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Dil L, Mérelle S, Lommerse N, Peen J, So P, Van R, Zoeteman J, Dekker J. Gender-specific pathways in mental health crisis in adolescents, from consultation to (in)voluntary admission: a retrospective study. BMC Psychiatry 2024; 24:235. [PMID: 38549065 PMCID: PMC10976791 DOI: 10.1186/s12888-024-05680-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 03/13/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND A strong increase in mental health emergency consultations and admissions in youths has been reported in recent years. Although empirical evidence is lacking, gender differences in risk of admission may have contributed to this increase. A clearer understanding of the relationship, if any, between gender and various aspects of (in)voluntary care would help in more evidence-based service planning. METHODS We analysed registry data for 2008-2017 on 3770 outpatient emergencies involving young people aged 12 to 18 years from one urban area in the Netherlands, served by outreaching psychiatric emergency services. These adolescents were seen in multiple locations and received a psychosocial assessment including a questionnaire on the severity of their problems and living conditions. Our aims were to (a) investigate the different locations, previous use of mental health service, DSM classifications, severity items, living conditions and family characteristics involved and (b) identify which of these characteristics in particular contribute to an increased risk of admission. RESULTS In 3770 consultations (concerning 2670 individuals), more girls (58%) were seen than boys. Boys and girls presented mainly with relationship problems, followed by disruptive disorders and internalizing disorders. Diagnostic differences diminished in hospitalisation. More specifically, disruptive disorders were evenly distributed. Suicide risk was rated significantly higher in girls, danger to others significantly higher in boys. More girls than boys had recently been in mental health care prior to admission. Although boys and girls overall did not differ in the severity of their problems, female gender predicted admission more strongly. In both boys and girls severity of problems and lack of involvement of the family significantly predicted admission. Older age and danger to others significantly predicted admission among boys, whereas psychosis, suicidality and poor motivation for treatment predicted admission among girls. CONCLUSION There are different pathways for youth admission, which can partly be explained by different psychiatric classifications as well as gender-specific differences with regard to age, suicide risk, danger to others and the influence of motivation for treatment. Finally, for both genders, family desire for hospitalisation is also an important predictor.
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Affiliation(s)
- Linda Dil
- NPI, Arkin, Buikslotermeerplein 420, 1025 WP, Amsterdam, The Netherlands.
- Department of Clinical Psychology, VU Faculties, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands.
| | - Saskia Mérelle
- Research Department 113 Zelfmoordpreventie, Paasheuvelweg 25, 1105 BP, Amsterdam, The Netherlands
| | - Nick Lommerse
- Research Department Arkin, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands
| | - Jaap Peen
- Research Department Arkin, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands
| | - Pety So
- Youz, Center for Youth Mental Healthcare, Lupinestraat 1, 2906CV, Capelle a/d IJssel, The Netherlands
| | - Rien Van
- NPI, Arkin, Domselaerstraat 126, 1093 MB, Amsterdam, The Netherlands
| | - Jeroen Zoeteman
- Psychiatric Emergency Service, Arkin, 1 e Constantijn Huijgensstraat 38, 1054 BR, Amsterdam, The Netherlands
| | - Jack Dekker
- Department of Clinical Psychology, VU Faculties, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands
- Research Department Arkin, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands
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Thoonen IMJ, Rietjens SJ, van Velzen AG, de Lange DW, Koppen A. Risk factors for deliberate self-poisoning among children and adolescents in The Netherlands. Clin Toxicol (Phila) 2024; 62:39-45. [PMID: 38421361 DOI: 10.1080/15563650.2024.2310153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/19/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION In the past decade, the number of deliberate self-poisonings involving young people has increased strongly worldwide. This study aimed to gain insight into risk factors associated with deliberate self-poisonings among children and adolescents reported to the Dutch Poisons Information Center. METHODS A study was performed between 1 February 2022 and 31 January 2023 involving those aged 8-17 years of age with deliberate self-poisoning. Data were collected on patient characteristics (age, gender, body mass index and living situation) and exposure characteristics (type of toxicant, way of acquiring toxicant and day of exposure). RESULTS The Dutch Poisons Information Center was consulted about 1,424 deliberate self-poisonings among children and adolescents (10-17 years old). A high percentage of patients were female (85 percent), had a body mass index classified as overweight/obese (27 percent) and lived in a mental healthcare facility (13 percent). Patients mainly exposed themselves to pharmaceuticals, especially over-the-counter medications such as paracetamol (46 percent) and ibuprofen (15 percent). Young people living with parents/caregivers had higher odds of ingesting prescription pharmaceuticals or over-the-counter medication, while those living in a mental healthcare facility were more likely to ingest household products, personal care products or foreign bodies (predominantly batteries). DISCUSSION This study sheds light on the pervasive issue of deliberate self-poisoning among children and adolescents, advocating for poisoning prevention strategies and promoting mental health of youth. Limitations include reliance on self-reported data from patients and the absence of clinical outcome data. CONCLUSIONS Female gender, a high body mass index and living in a mental healthcare facility are associated with in increased risk of deliberate self-poisonings in children and adolescents (10-17 years old). Prevention of deliberate self-poisonings among youth could focus on restricting access to medication and other potentially hazardous non-pharmaceuticals, such as household products and batteries, as well as limiting the sales of over-the-counter medication, especially paracetamol, to this young population.
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Affiliation(s)
- Ilze M J Thoonen
- Dutch Poisons Information Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Saskia J Rietjens
- Dutch Poisons Information Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Agnes G van Velzen
- Dutch Poisons Information Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dylan W de Lange
- Dutch Poisons Information Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arjen Koppen
- Dutch Poisons Information Center, University Medical Center Utrecht, Utrecht, The Netherlands
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Brown SA, Moeketsi TD, Musekiwa A, Moodley SV. Readmission of adolescent psychiatric patients to a specialised unit in Gauteng, South Africa. S Afr J Psychiatr 2023; 29:2018. [PMID: 38860147 PMCID: PMC11163387 DOI: 10.4102/sajpsychiatry.v29i0.2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 06/02/2023] [Indexed: 06/12/2024] Open
Abstract
Background Readmission rates to child and adolescent psychiatric units among the youth have been reported to be increasing. Aim The study aimed to determine the readmission rate and factors associated with readmission of adolescent psychiatric patients at a child and adolescent psychiatric unit. Setting A specialised psychiatric hospital in Gauteng province, South Africa. Methods This retrospective cohort study utilised data from the records of patients admitted to the adolescent inpatient unit over a period of five years. The cumulative incidence and incidence rate of readmission within one year of discharge from the index admission was calculated using survival analysis methods. Characteristics significantly associated with readmission were determined by applying the multivariable Cox proportional hazards regression model. Results Among the 189 patients included in the analysis, the cumulative incidence of readmission within one year of discharge was 17.5%. The incidence rate was 5.31 readmissions per 10 000 person-days. The final multivariable model showed that a diagnosis of schizophrenia (p = 0.015), a diagnosis of attention deficit hyperactivity disorder (p = 0.039), and coming from a child and youth care centre or temporary safe care (p = 0.018) increased the risk of readmission while having a medical condition (p = 0.008) reduced the risk. Conclusion Psychiatric diagnosis and residential care could be potential risk markers for readmission. Improving the collaboration between health and social services in residential care would be beneficial. Contribution Identifying factors that predispose adolescent psychiatric patients to readmission can inform and improve management and risk assessments.
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Affiliation(s)
- Sarah-Anne Brown
- Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Tshepiso D. Moeketsi
- Department of Psychiatry, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Alfred Musekiwa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Saiendhra V. Moodley
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Dani A, Balachandran S, McGill K, Whyte I, Carter G. Prevalence of Depression and Predictors of Discharge to a Psychiatric Hospital in Young People with Hospital-Treated Deliberate Self-Poisoning at an Australian Sentinel Unit. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15753. [PMID: 36497828 PMCID: PMC9737120 DOI: 10.3390/ijerph192315753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Hospital treated deliberate self-poisoning is common in young people. Internationally, estimates of rates of depression in this population are very wide (14.6% to 88%). The aims of this study were to determine the prevalence of depression and the independent predictors of referral for psychiatric hospitalisation in young people (aged 16 to 25 years) following an index episode of hospital treated deliberate self-poisoning. METHOD A retrospective cohort study design (n = 1410), with data drawn from a population-based clinical case register. Unadjusted and adjusted estimates of predictors of referral for psychiatric admission (after-care) used logistic regression models. RESULTS Prevalence of any depression diagnosis was 35.5% (n = 500); and 25.4% (n = 358) were referred for a psychiatric admission. The adjusted estimates for predictors of psychiatric inpatient referral were: high suicidal level (OR 118.21: CI 95% 63.23-220.99), low/moderate suicidal level (14.27: 9.38-21.72), any depression (2.88: 1.97-4.22), any psychosis (4.06; 1.15-14.36), older age (1.12: 1.04-1.21), and number of support people (0.88: 0.78-0.98). CONCLUSION Depression was diagnosed in more than a third and was an independent predictor of psychiatric inpatient referral, so service providers need to account for this level of need in the provision of assessment and after-care services. Evidence-based guidelines for psychiatric inpatient after-care for deliberate self-poisoning and/or depression in young people are limited. Our explanatory model included suicidal level, depression, psychosis, older age, and available support persons, suggesting that the treating clinicians were making these discharge decisions for admission in keeping with those limited guidelines, although the balance of benefits and harms of psychiatric hospitalisation are not established. Future research examining patient experiences, effectiveness of psychiatric hospitalisation, and alternatives to hospitalisation is warranted.
