Prognostic Factors for Adulthood Psychosis in Adolescent Psychiatry Services: A Longitudinal Total Birth Cohort Study

BACKGROUND AND HYPOTHESIS: As many as half of all psychotic disorders diagnosed by age 28 in the population emerge in individuals who attended child and adolescent psychiatry services, highlighting important opportunities for psychosis prediction and prevention. An important next step is to identify prognostic factors for later psychotic disorders within this clinical population. We assessed a large number of potential prognostic factors for adult-onset psychosis within adolescent psychiatry services. STUDY DESIGN: Linked population-wide register data for all individuals born in Finland 1987-1992. Using survival analyses, we assessed a range of clinical, service use, and sociodemographic characteristics in adolescent psychiatry patients (ie, individuals who were diagnosed with a mental disorder in specialist-level services in adolescence [ages 13-17 years]) as prognostic factors for adult-onset psychotic disorders (ages 18-30 years; individuals diagnosed with psychosis before age 18 [n = 2276] were excluded). STUDY RESULTS: Among adolescent psychiatry patients (n = 27 626), cumulative risk of psychosis between ages 18 and 30 was 8.5%. Within-service significant prognostic factors for psychosis included: total number of mental disorder diagnoses received in adolescence, young maternal age, premature birth, older age at first adolescent psychiatry contact, history of child psychiatry contact, psychiatric inpatient admission in adolescence, parental history of psychosis, and parental history of inpatient psychiatric admission. CONCLUSIONS: Our findings demonstrate that a number of clinical, service use, and sociodemographic factors have prognostic significance for the development of adulthood psychosis among adolescent psychiatry patients.