Longitudinal examination of youth readmission to mental health inpatient units. Issue 4 (3rd March 2020) - Miller, David A.A.
Abstract : Objective: 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. Method: 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. Results: 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. Conclusion: 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. Key Practitioner Message: 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.