TY - JOUR
T1 - Identifying individuals with intellectual disability who access mental health support and are at high risk for adverse clinical outcomes
T2 - cohort study
AU - Baksh, R. Asaad
AU - Sheehan, Rory
AU - Hassiotis, Angela
AU - Smith, James
AU - Strydom, Andre
N1 - Funding Information:
This study is funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research awarded to A.H. as chief investigator (grant number NIHR200120). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. R.A.B. was supported by a Jérôme Lejeune Foundation postdoctoral research fellowship.
Publisher Copyright:
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.
PY - 2023/10/10
Y1 - 2023/10/10
N2 - Background People with intellectual disability often experience aggressive challenging behaviour and mental health issues. It can be difficult to identify those who are at higher risk of adverse clinical outcomes when in clinical care. Aims To characterise potential subgroups in adults with intellectual disability referred to mental health services in those presenting with aggressive behaviour or common mental disorders (CMDs). Method There were 836 adults (≥18 years) with intellectual disability and a record of aggressive challenging behaviour, and 205 patients with intellectual disability and CMDs, who were seen in specialist mental health services over a 5-year period. Cluster analysis was used to define patient characteristics associated with clinical outcome. Results Distinct patient groups with differentiated profiles were observed in people with intellectual disability displaying aggressive challenging behaviour, and in those presenting with CMDs. Characteristics of the aggressive behaviour group who experienced adverse outcomes included being <30 years old, being male, more mentions of aggression and agitation in their clinical record, a diagnosis of pervasive developmental disorder and prescription of psychotropic medication. Characteristics of the CMD cluster that experienced adverse clinical outcomes were being older, being a White male, having a mild intellectual disability and physical health concerns. Conclusions People with intellectual disability who experience adverse clinical outcomes can be identified with a cluster analysis approach of common features, but differ by clinical presentation. This could be used not only to stratify this clinically heterogeneous population in terms of response to interventions, but also improve precision in the development of tailored interventions.
AB - Background People with intellectual disability often experience aggressive challenging behaviour and mental health issues. It can be difficult to identify those who are at higher risk of adverse clinical outcomes when in clinical care. Aims To characterise potential subgroups in adults with intellectual disability referred to mental health services in those presenting with aggressive behaviour or common mental disorders (CMDs). Method There were 836 adults (≥18 years) with intellectual disability and a record of aggressive challenging behaviour, and 205 patients with intellectual disability and CMDs, who were seen in specialist mental health services over a 5-year period. Cluster analysis was used to define patient characteristics associated with clinical outcome. Results Distinct patient groups with differentiated profiles were observed in people with intellectual disability displaying aggressive challenging behaviour, and in those presenting with CMDs. Characteristics of the aggressive behaviour group who experienced adverse outcomes included being <30 years old, being male, more mentions of aggression and agitation in their clinical record, a diagnosis of pervasive developmental disorder and prescription of psychotropic medication. Characteristics of the CMD cluster that experienced adverse clinical outcomes were being older, being a White male, having a mild intellectual disability and physical health concerns. Conclusions People with intellectual disability who experience adverse clinical outcomes can be identified with a cluster analysis approach of common features, but differ by clinical presentation. This could be used not only to stratify this clinically heterogeneous population in terms of response to interventions, but also improve precision in the development of tailored interventions.
KW - adverse clinical outcomes
KW - aggressive challenging behaviour
KW - cluster analysis
KW - common mental disorders
KW - Intellectual disability
UR - https://www.scopus.com/pages/publications/85175454585
U2 - 10.1192/bjo.2023.574
DO - 10.1192/bjo.2023.574
M3 - Article
AN - SCOPUS:85175454585
SN - 2056-4724
VL - 9
JO - BJPsych Open
JF - BJPsych Open
IS - 6
M1 - e183
ER -