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Abstract <p>The transition from Child and Adolescent (CAMHS) to Adult Mental Health Services (AMHS) can be challenging. Drawing on the sample of the European MILESTONE project, we explored changes in clinical profiles and treatment outcomes in adolescents transitioning to AMHS over two years, focusing on different pharmacological treatment patterns. The sample (N = 690; mean age: 17.7 years; SD = 0.29) was categorised into three groups based on medication patterns: <i>continuous</i> (Group 1), <i>intermittent</i> (Group 2), and <i>never medicated</i> (Group 3). Participants underwent four evaluations over two years using tools measuring psychopathology and functioning, including the Health of the Nation Outcome Scale for Child and Adolescents (HoNOSCA) and ASEBA Battery. We employed repeated-measures models to analyse clinical rating changes and a two-way mixed ANOVA to assess interaction between time and groups. Group 3 had significantly lower mean HoNOSCA ratings than Groups 1 and 2 (p &lt; 0.001), indicating better mental health. By the last time point (T4), the factors associated with a reduced risk of severe illness included an improvement in the risk of suicide attempts (p = 0.038), enhanced everyday functional skills (p = 0.008), higher quality of life (p = 0.001), and being male (p = 0.020). The ASEBA Battery showed Group 1 had more internalising symptoms, while Group 2 had more externalising symptoms than Group 3. During the transition from CAMHS to AMHS, continuous medication was associated with higher symptom severity than intermittent or no pharmacological treatment. This may reflect either a more severe initial symptomatology requiring sustained pharmacotherapy or a medication-related paradox, whereby symptoms persist or intensify owing to treatment resistance or side effects.</p> Trial registration <p>“MILESTONE study” registration: ISRCTN ISRCTN83240263 Registered 23 July 2015; ClinicalTrials.gov NCT03013595 Registered 6 January 2017.</p>

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Mental health trajectories of adolescents treated with psychotropic medications: insights from the european milestone study

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  • 发表日期：

    2025年10月17日

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  • Marta Magno,
  • Donato Martella,
  • Silvia Leone,
  • Giovanni Allibrio,
  • Angelo Bertani,
  • Elisa Caselani,
  • Patrizia Conti,
  • Samuele Cortese,
  • Gwen Dieleman,
  • Tomislav Franic,
  • Suzanne Gerritsen,
  • Deborah Maffezzoni,
  • Francesco Margari,
  • Ottaviano Martinelli,
  • Fiona McNicholas,
  • Rocco Micciolo,
  • Renata Nacinovich,
  • Diane Purper Ouakil,
  • Adriana Pastore,
  • Francesco Rinaldi,
  • Paramala Santosh,
  • Paolo Scocco,
  • Ulrike Schulze,
  • Swaran Singh,
  • Antonella Squarcia,
  • Paolo Stagi,
  • Cathy Street,
  • Elena Toffol,
  • Helena Tuomainen,
  • Larissa S. van Bodegom,
  • Stefano Vicari,
  • Giovanni de Girolamo,
  • Jason Madan,
  • Moli Paul,
  • Mathilde M. Overbeek,
  • Nikolina Davidović,
  • Virginie Maurice,
  • Frédérick Russet,
  • Anne Sartor,
  • Rebecca Appleton,
  • Federico Fiori,
  • Gaëlle Hendrickx,
  • Laura Iozzino,
  • Kate Lievesley,
  • Mathilde Mastroianni,
  • Aesa Parenti,
  • Melanie Saam,
  • Giulia Signorini,
  • Jatinder Singh,
  • Priya Tah,
  • Helena Jerkovic

摘要

Abstract

The transition from Child and Adolescent (CAMHS) to Adult Mental Health Services (AMHS) can be challenging. Drawing on the sample of the European MILESTONE project, we explored changes in clinical profiles and treatment outcomes in adolescents transitioning to AMHS over two years, focusing on different pharmacological treatment patterns. The sample (N = 690; mean age: 17.7 years; SD = 0.29) was categorised into three groups based on medication patterns: continuous (Group 1), intermittent (Group 2), and never medicated (Group 3). Participants underwent four evaluations over two years using tools measuring psychopathology and functioning, including the Health of the Nation Outcome Scale for Child and Adolescents (HoNOSCA) and ASEBA Battery. We employed repeated-measures models to analyse clinical rating changes and a two-way mixed ANOVA to assess interaction between time and groups. Group 3 had significantly lower mean HoNOSCA ratings than Groups 1 and 2 (p < 0.001), indicating better mental health. By the last time point (T4), the factors associated with a reduced risk of severe illness included an improvement in the risk of suicide attempts (p = 0.038), enhanced everyday functional skills (p = 0.008), higher quality of life (p = 0.001), and being male (p = 0.020). The ASEBA Battery showed Group 1 had more internalising symptoms, while Group 2 had more externalising symptoms than Group 3. During the transition from CAMHS to AMHS, continuous medication was associated with higher symptom severity than intermittent or no pharmacological treatment. This may reflect either a more severe initial symptomatology requiring sustained pharmacotherapy or a medication-related paradox, whereby symptoms persist or intensify owing to treatment resistance or side effects.

Trial registration

“MILESTONE study” registration: ISRCTN ISRCTN83240263 Registered 23 July 2015; ClinicalTrials.gov NCT03013595 Registered 6 January 2017.