Applying clinical staging to young people who present for mental health care


  • Declaration of conflict of interest: Professor Ian B. Hickie (‘IBH’) is the executive director of the Brain & Mind Research Institute, a Centre of the University of Sydney. He is a member of the Medical Advisory Panel for BUPA Health Insurance (Australia) and also a Board Member of Psychosis Australia Trust. From 2012, he is a Commissioner in Australia's new National Mental Health Commission. IBH was previously (until 2012) a director of headspace: the national youth mental health foundation. IBH was previously chief executive officer (till 2003) and clinical adviser (till 2006) of beyondblue, an Australian National Depression Initiative. He has led projects for health professionals and the community supported by governmental, community agency and drug industry partners (Wyeth, Eli Lily, Servier, Pfizer, AstraZeneca) for the identification and management of depression and anxiety. He has served on advisory boards convened by the pharmaceutical industry in relation to specific antidepressants, including nefazodone, duloxetine and desvenlafaxine, and has participated in a multicentre clinical trial of agomelatine effects on sleep architecture in depression. IBH is also supported by a National Health and Medical Research Council Australian Medical Research Fellowship. In addition to national and international Government-based grant bodies, investigator-initiated mental health research at the BMRI has been supported by various pharmaceutical manufacturers (including Servier and Pfizer) and not-for-profit entities (including the Heart Foundation, beyondblue and the BUPA Foundation). IBH has previously received support for travel to international and national research meetings from a range of independent associations and the pharmaceutical industry (including Servier, Pfizer, Eli-Lilly, Wyeth and Astra Zeneca). A/Professor Nicholas Glozier currently receives funding for investigator initiated research from the National Health and Medical Research Council, Australian Research Council, the Wellcome Trust, the Heart Foundation and beyondblue. In the past three years he has received support for travel to present research findings at international and national research meetings from Epilepsy Action, the National Heart Foundation, Lundbeck and Servier. He has received an honorarium for an expertreport from Servier Laboratories.

Professor Ian B. Hickie, Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, 100 Mallet Street, Camperdown, NSW 2050, Australia. Email:


Aim: The study aims to apply clinical staging to young people who present for mental health care; to describe the demographic features, patterns of psychological symptoms, disability correlates and clinical stages of those young people; and to report longitudinal estimates of progression from less to more severe stages.

Methods: The study uses cross-sectional and longitudinal assessments of young people managed in specialized youth clinics. On the basis of clinical records, subjects were assigned to a specific clinical ‘stage’ (i.e. ‘help-seeking’, ‘attenuated syndrome’, ‘discrete disorder’ or ‘persistent or recurrent illness’).

Results: Young people (n = 209, mean age = 19.9 years (range = 12–30 years), 48% female) were selected from a broader cohort of n = 1483 subjects. Ten percent were assigned to the earliest ‘help-seeking’ stage, 54% to the ‘attenuated syndrome’ stage, 25% to the ‘discrete disorder’ stage and 11% to the later ‘persistent or recurrent illness’ stage. The interrater reliability of independent ratings at baseline was acceptable (κ = 0.71). Subjects assigned to the ‘attenuated syndrome’ stage reported symptom and disability scores that were similar to those assigned to later stages. Longitudinally (median = 48 weeks), transition to later clinical stages were 11% of the ‘help-seeking’, 19% of the ‘attenuated syndrome’ and 33% of the ‘discrete disorder’ groups.

Conclusion: Among young people presenting for mental health care, most are clinically staged as having ‘attenuated syndromes’. Despite access to specialized treatment, a significant number progress to more severe or persistent disorders.