Predictors of Rehospitalization for Depressed Adolescents Admitted to Acute Psychiatric Treatment

Abstract

Objective Presently, little is known about what factors predict adolescent psychiatric rehospitalization. Thus, the present study tested whether a battery of demographic and clinical characteristics predicted readmission within 6 months of discharge. Methods Participants were 165 adolescents (112 females) aged 13–19 years (mean = 15.61, SD = 1.48) admitted to an acute residential treatment program between November 25, 2013, and November 18, 2014. Patients met diagnostic criteria (DSM-IV-TR) for current major depressive disorder or dysthymia. At admission, participants completed a battery of clinical interviews and questionnaires assessing demographics, early life stress, comorbid diagnoses, psychiatric symptoms, suicidality, self-injury, and risky behavior engagement. At discharge, psychiatric symptoms were reassessed. Readmission to the same residential service was monitored over a 6-month period following discharge. Results Overall, 12.1% of adolescents were rehospitalized. We conducted a series of Cox regression survival analyses to test demographic and clinical predictors of patients’ time to readmission. More frequent self-injurious behaviors in the month prior to hospitalization was significantly associated with a more rapid time to rehospitalization (β = 0.05, SE = .02, Wald1 = 4.35, P = .037, OR = 1.05, 95% CI = 1.003–1.10). Conclusions It is critical to more effectively manage self-injury during the treatment of depressed adolescents, as this is the strongest predictor of later rehospitalization.

Examining the Course of Suicidal and Nonsuicidal Self-Injurious Thoughts and Behaviors in Outpatient and Inpatient Adolescents

“…“ The SITBI has demonstrated sound psychometric properties, including excellent interrater reliability (average κ = .99), strong test-retest reliability across a 6-month period (average κ = .70), strong parent-adolescent agreement on the presence of suicide ideation, suicide plans, suicide attempts, and NSSI, and construct validity with respect to other measures of suicide ideation (average κ = .54), suicide attempts (κ = .65), and NSSI (average κ = .87; Nock et al 2007). The SITBI has been used in a number of previous studies to assess SITBs among inpatient (Auerbach et al 2015; van Alphen et al in press) and community/outpatient adolescent samples (Barrocas et al 2012; Nock et al 2009). Notably, examination of SITBs using a structured interview allowed for follow-up questions and resolution of misunderstandings that commonly occur using brief self-report methodologies (Millner et al 2015; Nock and Kessler 2006).…”

Impulsivity and Suicidality in Adolescent Inpatients

“…Extending previous research (Carver et al 2011; Johnson et al 2013), we tested our model in a sample of adolescent psychiatric inpatients assessed within 48 h of admission to an acute psychiatric treatment facility. Importantly, psychiatric adolescent inpatients are at greatest risk for suicide (Auerbach et al 2015; Stewart et al 2015), and they represent a vastly understudied population (van Alphen et al 2016). Before testing hypotheses, we conducted an exploratory factor analysis of the emotion- and non-emotion-relevant impulsivity subscales to determine whether the structure was consistent with past research in young adults (see Carver et al 2011; Johnson et al 2013).…”

Reducing pediatric psychiatric hospital readmissions and improving quality care through an innovative Readmission Risk Predictor Tool

“…The RPT is a unique evidence‐based instrument to identify risk factors in the prediction of readmissions among pediatric psychiatric patients. A better understanding of the risk factors associated with readmissions can guide the clinician in more effective interventions (Van Alphen et al., ). The utilization of case management post‐discharge to reduce readmissions was confirmed by research involving children and adolescents in a psychiatric hospital (Romansky et al., 2003).…”

“…Finally, the fourth most common rehospitalization diagnosis was ASD. However, there are controversies over diagnoses predicting readmissions with some studies reporting that diagnoses did not predict readmissions (James et al., ; Van Alphen et al., ), while other studies linked diagnoses to readmission risk (Blader, ; Yampolskaya et al., ).…”