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Psychosis and bipolar disorder risk in child and adolescent mental health services in the UK: population cohort study

Kirstie O’Hare Orcid Logo, Ulla Lång, Colm Healy, Ioanna Kougianou, Animesh Talukder, Robin Murray, Stephen M. Lawrie Orcid Logo, Ann John Orcid Logo, Ian Kelleher Orcid Logo

The British Journal of Psychiatry, Pages: 1 - 7

Swansea University Author: Ann John Orcid Logo

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DOI (Published version): 10.1192/bjp.2025.48

Abstract

Background: Current approaches to identifying individuals at elevated risk for psychosis capture only a small proportion of future psychotic disorders. Recent Finnish research suggests that a substantial proportion of individuals at risk of psychosis attend child and adolescent mental health service...

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Published in: The British Journal of Psychiatry
ISSN: 0007-1250 1472-1465
Published: Royal College of Psychiatrists 2025
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URI: https://cronfa.swan.ac.uk/Record/cronfa68827
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To what extent this is true outside Finland, however, is not known. Aims: To establish the proportion of all psychotic and bipolar disorder diagnoses that occurred in individuals who had, at some stage in childhood and adolescence, attended CAMHS in Wales (United Kingdom). We also wished to identify whether, within CAMHS, certain risk markers were associated with increased psychosis risk.Method: We examined healthcare contacts for individuals born 1991-1998 (n=348,226), followed up to age 25-32 years. Using linked administrative healthcare records, we identified all psychotic and bipolar disorder diagnoses in the population and then identified the proportion of cases where the individual had attended CAMHS. Regression analyses were used to examine associations between sociodemographic and clinical risk markers with psychotic and bipolar disorder outcomes.Results: Of all individuals diagnosed with a psychotic or bipolar disorder by the study endpoint, 44.78% had, at some point in childhood or adolescence, attended CAMHS (HR = 6.28, 95% CI = 5.92-6.65). Low birthweight (OR = 1.33, 95% CI = 1.15-1.53), out-of-home care experience (OR = 2.05, 95% CI = 1.77-2.38), inpatient CAMHS admission (OR = 1.49, 95% CI = 1.29-1.72), and attending CAMHS in childhood (in addition to adolescence; OR = 1.16, 95% CI = 1.02-1.30) were all within-CAMHS risk markers for psychotic and bipolar disorders.Conclusions: A substantial proportion (45%) of future psychotic and bipolar disorder cases emerge in individuals who had attended CAMHS. 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spelling 2025-10-16T15:15:48.0034077 v2 68827 2025-02-07 Psychosis and bipolar disorder risk in child and adolescent mental health services in the UK: population cohort study ed8a9c37bd7b7235b762d941ef18ee55 0000-0002-5657-6995 Ann John Ann John true false 2025-02-07 MEDS Background: Current approaches to identifying individuals at elevated risk for psychosis capture only a small proportion of future psychotic disorders. Recent Finnish research suggests that a substantial proportion of individuals at risk of psychosis attend child and adolescent mental health services (CAMHS) earlier in life, creating important opportunities for prediction and prevention. To what extent this is true outside Finland, however, is not known. Aims: To establish the proportion of all psychotic and bipolar disorder diagnoses that occurred in individuals who had, at some stage in childhood and adolescence, attended CAMHS in Wales (United Kingdom). We also wished to identify whether, within CAMHS, certain risk markers were associated with increased psychosis risk.Method: We examined healthcare contacts for individuals born 1991-1998 (n=348,226), followed up to age 25-32 years. Using linked administrative healthcare records, we identified all psychotic and bipolar disorder diagnoses in the population and then identified the proportion of cases where the individual had attended CAMHS. Regression analyses were used to examine associations between sociodemographic and clinical risk markers with psychotic and bipolar disorder outcomes.Results: Of all individuals diagnosed with a psychotic or bipolar disorder by the study endpoint, 44.78% had, at some point in childhood or adolescence, attended CAMHS (HR = 6.28, 95% CI = 5.92-6.65). Low birthweight (OR = 1.33, 95% CI = 1.15-1.53), out-of-home care experience (OR = 2.05, 95% CI = 1.77-2.38), inpatient CAMHS admission (OR = 1.49, 95% CI = 1.29-1.72), and attending CAMHS in childhood (in addition to adolescence; OR = 1.16, 95% CI = 1.02-1.30) were all within-CAMHS risk markers for psychotic and bipolar disorders.Conclusions: A substantial proportion (45%) of future psychotic and bipolar disorder cases emerge in individuals who had attended CAMHS. This demonstrates important opportunities for early intervention and prevention at a greater scale than current strategies allow. Journal Article The British Journal of Psychiatry 0 1 7 Royal College of Psychiatrists 0007-1250 1472-1465 Child and adolescent psychiatry; bipolar type I or II disorders; psychotic disorders/schizophrenia; big data; epidemiology 14 5 2025 2025-05-14 10.1192/bjp.2025.48 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee This project was funded by awards to IK from the Health Research Board (ECSA-2020-005), the Academy of Medical Sciences (APR8\1005), and the UK Department for Business, Energy and Industrial Strategy. 