Symptom, family, and service predictors of children's psychiatric rehospitalization within one year of discharge

Abstract

Objective: To investigate predictors of readmission to inpatient psychiatric treatment for children aged 5 to 12 discharged from acute-care hospitalization.

Method: One hundred nine children were followed for 1 year after discharge from inpatient care. Time to rehospitalization was the outcome of interest. Predictors of readmission, examined via the Cox proportional hazards model, were symptom and family factors assessed at admission, aspects of psychiatric treatment, and demographic variables.

Results: The Kaplan-Meier rehospitalization risk within 1 year of discharge, taking into account known readmissions and censored observations, was 0.37. Most readmissions (81%) occurred within 90 days of discharge. Four variables contributed simultaneously to predicting readmission risk. More severe conduct problems, harsh parental discipline, and disengaged parent-child relations conferred a higher risk for rehospitalization; these risks were attenuated when parents disclosed higher stress in their parenting roles.

Conclusions: Findings showed that psychiatric rehospitalization of children is common, most likely in the trimester after discharge, and highly related to both child symptoms and family factors measurable at admission. Results suggest that efforts to improve postdischarge outcomes of children should target the initial period following inpatient care, address vigorously the complex treatment needs of those with severe conduct problems, and aim to improve parent-child relations.

Fig. 1

Joint effects of parenting stress with conduct problems (A), with parental involvement (B), and with corporal punishment (C) on rehospitalization risk. The high parenting stress subgroup represented the highest tertile (Table 1). The lowest conduct problem tertile represented the low conduct problem subgroup. The highest parental involvement tertile represented the high involvement subgroup. All survival curves indicate the greatest hospitalization risk (viz., the lowest line in each graph) for the group which combines low parenting stress with the other risk factor (high conduct problems, low parental involvement, and high corporal punishment).