Transdiagnostic clinical staging in youth mental health: A first international consensus statement

Authors

Jai L. Shah
Jan Scott
Patrick D. McGorry
Shane P.M Cross
Matcheri S. Keshavan
Barnaby Nelson
Stephen J. Wood
Steven Marwaha
Alison R. Yung
Elizabeth M. Scott, The University of Notre Dame AustraliaFollow
Dost Öngür
Philippe Conus
Chantal Henry
Ian B. Hickie

Publication Details

Shah, J. L., Scott, J., McGorry, P. D., Cross, S. P., Keshavan, M. S., Nelson, B., Wood, S. J., Marwaha, S., Yung, A. R., Scott, E. M., Öngür, D., Conus, P., Henry, C., & Hickie, I. B. (2020). Transdiagnostic clinical staging in youth mental health: A first international consensus statement. World Psychiatry, 19 (2), 233-242.

Abstract

Recognizing that current frameworks for classification and treatment in psychiatry are inadequate, particularly for use in young people and early intervention services, transdiagnostic clinical staging models have gained prominence. ese models aim to identify where individuals lie along a continuum of illness, to improve treatment selection and to better understand patterns of illness continuity, discontinuity and aetiopathogenesis. All of these factors are particularly relevant to help-seeking and mental health needs experienced during the peak age range of onset, namely the adolescent and young adult developmental periods (i.e., ages 12-25 years). To date, progressive stages in transdiagnostic models have typically been defined by traditional symptom sets that distinguish “sub-threshold” from “threshold-level” disorders, even though both require clinical assessment and potential interventions. Here, we argue that staging models must go beyond illness progression to capture additional dimensions of illness extension as evidenced by emergence of mental or physical comorbidity/complexity or a marked change in a linked biological construct. To develop further consensus in this nascent field, we articulate principles and assumptions underpinning transdiagnostic clinical staging in youth mental health, how these models can be operationalized, and the implications of these arguments for research and development of new service systems. We then propose an agenda for the coming decade, including knowledge gaps, the need for multi-stakeholder input, and a collaborative international process for advancing both science and implementation.

(World Psychiatry 2020;19:233–242)

Keywords

clinical staging, youth mental health, transdiagnostic, progression, extension, heterotypy, homotypy, health services, service transformation

Link to Publisher Version (URL)

10.1002/wps.20745