Title: Early identification and treatment of young people at high risk of recurrent mood disorders: a feasibility study
Funder: Department of Health (England)

Abstract: Background Depression and bipolar disorder are prevalent, recurrent life course disorders that usually begin in adolescence/early adulthood. The introduction of Early Intervention in Psychosis services (EIP) has transformed the NHS approach to schizophrenia, but there is no equivalent strategy to improve early case identification or treatment rates for recurrent mood disorders. Depression is ranked 1st and bipolar disorder 6th (above schizophrenia) in the global burden of diseases study, but fewer than 50% of younger adults with mood disorders access traditional health services and EIP have not reversed this underutilization. Before advocating new services or changes to EIP we first need to clarify our clinical understanding of early onset recurrent mood disorders and barriers to effective treatment Aims We will gather quantitative and qualitative data to inform core components of a future programme grant application. This study will: (a) explore the feasibility of identifying young persons at risk of recurrent depression or bipolar disorder currently accessing a range of clinical services (b) examine the utility and acceptability of a psychological intervention specifically targeted at overcoming current problems and reducing the risk of future mood episodes (c) establish stakeholder and young people panels (with input from parents) to help identify barriers to engagement, potential modifications to current services, and through feedback on study findings consider clinical innovations and research priorities Plan of Investigation In 16-25 year olds, we will: 1. Retrospectively assess the number of and presentation of clinically diagnosed cases of mood disorders across a range of NHS settings over the preceeding 2 years 2. Prospectively examine the feasibility and acceptibility of using self-rating tools to detect mood episodes and identify those at high risk of recurrences 3. Assess symptoms, quality of life, service use and stability of diagnosis over one year 4. Explore the uptake, acceptability and outcomes of a CBT intervention specifically for individuals at high risk of recurrent mood disorder 5. Develop young people panels to discuss their (and parental) views on acceptable service models We will also establish stakeholder and steering and monitoring groups to review study findings Potential Impact The study will be an important vehicle for developing a dialogue between patients, parents, the public, primary care and NHS services so that all are involved from the outset in openly discussing possible service modifications that might enable providers to respond more effectively to young people at risk of recurrent mood disorders in adulthood. It will raise clinical awareness of the risk of recurrent mood disorders in youth and may increase case recognition and treatment. It will help establish whether screening is acceptable to services and patients; feedback about the therapy and its outcomes will inform modifications to maximize treatment acceptability to our target population. Longer term, the project could generate a more coordinated and effective NHS approach to mood disorders.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH