Psychiatry Section, Psychophysiological Selection Office, Italian Army National Recruitment and Selection Center, 06034, Foligno, PG, Italy.
Private Accredited Hospital Villa Igea, 41126, Saliceta San Giuliano, MO, Italy.
Eur Child Adolesc Psychiatry. 2022 May;31(5):805-818. doi: 10.1007/s00787-020-01717-y. Epub 2021 Jan 24.
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.
年轻人从儿童和青少年心理健康服务（CAMHS）过渡到成人心理健康服务（AMHS）是一个复杂的过程。过渡率报告差异较大，定义和范围广泛。关于成功过渡的预测因素的数据很少。我们在儿童和青少年强化治疗病房（CAITW）的前住院患者队列中探讨了与过渡相关的因素。将先前在 CAITW 住院的患者的社会人口统计学和临床特征与符合年龄要求的 AMHS 数据相匹配。我们建立了多个逻辑回归模型，以确定与转至 AMHS（住院或门诊）以及转至 AMHS 后 6 个月（短期 RIT）、12 个月（中期 RIT）和 24 个月（长期 RIT）时治疗保留（RIT）相关的因素。从 322 名住院患者中，有 126 名在研究期间达到了转至 AMHS 的年龄门槛。转院率为 50%。在过渡年龄界限后的两年，CAMHS-AMHS 的连续护理在 40%的病例中发现，而在 6%的病例中发现脱离。住院时间较长且多次住院、使用非典型抗精神病药物处方和精神障碍诊断是短期和中期 RIT 的相关因素。有阳性精神疾病家族史与短期和中期 RIT 的成功呈负相关。精神病诊断和学习支持的学校出勤率与长期 RIT 相关。曾因精神疾病住院的青少年儿童转至 AMHS 的比例相对较高。精神障碍诊断似乎是这些患者过渡的最强预测因素。进一步的研究应关注患者的就学需求和有心理健康问题的父母的子女，以加强家庭和教育系统的参与。
