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

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Abstract

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.

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Data availability

The data that support the findings of this study are available on request from the corresponding author.

Code availability

The statistic and data science software STATA Ver 14.3 was used for data analysis.

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Acknowledgements

The authors wish to thank the anonymous reviewers whose comments and helpful suggestions have contributed greatly in improving the original manuscript.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Psychiatry Section, Psychophysiological Selection Office, Italian Army National Recruitment and Selection Center, 06034, Foligno, PG, Italy

    Giancarlo Pontoni

  2. Private Accredited Hospital Villa Igea, 41126, Saliceta San Giuliano, MO, Italy

    Elena Di Pietro, Vittoria Neviani & Giovanni Neri

  3. Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125, Modena, Italy

    Tommaso Neri, Giorgio Mattei, Fedora Longo, Ernesto Caffo & Gian Maria Galeazzi

  4. Marco Biagi Department of Economics and Marco Biagi Foundation, University of Modena and Reggio Emilia, 41121, Modena, Italy

    Giorgio Mattei

  5. Child and Adolescent Mental Health Service Empoli, Azienda USL Toscana Centro, 50053, Empoli, FI, Italy

    Paolo Stagi

  6. Department of Mental Health and Drug Abuse, Azienda USL Modena, 41124, Modena, Italy

    Fabrizio Starace

Authors
  1. Giancarlo Pontoni
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  2. Elena Di Pietro
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Contributions

All those named as authors have made a sufficient contribution to the work as specified below: work conception and design: GP, EP, GMG; data acquisition: GP, EP, VN, TN, GN; data analysis; GP, GM; data interpretation; GMG, GP, EP, FS, PS; work drafting: GP, EP, TN; work critically revision: GMG, FS, PS, GN, GM, VN, FL; final approval and all work accountability agreement: all the authors.

Corresponding author

Correspondence to Gian Maria Galeazzi.

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Conflict of interests

All the authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; expert testimony or patent licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. The authors declare that they have no conflict of interest.

Ethics approval

The study was approved by the Research Ethics Committee of the University of Modena and Reggio Emilia, Italy (identification protocol number: 2023/C.E. dated 29/05/2017).

Consent to participate

The study used anonymized already available routine clinical data and administrative indicators, all treatment was delivered and all data was collected with valid informed consent of the patients or their guardians.

Consent for publication

This study analyzes anonymized routine clinical and administrative data already collected. It reports aggregated results for which no consent for publication has been requested, according to the Research Ethics Committee approval obtained, which waives the need to obtain consent for publication for all patients not assisted and/or not traceable at the moment of data collection and analysis.

Appendix

Appendix

See Tables 5, 6.

Table 5 Variables included in the CAITWa admission (T0) data extraction form
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Table 6 Variables included in the AMHS timepoints (T1-T3) data collection form
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Pontoni, G., Di Pietro, E., Neri, T. et al. Factors associated with the transition of adolescent inpatients from an intensive residential ward to adult mental health services. Eur Child Adolesc Psychiatry 31, 805–818 (2022). https://doi.org/10.1007/s00787-020-01717-y

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  • DOI: https://doi.org/10.1007/s00787-020-01717-y

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