ArticleFrontiers in psychiatry2026
Sex-specific diagnostic trajectories and time to transition from non-SMI to severe mental illness in Chinese adolescent inpatients.
Article in Frontiers in psychiatry, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: Adolescence is a high-risk period for mental disorders, and early clinical presentations often show uncertainty and pluripotentiality. Longitudinal evidence on transitions from non-specific diagnoses to severe mental illness (SMI-defined as schizophrenia spectrum and bipolar disorders) in non-Western populations remains limited. Using real-world data, we aimed to characterize diagnostic stability, transitions from non-SMI to SMI, and sex- and age-related predictors in Chinese adolescent inpatients. Methods: This retrospective longitudinal cohort study utilized electronic medical records from a large tertiary psychiatric hospital in Eastern China (2010-2026). We included 884 first-time inpatients aged 12-17 years with ≥3 years of follow-up and at least two complete inpatient records. ICD-10 diagnoses were grouped into SMI and non-SMI categories. Sankey diagrams and transition matrices were used to describe diagnostic trajectories from baseline to the last admission. Among patients with non-SMI at baseline, Kaplan-Meier analyses examined the time to transition to SMI, and multivariable logistic regression tested the independent effects of sex and baseline age on SMI conversion. Results: Over a median follow-up of 4.60 years (IQR 3.63-6.53), SMI diagnoses showed high stability: 81%(243/300)of schizophrenia spectrum disorders and 74%(104/141) of bipolar disorders remained unchanged. Overall, 39.2%(346/884)of patients experienced at least one diagnostic change, primarily within non-SMI categories; depressive disorders were the most frequent antecedent of bipolar disorder (13%(22/171) converted). Sex-stratified analyses suggested that certain externalising and obsessive-compulsive presentations in males, and internalising and stress-related presentations in females, were more frequently followed by SMI; however, several subgroup estimates were based on small numbers and should be considered exploratory. Kaplan-Meier curves indicated that the risk of transition from non-SMI to SMI clustered between 4 and 8 years after the first admission. Each 1-year increase in baseline age was associated with a 38% higher risk of SMI conversion ( Conclusions: Adolescent psychiatric diagnoses show substantial longitudinal evolution, with relatively stable SMI once established but appreciable medium- to long-term progression from non-SMI to SMI. The identified sex-specific pathways and the 4-to-8-year high-risk window support longitudinal, developmentally informed monitoring-particularly for older male adolescents with severe or atypical non-SMI presentations.
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