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Affiliation(s)
- Anitha Dani
- Child and Adolescent Mental Health Service, Hunter New England Mental Health Service, Newcastle, NSW 2302, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Srilaxmi Balachandran
- Child and Adolescent Mental Health Service, Hunter New England Mental Health Service, Newcastle, NSW 2302, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Katie McGill
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
- Research Evaluation and Dissemination (MH-READ), Hunter New England Mental Health Service, Newcastle, NSW 2298, Australia
| | - Ian Whyte
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
- Calvary Mater Newcastle Hospital, Waratah, NSW 2298, Australia
| | - Greg Carter
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
- Calvary Mater Newcastle Hospital, Waratah, NSW 2298, Australia
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Cybulski L, Ashcroft DM, Carr MJ, Garg S, Chew-Graham CA, Kapur N, Webb RT. Risk factors for nonfatal self-harm and suicide among adolescents: two nested case-control studies conducted in the UK Clinical Practice Research Datalink. J Child Psychol Psychiatry 2022; 63:1078-1088. [PMID: 34862981 DOI: 10.1111/jcpp.13552] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The characteristics of adolescents who die by suicide have hitherto been examined in uncontrolled study designs, thereby precluding examination of risk factors. The degree to which antecedents of nonfatal self-harm and suicide at young age differ remains unknown. METHOD We delineated two nested case-control studies of patients aged 10-19 years using the Clinical Practice Research Datalink with interlinked hospital and national mortality records. Cases were adolescents who between 1st January 2003 and 31st December 2018 had died from suicide (N = 324) - study 1; experienced their first self-harm episode (N = 56,008) - study 2. In both studies, cases were matched on sex, age and practice-level deprivation quintile to 25 controls. By fitting conditional logistic regression, we examined how risks varied according to psychiatric diagnoses, prescribed psychotropic medication, patterns of clinical contact and area-level deprivation. RESULTS Suicides occurred more often among boys (66%), but self-harm was more common in girls (68%). Most individuals who self-harmed or died from suicide presented to their GP at least once in the preceding year (85% and 75% respectively). Only a third of cases had one of the examined diagnostic categories recorded. Depression was most strongly associated with elevated risks for both outcomes (self-harm: OR 7.9; 95% CI 7.8-8.2; suicide: OR 7.4; 95% CI 5.5-9.9). Except for autism spectrum disorder, all other diagnostic categories were linked with similar risk elevations for self-harm as for suicide. Whilst self-harm risk rose incrementally with increasing levels of area-level deprivation, suicide risks did not. CONCLUSIONS We observed few marked differences in risk factor profiles for nonfatal self-harm versus suicide. As most adolescents who had harmed themselves or died by suicide were known to services in the preceding year, their underlying pathology may not be adequately identified and treated. Our findings highlight the need for a multiagency approach to treatment and prevention.
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Affiliation(s)
- Lukasz Cybulski
- Division of Psychology & Mental Health, Faculty of Biology, Medicine, and Health, School of Health Sciences, Centre for Mental Health & Safety, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Darren M Ashcroft
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Division of Pharmacy & Optometry, Faculty of Biology, Medicine and Health, School of Health Sciences, Centre for Pharmacoepidemiology and Drug Safety, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Matthew J Carr
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Division of Pharmacy & Optometry, Faculty of Biology, Medicine and Health, School of Health Sciences, Centre for Pharmacoepidemiology and Drug Safety, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Shruti Garg
- Division of Neuroscience & Experimental Psychology, Faculty of Biology, Medicine and Health, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre (MAHSC), Manchester, UK.,Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation, Manchester, UK
| | - Carolyn A Chew-Graham
- Faculty of Medicine and Health Sciences, School of Primary, Community and Social Care, Keele University, Staffs, UK
| | - Nav Kapur
- Division of Psychology & Mental Health, Faculty of Biology, Medicine, and Health, School of Health Sciences, Centre for Mental Health & Safety, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Roger T Webb
- Division of Psychology & Mental Health, Faculty of Biology, Medicine, and Health, School of Health Sciences, Centre for Mental Health & Safety, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Tay EY, Tan GF, Yeo AWC, Tham EH. Intentional Poisoning in Pediatric Patients: Examining the Risk Factors. Pediatr Emerg Care 2021; 37:e1510-e1514. [PMID: 32304525 DOI: 10.1097/pec.0000000000002101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Poisonings in children are common reasons for presentation to the emergency department and can potentially have serious complications. Our research aims to review risk factors leading to intentional self-poisoning. METHODS A retrospective medical record review of all intentional pediatric poisoning cases presenting to the Children's Emergency at National University Hospital, Singapore between January 2014 and December 2015 was performed. RESULTS Eighty-seven cases of intentional poisonings were identified, 31 (36.5%) of which were with suicidal intent. The majority of cases were female (85.1%) and adolescents older than 16 years (93.1%). A known psychiatric history was present in 57.5% and 62 (71.3%) had a history of deliberate self-harm. Being diagnosed with a new psychiatric illness during that presentation was associated with a history of self-harm (adjusted odds ratio [Adj OR], 6.74; 95% confidence interval [CI]; 1.04-43.62; P = 0.045). Twenty-seven (31.0%) patients had a history of intentional poisoning, and 15 (17.2%) went on to have subsequent presentations for poisoning. Recurrent poisoning attempts were strongly associated with a known psychiatric history (Adj OR, 5.91; 95% CI, 1.62-21.58; P = 0.007) and a history of deliberate self-harm (Adj OR, 7.49; 95% CI, 1.38-40.66; P = 0.02). Deliberate overdosing on personal long-term medication was seen in 15 (35.7%) of 42, of which 12 (80%) of 15 were psychiatric medications. CONCLUSIONS Known psychiatric history or a history of deliberate self-harm are risk factors for intentional poisoning. Appropriate risk stratification and preemptive interventions involving closer surveillance or cognitive behavioral programs are possible measures to prevent intentional self-poisoning, especially in these at-risk groups.
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Affiliation(s)
- Elaine Yiling Tay
- From the Department of Family Medicine, NUHS Family Medicine Residency, National University Health System
| | - Grace Fangmin Tan
- Department of Internal Medicine, Singhealth Internal Medicine Residency
| | - Andrea Wei Ching Yeo
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore
| | - Elizabeth Huiwen Tham
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore
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Fadum EA, Carlsen EØ, Ramberg M, Strand LA, Håberg SE, Borud E, Martinussen M. Social and life skills in adolescents who have self-harmed: analysis of survey responses from a national sample of adolescents in Norway. BMJ Open 2021; 11:e054707. [PMID: 34772755 PMCID: PMC8593742 DOI: 10.1136/bmjopen-2021-054707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Social and life skills (SLS) may be important in the prevention and treatment of self-harm, but few studies have described this relationship. We examined three components of SLS in adolescents who reported self-harm that was, according to themselves, diagnosed by a clinician. DESIGN Cross-sectional. SETTING National screening prior to military service. PARTICIPANTS 176 284 residents of Norway born in 1999-2001 received a declaration of health. We included 171 486 individuals (84 153 (49%) women and 87 333 (51%) men) who were 17 (n=1 67 855) or 18 years of age (n=3631) when they completed the declaration. OUTCOME MEASURE The main outcome was clinically diagnosed self-harm, defined as self-harm that the adolescents themselves stated had been diagnosed by a clinician. Components of SLS were social interactions; coping strategies; and emotional regulation/aggression. The association between SLS and self-reported clinically diagnosed self-harm was assessed in hierarchical multiple regression models controlling for sex; school absence; and feelings of emotional pain. RESULTS Three percent (n=5507) of the adolescents reported clinically diagnosed self-harm. The three components of SLS together added little to the prediction of clinically diagnosed self-harm (∆R2=0.02). After controlling for school absence and emotional pain, emotional regulation/aggression was the only SLS-component that was independently associated with clinically diagnosed self-harm (OR 1.33, 95% CI 1.31 to 1.36). The young men who said they had been clinically diagnosed for self-harm scored slightly worse on social interactions (Hedge's g (g) = -0.13, p<0.001) and emotional regulation/aggression (g = -0.18, p<0.001) than the young women in this group. CONCLUSION Young women and young men who reported clinically diagnosed self-harm had more problems with emotional regulation/aggression than other adolescents, but did not have worse social interactions or coping strategies.
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Affiliation(s)
- Elin Anita Fadum
- Institute of Military Epidemiology, Norwegian Armed Forces Joint Medical Services, Ullensaker, Akershus, Norway
| | - Ellen Øen Carlsen
- Institute of Military Epidemiology, Norwegian Armed Forces Joint Medical Services, Ullensaker, Akershus, Norway
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Maria Ramberg
- Department of Child and Adolescent Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Leif Aage Strand
- Institute of Military Epidemiology, Norwegian Armed Forces Joint Medical Services, Ullensaker, Akershus, Norway
| | - Siri Eldevik Håberg
- Institute of Military Epidemiology, Norwegian Armed Forces Joint Medical Services, Ullensaker, Akershus, Norway
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Oslo, Norway
| | - Einar Borud
- Institute of Military Epidemiology, Norwegian Armed Forces Joint Medical Services, Ullensaker, Akershus, Norway
- Institute of Community Medicine, UiT The Arctic University of Norway Faculty of Health Sciences, Tromso, Troms, Norway
| | - Monica Martinussen
- Regional Centre for Child and Youth Mental Health & Child Welfare, UiT The Arctic University of Norway, Tromso, Norway
- Norwegian Command and Staff College, Norwegian Defence University College, Oslo, Norway
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D’Aiello B, Menghini D, Averna R, Labonia M, Vicari S. Risk Factors for Revolving Door in Children and Adolescents with Psychiatric Disorders. J Clin Med 2021; 10:jcm10215004. [PMID: 34768521 PMCID: PMC8585028 DOI: 10.3390/jcm10215004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/20/2021] [Accepted: 10/23/2021] [Indexed: 11/16/2022] Open
Abstract
Revolving Door (RD) is a frequent phenomenon afflicting children and adolescents with psychiatric diagnoses. Nevertheless, risk factors for RD are still a matter of debate. To better understand RD phenomenon, we conducted a retrospective study on 224 children and adolescents (165 females and 59 males, aged 6-16 years) with a psychiatric hospitalization, taking the multiple risk factors together. At this aim, 108 patients with multiple hospitalizations and 116 patients with only one hospitalization were compared on demographic characteristics, clinical conditions, psychiatric ward stay, and post-discharge management factors. More than half of psychiatric patients were readmitted within three months of discharge. RD patients presented greater severity of illness, needed longer stays, and were more frequently placed in residential facilities than non-RD patients. Non-suicidal self-injurious and adoption were the main predictors of RD. Clinical instruments that detected behavioural and emotional symptoms, suicidal ideation severity, and level of impairment of the person's functioning were useful to identify patients at high risk for RD. In conclusion, our findings pointed out that several risk factors have to be considered to better understand and, in the future, prevent RD phenomenon.
