Exploring associations between early substance use and longitudinal socio-occupational functioning in young people engaged in a mental health service

Jacob J Crouse; Kate M Chitty; Frank Iorfino; Django White; Alissa Nichles; Natalia Zmicerevska; Adam J Guastella; Ahmed A Moustafa; Daniel F Hermens; Elizabeth M Scott; Ian B Hickie

doi:10.1371/journal.pone.0210877

Exploring associations between early substance use and longitudinal socio-occupational functioning in young people engaged in a mental health service

PLoS One. 2019 Jan 17;14(1):e0210877. doi: 10.1371/journal.pone.0210877. eCollection 2019.

Authors

Jacob J Crouse¹, Kate M Chitty², Frank Iorfino¹, Django White¹, Alissa Nichles¹, Natalia Zmicerevska¹, Adam J Guastella¹, Ahmed A Moustafa^{3

4

5}, Daniel F Hermens^{1

6}, Elizabeth M Scott^{1

7}, Ian B Hickie¹

Affiliations

¹ Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia.
² Translational Australian Clinical Toxicology (TACT) Research Group, Discipline of Pharmacology, The University of Sydney, Camperdown, NSW, Australia.
³ School of Social Sciences and Psychology, Western Sydney University, Milperra, NSW, Australia.
⁴ MARCS Institute for Brain, Behaviour and Development, Milperra, NSW, Australia.
⁵ Department of Social Sciences, College of Arts and Sciences, Qatar University, Doha, Qatar.
⁶ Sunshine Coast Mind and Neuroscience-Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia.
⁷ Notre Dame Medical School, Sydney, NSW, Australia.

Abstract

Neuropsychiatric disorders (including substance misuse) are associated with the greatest burden of functional disability in young people, and contributory factors remain poorly understood. Early-onset substance use is one candidate risk factor which may inform functional prognosis and facilitate direction of interventions aiming to curtail impairment. Accordingly, we modelled associations between early-onset use of alcohol, tobacco, cannabis and amphetamine-type stimulants (ATSs) and longitudinal socio-occupational functioning (indexed by the Social and Occupational Functioning Assessment Scale) in an observational cohort presenting to early intervention mental health services. A clinical proforma collated demographic, clinical, and socio-occupational information for up to 60-months from presentation to services in young people aged 17-30. Of the wider cohort (n = 2398), 446 participants were selected with complete alcohol and substance use data. Latent class analysis was used to derive an 'early-onset' (n = 243) and 'later-onset' class (n = 203) based on age of first use of alcohol, tobacco, cannabis and ATSs. Maximum-likelihood multilevel analyses modelled functioning over time in care and tested associations with substance use latent class, age, gender and diagnosis. Membership in the 'early-onset' class (B = -1.64, p = 0.05), male gender (B = -3.27, p<0.001) and psychotic disorder diagnosis (B = -7.62, p<0.001) were associated with poorer functioning at presentation and at least one other time-point. To our knowledge, this is the first study to explore associations of early-onset substance use and longitudinal functioning in a cohort of young people with mental disorders. The identified factors may be useful for directing specific social (e.g. Social Recovery Therapy) or occupational (e.g. Individual Placement and Support) interventions to at-risk individuals, early in illness course.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Age of Onset
Cohort Studies
Comorbidity
Early Medical Intervention
Employment
Female
Humans
Likelihood Functions
Longitudinal Studies
Male
Mental Disorders / epidemiology
Mental Disorders / psychology
Mental Health Services
Models, Psychological
New South Wales / epidemiology
Social Support
Socioeconomic Factors
Substance-Related Disorders / epidemiology*
Substance-Related Disorders / psychology*
Young Adult

Grants and funding

JC was supported by a postgraduate Research Training Program Stipend (provided by The University of Sydney, no stipend number). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. KC funding provided by NHMRC Early Career Fellowship Grant (number: 1122362). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. FI was supported by an Australian Postgraduate Award stipend (no stipend number). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. AN was supported by Brain & Mind Centre, Clinical Research Officer. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. NZ was supported as Research Officer at the Brain and Mind Centre, University of Sydney. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. DW was employed by The University of Sydney. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. AM was supported as Senior Lecturer, Western Sydney University. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. AG was supported by NHRMC Career Development Fellowship, The University of Sydney. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. DH was supported by Sunshine Coast Mind & Neuroscience Thompson Institute. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. ES was supported as Medical Director, Young Adult Mental Health Unit, St Vincent’s Hospital Darlinghurst, Discipline Leader of Adult Mental Health, School of Medicine, University of Notre Dame, Research Affiliate, The University of Sydney and Consultant Psychiatrist. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. IH was supported by (2018-2022) Optimising Personalised Care, at scale, for Young People with Emerging Mood Disorders, $951,005 over 5 years (APP1136259); NHMRC Research fellowship (no. 1046899). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.