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

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.

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Journal
Molecular Psychiatry
Published
2025-10-17
DOI
https://doi.org/10.1038/s41380-025-03307-3
Primary Topic
Adolescent and Pediatric Healthcare
Type
article
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0.00

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article

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

Renata Nacinovich, Giovanni de Girolamo, Samuele Cortese, Rocco Micciolo et al.
Molecular Psychiatry
Adolescent and Pediatric Healthcare
article

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

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

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.

Molecular PsychiatryVol. 31(1)
University College Dublin (IE), Augsburg University (US), University of Parma (IT), AOL (United States) (US), University of Salento (IT), Inserm (FR), King's College London (GB), American Academy of Child and Adolescent Psychiatry (US), University of Trento (IT), Universität Ulm (DE), South London and Maudsley NHS Foundation Trust (GB), University of Kent (GB), Solent NHS Trust (GB), Mental Health Research UK (GB), University Hospital Augsburg (DE), Children's Health Ireland at Crumlin (IE), Centre Hospitalier Universitaire de Lille (FR), University of Warwick (GB), University of Oxford (GB), German Center for Pediatric and Adolescent Rheumatology (DE), Arq Psychotrauma Expert Group (NL), Lille’s Cardiology Hospital (FR), Centre Hospitalier Universitaire de Montpellier (FR), Centre de recherche en Epidémiologie et Santé des Populations (FR), Coventry and Warwickshire Partnership NHS Trust (GB), Azienda Ospedaliera San Gerardo (IT), Centro San Giovanni di Dio Fatebenefratelli (IT), Maudsley Hospital (GB), Azienda Unita' Sanitaria Locale di Parma (IT), Bambino Gesù Children's Hospital (IT), Azienda Socio Sanitaria Territoriale Lariana (IT), Policlinico Tor Vergata (IT), Yulius (NL), Klinik und Poliklinik für Kinder- und Jugendpsychiatrie (DE), Istituti di Ricovero e Cura a Carattere Scientifico (IT), University Hospital Ulm (DE), Azienda Usl Toscana Centro (IT), Azienda Ospedaliera Treviglio (IT), Hôpital Fontmaure (FR), University of Southampton (GB), University College London (GB), University of Bari Aldo Moro (IT), New York University (US), University of Milano-Bicocca (IT), University of Split (HR), KU Leuven (BE)
Solent NHS Trust, Ospedale Pediatrico Bambino Gesù, York University, University of Southampton, University of Warwick, King's College London, European Commission, University College Dublin, Institut National de la Santé et de la Recherche Médicale, Università degli Studi di Milano-Bicocca, Erasmus Medisch Centrum, Università degli Studi di Trento, Universität Ulm, Warwick Medical School, Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca
Openalex Percentile: Top 61%
Adolescent and Pediatric Healthcare
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