{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T17:39:55Z","timestamp":1773769195123,"version":"3.50.1"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T00:00:00Z","timestamp":1773705600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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\u2014defined 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective longitudinal cohort study utilized electronic medical records from a large tertiary psychiatric hospital in Eastern China (2010\u20132026). We included 884 first-time inpatients aged 12\u201317 years with \u22653 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\u2013Meier analyses examined the time to transition to SMI, and multivariable logistic regression tested the independent effects of sex and baseline age on SMI conversion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Over a median follow-up of 4.60 years (IQR 3.63\u20136.53), 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\u2013compulsive 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\u2013Meier 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 (\n                      <jats:italic>OR<\/jats:italic>\n                      = 1.38, 95%\n                      <jats:italic>CI<\/jats:italic>\n                      1.19\u20131.60,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001), and, after adjusting for age, males had approximately twice the risk of SMI conversion compared with females (\n                      <jats:italic>OR<\/jats:italic>\n                      = 1.90, 95%\n                      <jats:italic>CI<\/jats:italic>\n                      1.17\u20133.07,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.009).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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\u2014particularly for older male adolescents with severe or atypical non-SMI presentations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2026.1793421","type":"journal-article","created":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T14:37:06Z","timestamp":1773758226000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Sex-specific diagnostic trajectories and time to transition from non-SMI to severe mental illness in Chinese adolescent inpatients"],"prefix":"10.3389","volume":"17","author":[{"given":"Xiang","family":"Kong","sequence":"first","affiliation":[{"name":"Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine","place":["Hangzhou, 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Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine","place":["Hangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongjing","family":"Mao","sequence":"additional","affiliation":[{"name":"Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine","place":["Hangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1038\/s41380-021-01161-7","article-title":"Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies","volume":"27","author":"Solmi","year":"2022","journal-title":"Mol Psychiatry"},{"key":"B2","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1001\/archpsyc.62.6.593","article-title":"Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity 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