A Longitudinal Study Identifying Adolescents at Risk for Acute Psychiatric Rehospitalization: A 2-Year Survivor Analysis.

BACKGROUND

Acute psychiatric hospitalizations are costly and associated with significant impairment in adolescence. A substantial proportion of adolescents require rehospitalization within the first 24 months following discharge, yet the research literature does not provide clear guidance on which adolescents are at greatest risk and what symptoms specifically drive this elevated risk level.

OBJECTIVE

This study aimed to (1) characterize adolescents at greatest risk of rehospitalization and (2) identify symptoms that contribute to the greatest risk of rehospitalization over the course of 3, 12, and 24 months post-discharge.

METHOD: Patients (N = 508; ages 13-17; 56% female; 50% sexual minority; 83% racial minority) completed self-report measures of symptom severity during the first 48 h of admission to psychiatric hospitalization. Latent profile analyses were conducted to identify distinct clinical profiles within the sample. Electronic medical records were reviewed to determine if participants were rehospitalized during the subsequent 24 months. Survival analyses were conducted to determine which latent profile and symptoms were associated with the greatest odds of re-admission in the short-term (3 months) and longer-term (12 and 24 months) post-discharge.

RESULTS

Three profiles emerged: Higher Severity & Many Previous Hospitalizations (n = 94; HSMPH), Higher Severity & Few Previous Hospitalizations (n = 305; HSFPH), and Lowest Severity & No Previous Hospitalizations (n = 109; LSNPH). Risk of rehospitalization differed between profiles during the first 12 (p = .003) and 24 months (p = .003), such that the rehospitalization risk for HSMH > HSFH (HR12-month = 1.68, HR24-month = 1.61, ps = .045) and HSFH > LS (HR12-month = 2.38, HR24-month = 2.13, ps< .035). Irritability was associated with greater odds of rehospitalization during the first 12 months post-discharge among participants with previous hospitalizations (n = 399; HR = 1.08, p = .032). Irritability was associated with a greater frequency of rehospitalizations across 24 months in the full sample (N = 508; IRR = 1.08, p = .005).

CONCLUSION

Irritability increases the risk of rehospitalization during the first-year post-discharge among adolescents with the highest clinical severity.