Psychiatric morbidity and associated factors over three years in an adolescent psychiatric population A prospective cohort study

In the transition from adolescence to adulthood, there is an enlargement in overall rates of psychiatric disorders, also an increase in psychiatric comorbidity and suicidal symptoms. At the same time, somatic conditions and especially chronic pain are common during adolescence, and strong associations have been found between chronic pain and psychiatric disorders. The overall aim of this thesis was to obtain knowledge on the course of psychiatric morbidity over three years in a clinical adolescent population, and investigate possible associations with somatic conditions, substance use, experiences of negative life events, resilience factors and received treatment procedures, also exploration of gender differences. The study was part of the Health Survey in Department of Children and Youth, Clinic of Mental Health Care, St. Olavs hospital (The St. Olav CAP Survey). Almost three out of four adolescents still had a psychiatric disorder after three years, and one out of three reported symptom load in the borderline/clinical range. Chronic pain, smoking and having tried illicit drugs at baseline were factors strongly associated with psychiatric morbidity three years later. Girls had a higher morbidity than boys, with an increased frequency of anxiety disorders, a five times higher prevalence of mood disorders, and a five to ten times higher prevalence of chronic pain. One out of four girls with a psychiatric disorder at follow-up had suicidal ideations, and one out of three had a previous history of suicidal behaviour. Furthermore, girls had lower psychosocial functioning, higher rates of school dropout and more experiences of negative life events than boys. Negative life events, especially exposure to interpersonal violence, were associated with suicidal ideation, suicidal behaviour, or school dropout, indicating a complex symptom burden, especially among the girls in this sample. Treatment procedures were extensive and consisted especially of psychotherapy for girls and medication for boys. Self-reported resilience was lowest among those with depressive disorders, highest among those with ADHD, and lower among girls than among boys in all diagnostic groups. The higher the personal and social resources, the less mental symptoms after three years, suggesting a protective potential. This thesis underlines the importance of performing a comprehensive assessment of mental health problems and risk factors in adolescent patients. To ask about suicidal ideation and suicidal behaviour, experiences of negative life events and school functioning is essential in order to reveal any such risks, provide interventions and prevent negative development. The results of this study should also encourage to investigate presence of pain, especially among girls, and to uncover smoking habits and illicit drug use. This thesis emphasizes the importance of resilience factors and targeted interventions for adolescents with psychiatric disorders to enhance optimal function, and it also accentuate the importance of continuous research to find the most effective interventions and facilitating factors