Leaving child and adolescent mental health services in the MILESTONE cohort: a longitudinal cohort study on young people's mental health indicators, care pathways, and outcomes in Europe

Adult psychiatric outcomes of young people who attended child and adolescent mental health services: a longitudinal total population study

BACKGROUND

There is an unprecedented societal focus on young people's mental health, including efforts to expand access to child and adolescent mental health services (CAMHS). There has, however, been a lack of research to date to investigate adult mental health outcomes of young people who attend CAMHS.

METHODS

We linked Finland's healthcare registries for all individuals born between 1987 and 1992. We investigated mental disorder diagnoses recorded in specialist adult mental health services (AMHS) and both inpatient and outpatient service use by age 29 (December 31, 2016) for former CAMHS patients.

RESULTS

Before the end of their 20s, more than half (52.4%, n = 21,183) of all CAMHS patients had gone on to attend AMHS. The most prevalent recorded adult psychiatric diagnoses received by former CAMHS patients were depressive disorders (30%, n = 11,768), non-phobic anxiety disorders (21%, n = 7,910), alcohol use disorders (9.5%, n = 3,427), personality disorders (9.3%, n = 3,366), and schizophrenia-spectrum disorders (7.6%, n = 2,945). In the total population, more than half of all AMHS appointments (53.1%, k = 714,239/1,345,060) were for former CAMHS patients. More than half of all inpatient psychiatry bed days were for former CAMHS patients (53.1%, k = 1,192,991/2,245,247).

CONCLUSION

While there is a strong focus on intervening in childhood and adolescence to reduce the burden of mental illness, these findings suggest that young people who receive childhood intervention very frequently continue to require specialist psychiatric interventions in adulthood, including taking up a majority of both outpatient and inpatient service use. These findings highlight the need for a greater focus on research to alter the long-term trajectories of CAMHS patients.

Engagement of people with lived experience in studies published in high-impact psychiatry journals: meta-research review

BACKGROUND

We evaluated studies published in high-impact psychiatry journals to assess (1) the proportion that reported in articles whether they engaged people with lived experience; (2) the proportion that likely engaged people with lived experience; and, if engagement occurred, (3) stages of research (planning, conduct, interpretation, dissemination); and (4) engagement level (consult, involve, partner).

METHODS

We searched PubMed on December 14, 2022, for articles in psychiatry journals with impact factor ≥ 10 and reviewed articles in reverse chronological order until 141 were included, based on pre-study precision estimation. We contacted authors to obtain information on engagement.

RESULTS

Three of 141 (2%) studies reported engagement of people with lived experience in articles. Of the other 138 studies, 74 authors responded to follow-up emails and 22 reported they engaged people with lived experience but did not report in the article. Depending on assumptions about engagement by non-responders, we estimated, overall, 18-31% of studies may have engaged people with lived experience. Engagement occurred in research planning (70%) and rarely interpretation (35%). Most involved consultation (providing opinions or perspectives, 53%) and few involved partnership (11%).

CONCLUSIONS

Engagement of people with lived experience in psychiatry research is uncommon, and when it does occur people are typically consulted but not engaged in roles with influence on decision-making. Funding agencies, ethics committees, journals, and academic institutions should take steps to support engagement of people with lived experience in psychiatry research.

Transition Readiness Among Youth Accessing Mental Health Services With Physical Health Co-Morbidities

BACKGROUND

Transition readiness, or skills and preparation for navigating adult health care, is an important factor in the successful transition from child and adolescent mental health services (CAMHS) to adult care; however, predictors of transition readiness are not fully understood. One factor which may impact transition readiness among youth accessing CAMHS is the presence of a co-occurring physical health condition; however, this has not been previously examined. Within a cohort of youth receiving CAMHS, the objective of this study was to understand if there is an association between co-occurring physical health conditions and transition readiness and if this relationship is impacted by severity of mental health symptoms.

METHODS

This study was a secondary analysis of baseline data from the Longitudinal Youth in Transition Study, including 237 16- to 18-year-old youth accessing outpatient CAMHS from four different clinical sites. Participants completed self-report measures on mental health symptoms, functioning, service use, transition readiness, and physical health conditions. Multiple linear regression models were used to measure the association between the presence of health conditions and transition readiness scores as well as determine if there was an interaction between mental health symptoms and physical health conditions to predict transition readiness.

RESULTS

Co-occurring physical conditions were reported by 41% of youth and were associated with greater overall transition readiness. There was no interaction between mental health symptom severity and co-occurring physical conditions, though attention problems were independently associated with lower transition readiness scores.

CONCLUSIONS

Youth accessing CAMHS who have a co-occurring physical condition have overall greater transition readiness than youth without a co-occurring condition. Further research should explore the role of frequency and types of healthcare encounters in transition readiness for transition age youth needing ongoing mental health care to better understand how to support self-management and care navigation skill development.

