Skip to main content

Advertisement

SpringerLink
Log in

Who Should Transition? Defining a Target Population of Youth with Depression and Anxiety That Will Require Adult Mental Health Care

  • Published:
The Journal of Behavioral Health Services & Research Aims and scope Submit manuscript

Abstract

The process of transitioning youth from child to adult mental health services is poorly managed, and many adolescents disengage from services during transfer. The waxing and waning of symptoms over time means that some youth who are asymptomatic prior to transfer (15–17 years) will be at high risk for recurrence during the transition period. There are no clear, evidence-based guidelines about who should transfer to adult care. Objectives were to propose: (1) criteria to define anxious or depressed youth (16–21 years) that should transfer and (2) levels of service needed in young adulthood. Natural history of psychopathology and treatment response for depression and anxiety was reviewed. Risk factors for recurrence and persistence, such as initial severity, comorbidity, and family functioning, can help to identify youth requiring transfer. Few controlled treatment studies have examined predictors of long-term course. Recommendations for follow-up care and ongoing monitoring during young adulthood are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

References

  1. Kessler RC, Berglund P, Demler O, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry. 2005;62(6):593–602.

    Article  PubMed  Google Scholar 

  2. Davis M. Addressing the needs of youth in transition to adulthood. Administration and Policy in Mental Health. 2003;30(6):495–509.

    Article  PubMed  Google Scholar 

  3. Singh SP. Transition of care from child to adult mental health services: the great divide. Current Opinion in Psychiatry. 2009;22(4):386–90.

    Article  PubMed  Google Scholar 

  4. Davis M, Koroloff N. The great divide: how mental health policy fails young adults. Research on Community-Based Mental Health Services for Children and Adolescents. 2010;14(1):53–74.

    Google Scholar 

  5. Pottick KJ, Bilder S, Vander Stoep A, et al. US patterns of mental health service utilization for transition-age youth and young adults. The Journal of Behavioral Health Services & Research. 2008;35(4):373–89.

    Article  Google Scholar 

  6. American Academy of Child and Adolescent Psychiatry. Practice parameters for the assessment and treatment of children and adolescents with depressive disorders. Journal of the American Academy of Child & Adolescent Psychiatry. 2007;46:1503–1526.

    Article  Google Scholar 

  7. Cheung AH, Zuckerbrot R, Jensen PS, et al. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): II. Treatment and ongoing management. Pediatrics. 2007;120(5):1313–26.

    Article  Google Scholar 

  8. Rutter M, Sroufe L. Developmental psychopathology: concepts and challenges. Development and Psychopathology. 2000;12(3):265–96.

    Article  CAS  PubMed  Google Scholar 

  9. Blum RW, Garell D, Hodgman CH, et al. Transition from child-centered to adult health-care systems for adolescents with chronic conditions. A position paper of the Society for Adolescent Medicine. Journal of Adolescent Health. 1993;14(7):570–576.

    Article  CAS  PubMed  Google Scholar 

  10. Paul M, Ford T, Kramer T, et al. Transfers and transitions between child and adult mental health services. The British Journal of Psychiatry. Supplement 2013;54:s36-40.

    Article  PubMed  Google Scholar 

  11. Davis M, Sondheimer DL. State child mental health efforts to support youth in transition to adulthood. The Journal of Behavioral Health Services & Research. 2005;32(1):27–42.

    Article  Google Scholar 

  12. McNamara N, McNicholas F, Ford T, et al. Transition from child and adolescent to adult mental health services in the Republic of Ireland: an investigation of process and operational practice. Early Intervention in Psychiatry. 2013;8(3):291–297.

    Article  PubMed  Google Scholar 

  13. Singh SP, Paul M, Ford T, et al. Transitions of care from Child and Adolescent Mental Health Services to Adult Mental Health Services (TRACK Study): a study of protocols in Greater London. BMC Health Services Research. 2008;8(135):1–7.

    Google Scholar 

  14. Belling R, McLaren S, Paul M, et al. The effect of organisational resources and eligibility issues on transition from child and adolescent to adult mental health services. Journal of Health Services Research & Policy. 2014;19(3):169–176.

    Article  Google Scholar 

  15. Singh SP, Paul M, Ford T, et al. Process, outcome and experience of transition from child to adult mental healthcare: multiperspective study. The British Journal of Psychiatry. 2010;197(4):305–12.

    Article  PubMed  Google Scholar 

  16. Hofstra MB, van der Ende J, Verhulst FC. Child and adolescent problems predict DSM-IV disorders in adulthood: a 14-year follow-up of a Dutch epidemiological sample. Journal of the American Academy of Child and Adolescent Psychiatry. 2002;41(2):182–9.

    Article  PubMed  Google Scholar 

  17. Taylor N, Fauset A, Harpin V. Young adults with ADHD: an analysis of their service needs on transfer to adult services. Archives of Disease in Childhood. 2010;95(7):513–7.

    Article  PubMed  Google Scholar 

  18. Swift KD, Hall CL, Marimuttu V, et al. Transition to adult mental health services for young people with attention deficit/hyperactivity disorder (ADHD): a qualitative analysis of their experiences. BMC Psychiatry. 2013;13(1):74.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Rapoport JL, Gogtay N. Childhood onset schizophrenia: support for a progressive neurodevelopmental disorder. International Journal of Developmental Neuroscience. 2011;29(3):251–8.

    Article  PubMed  Google Scholar 

  20. Pine DS, Cohen P, Gurley D, et al. The risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. Archives of General Psychiatry. 1998;55(1):56–64.

    Article  CAS  PubMed  Google Scholar 

  21. Dunn V, Goodyer IM. Longitudinal investigation into childhood- and adolescence-onset depression: psychiatric outcome in early adulthood. The British Journal of Psychiatry. 2006;188:216–22.

    Article  PubMed  Google Scholar 

  22. Emslie GJ, Rush AJ, Weinberg WA, et al. Recurrence of major depressive disorder in hospitalized children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry. 1997;36(6):785–92.

    Article  CAS  PubMed  Google Scholar 

  23. Birmaher B, Williamson DE, Dahl RE, et al. Clinical presentation and course of depression in youth: does onset in childhood differ from onset in adolescence? Journal of the American Academy of Child & Adolescent Psychiatry. 2004;43(1):63–70.

    Article  Google Scholar 

  24. Essau CA, Conradt J, Petermann F. Course and outcome of anxiety disorders in adolescents. Journal of Anxiety Disorders. 2002;16(1):67–81.

    Article  PubMed  Google Scholar 

  25. Asarnow JR, Goldstein MJ, Carlson GA, et al. Childhood-onset depressive disorders. Journal of Affective Disorders. 1988;15(3):245–253.

    Article  CAS  PubMed  Google Scholar 

  26. Goodyer I, Germany E, Gowrusankur J, et al. Social influences on the course of anxious and depressive disorders in school-age children. The British Journal of Psychiatry. 1991;158(5):676–684.

    Article  CAS  PubMed  Google Scholar 

  27. Rao U, Ryan ND, Birmaher B, et al. Unipolar depression in adolescents: clinical outcome in adulthood. Journal of the American Academy of Child & Adolescent Psychiatry. 1995;34(1):566–578.

    Article  CAS  Google Scholar 

  28. Mccauley E, Myers K, Mitchell J, et al. Depression in young people: initial presentation and clinical course. Journal of the American Academy of Child & Adolescent Psychiatry. 1993;32(4):714–722.

    Article  CAS  Google Scholar 

  29. Thomsen PH. Obsessive-compulsive disorder in children and adolescents. A 6-22-year follow-up study. Clinical descriptions of the course and continuity of obsessive-compulsive symptomatology. European Child & Adolescent Psychiatry. 1994;3(2):82–96.

    Article  Google Scholar 

  30. Bruce SE, Yonkers KA, Otto MW, et al. Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study. The American Journal of Psychiatry. 2005;162(6):1179–1187.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Beesdo-Baum K, Knappe S, Fehm L, et al. The natural course of social anxiety disorder among adolescents and young adults. Acta Psychiatrica Scandinavica. 2012;126(6):411–25.

    Article  CAS  PubMed  Google Scholar 

  32. Rutter M, Kim-Cohen J, Maughan B. Continuities and discontinuities in psychopathology between childhood and adult life. Journal of Child Psychology and Psychiatry. 2006;47(3–4):276–95.

    Article  PubMed  Google Scholar 

  33. Lewinsohn PM, Rohde P, Seeley JR. Major depressive disorder in older adolescents: prevalence, risk factors, and clinical implications. Clinical Psychology Review. 1998;18(7):765–794.

