Literature Collection

This editorial argues for integrated, developmentally informed models of mental health care for adolescents that address pervasive structural misalignments across health, education and social care. Adolescent admissions must be understood within a whole-system and lifespan framework, recognising varied reasons for admission and long-term impacts on engagement, trust and identity.

BACKGROUND: With the increasing median age of people with multiple sclerosis (MS), age-related syndromes such as frailty have emerged as new challenges to patient well-being. Prior research on frailty in MS has primarily focused on physical aspects, leaving the relationship between frailty and mental health unexplored. OBJECTIVE: To investigate the associations between frailty, mental health, and quality of life (QoL) in people with MS. DESIGN: Cross-sectional questionnaire-based study conducted at the Center for MS Care at the University of Kansas Medical Center. METHODS: Participants completed validated measures of frailty (Tilburg Frailty Indicator), anxiety and depression (Hospital Anxiety and Depression Scale), QoL (Multiple Sclerosis Quality of Life-54), and disability level (Patient-Determined Disease Steps). RESULTS: A total of 204 patients with MS (median age: 51 (interquartile range = 18) years, 74% women) took part in the study. Overall, 50.5% of respondents were classified as frail. Frail participants were older than their non-frail counterparts (p = 0.018) and had higher levels of anxiety and depression (p < 0.001). Frailty status was also associated with lower QoL scores across physical and mental health domains (p < 0.001). In logistic regression analyses adjusted for age, sex, and disability, higher anxiety scores (odds ratio (OR) = 1.45, 95% confidence interval (CI) (1.28, 1.65), p < 0.001) and depression scores (OR = 1.58, 95% CI (1.365, 1.843), p < 0.001) were associated with greater odds of being frail. CONCLUSION: This study revealed a strong association between frailty, mental health, and QoL in people with MS. These findings underscore the need for greater attention to both physical and psychological well-being in people with MS. Future research should explore whether integrated care strategies may improve outcomes in this population.; Frailty, mental health, and quality of life in people with multiple sclerosis This study revealed strong associations between frailty and mental health measures, independent of age, sex, and disability, in people with MS. Frail participants exhibited a higher proportion of anxiety (58.3% vs. 14.9%) and depressive symptoms (41.7% vs. 5.0%), as well as lower quality of life, compared to the non-frail. These observations emphasize the importance of conducting further research on integrated care strategies to maximize both the physical and psychological well-being in MS communities.; eng

BACKGROUND: Generalized anxiety disorder (GAD) is one of the most common mental disorders in primary care (PC). GAD has low remission and high relapse rates over long follow-up periods. Qualitative evidence was synthesized to understand the implementation of care and treatment options for people with GAD in PC. METHODS: Research published from 2008 to September 2020 was searched in five databases (MEDLINE, EMBASE, CINAHL, WOS and PsycArticles). Studies that used qualitative methods for data collection and analysis to investigate the implementation of care and treatment options for people with GAD in PC and outpatient settings were included. Non-qualitative studies, mixed methods studies that did not separately report qualitative findings and studies in languages other than English or Spanish were excluded. We used the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) framework to assess the overall confidence in the findings. RESULTS: The results with a moderate level of confidence showed that the trajectory of care for people with GAD in PC and outpatient settings is long and fluctuates over time, involving multiple difficulties in accessing and maintaining initial treatment or successive treatment options. In addition, there are wide variations in the preferences for and acceptability of different treatment options. The results with a high level of confidence indicated that more information on GAD and its treatment options is needed for PC practitioners, GAD patients and their carers. The results with a low level of confidence suggested that patients use antidepressants for longer than recommended and that the interruption of treatment is not usually planned. CONCLUSIONS: Initial resistance to new treatments among people with GAD can make access and adherence to treatment difficult. Improving care may require patients to be informed of possible trajectories in stepped care pathways before the initiation of treatment so they are aware that they may need to try a number of options until the most effective treatment for them is found. Increased awareness of and information materials on GAD may facilitate both appropriate diagnosis and long-term care.

BACKGROUND: Early intervention for eating disorders (EDs) models and services is not formalized in Canada, despite increasing demand for care and well-established clinical, social, and economic benefits of intervening early. PURPOSE: FREEDcan (First Episode Rapid Early Intervention for Eating Disorders-Canada) introduces a community-based model to improve early identification, initial response, and access to evidence-based interventions for young people aged 8-25 years with early-stage EDs. METHODS: FREEDcan was co-adapted from the United Kingdom's evidence-based FREED model for the Canadian context with a multi-partner advisory group of clinicians, community organizations, youth and family advisors, researchers, and an implementation science team. It has three pillars: early identification, initial response, and evidence-based interventions for early-stage EDs. Implementation is supported by intersectoral partnerships, community-driven adaptation, and integrated workforce expansion to build capacity and facilitate sustainable, integrated early intervention. ANTICIPATED OUTCOMES: From a service perspective, FREEDcan aims to improve early detection of EDs, reduce duration of untreated illness through rapid, low-barrier responses, and increase access to stage-appropriate interventions. Additional implementation-based outcomes are anticipated, including evidence for core components, costs, and adaptations relevant to scaling this model in diverse regions across Canada. CONCLUSIONS: FREEDcan has the potential to provide an accessible, youth-centered, developmentally appropriate approach to early ED care within a collaborative, community-driven, integrated care framework. Using a learning health systems approach, it strives for continuous evaluation to support real-time learning, opportunities for model improvement, and evidence-generation for a new integrated model of care for early-stage ED care for young people in Canada.; FREEDcan is a new early intervention model in Canada aimed at helping young people aged 8–25 years receive support for eating disorders (EDs) as early as possible. Although the need for ED care is increasing, early intervention has not been widely available in Canada. FREEDcan, adapted from the UK’s FREED model, seeks to address this gap by identifying EDs early, responding quickly, and providing treatments that are proven to work in the early stages. The model was developed through a collaborative process that integrates research, clinical expertise, and lived expertise. FREEDcan involves partnerships across different sectors including community and primary care so that early intervention can be built into existing care systems. FREEDcan also works to raise awareness about EDs, expand and strengthen the workforce, and make early support more accessible. FREEDcan’s community-driven strategy helps young people and their families receive timely and appropriate support no matter where they live. The model is continuously evaluated, allowing for real-time learning and adaptation for real-time learning and adaptation. By fostering collaboration and integrated care, FREEDcan has the potential to significantly improve early intervention for EDs in Canada, making care more accessible, equitable, and effective.; eng

Frequent emergency department (ED) users often have complex behavioral health and social needs. However, policy makers often focus on this population's medical system use without examining its use of behavioral health and social services systems. To illuminate the wide-ranging needs of frequent ED users, we compared medical, mental health, substance use, and social services use among nonelderly nonfrequent, frequent, and superfrequent ED users in San Francisco County, California. We linked administrative data for fiscal years 2013-15 for beneficiaries of the county's Medicaid managed care plan to a county-level integrated data system. Compared to nonfrequent users, frequent users were disproportionately female, white or African American/black, and homeless. They had more comorbidities and annual outpatient mental health visits (11.93 versus 4.16), psychiatric admissions (0.73 versus 0.07), and sobering center visits (0.17 versus <0.01), as well as disproportionate use of housing and jail health services. Our findings point to the need for shared knowledge across domains, at the patient and population levels. Integrated data can serve as a systems improvement tool and help identify patients who might benefit from coordinated care management. To deliver whole-person care, policy makers should prioritize improvements in data sharing and the development of integrated medical, behavioral, and social care systems.