Can we improve the clinical and research utility of staging frameworks for youth mental health?

Globally, 75% of depressive, bipolar, and psychotic disorders emerge by age 25. These disorders are often preceded by non-specific symptoms or attenuated clinical syndromes and help-seeking youth typically present with co-occurring mental disorders and/or physical comorbidities. This has led many youth mental health services to adopt trans-diagnostic clinical staging models as these offer a framework for classifying and understanding the multi-dimensional and dynamic nature of emerging mental disorders and inform the selection of treatment interventions. However, given evidence of ongoing challenges in applying trans-diagnostic staging frameworks in research and clinical practice we suggest some refinements to the model to enhance reliability, consistent recording and utility. The key proposal is to introduce two additional concepts namely within stage heterogeneity and stage modifiers, with the latter categorized into factors associated with Progression (potential predictors of stage transition and illness trajectories) and Extension (characteristics that add complexity to selection of current treatments).