{
  "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.",
  "authors": [
    {
      "affiliations": [
        "Unit of Epidemiological Psychiatry and Digital Mental Health, IRCCS Fatebenefratelli, Brescia, Italy"
      ],
      "name": "Miriam D’Addazio"
    },
    {
      "affiliations": [
        "Unit of Epidemiological Psychiatry and Digital Mental Health, IRCCS Fatebenefratelli, Brescia, Italy"
      ],
      "name": "Silvia Leone"
    },
    {
      "affiliations": [
        "Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy"
      ],
      "name": "Anna Caterina Leucci"
    },
    {
      "affiliations": [
        "Unit of Epidemiological Psychiatry and Digital Mental Health, IRCCS Fatebenefratelli, Brescia, Italy"
      ],
      "name": "Marta Magno"
    },
    {
      "affiliations": [
        "Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy"
      ],
      "name": "Anna Rita Atti"
    },
    {
      "affiliations": [
        "Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy"
      ],
      "name": "Stefano Calza"
    },
    {
      "affiliations": [
        "Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy"
      ],
      "name": "Martina Carnevale"
    },
    {
      "affiliations": [
        "Unit of Epidemiological Psychiatry and Digital Mental Health, IRCCS Fatebenefratelli, Brescia, Italy"
      ],
      "name": "Elisa Caselani"
    },
    {
      "affiliations": [
        "Unit of Epidemiological Psychiatry and Digital Mental Health, IRCCS Fatebenefratelli, Brescia, Italy"
      ],
      "name": "Laura Iozzino"
    },
    {
      "affiliations": [
        "Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy"
      ],
      "name": "Federica Marcolini"
    },
    {
      "affiliations": [
        "Unit of Epidemiological Psychiatry and Digital Mental Health, IRCCS Fatebenefratelli, Brescia, Italy",
        "Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy"
      ],
      "name": "Donato Martella"
    },
    {
      "affiliations": [
        "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"
      ],
      "name": "Samuele Cortese"
    },
    {
      "affiliations": [
        "Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, Netherlands"
      ],
      "name": "Gwendolyn Dieleman"
    },
    {
      "affiliations": [
        "Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia"
      ],
      "name": "Tomislav Franić"
    },
    {
      "affiliations": [
        "ARQ National Psychotrauma Centre, Diemen, Netherlands"
      ],
      "name": "Athanasios Maras"
    },
    {
      "affiliations": [
        "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"
      ],
      "name": "Fiona McNicholas"
    },
    {
      "affiliations": [
        "CHU Monpellier, Child and Adolescent Psychiatry Unit (MPEA1), University of Monpellier, Monpellier, France",
        "INSERM CESP U1018, Villejuif, France"
      ],
      "name": "Diane Purper-Ouakil"
    },
    {
      "affiliations": [
        "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"
      ],
      "name": "Paramala Santosh"
    },
    {
      "affiliations": [
        "University of Ulm, Ulm, Germany"
      ],
      "name": "Ulrike M E Schulze"
    },
    {
      "affiliations": [
        "School of Nursing & Midwifery, University of Worcester, Worcester, UK"
      ],
      "name": "Cathy Street"
    },
    {
      "affiliations": [
        "Paediatrics, Warwick Medical School, Coventry, UK"
      ],
      "name": "Swaran Preet Singh"
    },
    {
      "affiliations": [
        "Department of Neurosciences, KU Leuven, Leuven, Belgium"
      ],
      "name": "Sabine Tremmery"
    },
    {
      "affiliations": [
        "Department of Psychology, University of Warwick, Coventry, UK"
      ],
      "name": "Helena Tuomainen"
    },
    {
      "affiliations": [
        "Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, Netherlands"
      ],
      "name": "Larissa van Bodegom"
    },
    {
      "affiliations": [
        "Department of Psychology, University of Warwick, Coventry, UK",
        "Warwick Medical School, Coventry, UK"
      ],
      "name": "Dieter Wolke"
    },
    {
      "affiliations": [
        "Child and Adolescent Psychiatry Unit, Bambino Gesu Pediatric Hospital, IRCCS, Rome, Italy",
        "Child Neuropsychiatry, Catholic University, Rome, Italy"
      ],
      "name": "Stefano Vicari"
    },
    {
      "affiliations": [
        "Unit of Epidemiological Psychiatry and Digital Mental Health, IRCCS Fatebenefratelli, Brescia, Italy"
      ],
      "name": "Giovanni de Girolamo"
    },
    {
      "affiliations": [],
      "name": "ON behalf of MILESTONE consortium"
    }
  ],
  "title": "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",
  "uid": "382778ce-0862-56d3-b4ba-660e7bea6d35"
}