Research
Admissions to acute adolescent psychiatric units: a prospective study of clinical severity and outcome
-
* Corresponding author: Ketil Hanssen-Bauer ketil.hanssen-bauer@r-bup.no
1 Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, PO Box 4623 Nydalen, N-0405 Oslo, Norway
2 Department of Research and Development, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
3 SINTEF Health research, Trondheim, Norway
4 Adolescent Acute Ward, Nordlandssykehuset, Bodø, Norway
5 Adolescent Acute Ward, St. Olav University hospital, Trondheim, Norway
6 Adolescent Psychiatric Clinic, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
7 Adolescent Psychiatric Acute Unit, Oslo University Hospital, Norway
International Journal of Mental Health Systems 2011, 5:1 doi:10.1186/1752-4458-5-1
Published: 6 January 2011Abstract
Background
Several countries have established or are planning acute psychiatric in-patient services that accept around-the-clock emergency admission of adolescents. Our aim was to investigate the characteristics and clinical outcomes of a cohort of patients at four Norwegian units.
Methods
We used a prospective pre-post observational design. Four units implemented a clinician-rated outcome measure, the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA), which measures mental health problems and their severity. We collected also data about the diagnoses, suicidal problems, family situations, and the involvement of the Child Protection Service. Predictions of outcome (change in HoNOSCA total score) were analysed with a regression model.
Results
The sample comprised 192 adolescents admitted during one year (response rate 87%). Mean age was 15.7 years (range 10-18) and 70% were girls. Fifty-eight per cent had suicidal problems at intake and the mean intake HoNOSCA total score was 18.5 (SD 6.4). The largest groups of main diagnostic conditions were affective (28%) and externalizing (26%) disorders. Diagnoses and other patient characteristics at intake did not differ between units. Clinical psychiatric disorders and developmental disorders were associated with severity (on HoNOSCA) at intake but not with outcome. Of adolescents ≥ 16 years, 33% were compulsorily admitted. Median length of stay was 8.5 days and 75% of patients stayed less than a month. Compulsory admissions and length of stay varied between units. Mean change (improvement) in the HoNOSCA total score was 5.1 (SD 6.2), with considerable variation between units. Mean discharge score was close to the often-reported outpatient level, and self-injury and emotional symptoms were the most reduced symptoms during the stay. In a regression model, unit, high HoNOSCA total score at intake, or involvement of the Child Protection Service predicted improvement during admission.
Conclusions
Acute psychiatric in-patient units for adolescents effectively meet important needs for young people with suicidal risks or other severe mental health problems. These units may act in suicide prevention, stabilizing symptom severity at a lower level within a short stay. It is important to explore the differences in outcome, compulsory admissions, and length of stay between units.