Inpatient Psychiatric Care Outcomes for Adolescents: A Test of Clinical and Psychosocial Moderators

Zambrowicz, Rachel; Stewart, Jessica; Cosby, Elizabeth A.; Esposito, Erika C.; Pridgen, Bryan; Auerbach, Randy P.

doi:10.1080/23794925.2019.1685419

Cited by 14 publications

(13 citation statements)

References 60 publications

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“…This study uses latent growth modeling (LGM) to examine changes in suicide capability during short-term treatment at a partial hospital program (PHP). Despite the key role PHP's play in the continuum of patient care, STBs and correlates of suicide risk are rarely investigated in these settings (c.f., Beard et al, 2016;Chu et al, 2019;Hearon et al, 2015;Hom et al, 2021;Zambrowicz et al, 2019). Prior studies have focused on changes in STBs from pre-to post-treatment and/or correlates of STBs at intake.…”

Section: The Current Studymentioning

confidence: 99%

“…We focused on NSSI and suicide ideation due to their conceptual and empirical links to variability in capability. NSSI is among the best predictors of suicidal behavior (Alqueza et al, 2021;Griep & MacKinnon, 2020;Liu, 2021;Ribeiro et al, 2016;Stewart et al, 2017) and is related to post-PHP outcomes (van Alphen et al, 2017;Zambrowicz et al, 2019). Suicide ideation severity is also associated with capability in many studies (Chu et al, 2017) and may increase capability through the mental rehearsal of suicidal behaviors (Anestis et al, 2017;George et al, 2016;Smith & Cukrowicz, 2010;Spangenberg et al, 2019).…”

Section: The Current Studymentioning

confidence: 99%

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Changes in suicide capability during short-term partial hospital treatment

Stewart¹,

Meddaoui²,

Kaufman³

et al. 2023

Journal of Affective Disorders Reports

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Section: The Current Studymentioning

confidence: 99%

Section: The Current Studymentioning

confidence: 99%

Changes in suicide capability during short-term partial hospital treatment

Stewart¹,

Meddaoui²,

Kaufman³

et al. 2023

Journal of Affective Disorders Reports

Self Cite

View full text Add to dashboard Cite

“…Despite the key role PHP's play in the continuum of patient care, STBs and correlates of suicide risk are rarely investigated in these settings (c.f., Beard et al, 2016;Chu et al, 2019;Hearon et al, 2015;Hom et al, 2021;Zambrowicz et al, 2019). Prior studies have focused on changes in Short-term Changes in Suicide Capability 6 STBs from pre-to post-treatment and/or correlates of STBs at intake.…”

Section: The Current Studymentioning

confidence: 99%

Changes in suicide capability during short-term partial hospital treatment

Stewart¹,

Meddaoui²,

Kaufman³

et al. 2022

Preprint

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Background. Suicide capability (fearlessness about death [FAD], preparation, and perceived capability [PC]) is presumed to be static, or to increase with exposure to provocative events. However, tests of this assumption have primarily used non-clinical samples. We examined short-term changes in capability among patients in a partial hospital program. Methods. We enrolled 296 adult patients (186 [62.7%] female; Mage=36.13, SDage=14.75) who completed diagnostic interviews and questionnaires assessing demographics, capability, and suicide ideation (SI) at intake. Capability was re-assessed twice during treatment and again at discharge, and SI was re-assessed at discharge. We used latent growth modeling (LGM) to quantify changes in capability. Results. FAD, preparation, and PC decreased from intake to discharge (ps<.001, ds=0.24-0.63) and unconditional LGM models suggested that all facets changed significantly throughout treatment. FAD was positively associated with preparation (r=0.57) and PC (r=0.25) at intake (ps<.001), but changes in FAD did not predict changes in other facets. Greater SI at intake was concurrently associated with higher capability (βs=0.26-1.83, ps<.01) and predicted steeper declines in preparation (β=-0.23) and PC (β=-0.04), ps=.04. Finally, higher intake preparation predicted more severe SI at discharge (β=0.16, p<.001). Limitations. There was no control group and there was unequal spacing between in-treatment assessments among participants. Results for SI may have been impacted by floor effects. Conclusions. Results suggest that aspects of capability can change over a short time. Conceptually related facets of capability did not change together; thus, future investigations of the short-term dynamics of capability should not treat it as a unitary construct.