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Affiliation(s)
- Barbara D’Aiello
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (B.D.); (D.M.); (R.A.); (M.L.)
- Department of Human Science, LUMSA University, 00193 Rome, Italy
| | - Deny Menghini
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (B.D.); (D.M.); (R.A.); (M.L.)
| | - Roberto Averna
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (B.D.); (D.M.); (R.A.); (M.L.)
| | - Milena Labonia
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (B.D.); (D.M.); (R.A.); (M.L.)
| | - Stefano Vicari
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (B.D.); (D.M.); (R.A.); (M.L.)
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-06-68592453
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Edgcomb JB, Sorter M, Lorberg B, Zima BT. Psychiatric Readmission of Children and Adolescents: A Systematic Review and Meta-Analysis. Psychiatr Serv 2020; 71:269-279. [PMID: 31822241 DOI: 10.1176/appi.ps.201900234] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate predictors of psychiatric hospital readmission of children and adolescents, a systematic review and meta-analysis was conducted. METHODS Following PRISMA statement guidelines, a systematic literature search of articles published between 1997 and 2018 was conducted in PubMed/MEDLINE, Google Scholar, and PsycINFO for original peer-reviewed articles investigating predictors of psychiatric hospital readmission among youths (<18 years old). Effect sizes were extracted and combined by using random-effects meta-analysis. Covariates were investigated with meta-regression and subgroup analyses. RESULTS Thirty-three studies met inclusion criteria, containing information on 83,361 children and adolescents, of which raw counts of readmitted vs. non-readmitted youths were available for 76,219. Of these youths, 13.2% (N=10,076) were readmitted. The mean±SD study follow-up was 15.9±15.0 months, and time to readmission was 13.1±12.8 months. Readmission was associated with, but not limited to, suicidal ideation at index hospitalization (pooled odds ratio [ORpooled]=2.35, 95% confidence interval [CI]=1.64-3.37), psychotic disorders (ORpooled=1.87, 95% CI=1.53-2.28), prior hospitalization (ORpooled=2.51, 95% CI=1.76-3.57), and discharge to residential treatment (ORpooled=1.84, 95% CI=1.07-3.16). There was evidence of moderate study bias. Prior investigations were methodologically and substantively heterogeneous, particularly for measurement of family-level factors. CONCLUSIONS Interventions to reduce child psychiatric readmissions should place priority on youths with indicators of high clinical severity, particularly with a history of suicidality, psychiatric comorbidity, prior hospitalization, and discharge to residential treatment. Standardization of methods to determine prevalence rates of readmissions and their predictors is needed to mitigate potential biases and inform a national strategy to reduce repeated child psychiatric hospital readmissions.
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Affiliation(s)
- Juliet Beni Edgcomb
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Edgcomb, Zima); Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati (Sorter); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Lorberg)
| | - Michael Sorter
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Edgcomb, Zima); Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati (Sorter); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Lorberg)
| | - Boris Lorberg
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Edgcomb, Zima); Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati (Sorter); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Lorberg)
| | - Bonnie T Zima
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Edgcomb, Zima); Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati (Sorter); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Lorberg)
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10
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Zhou H, Roberts PA, Dhaliwal SS, Della PR. Risk factors associated with paediatric unplanned hospital readmissions: a systematic review. BMJ Open 2019; 9:e020554. [PMID: 30696664 PMCID: PMC6352831 DOI: 10.1136/bmjopen-2017-020554] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 09/21/2018] [Accepted: 10/23/2018] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To synthesise evidence on risk factors associated with paediatric unplanned hospital readmissions (UHRs). DESIGN Systematic review. DATA SOURCE CINAHL, EMBASE (Ovid) and MEDLINE from 2000 to 2017. ELIGIBILITY CRITERIA Studies published in English with full-text access and focused on paediatric All-cause, Surgical procedure and General medical condition related UHRs were included. DATA EXTRACTION AND SYNTHESIS Characteristics of the included studies, examined variables and the statistically significant risk factors were extracted. Two reviewers independently assessed study quality based on six domains of potential bias. Pooling of extracted risk factors was not permitted due to heterogeneity of the included studies. Data were synthesised using content analysis and presented in narrative form. RESULTS Thirty-six significant risk factors were extracted from the 44 included studies and presented under three health condition groupings. For All-cause UHRs, ethnicity, comorbidity and type of health insurance were the most frequently cited factors. For Surgical procedure related UHRs, specific surgical procedures, comorbidity, length of stay (LOS), age, the American Society of Anaesthesiologists class, postoperative complications, duration of procedure, type of health insurance and illness severity were cited more frequently. The four most cited risk factors associated with General medical condition related UHRs were comorbidity, age, health service usage prior to the index admission and LOS. CONCLUSIONS This systematic review acknowledges the complexity of readmission risk prediction in paediatric populations. This review identified four risk factors across all three health condition groupings, namely comorbidity; public health insurance; longer LOS and patients<12 months or between 13-18 years. The identification of risk factors, however, depended on the variables examined by each of the included studies. Consideration should be taken into account when generalising reported risk factors to other institutions. This review highlights the need to develop a standardised set of measures to capture key hospital discharge variables that predict unplanned readmission among paediatric patients.
