Effects of mental health on transition readiness in primary care

Adolescents and young adults often lack appropriate healthcare transition preparation, a concern amplified by prevalent mental health issues. Our study aimed to assess the relationship between transition readiness and behavioral health screening across multiple domains in adolescents within a primary care medical home.

We conducted a retrospective cohort study (October 2021-December 2024) for new, preventive and follow-up visits where patients (ages 14-25 years) completed validated depression, transition readiness screening, Transition Readiness Assessment Questionnaire (TRAQ) and the Patient Questionnaire-9 (PHQ-9). Nonparametric median tests for continuous variables and chi-squared tests for categorical variables assessed for differences for patient age, race/ethnicity, legal sex, and insurance type. Linear and linear logistic regression was also performed.

Patients (median 17.0 years; 62.8 % female; Hispanic 44.9 %; public insurance 62.2 %) completed the TRAQ and PHQ-9 for 3010 visits. Patients with PHQ-9 > 10 were more likely to be female, non-Hispanic White at follow up visits with private insurance; p < 0.001. There was no significant relationship between PHQ-9 and TRAQ scores. Linear regression showed significance for age at visit, legal sex (female), non-Hispanic White, visit type (follow up); p < 0.001 and English language (p = 0.017); logistic regression showed significance for age at visit, legal sex (female), non-Hispanic white, follow up visits (p < 0.001).

Age, legal sex, race/ethnicity, and insurance status significantly influence transition readiness among AYA. While positive depression screens do not show a direct association with transition readiness, depression may still affect health factors that indirectly shape readiness for transition.