A NEET distinction: youths not in employment, education or training follow different pathways to illness and care in psychosis

Abstract

PurposeThe early phases of psychosis, including the prodrome, often feature educational/occupational difficulties and various symptoms and signs, that can render or keep youths “Not in Employment, Education or Training” (NEET). Conversely, NEET status itself may increase risk for illness progression and impaired functioning, and impede access to appropriate services for psychosis. As these issues have not been investigated, we aimed to examine differences in the illness and care pathways and characteristics of youths with psychosis who are NEET and non-NEET.MethodsYouths entering a catchment-based Canadian early intervention service for psychosis (N = 416) were assessed as being NEET or non-NEET and compared on symptomatology, premorbid adjustment, prodrome and duration of untreated psychosis (DUP).ResultsThirty-nine percent of the sample was NEET. Compared to non-NEET youths, NEET youths had 34% higher negative symptoms scores, longer prodromes (median of 52 weeks vs. 24 weeks), and were more often continuously ill after their first psychiatric change until the onset of psychosis (62% vs. 45%). Both groups had similar premorbid adjustment scores until late adolescence when scores were significantly worse for NEET youths. Accounting for other predictors, NEET youths had 23% longer DUPs on average, despite having made more help-seeking attempts.ConclusionsDespite being more narrowly defined, NEET status was thrice as prevalent in our sample as in the Canadian population. The NEET group followed a distinct trajectory of persistent symptoms and functional decline before presenting with a psychotic disorder. The systemic delays that NEET youths encountered indicate a need for better-targeted early identification efforts.

Group differences in social inclusion between young adults aged 18 to 25 with serious mental illness and same-aged peers from the general community

“…Comparisons to previous literature are complicated by the lack of studies using psychometric measures of social inclusion to examine group differences between young adults from the general community and those with SMI. Nonetheless, these findings are consistent with evidence that young adults with SMI have smaller social networks (Gayer-Anderson & Morgan, 2013), are less vocationally engaged (Iyer et al, 2018), experience lower levels of independence (Breitborde, Woolverton, Frost, & Kiewel, 2014) and higher levels of housing instability (Narendorf, Cross, Santa Maria, Swank, & Bordnick, 2017) than those from the general community.…”

“…Young adults with SMI are considered socially excluded (Social Exclusion Unit, 2005). This is largely based on evidence from objective indicators, for example, lower vocational engagement relative to peers from the general community (Iyer et al, 2018). However, subjective indicators are under-researched in this population (Sündermann, Onwumere, Bebbington, & Kuipers, 2013), where loneliness remains poorly understood (Lim, Gleeson, Alvarez-Jimenez, & Penn, 2018).…”

The Use of Text Messaging to Improve Clinical Engagement for Individuals With Psychosis: Systematic Review

“…The major psychoses (ie, schizophrenia spectrum and bipolar I disorder) are recognized as a leading cause of disability worldwide [1] and are associated with poverty [2], premature mortality [3], impaired cognitive function [4], loss of education and employment [5], and increased global economic burden [6]. Published practice guidelines outlining the usual treatment for psychosis identify antipsychotic medication as a frontline treatment for positive symptom management and adjunct psychosocial interventions such as psychoeducation, family support, vocational interventions, and cognitive behavioral skills-based therapies [7][8][9][10][11].…”

Psychometric properties of the Assessment Tool for Perceived Agency (ATPA-22) – utility for the rehabilitation of young adults not in education, employment or training (NEETs)

“…The Nordic countries have been characterized by relatively low NEET rates, the highest rates occurring in the southern regions of Europe [13][14][15][16]. In several studies, NEETs have been identified as at high risk for adverse economic, health, and psychosocial outcomes [17][18][19]. The mean proportion of young persons classified as NEETs was in OECD 14.3% for persons aged 18-to 24 [16].…”