McRae S, Edwards J, Speechley KN, Sukhera J, Zou G, Anderson KK. The prevalence and impact of adolescent hospitalization to adult psychiatric units.
Early Interv Psychiatry 2022;
16:752-759. [PMID:
34480512 DOI:
10.1111/eip.13219]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 07/29/2021] [Accepted: 08/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND
With increasing psychiatric hospitalizations among adolescents and constrained hospital resources, there are times when youth are hospitalized in adult inpatient psychiatry units. Evidence on the prevalence of this practice and associated impacts is lacking.
AIMS
We sought to explore the prevalence, determinants, and outcomes related to the hospitalization of adolescents aged 12-17 years on adult inpatient psychiatry units in Ontario.
METHODS
Using health administrative data, we constructed a cohort of adolescents with an inpatient psychiatric admission in Ontario (2007-2011). We classified adolescents as having an admission to an adult psychiatry unit or to other inpatient units. Multivariable regression models were used to estimate prevalence ratios (PR) for factors associated with adult admission, as well as risk ratios (RR) for the impact of adult admission on length of stay, discharge against medical advice, and 30-day readmission.
RESULTS
Over the study period, 22.6% of adolescents with a psychiatric hospitalization (n = 16 998) had an admission to an adult psychiatry unit. Older age (16 vs. 15 years: PR = 2.27, 95% CI = 2.07-2.48; 17 vs. 15 years: PR = 2.91, 95% CI = 2.66-3.18), rural residence (PR = 1.46, 95% CI = 1.38-1.55), psychotic (PR = 1.25, 95% CI = 1.15-1.36) or personality disorder (PR = 1.59, 95% CI = 1.41-1.80) diagnoses, and involuntary status (PR = 2.18, 95% CI = 2.05-2.31) were independently associated with adult admission. Adolescents admitted to adult units were more likely to be discharged against medical advice (RR = 1.77, 95% CI = 1.45-2.17).
CONCLUSIONS
Nearly one in four adolescent psychiatric admissions occurs on an adult psychiatric unit. These findings help to fill gaps in the prior literature, and highlight the need for further research to inform policy decisions and resource allocation for adolescent inpatient psychiatric care.
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