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Affiliation(s)
- Huaqiong Zhou
- General Surgical Ward, Princess Margret Hospital for Children, Perth, Western Australia, Australia
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Pam A Roberts
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | | | - Phillip R Della
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
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11
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Doupnik S, Rodean J, Zima BT, Coker TR, Worsley D, Rehm KP, Gay JC, Hall M, Marcus S. Readmissions after Pediatric Hospitalization for Suicide Ideation and Suicide Attempt. J Hosp Med 2018; 13:743-751. [PMID: 30484776 PMCID: PMC7253152 DOI: 10.12788/jhm.3070] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 06/07/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To inform resource allocation toward a continuum of care for youth at risk of suicide, we examined unplanned 30-day readmissions after pediatric hospitalization for either suicide ideation (SI) or suicide attempt (SA). METHODS We conducted a retrospective cohort study of a nationally representative sample of 133,516 hospitalizations for SI or SA among 6- to 17-year-olds to determine prevalence, risk factors, and characteristics of 30-day readmissions using the 2013 and 2014 Nationwide Readmissions Dataset (NRD). Risk factors for readmission were modeled using logistic regression. RESULTS We identified 95,354 hospitalizations for SI and 38,162 hospitalizations for SA. Readmission rates within 30 days were 8.5% for SI and SA hospitalizations. Among 30-day readmissions, more than one-third (34.1%) occurred within 7 days. Among patients with any 30-day readmission, 11% had more than one readmission within 30 days. The strongest risk factors for readmission were SI or SA hospitalization in the 30 days preceding the index SI/SA hospitalization (adjusted odds ratio [AOR]: 3.14, 95% CI: 2.73-3.61) and hospitalization for other indications in the previous 30 days (AOR: 3.18, 95% CI: 2.67-3.78). Among readmissions, 94.5% were for a psychiatric condition and 63.4% had a diagnosis of SI or SA. CONCLUSIONS Quality improvement interventions to reduce unplanned 30-day readmissions among children hospitalized for SI or SA should focus on children with a recent prior hospitalization and should be targeted to the first week following hospital discharge. FUNDING Dr. Zima received funding from the Behavioral Health Centers of Excellence for California (SB852).
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Affiliation(s)
- Stephanie Doupnik
- Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, and PolicyLab, The Children's Hospital of Philadelphia, Phildelphia, Pennsylvania, USA.
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jonathan Rodean
- Children's Hospital Association, Washington, DC, and Overland Park, Kansas, USA
| | - Bonnie T Zima
- UCLA Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California, USA
| | - Tumaini R Coker
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington; Monroe Carell Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
- Monroe Carell Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Diana Worsley
- Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, and PolicyLab, The Children's Hospital of Philadelphia, Phildelphia, Pennsylvania, USA
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kris P Rehm
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - James C Gay
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Matt Hall
- Children's Hospital Association, Washington, DC, and Overland Park, Kansas, USA
| | - Steve Marcus
- Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, and School of Social Policy and Practice and Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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12
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Qin P, Sun S, Bøe AS, Stanley B, Mehlum L. Injuries prior and subsequent to index poisoning with medication among adolescents: a national study based on Norwegian patient registry. BMC Psychiatry 2018; 18:200. [PMID: 29914430 PMCID: PMC6006963 DOI: 10.1186/s12888-018-1778-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 06/07/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescents treated for self-poisoning with medication have a high prevalence of mental health problems and constitute a high-risk population for self-harm repetition. However, little is known about whether this population is also prone to injuries of other forms. METHODS Data were extracted from the Norwegian Patient Registry to include all incidents of treated injuries in adolescents aged 10-19 years who were treated for self-poisoning with medication during 2008-2011. This longitudinal approach allowed for the inclusion of injuries of various forms both before and after the index poisoning with medication. Gender differences and associations of injuries with recorded deliberate self-harm or psychiatric comorbidity at index poisoning were analysed. Forms of injury and psychiatric illnesses were coded according to the ICD-10 system. RESULTS 1497 adolescents treated for self-poisoning with medication were identified from the source database, including 1144 (76.4%) girls and 353 (23.6%) boys. For these 1497 adolescents a total of 2545 injury incidents were recorded in addition to the index poisoning incidents, consisting of 778 injury incidents taking place before the index poisoning and 1767 incidents taking place subsequently. Altogether 830 subjects (55.4%) had an injury treated either before or after the index poisoning. Injuries to the hand and wrist as well as injuries to the head, neck and throat were predominant in males. Females were more likely to repeat poisoning with medication, particularly those with psychiatric disorders. CONCLUSION Adolescents treated for poisoning with medication represent a high-risk population prone to both prior and subsequent injuries of other forms, and should be assessed for suicidal intent and psychiatric illness.
