Readmissions to adolescent psychiatric inpatient care: A register study
Vadén, Visa (2024)
2024
Lääketieteen lisensiaatin tutkinto-ohjelma - Licentiate's Programme in Medicine
Lääketieteen ja terveysteknologian tiedekunta - Faculty of Medicine and Health Technology
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Hyväksymispäivämäärä
2024-10-17
Julkaisun pysyvä osoite on
https://urn.fi/URN:NBN:fi:tuni-202410159272
https://urn.fi/URN:NBN:fi:tuni-202410159272
Tiivistelmä
Introduction
Readmissions to inpatient care shortly after discharge are considered a problem. In psychiatry, repeated readmissions are referred to as “revolving door” phenomenon and are assumed to illustrate failure of care. We set out to study readmissions in adolescent psychiatry. The aim of our study was to determine the proportions of patients who are readmitted to the hospital in general during adolescent years, and those who are readmitted within 30 days of discharge. We investigated the association of various sociodemographic, psychosocial, and symptom- and disorder-related factors with readmission.
Materials and methods
We conducted a retrospective chart review of all patients admitted to the adolescent psychiatric ward at Tampere University Hospital from 2016 to 2020. We collected data on patient age, gender, family risk factors, diagnoses, symptoms, and any new treatment episodes. We cross-tabulated gender, child protection involvement, diagnoses, symptoms, and family risk factors with overall readmission, readmission within 30 days of discharge, and the number of readmissions. To explore independent associations of the partially overlapping explaining variables, we used multivariable analyses.
Results
Nearly half of the patients (48.4%) experienced a readmission during adolescent years. Thirteen percent of patients were readmitted within 30 days of discharge. In the multivariable analyses, female gender, a diagnosis from the schizophrenia disorder group, mood disorder group, anxiety disorder group, and somatoform disorder group predicted readmission. Additionally, symptoms of psychosis, self-harm, and eating disorders increased the risk of readmission. Conversely, depressive symptoms and concerning substance use were found to be protective against readmissions.
Discussion
In our study, the number of readmissions was significantly higher than in many other studies. However, the 30-day readmission rates were closer to those found in other research. These differences are likely due to variations in patient populations, healthcare systems, and treatment practices. Readmissions were predicted by disorders with a chronic course and self-harm. This suggests that illness-related factors play a major role. However, female gender predicted readmissions in general and within 30 days when disorder-related factors were accounted for. Such gender difference may warrant societal attention to gender inequalities.
Readmissions to inpatient care shortly after discharge are considered a problem. In psychiatry, repeated readmissions are referred to as “revolving door” phenomenon and are assumed to illustrate failure of care. We set out to study readmissions in adolescent psychiatry. The aim of our study was to determine the proportions of patients who are readmitted to the hospital in general during adolescent years, and those who are readmitted within 30 days of discharge. We investigated the association of various sociodemographic, psychosocial, and symptom- and disorder-related factors with readmission.
Materials and methods
We conducted a retrospective chart review of all patients admitted to the adolescent psychiatric ward at Tampere University Hospital from 2016 to 2020. We collected data on patient age, gender, family risk factors, diagnoses, symptoms, and any new treatment episodes. We cross-tabulated gender, child protection involvement, diagnoses, symptoms, and family risk factors with overall readmission, readmission within 30 days of discharge, and the number of readmissions. To explore independent associations of the partially overlapping explaining variables, we used multivariable analyses.
Results
Nearly half of the patients (48.4%) experienced a readmission during adolescent years. Thirteen percent of patients were readmitted within 30 days of discharge. In the multivariable analyses, female gender, a diagnosis from the schizophrenia disorder group, mood disorder group, anxiety disorder group, and somatoform disorder group predicted readmission. Additionally, symptoms of psychosis, self-harm, and eating disorders increased the risk of readmission. Conversely, depressive symptoms and concerning substance use were found to be protective against readmissions.
Discussion
In our study, the number of readmissions was significantly higher than in many other studies. However, the 30-day readmission rates were closer to those found in other research. These differences are likely due to variations in patient populations, healthcare systems, and treatment practices. Readmissions were predicted by disorders with a chronic course and self-harm. This suggests that illness-related factors play a major role. However, female gender predicted readmissions in general and within 30 days when disorder-related factors were accounted for. Such gender difference may warrant societal attention to gender inequalities.