2025-10-16T15:15:48.0034077 2025-02-07T09:25:18.5185834 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Kirstie O’Hare 0000-0002-1166-9792 1 Ulla Lång 2 Colm Healy 3 Ioanna Kougianou 4 Animesh Talukder 5 Robin Murray 6 Stephen M. Lawrie 0000-0002-2444-5675 7 Ann John 0000-0002-5657-6995 8 Ian Kelleher 0000-0003-1484-651x 9 68827__34384__f391309490434428ae9b8093790a2d20.pdf 68827.VoR.pdf 2025-06-02T15:36:50.0907878 Output 248661 application/pdf Version of Record true © The Author(s), 2025. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence. true eng https://creativecommons.org/licenses/by/4.0/
title Psychosis and bipolar disorder risk in child and adolescent mental health services in the UK: population cohort study
spellingShingle Psychosis and bipolar disorder risk in child and adolescent mental health services in the UK: population cohort study
Ann John
title_short Psychosis and bipolar disorder risk in child and adolescent mental health services in the UK: population cohort study
title_full Psychosis and bipolar disorder risk in child and adolescent mental health services in the UK: population cohort study
title_fullStr Psychosis and bipolar disorder risk in child and adolescent mental health services in the UK: population cohort study
title_full_unstemmed Psychosis and bipolar disorder risk in child and adolescent mental health services in the UK: population cohort study
title_sort Psychosis and bipolar disorder risk in child and adolescent mental health services in the UK: population cohort study
author_id_str_mv ed8a9c37bd7b7235b762d941ef18ee55
author_id_fullname_str_mv ed8a9c37bd7b7235b762d941ef18ee55_***_Ann John
author Ann John
author2 Kirstie O’Hare
Ulla Lång
Colm Healy
Ioanna Kougianou
Animesh Talukder
Robin Murray
Stephen M. Lawrie
Ann John
Ian Kelleher
format Journal article
container_title The British Journal of Psychiatry
container_volume 0
container_start_page 1
publishDate 2025
institution Swansea University
issn 0007-1250
1472-1465
doi_str_mv 10.1192/bjp.2025.48
publisher Royal College of Psychiatrists
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
active_str 0
description Background: Current approaches to identifying individuals at elevated risk for psychosis capture only a small proportion of future psychotic disorders. Recent Finnish research suggests that a substantial proportion of individuals at risk of psychosis attend child and adolescent mental health services (CAMHS) earlier in life, creating important opportunities for prediction and prevention. To what extent this is true outside Finland, however, is not known. Aims: To establish the proportion of all psychotic and bipolar disorder diagnoses that occurred in individuals who had, at some stage in childhood and adolescence, attended CAMHS in Wales (United Kingdom). We also wished to identify whether, within CAMHS, certain risk markers were associated with increased psychosis risk.Method: We examined healthcare contacts for individuals born 1991-1998 (n=348,226), followed up to age 25-32 years. Using linked administrative healthcare records, we identified all psychotic and bipolar disorder diagnoses in the population and then identified the proportion of cases where the individual had attended CAMHS. Regression analyses were used to examine associations between sociodemographic and clinical risk markers with psychotic and bipolar disorder outcomes.Results: Of all individuals diagnosed with a psychotic or bipolar disorder by the study endpoint, 44.78% had, at some point in childhood or adolescence, attended CAMHS (HR = 6.28, 95% CI = 5.92-6.65). Low birthweight (OR = 1.33, 95% CI = 1.15-1.53), out-of-home care experience (OR = 2.05, 95% CI = 1.77-2.38), inpatient CAMHS admission (OR = 1.49, 95% CI = 1.29-1.72), and attending CAMHS in childhood (in addition to adolescence; OR = 1.16, 95% CI = 1.02-1.30) were all within-CAMHS risk markers for psychotic and bipolar disorders.Conclusions: A substantial proportion (45%) of future psychotic and bipolar disorder cases emerge in individuals who had attended CAMHS. This demonstrates important opportunities for early intervention and prevention at a greater scale than current strategies allow.
published_date 2025-05-14T05:26:32Z
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