SCOPE for HEALTH: integrating physical and sexual health within youth mental-health pathways using longitudinal population data

Background: Youth with mental-health difficulties (MHD) often experience co-occurring physical, behavioural, and sexual-health needs that fall between siloed services. SCOPE for HEALTH aims to inform integrated, youth-friendly care pathways by quantifying these intersections using longitudinal cohort data across nine years from three waves of the Growing Up in Ireland (GUI) 9-year-old cohort. Findings will be translated into service design through collaboration with academics, clinicians, decision-makers, and patient partners.

 

Approach: GUI is a large-scale fixed panel study tracking the wellbeing of children and young adults in Ireland. Participants were included if they self-reported a mental-health diagnosis from a healthcare professional at one or more time points. They were categorised as ‘Always MHD’ (reported MHD at all three waves), ‘Occasional MHD’ (one or two waves), or ‘Never MHD’ (no MHD). Primary outcomes spanned mental health (anxiety, depression, life satisfaction, optimism), physical health (chronic condition, sleep difficulty), health behaviours (smoking, vaping), and sexual health (sexual orientation,

 

Sexually Transmitted Infection (STI) history). Descriptive statistics profiled groups. For continuous outcomes, one-way ANOVA with Bonferroni post-hoc tests was used; for categorical outcomes, χ² tests with Bonferroni-adjusted pairwise comparisons of column proportions were conducted. Analyses were performed in SPSS.

 

Results: A total of 2057 participants were included (Always MHD: n=192; Occasional MHD: n=513; Never MHD: n=1387). Females were overrepresented in the Always and Occasional MHD groups (71.6% and 57.7%, respectively). Youth in these groups had significantly higher anxiety and depression scores, and lower life satisfaction and optimism, compared to those with no MHD (all p<0.001). Those without MHD were more likely to report no sleep difficulties (61.8%) compared with Always (19.3%) and Occasional (30.5%) groups (p<0.001). Chronic conditions were reported more frequently among Always (69.5%) and Occasional (53.1%) MHD participants than those with no MHD (16.4%; p<0.001). Sexual minorities were overrepresented in the MHD groups, and those with persistent MHD were more likely to have a history of STI (p=0.0438). Youth with MHD were more likely to vape (p=0.013) or smoke daily (p<0.001) compared with those without MHD. These findings indicate that persistent MHD is associated with clustered risks across physical, behavioural, and sexual-health domains that current service configurations may not address effectively.

 

Implications: Applying a population-health lens to longitudinal data can inform the design of youth-centred integrated-care models. These findings suggest persistent MHD is associated with clustered risks across physical, behavioural and sexual-health domains that current service configurations may not address well.

 

Key design elements include: (i) routine screening for sleep, chronic conditions, and substance use within mental-health contacts; (ii) sexual-health assessment with on-site or rapid referral pathways inclusive of sexual-minority youth; (iii) brief interventions (e.g., MECC) at every contact; (iv) shared care plans linking primary care, CAMHS, community sexual-health services, and digital supports; and (v) equity monitoring of reach and outcomes by gender and sexual orientation. Consideration of these in a co-designed model of care will be important for the future provision of tailored effective physical and sexual care for youth with mental health difficulties.