    Article  CAS  PubMed  Google Scholar 

  34. Hankin BL. Future directions in vulnerability to depression among youth: integrating risk factors and processes across multiple levels of analysis. Journal of Clinical Child and Adolescent Psychology. 2012;41(5):695–718.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Rohde P, Lewinsohn PM, Klein DN, et al. Key characteristics of major depressive disorder occurring in childhood, adolescence, emerging adulthood, and adulthood. Clinical Psychological Science. 2012;1(1):41–53.

    Article  Google Scholar 

  36. Lewinsohn PM, Clarke GN, Seeley JR, et al. Major depression in community adolescents: age at onset, episode duration, and time to recurrence. Journal of the American Academy of Child & Adolescent Psychiatry. 1994;33(6):809–818.

    Article  CAS  Google Scholar 

  37. Birmaher B, Brent DA, Kolko D, Baugher M, et al. Clinical outcome after short-term psychotherapy for adolescents with major depressive disorder. Archives of General Psychiatry. 2000;57(1):29–36.

    Article  CAS  PubMed  Google Scholar 

  38. Ogburn KM, Sanches M, Williamson DE, et al. Family environment and pediatric major depressive disorder. Psychopathology. 2010;43(5):312–8.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Gilman SE, Kawachi I, Fitzmaurice GM, et al. Socio-economic status, family disruption and residential stability in childhood: relation to onset, recurrence and remission of major depression. Psychological Medicine. 2003;33(8):1341–55.

    Article  CAS  PubMed  Google Scholar 

  40. Sanford M, Szatmari P, Spinner M, et al. Predicting the one-year course of adolescent major depression. Journal of the American Academy of Child & Adolescent Psychiatry. 1995;34(12):1618–1628.

    Article  CAS  Google Scholar 

  41. Rao U, Hammen CL, Poland RE. Longitudinal course of adolescent depression: neuroendocrine and psychosocial predictors. Journal of the American Academy of Child & Adolescent Psychiatry. 2010;49(2):141–151.

    Google Scholar 

  42. Steinhausen HC, Haslimeier C, Winkler Metzke C. The outcome of episodic versus persistent adolescent depression in young adulthood. Journal of Affective Disorders. 2006;96(1–2):49–57.

    Article  PubMed  Google Scholar 

  43. Kovacs M, Devlin B. Internalizing disorders in childhood. Journal of Child Psychology and Psychiatry. 1998;39(1):47–63.

    Article  CAS  PubMed  Google Scholar 

  44. Nolen-Hoeksema S, Girgus JS, Seligman MEP. Predictors and consequences of childhood depressive symptoms: a 5-year longitudinal study. Journal of Abnormal Psychology. 1992;101(3):405–422.

    Article  CAS  PubMed  Google Scholar 

  45. Kovacs M, Feinberg TL, Crouse-Novak M, et al. Depressive disorders in childhood. II. A longitudinal study of the risk for a subsequent major depression. Archives of General Psychiatry. 1984;41(7):643–9.

    Article  CAS  PubMed  Google Scholar 

  46. Hammen C, Brennan PA, Keenan-Miller D, et al. Early onset recurrent subtype of adolescent depression: clinical and psychosocial correlates. Journal of Child Psychology and Psychiatry. 2008;49(4):433–40.

    Article  PubMed  Google Scholar 

  47. Lewinsohn PM, Rohde P, Seeley JR, et al. Natural course of adolescent major depressive disorder in a community sample: predictors of recurrence in young adults. The American Journal of Psychiatry. 2000;157(10):1584–91.

    Article  CAS  PubMed  Google Scholar 

  48. Daley SE, Hammen CL, Rao U. Predictors of first onset and recurrence of major depression in young women during the 5 years following high school graduation. Journal of Abnormal Psychology. 2000;109(3):525–533.

    Article  CAS  PubMed  Google Scholar 

  49. Weissman MM, Wolk S, Wickramaratne P, et al. Children with prepubertal-onset major depressive disorder and anxiety grown up. Archives of General Psychiatry. 1999;56(9):794–801.

    Article  CAS  PubMed  Google Scholar 

  50. Last CG, Perrin S, Hersen M, et al. A prospective study of childhood anxiety disorders. Journal of the American Academy of Child and Adolescent Psychiatry. 1996;35(11):1502–10.

