Diagnostic profiles, comorbidity, and service utilization in child and adolescent psychiatry: Comparing single- and multi-center follow-up

Child and adolescent psychiatric disorders represent a substantial global health burden, and continuity of care is often undermined by fragmented service use and poor follow-up. In Turkey, little is known about how multi-center follow-up influences diagnostic distribution, comorbidity, treatment patterns, and service utilization. This retrospective chart review included 3,511 patients (0–18 years) evaluated at a tertiary-level child and adolescent psychiatry outpatient clinic in Turkey during January 2024. Data extracted from electronic records included sociodemographic features, referral type, presenting complaints, DSM-5 diagnoses, comorbidities, psychotropic use, adverse effects, socioeconomic status, and follow-up recommendations. Patients were categorized as single-center (exclusive follow-up at the study site) or multi-center (concurrent or prior follow-up in another clinic). Among 3,511 patients (1,769 single-center; 1,742 multi-center), multi-center patients were older (10.8 vs 9.8 years; p<.001) and more often male, with higher comorbidity, psychotropic initiation, and adverse effects; high SES was more common in single-center care, and ~10% of visits were unnecessary, over half due to duplicate evaluations in multi-center patients. ADHD was the most common diagnosis, particularly in the multi-center group (34.0% vs. 24.9%), while anxiety disorders and depressive disorders were more frequent in single-center patients (p<.001). Multi-center follow-up reflected greater clinical complexity with more neurodevelopmental disorders, comorbidity, and adverse effects, whereas single-center follow-up was linked to internalizing disorders. Unnecessary appointments highlighted the need for integrated referrals, effective triage, and parent psychoeducation to improve continuity of child and adolescent mental health care in Turkey.