Factors Leading to Psychiatric Hospitalization for Suicidal Ethnic Minority Adolescents

Purpose: Suicide is the third leading cause of death for U.S. adolescents. The psychiatric emergency service (PES) has been identified as a key entry point for youth into the mental health system. Given ethnic minority adolescents are more likely to use PES, we need to know more about the factors associated with the treatment decision for suicidal ethnic minority adolescents presenting at the PES, in particular predictors of their discharge disposition. The purpose of the current study is to identify factors leading to psychiatric hospitalization among a diverse group of suicidal adolescents. This retrospective study will investigate specific demographic and diagnostic factors in order to identify those that are predictive of either outpatient disposition or inpatient hospitalization.

Method: The current study was conducted with a sample of 755 suicidal children and adolescents who presented to a psychiatric emergency service adjacent to the Emergency Department of a large urban mid-sized hospital. The relationship between the independent variables and the dependent variable was hypothesized as path models, which were tested using structural equation modeling with AMOS 6.0. All descriptive statistics were calculated with SPSS 13.0. Three fit indices (CFI, NFI, RMSEA) will be utilized to evaluate model fit for the current SEM analysis. Another goal of the current study was to examine whether the nature of the relationships between study variables was similar across gender and race/ethnicity groups, and invariant group analyses was employed.

Results: Descriptive statistics reveal that 511 subjects were diagnosed with a mood disorder, 195 a behavior disorder, and 41 a thought disorder. Additionally, 189 clients were dispositioned to receive outpatient treatment while 559 were dispositioned to receive inpatient treatment. The GAF scores of all participants ranged from 10 to 80 with a mean of 31.99 (sd = 11.96). Testing the model with all participants (n = 755) revealed excellent model fit with the data: CFI = .997, NFI = .993, RMSEA = .030 (90% ci = .00 to .05). The model fit across the three race groups and for males and females were equally well. For each increase in a clients GAF score by one, a client was approximately 2.6% less likely to be hospitalized.

Implications: This study makes a rare contribution to our understanding of factors associated with the treatment decision for suicidal ethnic minority children and adolescents. The practice implications social workers working in hospital will be discussed.