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Affiliation(s)
- Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical medicine, University of Oslo, Sognsvannsveien 21, N-0372, Oslo, Norway.
| | - Shihua Sun
- 0000 0004 1761 1174grid.27255.37Department of Epidemiology, Shandong University School of Public Health and Shandong University Center for Suicide Prevention Research, Jinan, China
| | - Anne Seljenes Bøe
- 0000 0004 1936 8921grid.5510.1National Centre for Suicide Research and Prevention, Institute of Clinical medicine, University of Oslo, Sognsvannsveien 21, N-0372 Oslo, Norway
| | - Barbara Stanley
- 0000 0004 1936 8921grid.5510.1National Centre for Suicide Research and Prevention, Institute of Clinical medicine, University of Oslo, Sognsvannsveien 21, N-0372 Oslo, Norway ,0000000419368729grid.21729.3fDepartment of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY USA
| | - Lars Mehlum
- 0000 0004 1936 8921grid.5510.1National Centre for Suicide Research and Prevention, Institute of Clinical medicine, University of Oslo, Sognsvannsveien 21, N-0372 Oslo, Norway
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Abstract
Introduction: Anorexia nervosa (AN) is a severe psychiatric disorder that is difficult to treat and is associated with frequent relapses and high mortality rates. Psychiatric symptomatology (eg, depression, anxiety, obsessive-compulsive disorder/behaviors) are common comorbidities. This review provides current information about safety and efficacy of antidepressant therapy for management of AN in adults. Methods: A literature review of randomized controlled trials, open-label studies, and case reports with adults or adults/adolescents was conducted. PubMed and Medline were searched using anorexia management and treatment, antidepressants, selective serotonin reuptake inhibitors (SSRIs), fluoxetine, sertraline, citalopram, and mirtazapine in AN, relapse prevention in AN, and psychotropic medications in AN. Results: The role and utility of antidepressants in AN were published in double-blind, placebo-controlled studies; open-label trials; and a retrospective study. Antidepressants should not be used as sole therapy for AN although their use for confounding symptomatology makes discerning efficacy difficult as they are given together with other therapies. Neurobiological changes due to starvation and AN itself complicate results interpretation. For safety, tricyclic antidepressants and monoamine oxidase inhibitors are not recommended, and bupropion is contraindicated. Use of SSRIs during acute treatment lacks efficacy. Use of SSRIs—primarily fluoxetine and to some extent citalopram, sertraline, or mirtazapine—may aid in relapse prevention and improvement of psychiatric symptomatology in weight-restored anorexic patients. Discussion: Health care professionals should use clinical judgment regarding fluoxetine or possibly citalopram, sertraline or mirtazapine as adjunctive treatment to psychotherapy for relapse prevention, improvement of depressive and anxiety symptoms, and/or obsessive-compulsive behaviors unresolved with nutritional rehabilitation and psychotherapy.
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Affiliation(s)
- Marketa Marvanova
- Chair and Associate Professor, Department of Pharmacy Practice, School of Pharmacy, College of Health Professions, North Dakota State University, Fargo, North Dakota,
| | - Kirstin Gramith
- PGY-1 Resident, University of Minnesota, Postgraduate Pharmacy Residency Program, Minneapolis, Minnesota
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14
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Nesvåg R, Jönsson EG, Bakken IJ, Knudsen GP, Bjella TD, Reichborn-Kjennerud T, Melle I, Andreassen OA. The quality of severe mental disorder diagnoses in a national health registry as compared to research diagnoses based on structured interview. BMC Psychiatry 2017; 17:93. [PMID: 28292279 PMCID: PMC5351165 DOI: 10.1186/s12888-017-1256-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 03/08/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Utilization of diagnostic information from national patient registries rests on the quality of the registered diagnoses. We aimed to investigate the agreement and consistency of diagnoses of psychotic and bipolar disorders in the Norwegian Patient Registry (NPR) compared to structured interview-based diagnoses given as part of a clinical research project. METHODS Diagnostic data from NPR were obtained for the period 01.01.2008-31.12.2013 for all patients who had been included in the Thematically Organized Psychosis (TOP) study between 18.10.2002 and 01.09.2014 with a Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnosis of schizophrenia (n = 537), delusional disorder (n = 48), schizoaffective disorder (n = 118) or bipolar disorder (n = 408). Diagnostic agreement between the primary DSM-IV diagnosis in TOP and the International Classification of Diseases, 10th revision (ICD-10) diagnoses in NPR was evaluated using Cohen's unweighted nominal kappa (κ). Diagnostic consistency was calculated as the proportion of all registered severe mental disorder diagnoses in NPR that were equivalent to the primary diagnosis given in the TOP study. RESULTS The proportion of patients registered with the equivalent ICD-10 diagnosis as the primary DSM-IV diagnosis given in TOP was 84.2% for the schizophrenia group, 68.8% for the delusional disorder group, 76.3% for the schizoaffective disorder group, and 78.4% for the bipolar disorder group. Diagnostic agreement was good for schizophrenia (κ = 0.74) and bipolar disorder (κ = 0.72), fair for schizoaffective disorder (κ = 0.63), and poor for delusional disorder (κ = 0.39). Among patients with DSM-IV schizophrenia, 4.7% were diagnosed with ICD-10 bipolar disorder, and among patients with DSM-IV bipolar disorder, 2.5% were diagnosed with ICD-10 schizophrenia. Diagnostic consistency was 84.9% for schizophrenia, 59.1% for delusional disorder, 65.9% for schizoaffective disorder, and 91.0% for bipolar disorder. CONCLUSIONS When compared to research-based diagnoses, clinical diagnoses of schizophrenia and bipolar disorder in the NPR are accurate and consistent, with minimal diagnostic overlap between the two disorders.
