The mental health of young people who are not in education, employment, or training: a systematic review and meta-analysis

Purpose There are increasing concerns about the intersection between NEET (not in education, employment, or training) status and youth mental ill-health and substance use. However, findings are inconsistent and differ across types of problems. This is the first systematic review and meta-analysis (PROSPERO-CRD42018087446) on the association between NEET status and youth mental health and substance use problems. Methods We searched Medline, EMBASE, Web of Science, ERIC, PsycINFO, and ProQuest Dissertations and Theses (1999–2020). Two reviewers extracted data and appraised study quality using a modified Newcastle–Ottawa Scale. We ran robust variance estimation random-effects models for associations between NEET and aggregate groups of mental ill-health and substance use measures; conventional random-effects models for associations with individual mental/substance use problems; and subgroup analyses to explore heterogeneity. Results We identified 24 studies from 6,120 references. NEET status was associated with aggregate groups of mental ill-health (OR 1.28, CI 1.06–1.54), substance use problems (OR 1.43, CI 1.08–1.89), and combined mental ill-health and substance use measures (OR 1.38, CI 1.15–1.64). Each disaggregated measure was associated with NEET status [mood (OR 1.43, CI 1.21–1.70), anxiety (OR 1.55, CI 1.07–2.24), behaviour problems (OR 1.49, CI 1.21–1.85), alcohol use (OR 1.28, CI 1.24–1.46), cannabis use (OR 1.62, CI 1.07–2.46), drug use (OR 1.99, CI 1.19–3.31), suicidality (OR 2.84, CI 2.04–3.95); and psychological distress (OR 1.10, CI 1.01–1.21)]. Longitudinal data indicated that aggregate measures of mental health problems and of mental health and substance use problems (combined) predicted being NEET later, while evidence for the inverse relationship was equivocal and sparse. Conclusion Our review provides evidence for meaningful, significant associations between youth mental health and substance use problems and being NEET. We, therefore, advocate for mental ill-health prevention and early intervention and integrating vocational supports in youth mental healthcare.

Disrupted functional connectivity of the brain reward system in substance use problems: a meta-analysis of functional neuroimaging studies

ABSTRACTImportanceExtensive literature suggests that the brain reward system is crucial in understanding the neurobiology of substance use disorders. However, across studies on substance use problems, evidence of reliable disruptions in functional connectivity is limited.ObjectiveTo uncover deficient functional connectivity with the brain reward system that are reliably associated with substance use problems, by meta-analytically synthesizing results of functional brain connectivity studies on substance use problems.Data SourcesIdentification of relevant functional brain connectivity studies on substance misuse was done using PubMed, Google Scholar and EMBASE (until September 2021) with the following terms: cannabis, cocaine, substance, methamphetamine, amphetamine, alcohol, tobacco, nicotine, functional connectivity, resting-state, task-based connectivity, psychophysiological interaction.Study SelectionGuidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses were followed, Publications were included if they reported stereotactic coordinates of functional brain connectivity results on individuals with substance use problems without a comorbid major mental illness or organic impairment.Data Extraction and SynthesisSpatially convergent brain regions across functional connectivity studies on subjects with substance use problems were analyzed using Activation Likelihood Estimation meta-analysis.Altered connectivity with regions of the brain reward system was performed carried out through voxelwise seed-based meta-analyses. Subanalyses were performed to examine mediating factors such as severity of illness, connectivity modalities and types of substances.Main Outcomes and MeasuresIdentification of deficits in functional brain connectivity with the reward system across studies on substance use problems.ResultsNinety-six studies using a seed-based connectivity approach were included, representing 5757 subjects with substance use problems. In subjects with substance use problems, the ventromedial prefrontal cortex exhibited hyperconnectivity with the ventral striatum, and hypoconnectivity with the amygdala and hippocampus. Executive striatum showed hyperconnectivity with motor thalamus and dorsolateral prefrontal cortex, and hypoconnectivity with anterior cingulate cortex and anterior insula. Finally, the limbic striatum was found to be hyperconnected to the orbitofrontal cortex, and hypoconnected to the precuneus, compared to healthy subjects.Conclusions and RelevanceThe current study provided meta-analytical evidence of deficient functional connectivity between brain regions of the reward system and cortico-striato-thalamocortical loops in addiction, in line with current influential neurobiological models. These results are consistent with deficits in motivation and habit formation occurring in addiction, and they also highlight alterations in brain regions involved in socio-emotional processing and attention salience.KEY POINTSQuestionWhat functional brain connectivities with the brain reward system are reliably disrupted across studies on substance use problems?FindingsSubjects with substance use problems exhibited deficient connectivity between the ventromedial prefrontal cortex and subcortical structures including the ventral striatum, amygdala, and hippocampus. Executive striatum showed hyperconnectivity with motor thalamus and dorsolateral prefrontal cortex, and hypoconnectivity with anterior cingulate cortex and anterior insula. Altered connectivity between limbic striatum and core regions of the default mode network was also observed.MeaningDeficient functional brain connectivity along the cortico-striato-thalamocortical loops may reflect deficits in habit formation, socio-emotional and salience processing in addiction.

