Do young people get the mental healthcare they need? Trajectories of depressive symptoms, correlates and care pathways in a clinical sample of young people reaching the upper age limit of their CAMHS

Abstract

Identifying young service users whose depressive symptoms persist into adulthood is crucial to avert potential difficulties they may face when transitioning from Child and Adolescent Mental Healthcare Services (CAMHS) to Adult Mental Healthcare Services (AMHS). As depressive symptoms are diverse in severity and stability, it is important to objectively identify those who require continued support. A clinical cohort of 763 young people from eight European countries, reaching the upper age limit of their CAMHS, was studied to identify trajectories of self-reported depressive problems (ASEBA Youth Self-Report and Adult Self-Report) over a 24-month follow-up period, as well as associated risk factors for persistent depression and service use, using growth mixture modeling. Self-reported, parent-reported, and clinician-reported interviews and questionnaires were used to collect information on risk factors for persistent depression and service use. We identified a low, a decreasing, an increasing and a high trajectory of depressive symptoms. The high trajectory could be predicted with almost all risk factors for persistent depression (i.g. higher clinician-rated psychopathology, more suicidality, comorbidity and being a victim of bullying) and these young people were likely to transition to AMHS or require specialist mental health care at a later date. More importantly, young people whose depressive symptoms increase to similar levels as the group with persistent high-levels of depressive symptoms (the increasing trajectory) could not be properly distinguished from other young people based on risk factors, while their needed continuation of treatment (either in AMHS or CAMHS) was equally likely as the end of care.

Keywords: Adolescents; Depressive symptoms; Mental healthcare; Transition; Young adults.