Krantz Mette Falkenberg, Dalsgaard Søren, Osler Merete, Jorgensen Martin Balslev, Jorgensen Anders, Jørgensen Terese Sara Høj
Child and Adolescent Mental Health Center, https://ror.org/049qz7x77Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Eur Psychiatry. 2025 Aug 26;68(1):e126. doi: 10.1192/j.eurpsy.2025.10091.
Little is known about the diagnostic trajectories following a first psychiatric diagnosis in childhood or adolescence. Such knowledge could aid clinicians in treatment, risk prediction, and psychoeducation. This study presents a comprehensive nationwide overview of diagnostic trajectories in children and adolescents after their first diagnosis in child and adolescent psychiatric hospitals.
Patients aged 0 to 17 years who received their first psychiatric diagnosis between January 1996 and December 2011 were identified through the Danish National Patient Registries. Shifts at the International Classification of Diseases (ICD-10) two-cipher level (F00-F99), grouped into 19 categories, were identified. Subsequent diagnoses during 10 years of follow-up until December 2021 were identified and analyzed using state sequence analysis and Cox proportional hazard regression models.
A total of 77,464 children and adolescents (32,733 [42.26%] girls) were identified with a first-time psychiatric diagnosis. Among these, 46.7% of girls and 37.6% of boys had at least one diagnostic shift after 10 years of follow-up. High entropy and low diagnostic stability were found in first-time diagnoses often presenting in adolescence, such as affective disorders, psychotic illness, and personality disorders, while lower entropy and high diagnostic stability were found in neurodevelopmental disorders and eating disorders. For most categories, girls had higher mean entropy measures than boys ( < 0.05).
Diagnostic shifts are common in child and adolescent psychiatric services, particularly when the first contact occurs in adolescence. Adequate focus on psychoeducation about emerging diagnostic shifts, and on timely detection, particularly in girls, and particularly in adolescence, is warranted.
关于儿童或青少年首次精神疾病诊断后的诊断轨迹，人们了解甚少。此类知识有助于临床医生进行治疗、风险预测和心理教育。本研究全面概述了全国范围内儿童和青少年在儿童及青少年精神病医院首次诊断后的诊断轨迹。
通过丹麦国家患者登记处确定了1996年1月至2011年12月期间首次接受精神疾病诊断的0至17岁患者。确定了国际疾病分类（ICD-10）两位数级别（F00-F99）的类别变化，共分为19类。使用状态序列分析和Cox比例风险回归模型，确定并分析了截至2021年12月的10年随访期间的后续诊断情况。
共确定了77464名首次被诊断患有精神疾病的儿童和青少年（32733名[42.26%]为女孩）。其中，46.7%的女孩和37.6%的男孩在随访10年后至少有一次诊断类别变化。在青少年期常见的首次诊断中，如情感障碍、精神病性疾病和人格障碍，发现了高熵和低诊断稳定性，而在神经发育障碍和进食障碍中则发现了较低的熵和高诊断稳定性。在大多数类别中，女孩的平均熵值高于男孩（P<0.05）。
在儿童和青少年精神科服务中，诊断类别变化很常见，尤其是首次接触发生在青少年期时。有必要充分关注关于新出现的诊断类别变化的心理教育，以及及时检测，特别是对女孩，尤其是在青少年期。
