The black hole of the transition process: dropout of care before transition age in adolescents.

Recent evidence confirms the risks of discontinuity of care when young people make a transition from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS), although robust data are still sparse. We aimed to identify when and how patients get lost to care during transition by tracking care pathways and identifying factors which influence dropping out of care during transition. This is a retrospective observational study of 760 patients who reached the transition age boundary within 12 months before transition time and being treated at CAMHS for at least during preceding 18 months. Data were collected at two time points: last visit to CAHMS and first visit to AHMS. Socio-demographic, clinical and service utilization variables on CAMHS treatment were collected. In the 12 months leading up to the transition boundary, 46.8% of subjects (n = 356) withdrew from CAHMS without further contact with AHMS, 9.3% withdrew from CAHMS but were referred to AHMS by other services, 29% were transferred from CAHMS to AHMS, 10% remained at CAHMS and 5% patients were transferred to alternative services. Fifty-six percent of subjects experience cessation of care before the transition age. The risk of dropout increases with shorter contact time in CAMHS, is greater in subjects without pharmacological treatment, and decreases in subjects with psychosis, bipolar disorder, eating disorders, mental retardation, and neurodevelopmental disorders. This study confirms that a large number of people drop out of care as they approach the CAMHS transition and experience discontinuity of care during this critical period.

[Sex as a moderating variable of internalizing and externalizing symptomatology in childhood]. / Sexo como variable moderadora de la sintomatología internalizante y externalizante en la infancia.

OBJECTIVE: One in one hundred minors has some mental health problem. Symptomatology varies according to gender. Most research has been conducted with the general population. The objective of this paper was to analyze the moderating role of sex in the presence of internalizing (emotional disorders, anxiety and depression) and externalizing symptomatology (behavioral disorders and hyperactivity) in childhood, as well as to compare the general population with the clinical population. METHODS: A descriptive cross-sectional study was conducted with 552 boys and girls between ten and twelve years of age, 94 mental health patients and 458 schoolchildren. Participants completed self-report measures: Strengths and Difficulties Questionnaire (SDQ-Cas), Modified Depression Scale (MDS) and a sociodemographic information questionnaire. For data analysis, descriptive statistics and multivariate and univariate mean comparisons were performed by parametric and re-sampling procedures. RESULTS: Statistically significant differences were observed between clinical and school population groups in externalizing, internalizing and depressive symptomatology (p<0.001). No sex differences were found in externalizing and depressive symptomatology. Sex differences were found in internalizing symptoms (p<0.001, pboot<0.001) as well as group interaction effects (p=0.016), girls had higher scores than boys, with greater differences in the clinical group (p<0.001, pboot=0.003). CONCLUSIONS: Research with mental health patients is essential to verify the existence or not of differences with the general population as well as differences by sex, which will allow adapting preventive and intervention strategies to each case.

OBJETIVO: Uno de cada cien menores tiene algún problema de salud mental. La sintomatología varía según el sexo. La mayoría de las investigaciones son realizadas con población general. El objetivo de este estudio fue analizar el papel moderador del sexo en la presencia de sintomatología internalizante (alteraciones emocionales, ansiedad y depresión) y externalizante (alteraciones comportamentales e hiperactividad) en la infancia, así como comparar población general con población clínica. METODOS: Se realizó un estudio descriptivo transversal con 552 niños y niñas entre diez y doce años, 94 pacientes de salud mental y 458 escolares. Los participantes cumplimentaron medidas de autoinforme: Cuestionario de capacidades y dificultades (Strengths and Difficulties Questionnaire, SDQ-Cas), Escala de depresión modificada (Modified Depression Scale, MDS) y un cuestionario de información sociodemográfica. Para el análisis de datos se realizaron los estadísticos descriptivos y comparaciones de medias multivariantes y univariantes, por procedimientos paramétricos y de remuestreo. RESULTADOS: Se observaron diferencias estadísticamente significativas entre los grupos clínico y de la población escolar en sintomatología externalizante, internalizante y depresiva (p<0,001). No se hallaron diferencias de sexo en sintomatología externalizante ni depresiva. En los síntomas internalizantes se encontraron diferencias de sexo (p<0,001, pboot<0,001), así como efectos de interacción con el grupo (p=0,016). Las niñas tuvieron puntuaciones más altas que los niños, con mayores diferencias en el grupo clínico (p<0,001, pboot=0,003). CONCLUSIONES: Las investigaciones con pacientes de salud mental son fundamentales para verificar la existencia o no de diferencias con la población general, así como las diferencias por sexo, lo que permitirá adaptar las estrategias preventivas y de intervención a cada caso.