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

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

Author information

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


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.

Conflict of interest statement

DH received honoraria for educational seminars (on ADHD) from Janssen-Cilag and Eli Lilly. ES was 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, and has received honoraria for educational seminars related to the clinical management of depressive disorders supported by Servier and Eli-Lilly pharmaceuticals. She has participated in a national advisory board for the antidepressant compound Pristiq, manufactured by Pfizer. She was the National Coordinator of an antidepressant trial sponsored by Servier. IH has been a Commissioner in Australia’s National Mental Health Commission since 2012. He is the Co-Director, Health and Policy at the Brain and Mind Centre (BMC) University of Sydney. The BMC operates an early-intervention youth services at Camperdown under contract to headspace. Professor Hickie has previously led community-based and pharmaceutical industry-supported (Wyeth, Eli Lily, Servier, Pfizer, AstraZeneca) projects focused on the identification and better management of anxiety and depression. He was a member of the Medical Advisory Panel for Medibank Private until October 2017, a Board Member of Psychosis Australia Trust and a member of Veterans Mental Health Clinical Reference group. He is the Chief Scientific Advisor to, and an equity shareholder in, Innowell. Innowell has been formed by the University of Sydney and PwC to deliver the $30m Australian Government-funded ‘Project Synergy’. Project Synergy is a three-year program for the transformation of mental health services through the use of innovative technologies. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

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