背景:进食障碍(ED)在青春期中后期达到高峰,通常持续到成年期。鉴于它们的早期发病和慢性,许多患者从儿童和青少年心理健康服务(CAMHS)过渡到成人心理健康服务(AMHS),专业ED护理。这种转变通常发生在18岁,当重要的生物学,社会心理,职业变革正在发生。因此,平稳有效的过渡对于确保服务连续性至关重要,以及降低ED复发和过早死亡的风险。这里,我们为患有ED的年轻人综合了从CAMHS到AMHS过渡的证据,旨在为未来的研究提供信息,临床实践,和医疗保健政策。
方法:对文献进行系统综述。这符合PRISMA准则。PubMed,Embase,和Scopus电子数据库从成立到2023年12月3日进行了查询。利用PICOS框架,在定性综合中评估了研究的合格性.有关方法的数据,分析方法,然后提取相关结果。使用关键的评估工具检查了证据质量。最后,概念映射被用来将发现组织成一个过渡框架。
结果:搜索返回了76篇文章。其中,最终审查中包括14个。文章分为“定性”(n=10),“横截面”(n=2),和“纵向队列”(n=2)基于研究设计的研究。总的来说,ED转换很复杂,多方面,对病人来说具有挑战性,看护者,和提供者一样。这是由于时间的相互作用(例如,ED开始和过渡的时间),利益相关者-(例如,患者对康复的矛盾情绪)和系统性-(例如,服务之间的差异)相关因素。大多数研究都是中等到高质量的。调查结果为制定旨在促进ED护理有效转移的五种过渡策略提供了信息:及时交谈,准备情况,Inclusion,准备工作,和协同作用(TRIPS)。
结论:对于患有ED的年轻人和其他相关利益相关者来说,从CAMHS到AMHS的过渡似乎存在问题。该领域将受益于TRIPS,一个可操作的,基于证据的框架,旨在减轻过渡的挑战,并随后改善ED轨迹。作为合乎逻辑的下一步,未来的工作应该对TRIPS框架进行实证检验,探索其预测效用和临床价值。
饮食失调通常在青年时期发展并持续到成年。鉴于此,许多年轻人从儿科过渡到成人护理,以进行持续治疗。这通常发生在18岁,当生活发生重要变化时,例如离开家或追求高等教育。因此,平稳有效的过渡对心理健康至关重要。本综述总结了研究从儿童到成人护理转变为年轻人饮食失调的研究。并随后制定了一个循证过渡框架(TRIPS)。根据综述中包含的14项研究,从儿童护理到成人护理的转变对于患有饮食失调的年轻人来说是具有挑战性的,以及照顾者和提供者。这是由于与过渡时间有关的几个因素,所涉及的利益相关者的类型,以及护理之间的差异。展望未来,该领域可能受益于旨在改善过渡和临床结果的TRIPS框架。
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.
Eating disorders often develop in youth and persist into adulthood. Given this, many young people transition from pediatric to adult care for ongoing treatment. This usually occurs at 18 years of age, when important life changes take place, such as leaving home or pursuing higher education. Hence, smooth and effective transitions are critical for mental health. The present
review summarized studies investigating transitions from pediatric to adult care for young people with eating disorders, and subsequently developed an evidence-informed transition framework (TRIPS). Based on the 14 studies included in the
review, transitions from pediatric to adult care are challenging for young people with eating disorders, as well as for caregivers and providers. This is due to several factors related to the timing of transitions, the types of stakeholders involved, and the differences between care. Looking ahead, the field may benefit from the TRIPS framework that aims to improve transitions and clinical outcomes.