Prospective analysis of sex differences and factors associated with suicidal thoughts and behaviours in young people from the MILESTONE Italian sample

Suicide is a significant leading cause of death among young people, particularly those struggling with mental disorders. The present study utilised data from 230 young people (aged 16-18 years) undergoing a transitional care process from Child and Adolescent Mental Health Services to Adult Mental Health Services within the MILESTONE European project (2014-2019), a longitudinal cluster randomised controlled trial. The objectives of this study were to monitor temporal patterns of general health and social functioning over two years, to detect sex differences, and to identify factors associated with Suicidal Thoughts and Behaviours (STB) at the first and last time points. The results demonstrate a decrease in STB over the two-year follow-up period among all participants. Females exhibited a higher prevalence of STB across all time points, whereas males only exhibited STB at the nine-month follow-up. The most influential factors associated with STB were previous suicide attempts and mood disorders at baseline, and mood disorders and relational problems at the end of follow-up. These findings emphasise the importance of monitoring STB and informing young people undergoing a transitional care period about its key risk factors. Moreover, sex differences in STB suggest the need for different preventive strategies for males and females.

Systematic review and meta-analysis of interventions to improve outcomes for parents or carers of children with anxiety and/or depression

QUESTION

Depression and anxiety are common among children and young people and can impact on the well-being of their parents/carers. Dominant intervention approaches include parent training; however, this approach does not directly address parents' well-being. Our objective was to examine the effect of interventions, with at least a component to directly address the parents' own well-being, on parents' well-being outcomes, including stress, depression and anxiety.

STUDY SELECTION AND ANALYSIS

A systematic search was performed in the following: MEDLINE, EMBASE, CINAHL, AMED, PsycINFO, Scopus, CENTRAL, Web of Science Core Collection (six citation indexes) and WHO ICTRP from inception to 30 December 2023. Interventions that aimed to support parents/carers managing the impact of their child's/young person's mental health were eligible. EPHPP (Effective Public Health Practice Project) was used to quality appraise the included studies. A meta-analysis of relevant outcomes was conducted.

FINDINGS

Fifteen studies were eligible comprising 812 parents/carers. Global methodological quality varied. Seven outcomes (anxiety, depression, stress, burden, self-efficacy, quality of life and knowledge of mood disorders) were synthesised at post-intervention. A small reduction in parental/carer anxiety favouring intervention was indicated in one of the analyses (g=-0.26, 95% CI -0.44 to -0.09, p=0.02), when excluding an influential case. Three outcomes were synthesised at follow-up, none of which were statistically significant.

CONCLUSIONS

Interventions directly addressing the well-being for parents of children with anxiety and/or depression appear not to be effective overall. Clearer conceptualisation of factors linked to parental distress is required to create more targeted interventions.

PROSPERO REGISTRATION NUMBER

CRD42022344453.

Adaptation and validation of the On Your Own Feet - Transition Experiences Scale evaluating transitions to adult services among adolescent mental health service users in Europe

PURPOSE

Experiences of young people transitioning from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) have mostly been investigated qualitatively. This study adapts and validates the On Your Own Feet - Transition Experiences Scale (OYOF-TES) in a sample of CAMHS users in Europe and describes young people's and parents' experiences with transition and end of care at CAMHS.

METHODS

The OYOF-TES was adapted to a mental health setting and translated. An End Of Care (OYOF-EOC) version (self- and parent-report) was developed. A total of 457 young people and 383 parents completed an OYOF-TES or OYOF-EOC. Psychometric properties and descriptives are presented.

RESULTS

The Cronbach's alphas of the OYOF-TES and OYOF-EOC parent/self-report ranged from 0.92 to 0.94. The two-factor structure was confirmed. The mean overall satisfaction reported by young people was 6.15 (0-10; SD=2.92) for transition and 7.14 (0-10; SD=2.37) for care ending. However, 26.7%-36.4% of young people were unsatisfied.

DISCUSSION

The OYOF-TES and OYOF-EOC can be used reliably in mental healthcare settings to capture young people's and parents' transition experiences. The majority of young people and parents was satisfied with the process of transition and care ending, yet a third of young people had negative experiences.

Psychological well-being and needs of parents and carers of children and young people with mental health difficulties: a quantitative systematic review with meta-analyses

QUESTION

For parents of children and young people (CYP) with diagnosed mental health difficulties, what are the levels of parents' well-being and psychological need?

STUDY SELECTION AND ANALYSIS

Medline, PsycINFO, EMBASE, AMED, CINAHL, Web of Science and Cochrane Library of Registered Trials were searched from inception to June 2023.

INCLUSION CRITERIA

parents of CYP aged 5-18 years with formal mental health diagnosis. Data were extracted from validated measures of well-being or psychological needs with established cut-off points or from a controlled study.

