Adolescents’ diagnosis with psychiatric disorders, especially psychosis and autism spectrum disorder (ASD), is associated with long term absence from education, employment, or training (“Not in Education, Employment or Training” = NEET), according to study results published in The British Journal of Psychiatry.

Researchers analyzed socioeconomic data and medical history from a Finnish Institute for Health and Welfare longitudinal study of children born in Finland in 1987. Individuals (n=55,273) included in the study lived in the country throughout the study period (2008 to 2015) and did not have diagnosed intellectual disabilities.

The investigators discovered that 1438 individuals (2.6%) had been outside of employment, education, training, parental leave, and jobseekers’ programs for at least 5 years. Of those individuals, 65.1% were male and 65% had not completed upper secondary school.


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A total of 44% of the cohort with long term NEET in young adulthood had been diagnosed with a psychiatric or neurodevelopmental disorder as an adolescent. Depressive disorders (20.1%) and anxiety disorders (16.6%) were most common. Proportionately, individuals with ASD (44%) and psychosis (36.5%) were most likely to experience long term NEET.

Not having completed upper secondary education had the highest effect size (OR 10.1 95% CI 9.0-11.2). A total of 10% of individuals who did not complete upper secondary school were later long term NEET.

The researchers found that 70.6% of individuals with ASD and 48.4% of individuals with psychosis experienced long term NEET when they had not completed upper secondary school.

Psychiatric or neurodevelopmental diagnosis in adolescence increased odds of long term NEET in young adulthood 7.1 times, the researchers found. ASD (OR 17.3 95% CI 11.5-26.0) and psychosis (OR 12.0 95% CI 9.5-15.2) had the highest effect sizes for long term NEET.

Associations held for Asperger syndrome (OR 29.4) and other ASD (OR 21.3) when they were analyzed individually. When researchers excluded individuals with schizophrenia and schizoaffective disorder, the association held for other kinds of psychosis (OR 14.5). Associations remained for other diagnostic categories when the researchers removed individuals diagnosed with substance use disorder, psychosis or ASD.

Patients who received inpatient treatment when they were under 10 years of age had 7.3 times higher odds of experiencing long term NEET. Those who received inpatient treatment between 10 and 20 years of age had 11.5 times higher odds of experiencing long term NEET.

“Our finding of clear associations between main psychiatric diagnoses in adolescence and long term NEET in young adulthood suggests that effective adolescent mental health services, including prevention, early intervention, social services and vocational rehabilitation, should be considered as important elements in a strategy to tackle young people’s marginalization,” the researchers said.

“Combining inclusive and targeted strategies could reduce individual suffering and the costs to society of long term NEET. The results of this study can function as a baseline if the number of young people who are marginalized or suffer from psychiatric disorders increases after the COVID-19 pandemic.”

Disclosure: A study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures

Reference

Ringbom I, Ringbom I, Suvisaari J, Kääriälä A, et al. Psychiatric disorders diagnosed in adolescence and subsequent long-term exclusion from education, employment or training: longitudinal national birth cohort study. Br J Psychiatry. Published online October 5, 2021. doi: 10.1192/bjp.2021.146