Psychiatric Readmission of Children and Adolescents: A Systematic Review and Meta-Analysis

Abstract

Objective: To investigate predictors of psychiatric hospital readmission of children and adolescents, a systematic review and meta-analysis was conducted.Methods: Following PRISMA statement guidelines, a systematic literature search of articles published between 1997 and 2018 was conducted in PubMed/MEDLINE, Google Scholar, and PsycINFO for original peer-reviewed articles investigating predictors of psychiatric hospital readmission among youths (,18 years old). Effect sizes were extracted and combined by using random-effects meta-analysis. Covariates were investigated with meta-regression and subgroup analyses.Results: Thirty-three studies met inclusion criteria, containing information on 83,361 children and adolescents, of which raw counts of readmitted vs. non-readmitted youths were available for 76,219. Of these youths, 13.2% (N=10,076) were readmitted. The mean6SD study followup was 15.9615.0 months, and time to readmission was 13.1612.8 months. Readmission was associated with, but not limited to, suicidal ideation at index hospitalization (pooled odds ratio [OR pooled ]=2.35, 95% confidence interval [CI]=1.64-3.37), psychotic disorders (OR pooled =1.87, 95% CI=1.53-2.28), prior hospitalization (OR pooled =2.51, 95% CI=1.76-3.57), and discharge to residential treatment (OR pooled =1.84, 95% CI=1.07-3.16). There was evidence of moderate study bias. Prior investigations were methodologically and substantively heterogeneous, particularly for measurement of family-level factors.

Pre-Discharge Predictors of 1-Year Rehospitalization in Adolescents and Young Adults with Severe Mental Disorders: A Retrospective Cohort Study

“…Our findings confirm that comorbid substance use disorders may lead to symptomatic relapse, impair clinical and psychosocial adjustment, reduce medication adherence, and lower the response to treatment among subjects with severe mental disorders [25,26]. As for suicidality, our analysis estimated that individuals who were admitted because of a suicide attempt were more likely to be rehospitalized, consistently with previous studies showing an association between suicidal behavior and readmission in both adolescents [9,12] and adults with early psychosis [27]. Youths with recent suicide attempts may receive more intensive care; therefore, readmissions may also reflect the risk as perceived by mental health care staff [12].…”

“…As for suicidality, our analysis estimated that individuals who were admitted because of a suicide attempt were more likely to be rehospitalized, consistently with previous studies showing an association between suicidal behavior and readmission in both adolescents [9,12] and adults with early psychosis [27]. Youths with recent suicide attempts may receive more intensive care; therefore, readmissions may also reflect the risk as perceived by mental health care staff [12]. Further, we could hypothesize a reciprocal link between suicide attempts and substance use disorders in influencing the readmission rates of youths with severe mental disorders.…”

“…However, the available evidence is extremely heterogeneous in terms of study design, target population, data source, and combination of considered characteristics [6,10,11]. Previous studies showed mixed findings, making it difficult to draw definitive conclusions about these potential predictors [9,12]. Furthermore, most of the studies are focused on children and adolescents [9], with few data from individuals in their late adolescence and early twenties.…”

Sociodemographic and clinical characteristics of patients with recurrent psychiatric readmissions in Qatar

“…Recurrent psychiatric readmissions place additional strain on the health care system and make treatment more expensive. [1][2][3][4][5] A higher readmission rate is generally considered an indicator of poor inpatient psychiatric services; post-discharge care, external stressors and other non-clinical factors are also recognized contributors. [6][7][8] Psychiatric readmission has been studied extensively, and attempts have been made to identify its predictors.…”

“…[9][10][11] Age, educational level, socioeconomic status, psychiatric diagnosis, psychiatric treatment, previous history of psychiatric hospitalization, length of hospital stay, adherence to treatment postdischarge and substance abuse are frequently reported to be associated with a higher incidence of psychiatric readmission; however, there is no consensus on the predictors of readmission. 3,5,11,12 Readmission after psychiatric discharge can stem from the natural progression of the patient's underlying disease, a new illness or problem unrelated to the index admission, or the consequence of poor communication regarding the dose and schedule of medication or follow-up plans. 11,13,14 With appropriate in-hospital and postdischarge care, however, a substantial number of readmissions can be prevented.…”