Miller David A A, Ronis Scott T, Slaunwhite Amanda K, Audas Rick, Richard Jacques, Tilleczek Kate, Zhang Michael
Department of Psychology, University of New Brunswick, Fredericton, NB, Canada.
BC Centre for Disease Control, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
Child Adolesc Ment Health. 2020 Nov;25(4):238-248. doi: 10.1111/camh.12371. Epub 2020 Mar 3.
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.
青少年在获取心理健康服务方面存在重大障碍。需求不断增长使这些障碍更加突出，部分原因是儿童和青少年反复住院。本研究的目的是确定加拿大新不伦瑞克省青少年再次入住住院精神科服务的人口统计学、社会经济和临床预测因素。
确定再次入院的关键人口统计学、支持因素和临床预测因素。使用新不伦瑞克省出院摘要数据库（DAD）汇编了一组2003年4月1日至2014年3月31日期间因精神科住院的3至19岁儿童和青少年（N = 3825）。主要分析包括采用对数秩检验的Kaplan-Meier生存方法，以评估再次入院时间的变异性，以及采用Cox回归以确定再次入院的显著预测因素。
在10年期间，总共27.8%的入院儿童和青少年至少有一次再次入院，57.3%在出院后90天内再次入院。双变量结果表明，来自非农村社区的11至15岁、社会经济地位处于中上层（SES）的男性青少年最有可能再次入院。再次入院可能性增加的显著预测因素包括年龄较大、男性、较高的SES、由医生转诊接受治疗、转至另一家医疗机构、精神病以及之前的精神科住院史。
再次入院差异的很大一部分可由青少年人口统计学特征（即年龄、SES、地理位置）和各种支持结构来解释，包括住院护理转诊和出院后支持服务。
青少年再次入住住院精神科护理受个体、环境和临床领域的多种多方面风险因素影响。本研究使用省级人口规模的纵向行政数据来证明各种个体和人口因素对再次入院可能性的影响，而大多数使用较小短期数据样本的研究明显缺乏这一点。在研究青少年再次入院情况时确保考虑临床背景之外的多个因素，可能有助于更全面地了解青少年住院模式。
