Abstract
Background: Adolescent inpatients with substance use disorder (SUD) and a history of child maltreatment (CM) present a vulnerable population at considerable risk of poor health and social outcomes. The aims of this study were to explore the proportion of adolescent inpatients with SUD and a history of CM and to compare these patients to inpatients with SUD and no history of CM. Methods: In this retrospective chart review, we explored adolescent patients who were consecutively admitted to a regional child and adolescent inpatient unit for psychiatric care and met DSM (5th ed) criteria for SUD. A standardized form was created and used to extract clinical information and psychosocial histories. Results: From 1 September 2019 to 28 February 2020, 126 adolescents were admitted with SUD, and for 80 (63.3%) patients, a history of CM was recorded in the medical charts. Patients with a history of CM were significantly more likely to be female (p = 0.02), have longer lengths of stay (p = 0.04), to be readmitted (p = 0.03), be diagnosed with trauma/stress-related (p = 0.04) and eating disorders (p = 0.05), to have a parent with a mental illness (p = 0.01), experienced physical (p < 0.01) and sexual (p < 0.01) assaults and homelessness (p < 0.01), and to engage in self-harming behaviors (p < 0.01) than inpatients with SUD but no history of CM. Conclusions: Almost two-thirds of adolescent inpatients with an SUD reported a history of CM. Addressing their specific clinical and psychosocial vulnerabilities through comprehensive treatment and discharge plans may reduce readmission and improve quality of life.
Highlights
Children who experience maltreatment are among the most vulnerable in Canada, and their mental health is a major concern
Inpatients with a history of maltreatment were approximately twice as likely to be diagnosed with a trauma disorder (odds ratios [OR]: 2.0; 95% CI: 0.88–4.55], more likely to have a parent with a mental illness/substance use disorder (OR: 1.7; 95% CI: 0.62–4.6), engage in self-harming behaviors (OR: 2.8; 1.09–7.43), experience sexual (OR: 2.9; 95% CI: 0.98–8.5) and physical assaults (OR: 2.65; 95% CI: 1.39–7.53)
The prevalence of child maltreatment recorded in medical charts in this clinical sample of adolescent inpatients admitted to psychiatry with a substance use disorder was 63.3%
Summary
Children who experience maltreatment are among the most vulnerable in Canada, and their mental health is a major concern. Our understanding of child maltreatment has evolved with respect to both the age of the child and the scope of the concept of maltreatment. Recent developments in Ontario, Canada, have expanded child protection to youth aged 16 and 17 years; youth who have left home due to safety concerns or are homeless may be eligible for support from Children’s Aid. Societies [1]. Child maltreatment includes physical abuse, emotional abuse, neglect, and sexual abuse, and through Bill 251, Combating Human Trafficking Act 2021, exploitation for child sex trafficking was added [2]. Global attention has recently been on youth who are being trafficked or exploited which, as noted by The World Health
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