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Predictors of transfer and prognosis after transfer from child and adolescent mental health services to adult mental health services—a Danish nationwide prospective register-based cohort study

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Abstract

Onset of mental health disorder peaks during adolescence making continuity of care during this period of life crucial both to ensure a smooth treatment course and high quality of mental health services for adolescents. We aimed to examine which clinical and sociodemographic features predict transfer from child and adolescent mental health services to adult mental health services and if transfer is associated with prognosis. A Danish register study including all 16–17-year-olds with an outpatient contact in child and adolescent mental health services, who were discharged in the period of 1/1/06–10/05/15. Out of 27,170 Danish adolescents, 16% transferred to adult mental health services. Transfer was predicted by schizophrenia (OR 6.16; 95% CI 5.51–6.90) and personality disorders (OR 2.08; 95% CI 1.84–2.34), while hyperkinetic (OR 0.54; 95% CI 0.49–0.59) and pervasive developmental disorders (OR 0.42; 95% CI 0.31–0.58) decreased likelihood of transfer. Transfer was also substantially predicted by inpatient admission (OR 3.37; 95% CI 3.14–3.61) and psychiatric medication (OR 2.07; 95% CI 1.92–2.23). Transfer was associated with higher rates of inpatient admission to adult mental health services (IRR 5.83; 95% CI 4.37–7.77), more psychiatric emergency contacts (IRR 12.0; 95% CI 10.7–13.4), more convictions (IRR 1.40; 95% CI 1.23–1.59) and suicide attempts (IRR 5.70; 95% CI 4.72–6.90). Policy-makers and clinicians should push for improvements and open a discussion of how to ensure continuity of care for adolescents with psychiatric disorders.

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Data availability

Danish registers are available to researchers pending approval from relevant Danish authorities.

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Funding

This study received no specific funding.

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Authors and Affiliations

  1. Copenhagen Research Center for Mental Health-CORE, Mental Health Centre Copenhagen, Copenhagen University Hospital, Mental Health Services Capital Region, Gentofte Hospitalsvej 15 4th Floor, 2900, Hellerup, Denmark

    Christina Østergaard Hansen, Merete Nordentoft & Carsten Hjorthøj

  2. Child and Adolescent Mental Health Centre, Mental Health Services Capital Region, Research Unit, Copenhagen University Hospital, Hellerup, Denmark

    Anne Amalie Elgaard Thorup

  3. Department of Public Health, University of Copenhagen, Section of Epidemiology, Copenhagen, Denmark

    Carsten Hjorthøj

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  1. Christina Østergaard Hansen
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Contributions

CØH and CH created the statistical analysis plan. CH provided data and CØH analyzed data under supervision from CH. AAET and MN provided feedback and supervision. CØH wrote the main manuscript text's first draft, and this was critically reviewed and revised by AAET, MN, and CH. All authors approved the final version of the manuscript.

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Correspondence to Christina Østergaard Hansen.

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Hansen, C.Ø., Thorup, A.A.E., Nordentoft, M. et al. Predictors of transfer and prognosis after transfer from child and adolescent mental health services to adult mental health services—a Danish nationwide prospective register-based cohort study. Eur Child Adolesc Psychiatry 33, 79–87 (2024). https://doi.org/10.1007/s00787-022-02136-x

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  • DOI: https://doi.org/10.1007/s00787-022-02136-x

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