Magnitude and Correlates of Symptomatic, Global Illness, and Social Functioning Response; Out-of-Home Placement; and Length of Stay in 1,189 Consecutively Hospitalized Children and Adolescents With Mental Disorders
Objective: To identify outcome predictors in hospitalized youth with mental disorders.
Methods: This retrospective analysis of systematically recorded clinical parameters in youth hospitalized for psychiatric treatment in 2004–2015 assessed magnitude and correlates of symptom response (SR), global illness response (GIR), social functioning (SF), out-of-home placement (OOHP), and length of stay (LOS). Backward elimination regression analyses were performed to identify independent baseline correlates of each of the 5 outcomes, with R2 representing the variance explained by the independent correlates retained in the final model.
Results: Across 1,189 youth (median age = 14.4 years; interquartile range = 11.6,16.1 years; range, 5–19 years; females = 61.5%), frequencies of coprimary outcomes were as follows: SR = 57.5% (statistically significant correlates = 13, R2 = 0.154), GIR = 30.0% (correlates = 5, R2 = 0.078), SF = 19.0% (correlates = 8, R2 = 0.207), OOHP recommendation = 35.2% (correlates = 13, R2 = 0.275), and mean ± SD LOS = 65.0 ± 37.5 days (correlates = 11, R2 = 0.219). In multivariable analyses, 11 factors were statistically significantly (P < .05) associated with > 1 poor outcome: 4 with 4 outcomes (disturbed social interaction, substance abuse/dependence symptoms; sole exception for both = LOS; disturbed drive/attention/impulse control, sole exception = OOHP; higher admission BMI percentile [but shorter LOS], sole exception = GIR), 3 with 3 outcomes (higher admission age [but good SF and shorter LOS], more abnormal psychosocial circumstances, more mental health diagnoses), and 4 with 2 outcomes (intelligence level [IQ] < 85, obsessive-compulsive disorder symptoms, disturbed social behavior, somatic findings). Additionally, 17 correlates were statistically significantly (P < .05) associated with 1 outcome, ie, SR = 6, OOHP = 5, LOS = 5, SF = 1.
Conclusions: Higher admission BMI percentile, disturbed social interaction, disturbed drive/attention/impulse control, and substance abuse/dependence symptoms were independently associated with multiple poor outcomes in mentally ill youth requiring inpatient care. Knowledge of global and specific correlates of poor inpatient treatment outcomes may help inform treatment decisions.
J Clin Psychiatry 2024;85(1):23m14897
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Kieling C, Baker-Henningham H, Belfer M, et al. Child and adolescent mental health worldwide: evidence for action. Lancet. 2011;378(9801):1515–1525. PubMedCrossRef
Polanczyk GV, Salum GA, Sugaya LS, et al. Annual research review: a meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry. 2015;56(3):345–365. PubMedCrossRef
Solmi M, Radua J, Olivola M, et al. Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Mol Psychiatry. 2022;27(1):281–295. PubMedCrossRef
Sadock BJ, Sadock VA. Kaplan and Sadock’s Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. Lippincott Williams & Wilkins; 2011.
