Adolescent Wellbeing Following Brief Psychiatric Hospitalization

Background and purpose: For adolescents, utilization of brief psychiatric inpatient treatment (BPIT) has been on the rise, typically used when youth are identified as in need of a safe and contained environment or to protect them or others at a time of crisis, suicidality, or escalation of behavior problems. Questions related to the effectiveness and overall impact of BPIT for youth have received some research attention, though previous studies largely focus on rehospitalization rates, rather than more comprehensive clinical status and wellbeing outcomes. Previous research also examines a narrow scope of predictors of outcomes rather than exploring a richer array of possible indicators of outcomes following BPIT.

The aim of this mixed-method study is to address previous gaps in research by: (1) exploring youths’ descriptions of their mental health status and wellbeing at 6-months following their first BPIT, and (2) examining a range of baseline predictors of mental health status at follow-up including socio-demographic characteristics, clinical characteristics including exposure to stress and trauma, quality of hospital experiences, illness perceptions, mental illness stigma, and various inter-personal and intra-personal resources/strengths at 6-months follow-up.

Methods: This study uses baseline and 6-month follow-up data from a voluntary sample of 80 adolescents receiving BPIT for the first time. Participants were recruited between 2007 and 2010, and engaged in two in-home, face-to-face interviews (within a week of hospital discharge and following 6 months). Hospital records provided supplemental background and clinical information. Youths’ well-being at follow-up was gauged by asking participants to describe how they are feeling and doing relative to 6 months prior. Conventional content analysis was used to summarize and interpret youths’ narratives. Hierarchical linear regression models were used to identify the most salient baseline predictors of mental health status (depression/CES-D) at follow-up.

Results: Most adolescents (59%) reported improved mental health status, referring to new or better coping skills or symptom diminishment; 26% indicated a ‘mixed’ status involving symptom and coping fluctuations, or improvement in some areas with no change or declines in others; 11.5% reported an unchanged status; and 3% reported feeling/doing worse. These categories significantly corresponded with adolescents’ ratings of depression (p<.001), life satisfaction (p<.001), and self-esteem (p<.01) at follow-up. Overall, adolescents evidenced a reduction in CES-D ratings over six months following BPIT (p<.001), though rates remained within the clinical range. Multivariate analyses examining baseline predictors of depression at follow-up, found that gender, sleep disturbances, attitudes toward psychotropic medication, exposure to mental illness stigma, and level of connectedness to school were among the most salient factors predicting depression 6-months post BPIT. These factors accounted for 48% of the variance of follow-up CES-D scores.

Conclusions and implications: This study finds that adolescents’ descriptions of wellbeing and functioning following BPIT corresponded well to other measures of clinical status, and provide more comprehensive and rich information about mental health status changes over time. This work also begins to identify clinical and psychosocial predictors of mental health status following BPIT. There is great clinical value in understanding what helps determine better clinical outcomes for adolescents following BPIT.