Longitudinal examination of youth readmission to mental health inpatient units.
Adolescent
Adolescent, Hospitalized
/ statistics & numerical data
Adult
Age Factors
Child
Child, Hospitalized
/ statistics & numerical data
Child, Preschool
Hospitals, Psychiatric
/ statistics & numerical data
Humans
Longitudinal Studies
Mental Disorders
/ epidemiology
New Brunswick
/ epidemiology
Patient Readmission
/ statistics & numerical data
Sex Factors
Socioeconomic Factors
Young Adult
Mental health
adolescents
children
psychiatric
readmissions
Journal
Child and adolescent mental health
ISSN: 1475-357X
Titre abrégé: Child Adolesc Ment Health
Pays: England
ID NLM: 101142157
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
accepted:
27
01
2020
pubmed:
10
6
2020
medline:
31
8
2021
entrez:
10
6
2020
Statut:
ppublish
Résumé
Significant barriers exist for youth in obtaining mental health services. These barriers are exacerbated by growing demand, attributed partially to children and adolescents who have repeat hospital admissions. The purpose of this study was to identify demographic, socioeconomic and clinical predictors of readmission to inpatient psychiatric services in New Brunswick, Canada. Key demographic, support and clinical predictors of readmission were identified. The New Brunswick Discharge Abstract Database (DAD) was used to compile a cohort of all children and adolescents ages 3-19 years with psychiatric hospital admissions between 1 April 2003 and 31 March 2014 (N = 3825). Primary analyses consisted of Kaplan-Meier survival methods with log-rank tests to assess time-to-readmission variability, and Cox regression to identify significant predictors of readmission. In total, 27.8% of admitted children and adolescents experienced at least one readmission within the 10-year period, with 57.3% readmitted to hospital within 90 days following discharge. Bivariate results indicated that male, upper-middle socioeconomic status (SES) youths aged 11-15 years from nonrural communities were most likely to be readmitted. Notable predictors of increased readmission likelihood were older age, being male, higher SES, referral to care by medical practitioner, discharge to another health facility, psychosis, and previous psychiatric admission. A significant portion of the variance in readmission was accounted for by youth demographic characteristics (i.e. age, SES, geographic location) and various support structures, including referrals to inpatient care and aftercare support services. Readmission to inpatient psychiatric care among youth is affected by a number of multifaceted risk factors across individual, environmental and clinical domains. This study used provincial population-scale longitudinal administrative data to demonstrate the influence of various individual and demographic factors on likelihood of readmission, which is notably absent from the majority of studies that make use of smaller, short-term data samples. Ensuring that multiple factors outside of the clinical context are considered when examining readmission among youth may contribute to a more thorough understanding of youth hospitalization patterns.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
238-248Subventions
Organisme : CIHR
ID : TT4-128269
Pays : Canada
Informations de copyright
© 2020 Association for Child and Adolescent Mental Health.
Références
Abas, M.A., Vanderpyl, J., Robinson, E., Le Proux, T., & Crampton, P. (2006). Socio-economic deprivation and duration of hospital stay in severe mental disorder. The British Journal of Psychiatry, 188, 581-582.
Arnold, E.M., Goldston, D.B., Ruggiero, A., Reboussin, B.A., Daniel, S.S., & Hickman, E.A. (2003). Rates and predictors of rehospitalization among formerly hospitalized adolescents. Psychiatric Services, 54, 994-998.
Blader, J.C. (2004). Symptom, family, and service predictors of children's psychiatric rehospitalization within one year of discharge. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 440-451.
Bobier, C., & Warwick, M. (2005). Factors associated with rehospitalisation to adolescent psychiatric care. Australian and New Zealand Journal of Psychiatry, 39, 600-606.
Canadian Institute for Health Information (2009). The Association Between Socio-economic Status and Inpatient Hospital Service Use for Depression. Available from: https://secure.cihi.ca/estore/productFamily.htm?pf=PFC1321&xml:lang=en&media=0 [last accessed 14 February 2020].
Canadian Institute for Health Information (2011). Health indicators 2011. Available from: https://secure.cihi.ca/estore/productFamily.htm?locale=en&pf=PFC1635 [last accessed 14 February 2020].
Canadian Institute for Health Information (2015a). Care for Children and Youth with Mental Disorders. Available from: https://secure.cihi.ca/estore/productFamily.htm?locale=en&pf=PFC2866 [last accessed 14 February 2020].
Canadian Institute for Health Information (2015b). National Health Expenditure Trends, 1975-2015. Available from: https://secure.cihi.ca/free_products/nhex-trends-narrative-report-2019-en-web.pdf [last accessed 14 February 2020].
Carlisle, C.E., Mamdani, M., Schachar, R., & To, T. (2012). Aftercare, emergency department visits, and rehospitalisation in adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 51, 283-293.
Cheng, C., Chan, C.W.T., Gula, C.A., & Parker, M.D. (2017). Effects of outpatient aftercare on psychiatric rehospitalization among children and emerging adults in Alberta, Canada. Psychiatric Services, 68, 696-703.
Donisi, V., Tedeschi, F., Wahlbeck, K., Haaramo, P., & Amaddeo, F. (2016). Pre-discharge factors predicting readmissions of psychiatric patients: A systematic review of the literature. BMC Psychiatry, 16, 1-17.
Feng, J.Y., Toomey, S.L., Zaslavsky, A.M., Nakamura, M.M., & Schuster, M.A. (2017). Readmission after pediatric mental health admissions. Pediatrics, 140, 1-9.
Fontanella, C.A. (2008). The influence of clinical, treatment, and healthcare system characteristics on psychiatric rehospitalisation of adolescents. American Journal of Orthopsychiatry, 78, 187-198.