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Affiliation(s)
- Ragnar Nesvåg
- Norwegian Institute of Public Health, P.O. Box 4044, Nydalen, N-0403, Oslo, Norway.
| | - Erik G. Jönsson
- 0000 0004 0389 8485grid.55325.34Norwegian Center for Mental Health Research (NORMENT), Oslo University Hospital & University of Oslo, P.O. Box 4956, Nydalen, N-0424 Oslo, Norway ,0000 0004 1937 0626grid.4714.6Department of Clinical Neuroscience, Centre of Psychiatric Research, Karolinska Institutet, Administration, Tomtebodavägen 18A, 5th floor, 171 77 Stockholm, Sweden
| | - Inger Johanne Bakken
- 0000 0001 1541 4204grid.418193.6Norwegian Institute of Public Health, P.O. Box 4044, Nydalen, N-0403 Oslo, Norway
| | - Gun Peggy Knudsen
- 0000 0001 1541 4204grid.418193.6Norwegian Institute of Public Health, P.O. Box 4044, Nydalen, N-0403 Oslo, Norway
| | - Thomas D. Bjella
- 0000 0004 0389 8485grid.55325.34Norwegian Center for Mental Health Research (NORMENT), Oslo University Hospital & University of Oslo, P.O. Box 4956, Nydalen, N-0424 Oslo, Norway
| | - Ted Reichborn-Kjennerud
- 0000 0001 1541 4204grid.418193.6Norwegian Institute of Public Health, P.O. Box 4044, Nydalen, N-0403 Oslo, Norway ,0000 0004 1936 8921grid.5510.1Institute of Clinical Medicine, University of Oslo, P.O. Box 1171, Blindern, N-0319 Oslo, Norway
| | - Ingrid Melle
- 0000 0004 0389 8485grid.55325.34Norwegian Center for Mental Health Research (NORMENT), Oslo University Hospital & University of Oslo, P.O. Box 4956, Nydalen, N-0424 Oslo, Norway ,0000 0004 1936 8921grid.5510.1Institute of Clinical Medicine, University of Oslo, P.O. Box 1171, Blindern, N-0319 Oslo, Norway
| | - Ole A. Andreassen
- 0000 0004 0389 8485grid.55325.34Norwegian Center for Mental Health Research (NORMENT), Oslo University Hospital & University of Oslo, P.O. Box 4956, Nydalen, N-0424 Oslo, Norway ,0000 0004 1936 8921grid.5510.1Institute of Clinical Medicine, University of Oslo, P.O. Box 1171, Blindern, N-0319 Oslo, Norway
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15
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Okumura Y, Nishi D. Risk of recurrent overdose associated with prescribing patterns of psychotropic medications after nonfatal overdose. Neuropsychiatr Dis Treat 2017; 13:653-665. [PMID: 28293108 PMCID: PMC5342613 DOI: 10.2147/ndt.s128278] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE We aimed to estimate risk of recurrent overdose associated with psychosocial assessment by psychiatrists during hospitalization for nonfatal overdose and prescribing patterns of psychotropic medications after discharge. METHODS A retrospective cohort study was conducted using a nationwide claims database in Japan. We classified patients aged 19-64 years hospitalized for nonfatal overdose between October 2012 and September 2013 into two cohorts: 1) those who had consulted a psychiatrist prior to overdose (n=6,790) and 2) those who had not (n=4,950). All patients were followed up from 90 days before overdose until 365 days after discharge. RESULTS Overall, 15.3% of patients with recent psychiatric treatment had a recurrent overdose within 365 days, compared with 6.0% of those without psychiatric treatment. Psychosocial assessment during hospital admission had no significant effect on subsequent overdose, irrespective of treatment by psychiatrists before overdose. There was a dose-response relationship for the association of benzodiazepine prescription after overdose with subsequent overdose in either cohort, even after accounting for average daily dosage of benzodiazepines before overdose and other confounders. In patients with recent psychiatric treatment, the cumulative proportion of recurrent overdose at 365 days was 27.7% for patients receiving excessive dosages of benzodiazepines, 22.0% for those receiving high dosages, 15.3% for those receiving normal dosages, and 7.6% for those receiving no benzodiazepines. In patients without psychiatric treatment, the cumulative proportion of recurrent overdose at 365 days was 24.3% for patients receiving excessive dosages of benzodiazepines, 18.0% for those receiving high dosages, 9.0% for those receiving normal dosages, and 4.1% for those receiving no benzodiazepines. CONCLUSION Lower dose of benzodiazepines after overdose is associated with lower risk of subsequent overdose.
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Affiliation(s)
- Yasuyuki Okumura
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo
| | - Daisuke Nishi
- Department of Mental Health Policy and Evaluation, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
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