    Article  CAS  PubMed  Google Scholar 

  51. Keller MB, Lavori PW, Wunder J, et al. Chronic course of anxiety disorders in children and adolescents. Journal of the American Academy of Child & Adolescent Psychiatry. 1992;31(4):595–599.

    Article  CAS  Google Scholar 

  52. Lewinsohn PM, Holm-Denoma JM, et al. Separation anxiety disorder in childhood as a risk factor for future mental illness. Journal of the American Academy of Child and Adolescent Psychiatry. 2008;47(5):548–55.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Stewart SE, Geller DA, Jenike M, et al. Long-term outcome of pediatric obsessive-compulsive disorder: a meta-analysis and qualitative review of the literature. Acta psychiatrica Scandinavica. 2004;110(1):4–13.

    Article  CAS  PubMed  Google Scholar 

  54. Micali N, Heyman I, Perez M, et al. Long-term outcomes of obsessive-compulsive disorder: follow-up of 142 children and adolescents. The British Journal of Psychiatry. 2010;197(2):128–34.

    Article  CAS  PubMed  Google Scholar 

  55. Woodward LJ, Fergusson DM. Life course outcomes of young people with anxiety disorders in adolescence. Journal of the American Academy of Child and Adolescent Psychiatry. 2001;40(9):1086–93.

    Article  CAS  PubMed  Google Scholar 

  56. Woodruff-Borden J, Morrow C, Bourland S, et al. The behavior of anxious parents: examining mechanisms of transmission of anxiety from parent to child. Journal of Clinical Child and Adolescent Psychology 2002;31(3):364–74.

    Article  PubMed  Google Scholar 

  57. Nakatani E, Krebs G, Micali N, et al. Children with very early onset obsessive-compulsive disorder: clinical features and treatment outcome. Journal of Child Psychology and Psychiatry, and Allied Disciplines. 2011;52(12):1261–8.

    Article  PubMed  Google Scholar 

  58. Wewetzer C, Jans T, Müller B, et al. Long-term outcome and prognosis of obsessive-compulsive disorder with onset in childhood or adolescence. European Child and Adolescent Psychiatry. 2001;10(1):37–46.

    Article  CAS  PubMed  Google Scholar 

  59. Nilsen TS, Eisemann M, Kvernmo S. Predictors and moderators of outcome in child and adolescent anxiety and depression: a systematic review of psychological treatment studies. European Child and Adolescent Psychiatry. 2013;22(2):69–87.

    Article  PubMed  Google Scholar 

  60. Emslie GJ, Rush AJ, Weinberg WA, et al. Fluoxetine in child and adolescent depression: acute and maintenance treatment. Depression and Anxiety. 1998;7(1):32–9.

    Article  CAS  PubMed  Google Scholar 

  61. Curry J, Silva S, Rohde P, et al. Recovery and recurrence following treatment for adolescent major depression. Archives of General Psychiatry. 2011;68(3):263–270.

    Article  PubMed  Google Scholar 

  62. Clarke GN, Rohde P, Lewinsohn PM, et al. Cognitive-behavioral treatment of adolescent depression: efficacy of acute group treatment and booster sessions. Journal of the American Academy of Child and Adolescent Psychiatry. 1999;38(3):272–9.

    Article  CAS  PubMed  Google Scholar 

  63. Vitiello B, Emslie G, Clarke G, et al. Long-term outcome of adolescent depression initially resistant to SSRI treatment. Journal of Clinical Psychiatry. 2011;72(3):388–396.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Manassis K, Avery D, Butalia S, et al. Cognitive-behavioral therapy with childhood anxiety disorders: functioning in adolescence. Depression and Anxiety. 2004;19(4):209–16.

    Article  PubMed  Google Scholar 

  65. Kennard BD, Silva SG, Tonev S, et al. Remission and recovery in the Treatment for Adolescents with Depression Study (TADS): acute and long-term outcomes. Journal of the American Academy of Child and Adolescent Psychiatry. 2009;48(2):186–95.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Nevo GA, Manassis K. Outcomes for treated anxious children: a critical review of long-term-follow-up studies. Depression and Anxiety. 2009;26(7):650–60.

