Factors associated with the transition of adolescent inpatients from an intensive residential ward to adult mental health services

• Published in: European child & adolescent psychiatry 2022-05, Vol.31 (5), p.805-818
• Main Authors: Pontoni, Giancarlo, Di Pietro, Elena, Neri, Tommaso, Mattei, Giorgio, Longo, Fedora, Neviani, Vittoria, Neri, Giovanni, Stagi, Paolo, Caffo, Ernesto, Starace, Fabrizio, Galeazzi, Gian Maria
• Format: Article
• Language: English
• Subjects: Adolescents; Age; Antipsychotics; Child & adolescent mental health; Child & adolescent psychiatry; Child and Adolescent Psychiatry; Children; Continuity of care; Diagnosis; Disengagement; Families & family life; Health problems; Health services; Inpatient care; Intensive treatment; Learning; Medical diagnosis; Medicine; Medicine & Public Health; Mental disorders; Mental health; Mental health services; Original Contribution; Patient admissions; Patients; Psychiatry; Psychosis; Regression analysis; School attendance; Sociodemographics; Teenagers; Young adults; Youth
• ISSN: 1018-8827; 1435-165X
• DOI: 10.1007/s00787-020-01717-y

Transition of young people from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) is a complex process. Transition rates are heterogeneously reported, with wide definitions and ranges. Few data are available regarding predictive factors of a successful transition. We explored factors associated with transition in a cohort of former inpatients of a Children and Adolescents Intensive Treatment Ward (CAITW). Socio-demographic and clinical features of patients previously admitted to CAITW were matched to AMHS data for those patients having reached age requirements. We built multiple logistic regression models to identify factors associated with transfer to AMHS (either inpatient or outpatient) and with successful retention in treatment (RIT) at six (short RIT), 12 (intermediate RIT) and 24 months after transfer (long RIT). From a cohort of 322 inpatients, 126 reached the age threshold for transfer to AMHS in the study period. The transfer rate was 50%. Two years after transition-age boundary, CAMHS-AMHS continuity of care was found in 40% and disengagement in 6% of cases. Longer and multiple hospitalizations, atypical antipsychotics prescription and a diagnosis of psychotic disorders were factors associated with short and intermediate RIT. A positive psychiatric family history was negatively associated with successful short and intermediate RIT. Diagnosis of psychosis and learning-supported school attendance were associated with long RIT. Young adults with a history of psychiatric inpatient admission as children or adolescents have a relatively high rate of transition to AMHS. A diagnosis of psychosis seems to be the strongest predictor for transition in these patients. Further research should focus on patients’ schooling needs and on children of parents with mental health problems to enhance family and educational system engagement.