Smith L, Strümpher J, Morton DG. Perceptions of mental healthcare professionals regarding inpatient therapy programmes for adolescents in the Eastern Cape, South Africa. J Child Adolesc Ment Health. 2015;27(1):59–73. PubMedCrossRef
Park JM, Ryan JP. Placement and permanency outcomes for children in out-of-home care by prior inpatient mental health treatment. Res Soc Work Pract. 2009;19(1):42–51. CrossRef
Holttinen T, Pirkola S, Rimpelä M, et al. Factors behind a remarkable increase in adolescent psychiatric inpatient treatment between 1980 and 2010 - a nationwide register study. Nord J Psychiatry. 2022;76(2):120–128. PubMedCrossRef
Degli Esposti M, Ziauddeen H, Bowes L, et al. Trends in inpatient care for psychiatric disorders in NHS hospitals across England, 1998/99-2019/20: an observational time series analysis. Soc Psychiatry Psychiatr Epidemiol. 2022;57(5):993–1006. PubMedCrossRef
Hazell P, Sprague T, Sharpe J. Psychiatric hospital treatment of children and adolescents in New South Wales, Australia: 12-year trends. BJPsych Open. 2016;2(1):1–5. PubMedCrossRef
Plener PL, Straub J, Fegert JM, et al. Behandlung psychischer Erkrankungen von Kindern in deutschen Krankenhäusern: analyse der Häufigkeiten der Jahre 2003 bis 2012. Nervenheilkunde. 2015;34(01/02):18–23. CrossRef
Kwok KHR, Yuan SNV, Ougrin D. Review: alternatives to inpatient care for children and adolescents with mental health disorders. Child Adolesc Ment Health. 2016;21(1):3–10. PubMedCrossRef
Green J, Jacobs B, Beecham J, et al. Inpatient treatment in child and adolescent psychiatry: a prospective study of health gain and costs. J Child Psychol Psychiatry. 2007;48(12):1259–1267. PubMedCrossRef
Emslie GJ, Rush AJ, Weinberg WA, et al. Recurrence of major depressive disorder in hospitalized children and adolescents. J Am Acad Child Adolesc Psychiatry. 1997;36(6):785–792. PubMedCrossRef
Meule A, Schrambke D, Furst Loredo A, et al. Inpatient treatment of anorexia nervosa in adolescents: a 1-year follow-up study. Eur Eat Disord Rev. 2021;29(2):165–177. PubMedCrossRef
Schlegl S, Diedrich A, Neumayr C, et al. Inpatient treatment for adolescents with anorexia nervosa: clinical significance and predictors of treatment outcome. Eur Eat Disord Rev. 2016;24(3):214–222. PubMedCrossRef
Delinsky SS, St Germain SA, Thomas JJ, et al. Naturalistic study of course, effectiveness, and predictors of outcome among female adolescents in residential treatment for eating disorders. Eat Weight Disord. 2010;15(3):e127–e135. PubMedCrossRef
Enns MW, Cox BJ, Inayatulla M. Personality predictors of outcome for adolescents hospitalized for suicidal ideation. J Am Acad Child Adolesc Psychiatry. 2003;42(6):720–727. PubMedCrossRef
Schlegl S, Quadflieg N, Löwe B, et al. Specialized inpatient treatment of adult anorexia nervosa: effectiveness and clinical significance of changes. BMC Psychiatry. 2014;14(1):258. PubMedCrossRef
Dobkin PL, Chabot L, Maliantovitch K, et al. Predictors of outcome in drug treatment of adolescent inpatients. Psychol Rep. 1998;83(1):175–186. PubMedCrossRef
Feenstra DJ, Laurenssen EMP, Hutsebaut J, et al. Predictors of treatment outcome of Inpatient Psychotherapy for adolescents with personality pathology. Pers Ment Health. 2014;8(2):102–114. PubMedCrossRef
Vall E, Wade TD. Predictors and moderators of outcomes and readmission for adolescent inpatients with anorexia nervosa: a pilot study. Clin Psychol. 2017;21(2):143–152. CrossRef
