Follow-up Treatment Utilization by Hospitalized Suicidal Adolescents

Abstract

This study examines treatment utilization in a sample of 99 adolescents who were psychiatrically hospitalized due to a risk of suicide and followed for 6 months. Descriptive information regarding participants’ use of various forms of outpatient and intensive treatment, including emergency, inpatient, and residential care is presented. In addition, the relationships between utilization of mental health services and various characteristics of the adolescents and their families were assessed. Overall treatment engagement was high, with 78 participants (79%) receiving some care for the duration of the follow-up period and 91 (92%) participating in at least one session of outpatient treatment, although the extent of utilization was highly variable. In addition, 28 participants (28%) were rehospitalized during follow-up. Both family and individual characteristics were associated with differences in adolescents’ participation in follow-up treatment. Specifically, adolescents with a family history of mood disorders were more likely to participate in outpatient treatment and less likely to require intensive treatments. Conversely, more impaired baseline functioning and suicide attempts during the follow-up period were associated with greater utilization of intensive treatments and less utilization of outpatient therapy. Given that 19 participants (19%) in our sample attempted suicide during the follow-up interval, the findings of this study suggest that, in spite of high rates of outpatient treatment engagement, rates of suicide attempts and use of intensive treatment services remain high. These results suggest the need for improved outpatient care, as well as possibly longer inpatient stays and more elaborate discharge and transition planning.

Predicting Persistence of Nonsuicidal Self‐Injury in Suicidal Adolescents

“…Other reports based on this sample have been published elsewhere (Selby, & Yen, 2014; Yen, Fuller, Solomon, & Spirito, 2014; Yen, Gagnon, & Spirito, 2013; Yen, Kuehn, et al, in press; Yen et al, 2012). The present study differs from those studies in that here we examine predictors of NSSI using the Functional Assessment of Self-Mutilation (FASM).…”

Factors influencing suicidal tendencies in patients with diagnosis of attempted suicide in medical history and relapse prevention

“…19% of adolescents in total attempted suicide anew in the monitored six-month period. The authors declare that patients who were psychiatrically hospitalized after attempted suicide require longer psychiatric hospitalization, better planning of passage from hospitalization to outpatient care and more intensive outpatient care (34).…”

Assessing the Quality Measure for Follow-up Care After Children’s Psychiatric Hospitalizations

“…This could influence follow-up on both the patient and provider side, which is consistent with the hypothesis that those with more severe illnesses are more likely to follow-up. 20 However, we observed that longer length of stay reduces the likelihood of follow-up, which may be counterintuitive to the severity hypothesis and require future investigation. For example, analyses with greater numbers of hospitalizations than we observed could parse out complex interactions between diagnosed conditions and the hospital length of stay.…”

“…Previous studies have consistently observed lower-than-optimal rates of follow-up among individuals, but comparisons are difficult to interpret given differences in populations by age, diagnosis, health insurance coverage (ie, Medicaid, private, etc), and inconsistent follow-up care specifications. [10][11][12][14][15][16][17]19,20 National performance on this measure is highly variable, and comparability across states and programs is difficult to ascertain. 21,22 Differences between Medicaid and CHIP notwithstanding, some state CHIPs report only on fee-for-service enrollees, whereas others include managed care or specific administrative subpopulations.…”

“…We did not observe effects by hospital, provider density, geographic setting, cost-sharing strata, or race, all of which were hypothesized on the basis of findings from other studies. [10][11][12][14][15][16][17]19,20 However, differences could be attributable to studies focused only on adults, 12,15 Medicaid recipients, 16,19 ED visits (rather than hospitalizations), 15 or disease-specific cohorts. 17,20 We also did not see large differences in performance over time despite the growing national emphasis on quality measurement after the Children' s Health Insurance Program Reauthorization Act of 2009 and release of the initial Child Core Set technical specifications in February 2011, just 2 years before the study period.…”