FINDINGS

32 of the 73 310 records screened were included. Pooled means showed clinical range scores for one measure of depression, and all included measures of anxiety, parenting stress and general stress. Meta-analyses showed greater depression (g=0.24, 95% CI 0.11 to 0.38) and parenting stress (g=0.34, 95% CI 0.20 to 0.49) in parents of CYP with mental health difficulties versus those without. Mothers reported greater depression (g=0.42, 95% CI 0.18 to 0.66) and anxiety (g=0.73, 95% CI 0.27 to 1.18) than fathers. Narrative synthesis found no clear patterns in relation to CYP condition. Rates of parents with clinically relevant levels of distress varied. Typically, anxiety, parenting stress and general stress scored above clinical threshold. Quality appraisal revealed few studies with a clearly defined control group, or attempts to control for important variables such as parent gender.

CONCLUSIONS

The somewhat mixed results suggest clinical anxiety, parenting and general stress may be common, with sometimes high depression. Assessment and support for parents of CYP with mental health problems is required. Further controlled studies, with consideration of pre-existing parental mental health difficulties are required.

PROSPERO REGISTRATION NUMBER

CRD42022344453.

Turning 18 in mental health services: a multicountry qualitative study of service user experiences and views

BACKGROUND

Worldwide, the division between Child and Adolescent Mental Health Services (CAMHS) and Adult Mental Health Services (AMHS) has frequently resulted in fragmented care with an unprepared, non-gradual transition. To improve continuity of care and other service transition experiences, service user input is essential. However, such previous qualitative studies are from a decade ago or focused on one mental disorder or country. The aim of the present study was to learn from service users' transition experiences and suggested improvements.

METHODS

Semi-structured interviews were held with young people aged 18-24 and/or parents/caregivers in the United Kingdom, Ireland, the Netherlands and Croatia. Inclusion was based on the experience of specialist mental health care before and after turning 18. Thematic analysis of transcribed and translated interview transcripts was performed using ATLAS.ti 9.

RESULTS

Main themes of service user experiences included abrupt changes in responsibilities, various barriers and a lack of preparation, communication and ongoing care. Young people expressed a great need for continuity of care. Their suggestions to improve transitional care included early and adequate preparation, joint working, improved communication from and between services, overlapping services, staying at CAMHS for longer and designated youth mental health teams.

CONCLUSIONS

Young people who experienced care before and after turning 18 suggested either altering the age limits of services or ensuring early preparation and communication regarding the transition and finding AHMS. This communication should include general changes when turning 18. Further considerations include increasing collaboration and overlap between CAMHS and AMHS.

Predictors of transitioning to adult mental health services and associated costs: a cross-country comparison

BACKGROUND

Young people are at risk of falling through the care gap after leaving child and adolescent mental health services (CAMHS) despite an ongoing need for mental health support. Currently, little is known about the predictors of transitioning to adult mental health services (AMHS), and associated healthcare and societal costs as young people cross the transition boundary.

OBJECTIVE

To conduct a secondary data analysis exploring predictors of transitioning or falling through the gap and associated costs.

METHODS

Data were used from a longitudinal study, which followed young people from seven European countries for 2 years after reaching their CAMHS boundary. Predictors of transitioning (including sociodemographic and clinical variables) and longitudinal resource use were compared for 488 young people who transitioned to AMHS versus those who fell through the gap.

FINDINGS

Young people were more likely to transition to AMHS if they were severely ill. Those from Italy, the Netherlands and the UK were more likely to fall through the gap than transition to AMHS. Healthcare costs fell for all young people over the study, with a sharper decrease for those who fell through the gap.

CONCLUSIONS

Total healthcare costs fell for all participants, indicating that the intensity of mental health support reduces for all young people as they cross the CAMHS boundary, regardless of clinical need.

CLINICAL IMPLICATIONS

It is important that alternative forms of mental health support are available for young people who do not meet the AMHS care threshold but still have mental health needs after leaving CAMHS.

@ease peer-to-peer youth walk-in centres in The Netherlands: A protocol for evaluating longitudinal outcomes, follow-up results and cost-of-illness

AIM

Innovative youth mental health services around the globe vigorously work on increasing highly needed mental health care accessibility but their service users and care effectiveness have rarely been studied. The Dutch youth walk-in centres of @ease opened in 2018, with currently 11 locations at which free anonymous peer-to-peer counselling is offered to young people aged 12-25. The aim of this protocol is to outline the to-be-conducted research at @ease.

METHODS

Three studies are outlined: (1) an outcome evaluation of @ease visits using hierarchical mixed model analyses and change calculations, (2) a cost-of-illness study using calculations for costs of truancy and care usage among these help-seeking young people, with regression analyses for risk group identification, and (3) a follow-up evaluation at three, six and 12 months to assess long-term effects after ending @ease visits. Data provided by young people include demographics, parental mental illness, truancy, past treatment, psychological distress (CORE-10) and health-related quality of life (EQ-5D-5L). Social and occupational functioning (SOFAS), suicidal ideation and need for referral are rated by the counsellors. Questionnaires are filled out at the end of every visit and at follow-up via e-mail or text, provided permission is given.

DISCUSSION

Research regarding the visitors and effectiveness of the @ease services is fully original. It offers unique insights into the mental wellbeing and cost-of-illness of young people who may otherwise remain unseen while suffering from a high disease burden. The upcoming studies shed light on this unseen group, inform policy and practice and direct future research.