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.

Out-of-home interventions for adolescents who were treated according to the Open Dialogue model for mental health care.

BACKGROUND: The Open Dialogue approach (OD) emphasizes community-based psychiatric treatment for adolescents, but its success in achieving this is poorly documented. OBJECTIVE: To analyse out-of-home intervention usage in a national sample of adolescent psychiatric patients and determine if OD is linked to increased time until out-of-home intervention. PARTICIPANTS AND SETTING: The register-based cohort study included all adolescents aged 13-20 who received psychiatric treatment in Finland between 2003 and 2008. The research group (n = 780) included adolescents whose treatment was initiated in the Western Lapland catchment area, where OD covered the entire psychiatric service. The comparison group (n = 44,088) included the rest of Finland. National register data encompassed the period from treatment onset until the end of the 10-year follow-up or death. The primary outcomes of interest were the times to the first and second out-of-home intervention, including foster care, supportive housing, and hospitalization. The secondary outcomes included the clinical/demographic characteristics of adolescents treated out-of-home. METHODS: The hypothesis was tested via an inverse probability of treatment-weighted Cox hazard model, plus within- and between-group comparisons to analyse the secondary outcome. RESULTS: OD was associated with increased time to the first (adjusted hazard ratio [aHR]: 0.61, 95%CI: 0.52-0.72) and second (aHR: 0.75, 95%CI: 0.58-0.96) out-of-home interventions. In both service types, there was a subgroup of adolescents with repeated out-of-home interventions, who also demonstrated poorer long-term outcomes. CONCLUSION: OD-based psychiatric services for adolescents are associated with fewer out-of-home interventions. The clinical significance of the findings warrants further research.

The 10-year treatment outcome of open dialogue-based psychiatric services for adolescents: A nationwide longitudinal register-based study.

AIM: To evaluate the 10-year treatment outcomes and cost-effectiveness of adolescents' mental health treatment initiated under the social network-oriented open dialogue (OD) approach. METHODS: This longitudinal register-based study included all persons who, for the first time, received psychiatric treatment in Finland during the period 1 January 2003-31 December 2008, and who were aged 13-20 at onset (n = 44 868). The OD group included all persons whose treatment commenced in the Western Lapland catchment area (n = 780), this being the only region in Finland where OD covered the entire mental healthcare service at the time of inclusion. The comparison group (CG) included the rest of Finland (n = 44 088). The primary outcome variables were psychiatric treatment and/or disability allowances at the end of the 10-year follow-up, or death. The secondary outcome variables were treatment and disability expenses. Generalized linear models weighted by inverse probability of treatment were used to study the association between OD and the primary outcomes. Population proportions were used to evaluate the cost-effectiveness of the approaches. RESULTS: Treatment that commenced outside OD was associated with higher odds of continuing to receive treatment (adjusted odds ratio [aOR] 1.4; 95%CI 1.2-1.6) and disability allowances (aOR 1.6; 95%CI 1.2-2.1) at the end of the 10-year follow-up. No significant difference in the mortality ratio emerged. The cumulative 10-year expenses per capita were lower under OD. CONCLUSIONS: OD associated with favourable long-term outcomes, but due the observational design and possible residual confounding, further studies with a more robust research design are required.