Modelling associations between neurocognition and functional course in young people with emerging mental disorders: a longitudinal cohort study
Open accessAbstract
Neurocognitive impairment is commonly associated with functional disability in established depressive, bipolar and psychotic disorders. However, little is known about the longer-term functional implications of these impairments in early phase transdiagnostic cohorts. We aimed to examine associations between neurocognition and functioning at baseline and over time. We used mixed effects models to investigate associations between neurocognitive test scores and longitudinal social and occupational functioning (“Social and Occupational Functioning Assessment Scale”) at 1–7 timepoints over five-years in 767 individuals accessing youth mental health services. Analyses were adjusted for age, sex, premorbid IQ, and symptom severity. Lower baseline functioning was associated with male sex (coefficient −3.78, 95% CI −5.22 to −2.34 p < 0.001), poorer verbal memory (coefficient 0.90, 95% CI 0.42 to 1.38, p < 0.001), more severe depressive (coefficient −0.28, 95% CI −0.41 to −0.15, p < 0.001), negative (coefficient −0.49, 95% CI −0.74 to −0.25, p < 0.001), and positive symptoms (coefficient −0.25, 95% CI −0.41 to −0.09, p = 0.002) and lower premorbid IQ (coefficient 0.13, 95% CI 0.07 to 0.19, p < 0.001). The rate of change in functioning over time varied among patients depending on their sex (male; coefficient 0.73, 95% CI 0.49 to 0.98, p < 0.001) and baseline level of cognitive flexibility (coefficient 0.14, 95% CI 0.06 to 0.22, p < 0.001), such that patients with the lowest scores had the least improvement in functioning. Impaired cognitive flexibility is common and may represent a meaningful and transdiagnostic target for cognitive remediation in youth mental health settings. Future studies should pilot cognitive remediation targeting cognitive flexibility while monitoring changes in functioning.
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Many flexibility researchers continue to operate within the well-established neuropsychology framework.
“Many flexibility researchers continue to operate within this well-established neuropsychology framework (e.g., Crouse et al., 2020; Stange et al., 2017).”
From Defining and measuring “psychological flexibility”: A narrative scoping review of diverse flexibility and rigidity constructs and perspectives (2021) · cites this paper as Crouse et al., 2020
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- Authors
- Crouse, J. J., Chitty, K. M., Iorfino, F., Carpenter, J. S., White, D., Nichles, A., Zmicerevska, N., Guastella, A. J., Scott, E. M., Lee, R. S. C., Naismith, S. L., Scott, J., Hermens, D. F., & Hickie, I. B.
- Affiliations
- The University of Sydney (AU)
- Monash University (AU)
- Newcastle University (GB)
- Corresponding author
- Crouse, Jacob J.
- ORCID
- Venue
- Translational Psychiatry
- Published
- 2020-01-21
- Volume
- 10
- Issue
- 1
- Pages
- 22-22
- ISSN
- 2158-3188 (ISSN-L)
- PMC
- PMC7026055
- OpenAlex
- W3000885137
- Semantic Scholar
- f68c6a0f9fc1945179417e97a01b35663a9d605a
- Cited by
- 21
- References
- 64
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 4 · 2023: 3 · 2022: 2 · 2021: 4 · 2020: 6
- FWCI
- 2.74
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Translational Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- Monash University Research Portal (Monash University) (publishedVersion, other-oa)
- PubMed (publishedVersion)
- ResearchOnline@ND (The University of Notre Dame) (submittedVersion)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- The Sydney eScholarship Repository (The University of Sydney) (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- Australian Government
- Department of Health | National Health and Medical Research Council (1061043, 511921)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- neurocognitive function, functional outcome, adolescent mental disorders, social and occupational functioning, cognitive flexibility, verbal memory, depressive symptoms, negative symptoms, positive symptoms, premorbid intelligence, sex differences, cognitive remediation, bipolar disorder, depression
- MeSH terms
- Adolescent, Humans, Longitudinal Studies, Male, Mental Health, Neuropsychological Tests, Psychotic Disorders, Cohort Studies
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