Hillen S, Dempfle A, Seitz J, et al. Motivation to change and perceptions of the admission process with respect to outcome in adolescent anorexia nervosa. BMC Psychiatry. 2015;15(1):140. PubMedCrossRef
Castro-Fornieles J, Casulà V, Saura B, et al. Predictors of weight maintenance after hospital discharge in adolescent anorexia nervosa. Int J Eat Disord. 2007;40(2):129–135. PubMedCrossRef
Hanssen-Bauer K, Heyerdahl S, Hatling T, et al. Admissions to acute adolescent psychiatric units: a prospective study of clinical severity and outcome. Int J Ment Health Syst. 2011;5(1):1. PubMedCrossRef
Halliday-Boykins CA, Henggeler SW, Rowland MD, et al. Heterogeneity in youth symptom trajectories following psychiatric crisis: predictors and placement outcome. J Consult Clin Psychol. 2004;72(6):993–1003. PubMedCrossRef
Benarous X, Cravero C, Jakubowicz B, et al. Looking for the good timing: predictors of length of stay and therapeutic outcomes in adolescent inpatients with severe or treatment-refractory mood disorders. J Child Adolesc Psychopharmacol. 2021;31(4):268–278. PubMedCrossRef
Kolko DJ. Short-term follow-up of child psychiatric hospitalization: clinical description, predictors, and correlates. J Am Acad Child Adolesc Psychiatry. 1992;31(4):719–727. PubMedCrossRef
Kennedy J, Hembry P, Green D, et al. Predictors of change in global psychiatric functioning at an inpatient adolescent psychiatric unit: a decade of experience. Clin Child Psychol Psychiatry. 2020;25(2):471–482. PubMedCrossRef
Setoya Y, Saito K, Kasahara M, et al. Evaluating outcomes of the child and adolescent psychiatric unit: a prospective study. Int J Ment Health Syst. 2011;5(1):7. PubMedCrossRef
Clarkin JF, Hurt SW, Crilly JL. Therapeutic alliance and hospital treatment outcome. Hosp Community Psychiatry. 1987;38(8):871–875. PubMedCrossRef
Serim Demirgoren B, Ozbek A, Gencer O. Factors affecting improvement of children and adolescents who were treated in the child and adolescent psychiatry inpatient unit. J Int Med Res. 2017;45(4):1318–1323. PubMedCrossRef
Sourander A, Helenius H, Leijala H, et al. Predictors of outcome of short-term child psychiatric inpatient treatment. Eur Child Adolesc Psychiatry. 1996;5(2):75–82. PubMedCrossRef
Comas M, Valentino K, Bridgett DJ, et al. The direct and interactive effects of physical abuse severity and negative affectivity on length of psychiatric hospitalization: evidence of differential reactivity to adverse environments in psychiatrically high-risk youth. Child Psychiatry Hum Dev. 2014;45(2):220–228. PubMedCrossRef
Stewart SL, Kam C, Baiden P. Predicting length of stay and readmission for psychiatric inpatient youth admitted to adult mental health beds in Ontario, Canada. Child Adolesc Ment Health. 2014;19(2):115–121. PubMedCrossRef
Pottick KJ, Hansell S, Miller JE, et al. Factors associated with inpatient length of stay for children and adolescents with serious mental illness. Soc Work Res. 1999;23(4):213–224. CrossRef
Pavkov TW, Goerge RM, Czapkowicz JG. Predictors of length of stay among youths hospitalized in state hospitals in Illinois. J Child Fam Stud. 1997;6(2):221–231. CrossRef
Gold J, Shera D, Clarkson B Jr. Private psychiatric hospitalization of children: predictors of length of stay. J Am Acad Child Adolesc Psychiatry. 1993;32(1):135–143. PubMedCrossRef
Zeshan M, Waqas A, Naveed S, et al. Factors predicting length of stay in an adolescent psychiatric unit, South Bronx, NY: a short report. J Can Acad Child Adolesc Psychiatry. 2018;27(2):142–147. PubMed
