

Help-Seekers in an Early Detection of Psychosis Service: The Non-cases.

Purpose: Enhancing early help-seeking is important for early intervention in psychosis. However, knowledge is limited about those help-seekers who are not initially found to have psychotic symptoms when assessed in services aiming at psychosis detection and, thus, deemed ineligible for early intervention of psychosis programs. We aimed to examine clinical diagnostic and socioeconomic pathways of help-seekers accessing an early detection of psychosis service with referral-free access. Specific focus was on the help-seekers initially assessed not to have psychotic symptoms, considered the non-cases, and to examine potential differences and similarities between non-cases and cases (i.e., those initially assessed to have psychotic symptoms). Methods: We followed 450 help-seekers assessed by a free-of-referral early detection of psychosis team in national registers for up to 4 years. We examined clinical diagnoses and status of not in education, employment, or training (NEET) before and after contact with the team. Results: Of the non-cases, 46% were referred to mental health services by the early detection of psychosis team for evaluation of other mental disorders, and 15% of these were subsequently diagnosed with a non-affective psychotic disorder during follow-up of 12-52 months. Prior to current help-seeking, 39% (n = 174) of the help-seekers had had contact with other mental health services. Nearly a quarter of help-seekers were NEETs at the time of assessment; the number increased during follow-up, both for cases and non-cases. Of the cases, 58% were subsequently clinically diagnosed by mental health services. Those seeking help who had no previous contact with mental health services were more frequently diagnosed with a non-affective psychotic disorder during follow-up (p = 0.05). Conclusion: Referral-free services to promote early detection of psychosis seem a valuable add-on to established pathways, allowing early intervention in psychosis. Our results point to an unmet mental health service need among non-cases; overall, in our sample, independent of case status, social functioning was markedly affected. Our results have implications for future focus in early detection of psychosis. Offering intervention to non-cases within the service has the potential to be cost effective, e.g., if a timely and targeted intervention reduces repeated contacts in other mental health services and social services.