Individual and Organizational Predictors of Pediatric Psychiatric Inpatient Admission in Connecticut Hospitals: A 6 Month Secondary Analysis

Abstract

The objective of this study is to test the hypotheses that bipolar disorders or depressive disorders, minority status, and the presence of pediatric inpatient psychiatric unit will be individual predictors of pediatric psychiatric inpatient admission, and to provide a model that will evaluate which individual and organizational characteristics predict pediatric psychiatric inpatient. For this purpose, a secondary analysis of the medical records of 1,520 pediatric patient visits between January 1, 2008 and June 30, 2008, was conducted using univariate and multivariate logistic regression. Independent predictors of pediatric psychiatric inpatient admission were presence of bipolar and depressive disorders, greater average daily census, and increasing operating margin. Minority status was a significant predictor of not being admitted, as was presence of an anxiety disorder, greater total margin and older age. The results indicate that both individual and organizational factors impact disposition outcomes in particular subsets of pediatric patients who present to emergency departments for psychiatric reasons.

Multi-center nationwide study on pediatric psychiatric inpatients 2000–2018: length of stay, recurrent hospitalization, functioning level, suicidality, violence and diagnostic profiles

“…We found major increases in affective disorders in subjects aged 13–18, including anxiety disorders, childhood affective disorders and depression. Depression is a major reason for CAP hospital admission [ 82 , 83 ] and readmission [ 84 ] among adolescents. The high prevalence of depression among our older age group may have been partly due to suicidality, which has been strongly associated with both depression [ 63 ] and inpatient admissions [ 26 , 64 ].…”

Predictors of voluntary and compulsory admissions after psychiatric emergency consultation in youth

“…Various studies have identified demographic characteristics and clinical factors as predictors of voluntary admission of young patients seen in psychiatric crisis situations [15][16][17][18]. Demographic characteristics that were found to be associated with decisions to hospitalize children and adolescents after emergency consultation were relatively older age, minority status, and having been adopted [16][17][18][19]. Clinical factors that were associated with a higher chance of admission were suicide attempt or self-injurious behavior, the clinician's appraisal of high suicide risk, the presence of a depressive or bipolar disorder, the severity of psychiatric symptoms, comorbidity, a lower score on the global assessment of functioning (GAF), and prior admission.…”

“…Clinical factors that were associated with a higher chance of admission were suicide attempt or self-injurious behavior, the clinician's appraisal of high suicide risk, the presence of a depressive or bipolar disorder, the severity of psychiatric symptoms, comorbidity, a lower score on the global assessment of functioning (GAF), and prior admission. The likelihood of hospitalization was also increased by a prior emergency consultation, substance abuse or dependence, and being on psychotropic medication [15][16][17][18][19]. However, both these demographic characteristics and the clinical factors cannot be modified to prevent emergency admissions.…”

“…Family factors may influence decisions to admit a child to a psychiatric hospital after emergency consultation. Contextual characteristics that were found to be associated with the decision to hospitalize children and adolescents after emergency consultation were the absence of parents at consultation; the time and day of consultation (there being a greater chance of admission at night and in school weeks rather than during school holidays); and a rural location [ 15 , 17 , 18 ]. The source of referral was also associated with the decision to hospitalize: in cases of self-referral and referral by a family member or someone from a school, there was less chance of admission [ 16 ].…”

Psychiatric emergencies among urban youth during COVID-19: Volume and acuity in a multi-channel program for the publicly insured

“…It may be that PES encounters involving these disorders are less severe or emergent than for primary psychotic disorders or substance use disorders. Research prior to the pandemic indicated that primary psychotic disorders are a significant predictor of inpatient admission in adolescents ( Huffman et al, 2012 ), and that youth psychiatric ED visits involving anxiety disorders and stress disorders are less likely to result in inpatient admission ( Hunter et al, 2015 ). In responding to anxiety or stress disorders, youth and families may have felt that risks related to COVID-19 outweighed the possible benefits of seeking PES.…”