Pejovic-Milovancevic M, Grujicic R, Stojkovic A, et al. Changes in hospital treatment of children and adolescents with mental health problems. Gen Hosp Psychiatry. 2020;64:108–109. PubMedCrossRef
den Dunnen W, Stewart SL, Currie M, et al. Predictors of out-of-home placement following residential treatment. Child Youth Serv Rev. 2013;35(3):518–524. CrossRef
Park JM, Solomon P, Mandell DS. Foster care placement among children who received inpatient psychiatric care. Child Youth Serv Rev. 2007;29(7):933–940. CrossRef
Gabel S, Finn M, Ahmad A. Day treatment outcome with severely disturbed children. J Am Acad Child Adolesc Psychiatry. 1988;27(4):479–482. PubMedCrossRef
Gabel S, Shindledecker R. Adolescent psychiatric inpatients: characteristics, outcome, and comparison between discharged patients from a specialized adolescent unit and nonspecialized units. J Youth Adolesc. 1992;21(4):391–407. PubMedCrossRef
Gabel S, Shindledecker R. Parental substance abuse and suspected child abuse/maltreatment predict outcome in children’s inpatient treatment. J Am Acad Child Adolesc Psychiatry. 1990;29(6):919–924. PubMedCrossRef
Vernal DL, Boldsen SK, Lauritsen MB, et al. Long-term outcome of early-onset compared to adult-onset schizophrenia: a nationwide Danish register study. Schizophr Res. 2020;220:123–129. PubMedCrossRef
Gowers SG, Harrington RC, Whitton A, et al. Brief scale for measuring the outcomes of emotional and behavioural disorders in children. Health of the Nation Outcome Scales for children and Adolescents (HoNOSCA). Br J Psychiatry. 1999;174(5):413–416. PubMedCrossRef
Shaffer D, Gould MS, Brasic J, et al. A children’s global assessment scale (CGAS). Arch Gen Psychiatry. 1983;40(11):1228–1231. PubMedCrossRef
Kromeyer-Hauschild K, Wabitsch M, Kunze D, et al. Perzentile für den Body-mass-Index für das Kindes- und Jugendalter unter Heranziehung verschiedener deutscher Stichproben. Monatsschr Kinderheilkd. 2001;149(8):807–818. [See Supplementary Appendix 1 for citation]CrossRef
Dilling H, ed. Internationale Klassifikation psychischer Störungen. ICD-10 Kapitel V (F) Diagnostische Kriterien für Forschung und Praxis. 3., korr. Aufl. 2014.
Burgess P, Pirkis J, Coombs T. Modelling candidate effectiveness indicators for mental health services. Aust N Z J Psychiatry. 2009;43(6):531–538. PubMedCrossRef
Greenham SL, Bisnaire L. An outcome evaluation of an inpatient crisis stabilization and assessment program for youth. Residential Treat Child Youth. 2008;25(2):123–143. CrossRef
Musil R, Seemüller F, Meyer S, et al. Subtypes of depression and their overlap in a naturalistic inpatient sample of major depressive disorder. Int J Methods Psychiatr Res. 2018;27(1):e1569. PubMedCrossRef
de Boer SBB, Boon AE, Verheij F, et al. Treatment outcome of adolescent inpatients with early-onset and adolescent-onset disruptive behavior. J Clin Psychol. 2017;73(4):466–478. PubMedCrossRef
Malone RP, Luebbert JF, Delaney MA, et al. Nonpharmacological response in hospitalized children with conduct disorder. J Am Acad Child Adolesc Psychiatry. 1997;36(2):242–247. PubMedCrossRef
Güveni̇r T, Taş FV, Özbek A. Child and adolescent mental health inpatient services in Turkey: is there a need and are they effective?: Türkiye’de Çocuk ve Ergen Ruh Sağlığı Yataklı Servisleri, Gerekli mi ve İşe Yarıyor mu? Archives of Neuropsychiatry / Noropsikiatri Arsivi. 2009;46(4):143–148.
