Adolescents with severe mental illness vulnerable when transitioning to adult care

TORONTO — For adolescents with severe mental illness, continuous care with a primary care doctor during the transition period to adult care is associated with better mental health outcomes in young adulthood, according to a new study from researchers at ICES and The Hospital for Sick Children (SickKids).

The study, published in JAMA Network Open looked at all adolescents in Ontario aged 12 to 16 with severe mental illness, determined by a hospitalization for schizophrenia, eating disorder, or mood disorder between 2002 and 2014 and followed through to 2017.

“Many adolescents with severe mental illness age out of paediatric care at 18 without a clear transfer of care to adult services. We sought to understand the extent to which family doctors provide stability across this vulnerable transition period,” says Dr. Alene Toulany, lead author of the study, ICES Fellow and Staff Physician, Adolescent Medicine, at SickKids.

Using health records, the researchers divided the 8,409 adolescents into three groups based on their primary care during the time of transition out of paediatric mental health care services (ages 17-18):

• Continuous primary care (65.1 per cent)
• Discontinuous primary care (28.4 per cent)
• No care during the transition period (6.4 per cent)

While overall hospitalizations rates were low following transition (an average of 14 per 10,000 per year), the study authors found a 30 per cent increased rate of mental health-related hospitalizations in young adults (age 19 to 26) with no primary care and a 20 per cent increased rate for those with discontinuous primary care during the transition period compared with continuous care.

“For adolescents with severe mental illness, timely and continuous access to primary care during their transition to adult care is associated with decreased mental-health related hospitalizations and emergency department visits, which points to the importance of both specialized services and primary care during this vulnerable stage of life,” says Dr. Astrid Guttmann, senior author on the study, Chief Science Officer at ICES and Staff Paediatrician and Senior Associate Scientist at SickKids.

This research is an example of how SickKids and ICES are contributing to making Ontario Healthier, Wealthier and Smarter. 

“Association of primary care continuity with outcomes following transition to adult care for adolescents with severe mental illness,” was published August 2 in JAMA Network Open.