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      A Digital Platform Designed for Youth Mental Health Services to Deliver Personalized and Measurement-Based Care

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          Abstract

          Mental disorders that commonly emerge during adolescence and young adulthood are associated with substantial immediate burden and risks, as well as potentially imparting lifetime morbidity and premature mortality. While the development of health services that are youth focused and prioritize early intervention has been a critical step forward, an ongoing challenge is the heterogeneous nature of symptom profiles and illness trajectories. Consequently, it is often difficult to provide quality mental health care, at scale, that addresses the broad range of health, social, and functional needs of young people. Here, we describe a new digital platform designed to deliver personalized and measurement-based care. It provides health services and clinicians with the tools to directly address the multidimensional needs of young people. The term “personalized” describes the notion that the assessment of, and the sequence of interventions for, mental disorders are tailored to the young person—and their changing needs over time, while “measurement-based” describes the use of systematic and continuing assessment of a young person’s outcomes over the entire course of clinical care. Together, these concepts support a framework for care that transcends a narrow focus on symptom reduction or risk reduction. Instead, it prioritizes a broader focus on enhancing social, health, and physical outcomes for young people and a commitment to tracking these outcomes throughout this key developmental period. Now, with twenty-first century technologies, it is possible to provide health services with the tools needed to deliver quality mental health care.

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          Most cited references72

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          Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication.

          Little is known about lifetime prevalence or age of onset of DSM-IV disorders. To estimate lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the recently completed National Comorbidity Survey Replication. Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview. Nine thousand two hundred eighty-two English-speaking respondents aged 18 years and older. Lifetime DSM-IV anxiety, mood, impulse-control, and substance use disorders. Lifetime prevalence estimates are as follows: anxiety disorders, 28.8%; mood disorders, 20.8%; impulse-control disorders, 24.8%; substance use disorders, 14.6%; any disorder, 46.4%. Median age of onset is much earlier for anxiety (11 years) and impulse-control (11 years) disorders than for substance use (20 years) and mood (30 years) disorders. Half of all lifetime cases start by age 14 years and three fourths by age 24 years. Later onsets are mostly of comorbid conditions, with estimated lifetime risk of any disorder at age 75 years (50.8%) only slightly higher than observed lifetime prevalence (46.4%). Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups. About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth.
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            Research domain criteria (RDoC): toward a new classification framework for research on mental disorders.

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              The Lancet Commission on global mental health and sustainable development

              The Lancet, 392(10157), 1553-1598
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                Author and article information

                Contributors
                Journal
                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                1664-0640
                23 August 2019
                2019
                : 10
                : 595
                Affiliations
                [1] 1Brain and Mind Centre, University of Sydney , Sydney, NSW, Australia
                [2] 2Research and development, Innowell, Pty Ltd. , Sydney, NSW, Australia
                [3] 3School of Medicine, University of Notre Dame , Sydney, NSW, Australia
                Author notes

                Edited by: Mario Alvarez-Jimenez, University of Melbourne, Australia

                Reviewed by: Catherine Doyen, Centre Hospitalier Sainte-Anne, France; Victoria E. Cosgrove, Stanford University, United States; Levi van Dam, University of Amsterdam, Netherlands

                *Correspondence: Frank Iorfino, frank.iorfino@ 123456sydney.edu.au

                This article was submitted to Child and Adolescent Psychiatry, a section of the journal Frontiers in Psychiatry

                Article
                10.3389/fpsyt.2019.00595
                6716201
                31507465
                28585a44-f29d-48d7-97b0-30a1b8c1da33
                Copyright © 2019 Iorfino, Cross, Davenport, Carpenter, Scott, Shiran and Hickie

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 11 January 2019
                : 26 July 2019
                Page count
                Figures: 3, Tables: 0, Equations: 0, References: 75, Pages: 9, Words: 4201
                Categories
                Psychiatry
                Perspective

                Clinical Psychology & Psychiatry
                youth,transdiagnostic,mental health care,technology,ehealth,mental disorders,routine outcome monitoring

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