Temporal patterns in adolescent psychiatric treatment and outcomes: a nationwide register-based cohort follow-up.

The rise in mental health problems among adolescents in high-income countries presents a challenge to service systems. For the development of services, there is a need for better insight into temporal psychiatric treatment-trends and outcomes. This study aims to analyze time-trends in both psychiatric treatment patterns and outcomes, utilizing a national sample of all adolescents receiving psychiatric treatment in Finland from 2003 to 2013. For time-trend-analysis, the sample was divided into two cohorts, using the onset year of 2008 as a cutoff. For each case, information on psychiatric treatment was gathered from registers within a five-year follow-up period from the onset of treatment or to death. The association between the inclusion year and outcome variables was studied via weighted generalized linear models. Adolescents in the latter cohort had a greater proportion (p < 0.001) of mood and anxiety diagnoses, a lower likelihood of hospitalization, a higher average of outpatient visits, and greater usage of psychotropics (excluding benzodiazepines). Those whose treatment began after 2008 were more likely to be alive (baseline characteristic adjusted Odds Ratio (aOR): 0.7, 95%CI: 0.6-0.8) and still in treatment contact (aOR: 1.4, 95%CI: 1.3-1.4) after four years from the onset. There was no difference in the long-term disability ratio. The results indicate favorable developments towards outpatient care in mental health services for adolescents with a significant decrease in mortality. Approaches to further developing cost-effective, personalized mental health services are discussed.

Factors contributing to readmission in patients with psychotic disorders, with a special reference to first follow-up visit in outpatient care.

BACKGROUND: Timely outpatient follow-up and readmission after discharge are common quality indicators in psychiatric care, but their association varies in previous research. We aimed to examine whether the impact of outpatient follow-up and other factors on readmission risk evolves over time in people with non-affective psychotic disorder (NAP). METHODS: The Finnish Quality of Care Register includes all people diagnosed with NAP since January 2010. Here, we followed patients with a hospital discharge between 2017 and 2021 until readmission, death, or up to 365 days. Time of the first outpatient follow-up appointment, length of stay (LOS), number of previous hospitalizations, psychosis diagnosis, substance use disorder (SUD), residential status, economic activity, gender, age, year, and region were included. Follow-up time was divided into five periods: week 1, weeks 2-4, weeks 5-13, weeks 14-25, and weeks 26-52, and each period was analyzed separately with Cox regression. RESULTS: Of the 29 858 discharged individuals, 54.1% had an outpatient follow-up within a week. A total of 10 623 (35.6%) individuals were readmitted. Short LOS increased the readmission risk in the first four weeks, whereas lack of outpatient follow-up raised the risk (adjusted HRs between 1.15 (95% CI 1.04-1.26) and 1.53 (1.37-1.71) in weeks 5-52. The number of previous hospitalizations remained a consistent risk factor throughout the follow-up, while SUD increased risk after 4 weeks and living without family after 13 weeks. CONCLUSIONS: Risk factors of readmission vary over time. These temporal patterns must be considered when developing outpatient treatment programs.

The Association of Antipsychotic Postponement With 5-Year Outcomes of Adolescent First-Episode Psychosis.

Background and Hypothesis: Based on the need-adapted approach, delaying antipsychotics could help identify first-episode psychosis (FEP) adolescents who might not require them. However, some individuals might need antipsychotics, and postponing could harm their prognosis. This nationwide register-based follow-up aimed to test these two hypotheses. Study Design: All adolescents aged 13-20 with a psychotic disorder (ICD-10 codes: F20-F29) in Finland between 2003 and 2013 were identified (n = 6354) from national registers. For each case, a fixed 1825-day follow-up period was established from the onset of psychosis or until death. The outcome was considered "good" if adolescents did not die and had not received psychiatric treatment and/or disability allowances during the final year of follow-up. Testing the first hypothesis involved all antipsychotic treatment-naïve adolescents with FEP (n = 3714). The second hypothesis was tested with a sub-sample of only those who had received antipsychotics during follow-up (n = 3258). To account for baseline confounders, hypotheses were tested via a stabilized inverse probability of treatment weighted generalized linear models with logit link function. Study Results: Immediate antipsychotic treatment after the onset of psychosis was associated with poor 5-year outcome (adjusted odds ratio [aOR]: 1.8, 95% CI: 1.6-2.1). There was no statistically significant association between antipsychotic postponement and treatment outcome in those who eventually received antipsychotic treatment (aOR: 1.02, 95% CI: 0.7-1.2, P: .8), thus not providing support for second hypothesis. Conclusions: There is a significant subgroup of adolescent with psychosis who do not require immediate antipsychotic treatment. A more robust design is needed to evaluate the causality of the observed association.