Fontanella, C.A., Pottick, K.J., Warner, L.A., & Campo, J.V. (2010). Effects of medication management and discharge planning on early rehospitalisation of psychiatrically hospitalized adolescents. Social Work in Mental Health, 8, 117-133.
Fontanella, C.A., Zuravin, S.J., & Burry, C.L. (2006). The effect of a medicaid managed care program on patterns of psychiatric rehospitalisation among adolescents: Evidence from Maryland. The Journal of Behavioral Health Services and Research, 33, 39-52.
Foster, E.M. (1999). Do aftercare services reduce inpatient psychiatric rehospitalisations? Health Services Research, 34, 715-736.
Heflinger, C.A., Simpkins, C.G., & Foster, E.M. (2002). Modeling child and adolescent psychiatric hospital utilization: A framework for examining predictors of service use. Children's Services: Social Policy, Research, & Practice, 5, 151-172.
Hudson, C.G. (2005). Socioeconomic status and mental illness: Tests of the social causation and selection hypotheses. American Journal of Orthopsychiatry, 75, 3-18.
James, S., Charlemagne, S.J., Gilman, A.B., Alemi, Q., Smith, R.L., Tharayil, P.R., & Freeman, K. (2010). Post-discharge services and psychiatric rehospitalization among children and youth. Administration and Policy in Mental Health and Mental Health Services Research, 37, 433-445.
Joyce, V.W., King, C.D., Nash, C.C., Lebois, L.A.M., Ressler, K.J., & Buonopane, R.J. (2019). Predicting psychiatric rehospitalization in adolescents. Administration and Policy in Mental Health and Mental Health Services Research, 46, 807-820.
Kalseth, J., Lassemo, E., Wahlbeck, K., Haaramo, P., & Magnussen, J. (2016). Psychiatric readmissions and their association with environmental and health system characteristics: A systematic review of the literature. BMC Psychiatry, 16, 376.
Kessler, R.C., Amminger, G.P., Aguilar-Gaxiola, S., Alonso, J., Lee, S., & Ustun, T.B. (2007). Age of onset of mental disorders: A review of recent literature. Current Opinion in Psychiatry, 20, 359-364.
Lakin, B.L., Brambila, A.D., & Sigda, K.B. (2004). Parental involvement as a factor in the rehospitalisation to a residential treatment center. Residential Treatment for Children and Youth, 22, 37-52.
Lee, K.J., Roberts, G., Doyle, L.W., Anderson, P.J., & Carlin, J.B. (2016). Multiple imputation for missing data in a longitudinal cohort study: A tutorial based on a detailed case study involving imputation of missing outcome data. International Journal of Social Research Methodology: Theory and Practice, 19, 575-591.
McLaughlin, K.A., Costello, E.J., Leblanc, W., Sampson, N.A., & Kessler, R.C. (2012). Socioeconomic status and adolescent mental disorders. American Journal of Public Health, 102, 1742-1750.
Ougrin, D., Corrigall, R., Poole, J., Zundel, T., Sarhane, M., Slater, V., … & Taylor, E. (2018). Comparison of effectiveness and cost-effectiveness of an intensive community supported discharge service versus treatment as usual for adolescents with psychiatric emergencies: A randomised controlled trial. The Lancet Psychiatry, 5, 477-485.
Pavkov, T.W., Goerge, R.M., & Lee, B.J. (1997). State hospital reentry among youth with serious emotional disturbance: A longitudinal analysis. Journal of Child and Family Studies, 6, 373-383.
Pedersen, J., & Aarkrog, T. (2001). A 10-year follow-up study of an adolescent psychiatric clientele and early predictors of readmission. Nordic Journal of Psychiatry, 55, 11-16.
Pottick, K.J., Hansell, S., Miller, J.E., & Davis, D.M. (1999). Factors associated with inpatient length of stay for children and adolescents with serious mental illness. Social Work Research, 23, 213-225.
Pylypchuk, Y., & Sarpong, E.M.. (2013). Comparison of health care utilization: United States versus Canada. Health Services Research, 48(2pt1), 560-581.
Romansky, J.B., Lyons, J.S., Lehner, R.K., & West, C.M. (2003). Factors related to psychiatric hospital rehospitalisation among children and adolescents in state custody. Psychiatric Services, 54, 356-362.
Ronis, S.T., Slaunwhite, A.K., & Malcom, K.E. (2017). Comparing strategies for providing child and youth mental health care services in Canada, the United States, and the Netherlands. Administration and Policy in Mental Health and Mental Health Services Research, 44, 955-966.
Stewart, S.L., Kam, C., & Baiden, P. (2014). Predicting length of stay and rehospitalisation for psychiatric inpatient youth hospitalised to adult mental health beds in Ontario, Canada. Child and Adolescent Mental Health, 19, 115-121.
Trask, E.V., Fawley-King, K., Garland, A.F., & Aarons, G.A. (2016). Do aftercare mental health services reduce risk of psychiatric rehospitalization for children? Psychological Services, 13, 127-132.
Wickizer, T.M., Lessler, D., & Boyd-Wickizer, J. (1999). Effects of health care cost-containment programs on patterns of care and rehospitalisations among children and adolescents. American Journal of Public Health, 89, 1353-1359.
Yampolskaya, S., Mowery, D., & Dollard, N. (2013). Predictors for readmission into children’s inpatient mental health treatment. Community Mental Health Journal, 49, 781-786.
Zhang, J., Harvey, C., & Andrew, C. (2011). Factors associated with length of stay and the risk of readmission in an acute psychiatric inpatient facility: A retrospective study. Australian and New Zealand Journal of Psychiatry, 45, 578-585.