Citation

Carlisle CE, Mamdani M, Schachar R, To T. J. Am. Acad. Child Adolesc. Psychiatry 2012; 51(3): 283-294.e4.

Copyright

(Copyright © 2012, American Academy of Child Adolescent Psychiatry, Publisher Lippincott Williams and Wilkins)

DOI

10.1016/j.jaac.2011.12.003

PMID

unavailable

Abstract

OBJECTIVE: U.S. and Canadian data demonstrate decreasing inpatient days, increasing nonurgent emergency department (ED) visits, and short supply of child psychiatrists. Our study aims to determine whether aftercare reduces ED visits and/or readmission in adolescents with first psychiatric hospitalization.

METHOD: We conducted a population-based cohort analysis using linked health administrative databases with accrual from April 1, 2002, to March 1, 2004. The study cohort included all 15- to 19-year-old adolescents with first psychiatric admission. Adolescents with and without aftercare in the month post-discharge were matched on their propensity to receive aftercare. Our primary outcome was time to first psychiatric ED visit or readmission. Secondary outcomes were time to first psychiatric ED visit and readmission, separately.

RESULTS: We identified 4,472 adolescents with first-time psychiatric admission. Of these, 57% had aftercare in the month post-discharge. Propensity-scorebased matching, which accounted for each individual's propensity for aftercare, produced a cohort of 3,004 adolescents. In matched analyses, relative to those with no aftercare in the month post-discharge, those with aftercare had increased likelihood of combined outcome (hazard ratio [HR] = 1.22, 95% confidence interval [CI] = 1.051.42), and readmission (HR = 1.38, 95% CI = 1.141.66), but not ED visits (HR = 1.14, 95% CI = 0.951.37).

CONCLUSIONS: Our results are provocative: we found that aftercare in the month post-discharge increased the likelihood of readmission but not ED visit. Over and above confounding by severity and Canadian/U.S. systems differences, our results may indicate a relative lack of psychiatric services for youth. Our results point to the need for improved data capture of pediatric mental health service use. © 2012 American Academy of Child and Adolescent Psychiatry.

Language: en

Keywords

adolescent; adult; human; female; male; psychosis; suicide attempt; comorbidity; mental health services; Diagnostic and Statistical Manual of Mental Disorders; mood disorder; readmission; aftercare; substance abuse; article; major clinical study; eating disorder; personality disorder; data base; health care quality; child psychiatry; priority journal; mental health service; anxiety disorder; emergency ward; health insurance; mental hospital; hospital discharge; outpatient care; adjustment disorder; outcome assessment; hospital readmission; disruptive behavior; continuity of care; emergency psychiatry