Journal of the American Academy of Child & Adolescent Psychiatry
ARTICLESSymptom, Family, and Service Predictors of Children's Psychiatric Rehospitalization Within One Year of Discharge
Section snippets
METHOD
SETTING, PARTICIPANTS, AND RECRUITMENT
Participants were recruited from the guardians of children admitted to the 15-bed psychiatric inpatient service of a not-for-profit general pediatric hospital during a 14-month period. This facility draws from a highly demographically and socially diverse patient base. Consequently, children received their preadmission and postdischarge services (psychiatric, educational, and social) through a wide range of providers, jurisdictions, and agencies.
There were 192 children admitted during this
FOLLOW-UP ASSESSMENTS OF REHOSPITALIZATION
The Services Utilization Survey, developed for this study, is a telephone interview that inquires about use of mental health and other services. It was administered to caregivers at 3, 6, and 12 months after discharge to obtain information on rehospitalization, including the dates of readmission and discharge.
Diagnosis.
Structured assessment at admission included (1) interviews with caregivers and children following a written outline with prompts that queried for DSM-IV symptoms for specific disorders; (2) telephone interviews and rating scales from teachers; and (3) review of prior psychiatric evaluation and treatment records. Admission diagnoses were determined in case conferences that included at least two child and adolescent psychiatrists, applying DSM-IV criteria.
Symptom Rating Scales.
Three symptom-focused questionnaires for
STATISTICAL ANALYSIS
A Kaplan-Meier survival curve was generated for the likelihood of remaining out of inpatient care during the follow-up period as a function of time since discharge. Children with no reported rehospitalizations were censored from the distribution after their last completed follow-up interview. Doing so led to censoring of 11 children after 90 days and 14 after 180 days; the remaining children who had not been rehospitalized participated in the 12-month assessment and were therefore
Sample Characteristics
Table 1 shows the age, gender, ethnicity, caregivers, and diagnostic groupings for the 109 participants.
For this clinically heterogeneous sample, DSM-IV principal diagnoses at admission were categorized into five major diagnostic classes (mood, disruptive, anxiety, psychotic, and pervasive developmental disorder [PDD]). Participants were then grouped into the mutually exclusive single or comorbid principal diagnoses shown under “Diagnosis.” Disruptive disorders (i.e., oppositional defiant and
DISCUSSION
In a preadolescent group admitted to an acute-care psychiatric inpatient service, survival analysis indicated a 1-year rehospitalization risk estimate of 0.37. Readmissions clustered strongly in the first 3 months. Severity of conduct problems, low parental involvement, and corporal punishment made independent contributions to a heightened rehospitalization risk, but higher parenting stress appeared to attenuate these factors.
Point estimates of readmission risk do not generalize readily from
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Supported by grants from NIMH ( R03MH058456 ) and the Helen and Irving Schneider Family Foundation.
The author thanks Ariella Levy and the staff of the Child Psychiatry Inpatient Unit at Schneider Children's Hospital for assistance with data collection, and Nina Schooler and Susan Essock for comments on earlier versions of this paper.