Risk Factors for Revolving Door in Children and Adolescents with Psychiatric Disorders.

Barbara D’Aiello,Stefano Vicari,Milena Labonia,Roberto Averna,Deny Menghini

doi:10.3390/jcm10215004

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.

Highlights

Revolving Door (RD) and non-RD patients did not differ for age (t222 = 0.61, p = 0.54; Cohen’s d = 0.08), IQ (t207 = −0.75, p = 0.45; Cohen’s d = 0.10), gender (χ2 1 = 2.73, p = 0.09; Φ = 0.11), familial history of psychiatric disorders (χ2 1 = 1.5, p = 0.21; Φ = −0.82), psychiatric diagnosis (χ2 4 = 3.91, p = 0.41; Cramer’s V = 0.13), and psychiatric comorbidities (χ2 4 = 2.97, p = 0.57; Cramer’s V = 0.22)
RD and non-RD patients did not differ for substances use (χ2 1 = 2.5, p = 0.11; Φ = −0.10)
A negative correlation was found in the RD group between the number of accesses and the number of days between the first and the second admission

Summary

Introduction

The term “revolving door” (RD) indicates repeated hospitalizations of the same patient in psychiatric units [1]. Psychiatric hospitalizations represent a huge burden in terms of costs and stress [2]. According to follow-up studies, 21–26% of adolescents in psychiatric care become frequent users of psychiatric services [3], and about a quarter of discharged patients experienced readmissions within one year [4,5,6]. The highest risk for rehospitalizations occurs within the first 3 months from discharge [4], and the first hospitalization length correlates with the risk of readmission [7,8,9]. Each additional day of hospitalization, during the first episode of psychiatric hospital stay, increases the possibility of rehospitalizations by 17% [10]

Methods

Results

Discussion

Conclusion