Behavioural Development, Long-term Outcomes and Opportunities to Optimize Youth Mental Health (BLOOM) is a project that aims to overcome age and diagnostic boundaries to generate person-specific longitudinal profiles of mental health in youth aged 9 to 25. The overarching objective is to lay the informational foundation to accurately predict both clinical outcomes and opportunities to optimize health trajectories. This project will recruit youth in need without any mental health diagnosis and follow them annually for 5 years. The present study includes assessment of antecedents, opportunities and outcomes that will establish eligibility for preventive interventions
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Due to the requirements of assessment procedures, youth who cannot communicate verbally due to known neurological conditions or intellectual disabilities will not be included. Youth who are already diagnosed with one of the DMDs by a physician and currently prescribed a treatment targeting the diagnosed condition (pharmacological or psychotherapeutic interventions), will not be eligible for inclusion.
Help-seeking group: Primary care mental health service providers within the CIUSSS-ODIM catchment area will be the major referral source for this group. Youth and families referred to or self-referring for mental health needs to CLSCs at Dorval-Lachine-LaSalle, CLSC Pierrefonds/Lac-Saint-Louis, Social Paediatrics Clinics and Aire-Ouverte centres throughout the CIUSSS-West Island catchment will be approached by a member of these programmes to assess interest. A screening contact (on site or via telephone) by a member of the research team (who will work on site with clinical teams) will follow to review eligibility criteria. To increase uptake and reduce clinician burden, information leaflets and posters will be made available at the waiting rooms, webpages and social media sites of these youth programmes (See the leaflet: Portraying Your Mental Health). Non help-seeking group: Parents referral pathway: For this group, youth will be recruited through their parents, who are current
Cohort
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Number of new onsets of one of the seven mental illnesses as per DSM-5 criteria
By applying a detailed diagnostic screen we will be able to capture all emerging mental illnesses as per the existing schedule of classification if present. But our primary outcome of interest (DMDs) is defined as a new onset of illnesses known to involve substantial functional impairment over multiple domains. These are moderate/severe major depressive disorder, bipolar disorder type I or type 2, schizoaffective disorder, schizophrenia, or schizophreniform disorder, anorexia and bulimia nervosa, OCD, moderate/severe ADHD, moderate or severe substance use disorder (SUD) all according to DSM-5 (as per DSM-5 Text Revision, updated September 2023). Notably, while epidemiological data indicates that features of some of these disorders (e.g. ADHD, OCD) begin at ages younger than 9, the mean age of diagnosis continues to be much later in practice.
Time-to-onset of severe psychopathology based on InterRAI instrument
In addition to primary diagnostic outcomes, we assess psychopathology in detail using in-person clinical interviews, speech recordings, self reports and parental reports. The scales used for this purpose are those embedded in the InterRAI child and youth module as well as self-report scales. Time-to-onset for the first supra-threshold symptom will be measured in each subject (reported in months since first observation)
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