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Transitions from child and adolescent to adult mental health services for eating disorders: an in-depth systematic review and development of a transition framework

Published version
Peer-reviewed

Repository DOI


Change log

Authors

Ragnhildstveit, Anya  ORCID logo  https://orcid.org/0000-0002-5796-3428
Tuteja, Nandita 
Seli, Paul 
Smart, Leo 
Uzun, Naz 

Abstract

Background: Eating disorders (EDs) peak in mid-to-late adolescence and often persist into adulthood. Given their early onset and chronicity, many patients transition from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS) for ongoing, speciality ED care. This transition typically occurs at 18 years of age, when important biological, psychosocial, and vocational changes take place. Thus, smooth and effective transitions are paramount for ensuring service continuity, as well as reducing the risk of ED relapse and premature death. Here, we synthesized evidence on transitions from CAMHS to AMHS for young people with EDs, aiming to inform future research, clinical practice, and healthcare policy. Methods: A systematic review of the literature was conducted. This adhered to PRISMA guidelines. PubMed, Embase, and Scopus electronic databases were queried from inception to December 3, 2023. Leveraging the PICOS framework, study eligibility was evaluated in the qualitative synthesis. Data regarding methodology, analytic approach, and associated outcomes were then extracted. The quality of evidence was examined using critical appraisal tools. Finally, concept mapping was applied to organize findings into a transition framework. Results: The search returned 76 articles. Of these, 14 were included in the final review. Articles were grouped into ‘qualitative’ (n = 10), ‘cross-sectional’ (n = 2), and ‘longitudinal cohort’ (n = 2) studies based on research design. Overall, ED transitions were complex, multifaceted, and challenging for patients, caregivers, and providers alike. This resulted from an interplay of temporal- (e.g., timing of ED onset and transition), stakeholder- (e.g., patient ambivalence towards recovery) and systemic- (e.g., differences between services) related factors. Most studies were of moderate-to-high quality. Findings informed the development of five transition strategies designed to facilitate effective transfers across ED care: Timely talks, Readiness, Inclusion, Preparation, and Synergy (TRIPS). Conclusions: Transitions from CAMHS to AMHS appear problematic for young people with EDs and other involved stakeholders. The field stands to benefit from TRIPS, an actionable, evidence-based framework that aims to alleviate challenges of transitioning and subsequently improve ED trajectories. As a logical next step, future work should empirically test the TRIPS framework, exploring its predictive utility and clinical value.

Description

Acknowledgements: We would like to acknowledge the patients, caregivers, and providers described in this review for their valuable contributions to science, namely in understanding transitions for young people with eating disorders and beyond. We would also like to acknowledge the scientists and clinicians who supported the research presented here.

Keywords

Eating disorder, Anorexia nervosa, Bulimia nervosa, Mental health services, Binge eating disorder, Systematic review, Age transitions

Journal Title

Journal of Eating Disorders

Conference Name

Journal ISSN

2050-2974

Volume Title

12

Publisher

BioMed Central
Sponsorship
Wellcome Trust (226392/Z/22/Z)