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Publications

Journal Article Epublish

PubMed: 42481172 DOI: 10.1136/bmjment-2025-302260

Sex differences in internalising and externalising symptom patterns, pathway and persistence in adolescents receiving psychiatric care: a 2-year follow-up of the MILESTONE European cohort.

BMJ Ment Health 29(1)

Authors: Miriam D'Addazio, Silvia Leone, Anna Caterina Leucci, Marta Magno, Anna Rita Atti, Stefano Calza, Martina Carnevale, Elisa Caselani, Laura Iozzino, Federica Marcolini, Donato Martella, Samuele Cortese, Gwendolyn Dieleman, Tomislav Franić, Athanasios Maras, Fiona McNicholas, Diane Purper-Ouakil, Paramala Santosh, Ulrike M E Schulze, Cathy Street, Swaran Preet Singh, Sabine Tremmery, Helena Tuomainen, Larissa van Bodegom, Dieter Wolke, Stefano Vicari, Giovanni de Girolamo

Affiliations

  • Unit of Epidemiological Psychiatry and Digital Mental Health, IRCCS Fatebenefratelli, Brescia, Italy.
  • Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
  • Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.
  • Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy.
  • Developmental EPI (Evidence synthesis, Prediction, Implementation) Lab, Centre for Innovation in Mental Health, School of Psychology, Faculty of Enviromental and Life Sciences, University of Southampton, Southampton, UK.
  • Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK.
  • Hampshire and Isle of Wight Healthcare, NHS Foundation Trust, Southampton, UK.
  • Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NYC, USA.
  • DiMePRe-J-Department of Precision and Rigenerative Medicine-Joinc Area, University of Bari "Aldo Moro", Bari, Italy.
  • Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, Netherlands.
  • Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia.
  • ARQ National Psychotrauma Centre, Diemen, Netherlands.
  • St John of God, Lucena Rathgar Dublin 6, Ireland.
  • University College Dublin, Belfield, Dublin 4, Ireland.
  • Children's Health Ireland (CHI) Crumlin, Dublin 12, Ireland.
  • CHU Monpellier, Child and Adolescent Psychiatry Unit (MPEA1), University of Monpellier, Monpellier, France.
  • INSERM CESP U1018, Villejuif, France.
  • Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
  • Centre for Interventional Pediatric Psychopharmacology and Rare Diseases (CIPPRD) & CIPP Rett Centre, National and Specialist Child and Adolescent Mental Health Services, Michael Rutter Centre, Maudsley Hospital, London, UK.
  • HealthTracker Ltd, Gillingham, UK.
  • University of Ulm, Ulm, Germany.
  • School of Nursing & Midwifery, University of Worcester, Worcester, UK.
  • Paediatrics, Warwick Medical School, Coventry, UK.
  • Department of Neurosciences, KU Leuven, Leuven, Belgium.
  • Department of Psychology, University of Warwick, Coventry, UK.
  • Warwick Medical School, Coventry, UK.
  • Child and Adolescent Psychiatry Unit, Bambino Gesu Pediatric Hospital, IRCCS, Rome, Italy.
  • Child Neuropsychiatry, Catholic University, Rome, Italy.

Abstract

BACKGROUND

Sex differences in adolescent mental disorders are well documented, but less is known about how these differences evolve during the transition to adulthood, particularly during the shift from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS), a critical period marked by vulnerability to discontinuity of care.

OBJECTIVE

To examine sex-specific differences in psychiatric symptom profiles and clinical trajectories during the CAMHS-AMHS transition using data from the European MILESTONE project, a 2-year longitudinal study.

METHODS

A cohort of 1004 adolescents (aged 17-19) in CAMHS was assessed at baseline (T1), 9 months (T2), 15 months (T3) and 24 months (T4). Measures included the Child Behavior Checklist/Adult Behavior Checklist, Health of the Nation Outcome Scales for Children and Adolescents, and the Specific Level of Functioning Scale. Multilevel modelling included sex, diagnosis and time point as covariates, testing three-way interactions for differential trajectories.

FINDINGS

Males showed higher symptom severity and impairment across measures, particularly in anxiety/somatic/trauma, eating disorder/obsessive-compulsive disorder (ED/OCD) and schizophrenia. Females exhibited better functioning. Significant sex differences emerged in internalising symptoms (eg, anxiety/somatic/trauma, autism spectrum disorder (ASD)), externalising symptoms (eg, attention deficit hyperactivity disorder (ADHD)), overall psychopathology (eg, ADHD, personality disorder/conduct disorder/substance use disorder) and functioning (eg, ED/OCD, schizophrenia spectrum disorder).

CONCLUSIONS

Sex-related differences in symptom severity, diagnosis and functioning persist across the CAMHS-AMHS transition, with males generally more impaired and females showing better adaptive outcomes.

CLINICAL IMPLICATIONS

Identifying sex-specific trajectories can enhance personalised transitional care, reduce misdiagnosis and guide targeted interventions-especially for under-recognised presentations such as ADHD/ASD in females and ED in males.

TRIAL REGISTRATION NUMBER

ISRCTN83240263.

MeSH

Autism Spectrum Disorder, Signs And Symptoms, Adolescent, Schizophrenia, Sex Characteristics, Sex, Diagnosis, Wounds And Injuries, Obsessive-Compulsive Disorder, Mental Health, Child, Attention Deficit Disorder With Hyperactivity, Sex Differences