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Adolescents with severe mental illness vulnerable when transitioning to adult care


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 healthcare 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 hospitalization 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. DOI:10.1001/jamanetworkopen.2019.8415. Author block: Toulany A, Stukel TA, Kurdyak P, Fu L, Guttmann A.

ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario

About The Hospital for Sick Children (SickKids)
The Hospital for Sick Children (SickKids) is recognized as one of the world’s foremost paediatric health-care institutions and is Canada’s leading centre dedicated to advancing children’s health through the integration of patient care, research and education. Founded in 1875 and affiliated with the University of Toronto, SickKids is one of Canada’s most research-intensive hospitals and has generated discoveries that have helped children globally. Its mission is to provide the best in complex and specialized family-centred care; pioneer scientific and clinical advancements; share expertise; foster an academic environment that nurtures health-care professionals; and champion an accessible, comprehensive and sustainable child health system. SickKids is a founding member of Kids Health Alliance, a network of partners working to create a high quality, consistent and coordinated approach to pediatric healthcare that is centred around children, youth and their families. SickKids is proud of its vision for Healthier Children. A Better World.For more information, please visit www.sickkids.ca. Follow us on Twitter (@SickKidsNews) and Instagram (@SickKidsToronto).

For more information, please contact:

Deborah Creatura
Media Advisor, ICES
[email protected]
(o) 416-480-4780 or (c) 647-406-5996

Sasha Babakhanova
The Hospital for Sick Children (SickKids)
[email protected]
416-813-7654 ext 228469


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