Abstract
BackgroundSeveral countries have established or are planning acute psychiatric in-patient services that accept around-the-clock emergency admission of adolescents. Our aim was to investigate the characteristics and clinical outcomes of a cohort of patients at four Norwegian units.MethodsWe used a prospective pre-post observational design. Four units implemented a clinician-rated outcome measure, the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA), which measures mental health problems and their severity. We collected also data about the diagnoses, suicidal problems, family situations, and the involvement of the Child Protection Service. Predictions of outcome (change in HoNOSCA total score) were analysed with a regression model.ResultsThe sample comprised 192 adolescents admitted during one year (response rate 87%). Mean age was 15.7 years (range 10-18) and 70% were girls. Fifty-eight per cent had suicidal problems at intake and the mean intake HoNOSCA total score was 18.5 (SD 6.4). The largest groups of main diagnostic conditions were affective (28%) and externalizing (26%) disorders. Diagnoses and other patient characteristics at intake did not differ between units. Clinical psychiatric disorders and developmental disorders were associated with severity (on HoNOSCA) at intake but not with outcome. Of adolescents ≥ 16 years, 33% were compulsorily admitted. Median length of stay was 8.5 days and 75% of patients stayed less than a month. Compulsory admissions and length of stay varied between units. Mean change (improvement) in the HoNOSCA total score was 5.1 (SD 6.2), with considerable variation between units. Mean discharge score was close to the often-reported outpatient level, and self-injury and emotional symptoms were the most reduced symptoms during the stay. In a regression model, unit, high HoNOSCA total score at intake, or involvement of the Child Protection Service predicted improvement during admission.ConclusionsAcute psychiatric in-patient units for adolescents effectively meet important needs for young people with suicidal risks or other severe mental health problems. These units may act in suicide prevention, stabilizing symptom severity at a lower level within a short stay. It is important to explore the differences in outcome, compulsory admissions, and length of stay between units.
Highlights
Several countries have established or are planning acute psychiatric in-patient services that accept around-the-clock emergency admission of adolescents
We do not know of any studies that have clarified the characteristics of adolescents treated in such acute psychiatric in-patient units that accept mainly emergency admissions
We studied the main effects of the predictors of change in HoNOSCA total score as the main effects in an analysis of variance (ANOVA) model using the general linear model (GLM) in SPSS
Summary
Several countries have established or are planning acute psychiatric in-patient services that accept around-the-clock emergency admission of adolescents. During the last few decades, the Norwegian Regional Health Authorities have established acute psychiatric inpatient units for adolescents nationwide. These units provide services for the entire adolescent population and are to stabilize the adolescents by reducing any acutely increased psychiatric symptoms, risk of suicide, and harm to others to a non-problematic level or to a level treatable by outpatient child and adolescent mental health services (CAMHS), by a general practitioner (GP), or by another community-based service. We do not know of any studies that have clarified the characteristics of adolescents treated in such acute psychiatric in-patient units that accept mainly emergency admissions. Whether emergency services should be organized as separate acute units is a topic of discussion in the United Kingdom (UK) [3]
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