Duddu V, Rhouma A, Qureshi M, et al. An acute in-patient psychiatric service for 16- to 17-year-old adolescents in the UK: a descriptive evaluation. BJPsych Bull. 2016;40(5):261–265. PubMedCrossRef
Bredel S, Brunner R, Haffner J, et al. Behandlungserfolg, Behandlungserleben und Behandlungszufriedenheit aus der Sicht von Patienten, Eltern und Therapeuten - Ergebnisse einer evaluativen Studie aus der stationären Kinder- und Jugendpsychiatrie. Success of treatment, experience of treatment, and satisfaction with treatment from the perspective of patients, parents, and therapists – Results of an evaluative study on inpatient treatment in child and adolescent psychiatry. Published online 2004. Accessed February 13, 2022. https://psydok.psycharchives.de/jspui/handle/20.500.11780/2745
Ghuman HS, Jayaprakash S, Saidel DH, et al. Variables predictive of the need for placement in a long-term structured setting for adolescents. Psychiatr Hosp. 1989;20(1):31–34. PubMed
Lee Y, Martin P, Hembry P, et al. Outcomes of inpatient psychiatric treatment for adolescents: a multiple perspectives evaluation. Clin Child Psychol Psychiatry. 2018;23(3):409–424. PubMedCrossRef
Hayes C, Simmons M, Simons C, et al. Evaluating effectiveness in adolescent mental health inpatient units: a systematic review. Int J Ment Health Nurs. 2018;27(2):498–513. PubMedCrossRef
Greenham SL, Persi J. The state of inpatient psychiatry for youth in Ontario: results of the ONCAIPS Benchmarking Survey. J Can Acad Child Adolesc Psychiatry. 2014;23(1):31–37. PubMed
Gavidia-Payne S, Littlefield L, Hallgren M, et al. Outcome evaluation of a statewide child inpatient mental health unit. Aust N Z J Psychiatry. 2003;37(2):204–211. PubMedCrossRef
Strik Lievers L, Curt F, Wallier J, et al. Predictive factors of length of inpatient treatment in anorexia nervosa. Eur Child Adolesc Psychiatry. 2009;18(2):75–84. PubMedCrossRef
O’Herlihy A, Worrall MA, Banerjee DS, et al. National In-Patient Child and Adolescent Psychiatry Study (NICAPS). Royal College of Psychiatrists; 2001.
DelBello MP, Hanseman D, Adler CM, et al. Twelve-month outcome of adolescents with bipolar disorder following first hospitalization for a manic or mixed episode. Am J Psychiatry. 2007;164(4):582–590. PubMedCrossRef
Fineberg BL, Kettlewell PW, Sowards SK. An evaluation of adolescent inpatient services. Am J Orthopsychiatry. 1982;52(2):337–345. PubMedCrossRef
Cropp C, Streeck-Fischer A, Jaeger U, et al. Der Zusammenhang zwischen Behandlungserleben und Behandlungserfolg bei der stationären Psychotherapie mit Kindern und Jugendlichen. Z Kinder Jugendpsychiatr Psychother. 2008;36(3):205–213. PubMedCrossRef
Green J, Kroll L, Imrie D, et al. Health gain and outcome predictors during inpatient and related day treatment in child and adolescent psychiatry. J Am Acad Child Adolesc Psychiatry. 2001;40(3):325–332. PubMedCrossRef
Luukkonen AH, Riala K, Hakko H, et al; Study-70 Workgroup. Bullying behaviour and substance abuse among underage psychiatric inpatient adolescents. Eur Psychiatry. 2010;25(7):382–389. PubMedCrossRef
Sellers CM, Díaz-Valdés A, Oliver MM, et al. The relationship between alcohol and cannabis use with nonsuicidal self-injury among adolescent inpatients: examining the 90 days prior to psychiatric hospitalization. Addict Behav. 2021;114:106759. PubMedCrossRef
Rømer Thomsen K, Callesen MB, Hesse M, et al. Impulsivity traits and addiction-related behaviors in youth. J Behav Addict. 2018;7(2):317–330. PubMedCrossRef
Zambrowicz R, Stewart JG, Cosby E, et al. Inpatient psychiatric care outcomes for adolescents: a test of clinical and psychosocial moderators. Evid Based Pract Child Adolesc Ment Health. 2019;4(4):357–368. PubMedCrossRef