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Predictors of psychiatric aftercare among formerly hospitalized adolescents

Carlisle CE, Mamdani M, Schachar R, To T. Can J Psychiatry. 2012; 57(11):666-76.


Objective — Timely aftercare can be viewed as a patient safety imperative. In the context of decreasing inpatient length of stay (LOS) and known child psychiatry human resource challenges, the researchers investigated time to aftercare for adolescents following psychiatric hospitalization.

Method — The researchers conducted a population-based cohort study of adolescents aged 15 to 19 years with psychiatric discharge between April 1, 2002, and March 1, 2004, in Ontario, using encrypted identifiers across health administrative databases to determine time to first psychiatric aftercare with a primary care physician (PCP) or a psychiatrist within 395 days of discharge.

Results — Among the 7,111 adolescents discharged in the study period, 24% had aftercare with a PCP or a psychiatrist within 7 days and 49% within 30 days. High socioeconomic status (adjusted hazard ratio [AHR] 1.31; 95% CI 1.21 to 1.43, P < 0.001) and psychotic disorders (AHR 1.24; 95% CI 1.12 to 1.36, P < 0.001) were associated with greater likelihood of aftercare. Youth in the northern part of the province (AHR 0.48; 95% CI 0.32 to 0.71, P < 0.001), rural areas (AHR 0.82; 95% CI 0.76 to 0.89, P < 0.001), and with self-harm or suicide attempts (AHR 0.58; 95% CI 0.53 to 0.64, P < 0.001) and substance use disorders (AHR 0.50; 95% CI 0.44 to 0.56, P < 0.001) were less likely to receive aftercare.

Conclusions — Hospitalization is the most intensive, intrusive, and expensive psychiatric treatment setting, yet in the cohort of formerly hospitalized adolescents fewer than 50% received psychiatry-related aftercare in the month post-discharge. Innovations are necessary to address geographic inequities and improve timely access to mental health aftercare for all youth.

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Keywords: Adolescent health Continuity of care Rural/northern health services

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