Changes in referral patterns to outpatient child and adolescent psychiatric services from 2005–2018

Abstract

Introduction

There has been a steep increase in referrals to child and adolescent psychiatric (CAP) services across Western countries. To fit CAP services to the increasing demand, it is important to gain more knowledge about the background for the increase in referrals and to investigate changes in referral patterns over time.

Methods

Cross-sectional observational study comparing referrals to outpatient CAP services from 2005, 2010 and 2018 to the only CAP center in the North Denmark Region.

Results

There was a 3.9 times increase in referrals from 2005 to 2018. Referrals for disorders with onset in early childhood (primarily autism and ADHD/ADD) increased from 2005 to 2010 but decreased from 2010 to 2018. There was an increase in the proportion of referrals for emotional disorders from 2010 to 2018. The proportion of girls referred for disorders with onset in early childhood increased from 2005 to 2018. The referral age for these disorders remained relatively high, and this was most pronounced for girls.

Conclusions

There has been significant changes in the referral pattern to outpatient CAP services. The increasing referral rates for girls for disorders with onset in early childhood could indicate improved ability in primary settings to recognize these symptoms in girls. However, late referral to CAP services for these disorders remains an issue. Educational services play an increasing role in referring children for these disorders, and it is important to ensure that they have the competences to identify children in need of assessment by CAP services.

Keywords:

• Child psychiatry
• adolescent psychiatry
• referral
• temporal changes

Acknowledgement

The authors thank Line Hedegård Bredahl, Cecilie Haugaard Christoffersen, Rasmus Hougaard Pedersen and Heidi Hattmann Hjortshøj for invaluable assistance with data collection. In addition, we would like to thank TrygFonden, AP Møllers Laegefond, Fru C. Hermansens Mindelegat, Aase og Ejner Danielsens Fond and Helsefonden for funding for this study.

Ethical approval

The Danish Patient Safety Authority approved the review of referral letters from 2018 (ref-number 3-3013-2794/1). The study was reported to the Danish Data Protection Agency (ref-number 2019-58). The study protocol was submitted to The North Denmark Region Committee on Health Research Ethics, who deemed that no further ethical approval was required for this study.

Author contributions

ASH, GKT and MBL developed the study concept. All authors contributed to the study design. ASH performed data analysis and interpretation under the supervision of GKT and MBL. ASH drafted the manuscript and GKT and MBL provided critical revisions. All authors read and approved the final manuscript.

Disclosure statement

The authors declare that they have no conflict of interests.

Data availability statement

The datasets for the current study are available from the corresponding author on reasonable request.

Additional information

Funding

This study received funding from TrygFonden; AP Møllers Laegefond; Fru C. Hermansens Mindelegat; Helsefonden and Aase og Ejner Danielsens Fond. The funders had no influence on the design, conduction, analyses or reporting of the study.

Notes on contributors

Anna Sofie Hansen

Anna Sofie Hansen is an MD, PhD student at the Department of Child and Adolescent Psychiatry, Aalborg University Hospital.

Gry Kjaersdam Telléus

Gry Kjaersdam Telléus, PhD, is a clinical and research psychologist at Aalborg University Hospital, Psychiatry.

Marlene Briciet Lauritsen

Marlene Briciet Lauritsen, Dr. Med, is a Clinical Professor at Aalborg University and a consultant child and adolescent psychiatrist at the Department of Child and Adolescent Psychiatry, Aalborg University Hospital.