Development of a Clinical, Psychosocial, and Comorbidity Service Needs Index for Youth Mental Health Care: An Exploratory Study (Preprint)

BACKGROUND The treatment needs of young people seeking mental health care are complex, challenging health services to identify and deliver a highly-personalized mix of interventions. Although many clinical decision-support tools exist for prognostication or assessing the risk of a specific outcome occurring, there is a necessity for tools to evaluate the multidimensional needs across domains relevant to treatment planning. OBJECTIVE We aimed to develop a service needs index that measures a young person’s needs across domains relevant to care provision and to examine the index’s construction under different assumptions. METHODS A cohort of young people (n=2193) aged 12-25-years who sought help at youth mental health services across Australia were invited to use a digital platform (Innowell) as part of their care and complete a multidimensional assessment. Using online assessment data from the eligible 1611 individuals (73.5%), a Service Needs Index comprised of three sub-indices (Clinical, Psychosocial, Comorbidity) was constructed and compared under two weighting approaches; an equal weighted scheme, and a weighting scheme constructed with expert input and correlation-optimization. These two approaches were compared with uncertainty and sensitivity analyses for three assumptions; normalization, aggregation, and weighting. The relationship between individual variables (questionnaire scores) and sub-indices were calculated using non-parametric correlation analysis. RESULTS The Clinical, Psychosocial, and Comorbidity Indices were derived using standardized questionnaires to assess mental health symptoms and history, work and social functioning, and physical health and substance use, respectively. The Expert Input Index was preferred to the Equal weighting scheme due to its more stable output. For the expert input indices, the Clinical Index and Psychosocial Index were moderately related (correlation=0.45). The Clinical Index also had strong correlations with external variables that were not used in its construction, including both psychological distress (K10; r=0.60) and work and social functioning (WSAS; r=0.54). Among those with the top 25% of Clinical Index scores, almost half also belonged in the group with the top 25% of Psychosocial Index scores, while 11.5% of the total sample were in the bottom 25% percentiles for both Clinical and Psychosocial Index scores. CONCLUSIONS A Service Needs Index for youth mental health should be assessed in real world settings before recommendations are made about its feasibility and acceptability, however, this tool could differentiate between needs to guide health-service level and individual-level decision making. The indexes could be delivered digitally and at scale to aid decision-making about the intensity, style, and duration of clinical, psychosocial, and allied services a young person requires, and increase the impact of investments for youth mental health.