Clinical, neurocognitive and demographic factors associated with functional impairment in the Australian Brain and Mind Youth Cohort Study (2008-2016)

Rico S C Lee, Daniel F. Hermens, Sharon L. Naismith, Manreena Kaur, Adam J. Guastella, Nick Glozier, Jan Scott, Elizabeth M. Scott, Ian B. Hickie

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Objectives We sought to determine the unique and shared contributions of clinical, neurocognitive and demographic factors to functional impairment in a large, transdiagnostic, clinical cohort of adolescents and young adults. Design Cross-sectional baseline data from a prospective, cohort study. Setting Help-seeking youth referred from outpatient services were recruited to the Brain and Mind Youth Cohort (2008-2016) in Sydney, Australia. Participants In total, 1003 outpatients were recruited, aged between 12 and 36 years (mean= 20.4 years, 54% female), with baseline diagnoses of affective, psychotic, developmental or behavioural disorders. Interventions Treatment as usual. Primary outcome measures Social and occupational functioning was used to index level of functional impairment. Structural equation modelling was used to examine associations between neurocognition, core clinical symptoms and alcohol and substance use, and clinician-rated and researcher-rated functional impairment. Moderator analyses were conducted to determine the potential influence of demographic and clinical factors (eg, medication exposure). Results Independent of diagnosis, we found that neurocognitive impairments, and depressive, anxiety and negative symptoms, were significantly associated with functioning. The association of neurocognition with social and occupational functioning remained significant even when constraining for age (15-25-year-olds only) or diagnosis (affective disorders only) in the final model. Conclusions This study demonstrated that, in a clinically representative sample of youth, the key determinants of functioning may not be disorder specific. Further, evidence of neurocognitive dysfunction suggests that interventions that target cognition and functioning should not necessarily be reserved just for older adults with established illness.

Original languageEnglish
Article number022659
Number of pages10
JournalBMJ Open
Issue number12
Publication statusPublished - 1 Dec 2018


  • alcohol use
  • functional impairment
  • mental illness
  • neurocognition
  • symptom dimensions
  • transdiagnostic

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