    Article  PubMed  Google Scholar 

  67. Saavedra LM, Silverman WK, Morgan-Lopez AA, et al. Cognitive behavioral treatment for childhood anxiety disorders: long-term effects on anxiety and secondary disorders in young adulthood. Journal of Child Psychology and Psychiatry. 2010;51(8):924–34.

    Article  PubMed  Google Scholar 

  68. Schoen C, Osborn R, Doty MM, et al. A survey of primary care physicians in eleven countries, 2009: perspectives on care, costs, and experiences. Health Affairs. 2009;28(6):w1171-83.

    Article  PubMed  Google Scholar 

  69. McGorry P, Bates T, Birchwood M. Designing youth mental health services for the 21st century: examples from Australia, Ireland and the UK. The British Journal of Psychiatry. 2013;54(1):30–35.

    Article  Google Scholar 

  70. Cosgrave EM, Yung AR, Killackey EJ, et al. Met and unmet need in youth mental health. Journal of Mental Health. 2008;17(6):618–628.

    Article  Google Scholar 

  71. Reid GJ, Stewart SL, Zaric GS, et al. Defining episodes of care in children’s mental health using administrative data. Adminstration and Policy in Mental Health. 2014: In press.

  72. Ryan B, Brown J, Terry A, et al. Exploring patient and provider perspectives regarding patient portals in primary care. Toronto, Ontario; 2014.

  73. Kauer SD, Reid SC, Crooke AHD, et al. Self-monitoring using mobile phones in the early stages of adolescent depression: randomized controlled trial. Journal of Medical Internet Research. 2012;14(3):e67.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Katzman MA, Bleau P, Blier P, et al. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry. 2014;14:S1.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Connolly SD, Bernstein GA. Practice parameter for the assessment and treatment of children and adolescents with anxiety disorders. Journal of the American Academy of Child and Adolescent Psychiatry. 2007;46(2):267–283.

    Article  PubMed  Google Scholar 

  76. Birmaher B, Brent D, Bernet W, et al. Practice parameter for the assessment and treatment of children and adolescents with depressive disorders. Journal of the American Academy of Child and Adolescent Psychiatry. 2007;46(11):1503–1526.

    Article  PubMed  Google Scholar 

  77. Frenette M. Does distance to school matter? Canadian Public Policy. 2004;30(4):427–443.

    Article  Google Scholar 

  78. Jivanjee P, Kruzich JM, Gordon LJ. The age of uncertainty: parent perspectives on the transitions of young people with mental health difficulties to adulthood. Journal of Child and Family Studies. 2009;18(4):435–446.

    Article  Google Scholar 

  79. Arnett JJ. Emerging adulthood. A theory of development from the late teens through the twenties. The American Psychologist. 2000;55(5):469–80.

    Article  CAS  PubMed  Google Scholar 

  80. National Institute for Health Research Service Delivery and Organization. Transition from CAMHS to Adult Mental Health Services (TRACK): A Study of Service Organisation, Policies, Process and User and Carer Perspectives. United Kingdom; 2010.

  81. Curry JF. Future directions in research on psychotherapy for adolescent depression. Journal of Clinical Child and Adolescent Psychology. 2014;43(3):510–526.

    Article  PubMed  Google Scholar 

Download references

G. Reid was supported by the Children’s Health Foundation.

Author information

Authors and Affiliations

  1. Department of Psychology, The University of Western Ontario, 361 Windermere Rd, Westminister Hall, Room 234E, N6A 3K7, London, ON, Canada

    Kyleigh E. Schraeder

  2. Departments of Psychology, Family Medicine and Paediatrics, The University of Western Ontario, London, ON, Canada

    Graham J. Reid

  3. Children’s Health Research Institute, London, ON, Canada

    Graham J. Reid

Authors
  1. Kyleigh E. Schraeder
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Graham J. Reid
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kyleigh E. Schraeder.

Ethics declarations

Conflict of Interest

The authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest, or non-financial interest in the subject matter or materials discussed in this manuscript.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(DOCX 73 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schraeder, K.E., Reid, G.J. Who Should Transition? Defining a Target Population of Youth with Depression and Anxiety That Will Require Adult Mental Health Care. J Behav Health Serv Res 44, 316–330 (2017). https://doi.org/10.1007/s11414-015-9495-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11414-015-9495-2

Keywords

Search

Navigation