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青少年住院精神科护理结果:临床和心理社会调节因素的检验

Inpatient Psychiatric Care Outcomes for Adolescents: A Test of Clinical and Psychosocial Moderators.

作者信息

Zambrowicz Rachel, Stewart Jeremy G, Cosby Elizabeth, Esposito Erika C, Pridgen Bryan, Auerbach Randy P

机构信息

Department of Psychiatry, Columbia University, New York, New York, USA.

Department of Psychology, Queen's University, Kingston, Ontario, Canada.

出版信息

Evid Based Pract Child Adolesc Ment Health. 2019;4(4):357-368. doi: 10.1080/23794925.2019.1685419. Epub 2019 Nov 22.

Abstract

Financial pressures have led to a reduced length of stay (LOS) in inpatient psychiatric facilities for adolescents, yet research on the outcomes of short-term programs remains scant. The present study evaluated the outcomes of an adolescent inpatient program by: (1) probing depression, anxiety, and suicidal ideation at admission and discharge and (2) testing whether clinical or psychosocial factors moderate treatment response. Participants included adolescents ( = 777) aged 13-19 years admitted to an inpatient treatment program for acute psychiatric concerns. Clinical interviews were administered to probe mental disorders and past suicidal thoughts and behaviors (STBs), and self-report measures assessed symptom severity, child abuse, and peer victimization (i.e., bullying). Results showed a significant decrease in depression, anxiety, and suicidal ideation from admission to discharge. Comorbidity, past month NSSI, and lifetime suicide attempts emerged as moderators of treatment response, and peer victimization predicted symptom severity at discharge. Although findings suggest an overall improvement, participants with more severe clinical presentations (e.g., comorbidity, past month NSSI, lifetime suicide attempts, and more severe bullying) reported greater symptom severity at admission and discharge, suggesting that these patients may benefit from longer inpatient stays to achieve further symptom reduction. Although this may incur greater costs in the short-term, it also may prevent unintended economic and psychosocial consequences in the long-term.

摘要

经济压力导致青少年在住院精神科机构的住院时间缩短,然而关于短期项目效果的研究仍然很少。本研究通过以下方式评估了一个青少年住院项目的效果:(1)在入院和出院时探究抑郁、焦虑和自杀意念;(2)测试临床或心理社会因素是否会调节治疗反应。参与者包括13至19岁因急性精神问题入院接受住院治疗项目的青少年(n = 777)。进行临床访谈以探究精神障碍以及过去的自杀想法和行为(STB),并通过自我报告测量评估症状严重程度、儿童虐待和同伴受害情况(即欺凌)。结果显示,从入院到出院,抑郁、焦虑和自杀意念显著下降。共病、过去一个月的非自杀性自伤行为(NSSI)和终生自杀未遂成为治疗反应的调节因素,同伴受害情况可预测出院时的症状严重程度。尽管研究结果表明总体有所改善,但临床表现更严重的参与者(例如共病、过去一个月的NSSI、终生自杀未遂以及更严重的欺凌)在入院和出院时报告的症状严重程度更高,这表明这些患者可能受益于更长时间住院以进一步减轻症状。虽然这在短期内可能会产生更高的成本,但从长远来看,也可能防止意外的经济和心理社会后果。

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