Vitamin D measurement and supplementation prescribing amongst adolescent psychiatric inpatients within a UK mental health trust: a re-audit

Background

Vitamin D deficiency has increasingly been recognised as an important contributor to both physical and mental health morbidity. Emerging evidence suggests associations between low vitamin D levels and neuropsychiatric symptoms including low mood, cognitive impairment and fatigue. Adolescents admitted to psychiatric inpatient units may represent a particularly high-risk group because of prolonged indoor admission, reduced sunlight exposure, and potential effects of psychotropic medication on vitamin D metabolism. A previous audit conducted across Essex Partnership University NHS Foundation Trust (EPUT) adolescent inpatient units in 2022 recommended incorporation of vitamin D testing into routine admission blood investigations. This re-audit aimed to evaluate current practice in monitoring vitamin D levels and prescribing supplementation within adolescent psychiatric inpatient settings.

Aims

To assess compliance with NICE guidance and Trust formulary recommendations regarding vitamin D measurement and management in adolescent psychiatric inpatients, and to compare findings with the previous 2022 audit cycle.

Methods

A retrospective re-audit was undertaken across all EPUT Child and Adolescent Mental Health Services (CAMHS) inpatient wards: Longview General Adolescent Unit, Larkwood Psychiatric Intensive Care Unit, and Poplar General Adolescent Unit. All patients admitted between 1 January and 31 May 2025 were included, with no exclusion criteria. Electronic patient records were reviewed using the same data collection tool employed in the 2022 audit to allow direct comparison. Data collected included vitamin D supplementation status on admission, whether serum 25-hydroxyvitamin D levels were measured during admission, recorded vitamin D levels, and whether treatment prescribed was appropriate according to NICE and Trust formulary guidance. Vitamin D status was classified as deficient (<25 nmol/L), insufficient (25–49 nmol/L), or sufficient (>50 nmol/L).

Results

Thirty-four patients were included in the re-audit. Vitamin D levels were measured in only 21 patients (61.8%), significantly below the expected compliance target of 100%. Compared with 2022 findings, the proportion of patients with sufficient vitamin D levels declined from 24% to 14.7%. Deficiency reduced marginally from 8% to 5.9%, while insufficiency decreased from 44% to 29.4%. However, the proportion of patients without vitamin D measurement increased substantially from 8% in 2022 to 38.2% in 2025, indicating deterioration in routine monitoring practices.

Ward-level analysis demonstrated variation between services. Longview showed a slight improvement in sufficiency rates but increased deficiency and unmeasured cases. Larkwood demonstrated reduced insufficiency but a marked rise in deficiency and absence of sufficient vitamin D levels. Poplar showed stable insufficiency rates but a significant worsening in the proportion of unmeasured patients.

Among 21 treatment cases reviewed, only 12 patients (57.1%) received management fully consistent with NICE and Trust guidance. Appropriate replacement therapy was generally prescribed for patients with true deficiency; however, inconsistencies remained in management of insufficiency and provision of diet and lifestyle advice.

Conclusions

This re-audit identified significant deterioration in vitamin D monitoring across adolescent psychiatric inpatient wards despite previous recommendations. Reduced testing limited accurate identification and treatment of deficiency and insufficiency. Although management of severe deficiency was generally appropriate, prescribing practices remained inconsistent across wards. These findings therefore support implementation of routine vitamin D testing within admission blood panels for adolescent psychiatric inpatients.

References

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