Care Facilities for Older People With Long-Term Substance Use: Promising Practices From Sweden

The stigma of alcohol and long-term substance use is well-known and may be even greater for older people. This is a presentation on “wet” eldercare facilities, i.e. care settings designed for older people with long-term substance use problems, where abstinence is abandoned for well-being. Wet eldercare facilities exist in several European countries and the Swedish ones have a hybrid formal organization: They target people over 50 years, but are regarded as nursing homes and residents lease their own flats inside the setting, which makes it correct to describe residents as tenants. Guided by symbolic interactionism, the aim is to analyze how residents in wet eldercare facilities manage to view these places in a positive light. Forty-two residents of four facilities were interviewed, revealing how the hybrid status of these places enabled residents to frame their situation as being “in the right place”, but for different reasons. Some framed the place as a nursing home, others as an ordinary flat. Although wet eldercare facilities are undisputedly linked to stigma and the inability to become sober, the formal hybrid organization enabled residents to construct less stigmatized characterizations of the place and of themselves. The study suggests that it is an (often-neglected) gerontological responsibility to counter stigma and improve the sense of dignity for older people living in stigmatized settings. Based on promising practices in the Swedish system, the study therefore presents strategies that enable older people to ascribe positive characteristics to themselves and to the place where they live.

“I Tried to Get Help About My Addiction but He Just Gave Me Tablets:” Male Aboriginal Drug and Alcohol Rehabilitation Clients’ Experiences and Preferences Speaking About Substance Use in Primary Care

Background Primary healthcare (PHC) services are crucial in supporting people with substance use problems. The aims of this study were to explore Aboriginal and Torres Strait Islander (hereafter Aboriginal) males in treatment for substance use problems experiences about speaking about their substance use with PHC staff, and their preferences for accessing PHC about their substance use.MethodsSemi-structured interviews with residential drug and alcohol rehabilitation treatment service clients. Thematic analysis was used to develop themes inductively and deductively. Two interviews were independently double coded by an Aboriginal researcher and the project was supported by an Aboriginal Advisory Group.ResultsTwenty male adults who self-identified as Aboriginal participated (mean age 27 years). Half reported visiting PHC and talking about their substance use before their residential service stay. Two major themes developed: (1) asking for help for substance use or mental health problems linked with substance use, (2) ways to improve access to PHC about substance use. Although some males were offered treatment, some were not, and others had concerns about the treatments offered. ConclusionThis research highlights opportunities to improve access and to better support Aboriginal males with substance use problems in PHC. Focus on culturally appropriate PHC and providing staff with training around substance use and treatment options may improve access. It is important to foster culturally appropriate services, develop PHC staff knowledge around substance use, focus on therapeutic relationships and have a range of treatment options available that can be tailored to individual circumstances.

Dual pathology in homeless people in the Health Area of Avilés

The main objective of the present study is to estimate the prevalence of severe mental and substance use disorders in homeless people (HP). The work was carried out on the basis of data obtained from a representative sample of HP in Avilés (Asturias) (n = 100) using the International Neuropsychiatric Interview (M.I.N.I.). The results of our study reveal a close relationship between substance use and homelessness. More than half of the HP have substance use disorders compared to substance use problems in the general population. Psychosocial care and the organization of a support network for the HP are discussed.