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“…Underinvestment, increasing patient loads, and staffing difficulties contributed to a national shortage in psychiatric beds before the onset of the pandemic. [14][15][16] Findings of a previous study 17 of boarding suggest that rates have been increasing since 2001, particularly among publicly insured youths. Initial reports suggested the boarding crisis worsened during the pandemic.…”

Section: Introductionmentioning

confidence: 98%

“…Patients who board for prolonged periods may experience worsening of symptoms. Underinvestment, increasing patient loads, and staffing difficulties contributed to a national shortage in psychiatric beds before the onset of the pandemic . Findings of a previous study of boarding suggest that rates have been increasing since 2001, particularly among publicly insured youths.…”

Section: Introductionmentioning

confidence: 99%

Psychiatric Boarding Patterns Among Publicly Insured Youths Evaluated by Mobile Crisis Teams Before and During the COVID-19 Pandemic

2023

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ImportancePsychiatric boarding occurs when patients needing intensive psychiatric services who are already under clinical supervision experience delays in their admission to psychiatric facilities. Initial reports have suggested that the US had a psychiatric boarding crisis during the COVID-19 pandemic; however, little is known about the consequences of this crisis for publicly insured youths.ObjectiveTo estimate pandemic-associated changes in psychiatric boarding rates and discharge modalities for people aged 4 to 20 years who accessed psychiatric emergency services (PES) through a mobile crisis team (MCT) evaluation and were covered by Medicaid or health safety net programs.Design, Setting, and ParticipantsThis retrospective cross-sectional study used data from the MCT encounters of a multichannel PES program in Massachusetts. A total of 7625 MCT-initiated PES encounters with publicly insured youths who lived in Massachusetts between January 1, 2018, and August 31, 2021, were assessed.Main Outcomes and MeasuresEncounter-level outcomes (psychiatric boarding status, repeat visits, and discharge disposition) during a prepandemic period (January 1, 2018, to March 9, 2020) were compared with outcomes during a pandemic period (March 10, 2020, to August 31, 2021). Descriptive statistics and multivariate regression analysis were used.ResultsAmong 7625 MCT-initiated PES encounters, the mean (SD) age of publicly insured youths was 13.6 (3.7) years; most youths identified as male (3656 [47.9%]), were of Black race (2725 [35.7%]) or Hispanic ethnicity (2708 [35.5%]), and spoke English (6941 [91.0%]). During the pandemic period, the mean monthly boarding encounter rate was 25.3 percentage points higher than the prepandemic period. After adjustment for covariates, the odds of an encounter resulting in boarding doubled during the pandemic (adjusted odds ratio [AOR], 2.03; 95% CI, 1.82-2.26; P &lt; .001), and boarding youths were 64% less likely to be discharged to inpatient psychiatric care (AOR, 0.36; 95% CI, 0.31-0.43; P &lt; .001). Publicly insured youths who boarded during the pandemic had significantly higher rates of 30-day readmissions (incidence rate ratio, 2.17; 95% CI, 1.88-2.50; P &lt; .001). Boarding encounters during the pandemic were significantly less likely to end in discharge to inpatient psychiatric units (AOR, 0.36; 95% CI, 0.31-0.43; P &lt; .001) or community-based acute treatment facilities (AOR, 0.70; 95% CI, 0.55-0.90; P = .005).Conclusions and RelevanceIn this cross-sectional study, publicly insured youths were more likely to experience psychiatric boarding during the COVID-19 pandemic and, if boarding, were less likely to transfer to a 24-hour level of care. These findings suggest that psychiatric service programs for youths were not prepared to support the levels of acuity and demand that emerged from the pandemic.

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Inpatient Psychiatric Care Outcomes for Adolescents: A Test of Clinical and Psychosocial Moderators

Cited by 14 publications

References 60 publications

Changes in suicide capability during short-term partial hospital treatment

Changes in suicide capability during short-term partial hospital treatment

Changes in suicide capability during short-term partial hospital treatment

Psychiatric Boarding Patterns Among Publicly Insured Youths Evaluated by Mobile Crisis Teams Before and During the COVID-19 Pandemic

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