Correlates of psychiatric inpatient readmissions of children and adolescents with mental disorders

To identify correlates of psychiatric readmission of youth, we conducted a consecutive, retrospective 1-year cohort study (07.01.2014-06.30.2015) of youth (age = 5-17.9) admitted to psychiatric inpatient facility. Stepwise elimination, multivariable logistic regression analyses were conducted to identify independent correlates of 1-year and 30-day psychiatric readmissions. The Family/Caregiver Interview Tool (FCIT) was given to caregivers of 30-day readmitted youth and analyzed using generalized linear model to predict time to readmission. Altogether, 1231 youth experienced 1534 hospitalizations. The 1-year readmission rate was 32.4%; 30-day readmission rate was 10.2%. Significant independent correlates of readmissions were longer length of stay, higher antipsychotic treatment rates, living closer to the hospital, and comorbid obesity, all accounting for 12.2% of variance. FCIT revealed that caregiver's ability to fill prescription after discharge delayed readmission, while shorter time to follow-up appointment hastened it. Illness exacerbation was responsible for 73% of 30-day readmissions; system of care factors accounted for 13%. Compared to clinicians, caregivers significantly underestimated environment of care factors (including caregiver's mental health) as the primary cause for readmission. Readmissions are common and correlate with illness severity and systems of care factors. Family support services may help reduce readmissions. Hospital-specific qualitative investigation may help identify intervention targets to reduce readmissions.