Factors Associated With Child and Youth Mental Health Readmissions From a US National Database

Objective

To describe and identify factors associated with mental health (MH) readmission rates for youth ages 5 to 17 years discharged between January 2019 and November 2019.

Method

This retrospective, cross-sectional analysis using the 2019 Nationwide Readmissions Database identified hospitalizations for patients with a primary diagnosis of an MH condition using the Clinical Classification Software groupings, which are based on ICD-10-CM codes. Various patient characteristics including comorbidities were included in univariate and multivariate analysis to study their association with psychiatric readmission.

Results

A 30-day readmission rate of 7.8% was found for the overall sample with significantly higher rates for youth younger than age 15 years. MH comorbidity was a factor in readmission rates; having ≥3 primary MH conditions was associated with higher rates of readmission (adjusted odds ratio [aOR] = 1.20). Significantly higher rates of readmission were noted for several diagnostic groupings including schizophrenia spectrum and other psychotic disorders (aOR = 1.95); bipolar and related disorders (aOR = 1.42); other specified and unspecified mood disorders (aOR = 1.42); disruptive, impulse-control, and conduct disorders (aOR = 1.32); and neurodevelopmental disorders (aOR = 1.23). Having public insurance (aOR=1.28) and a longer length of stay (AOR = 1.71 for ≥15 days) were associated with significantly higher odds of an MH readmission.

Conclusion

A concerning number of children admitted for MH conditions in 2019 were readmitted within 30 days (7.8%). Younger children, children with specific MH diagnoses, children with public health insurance, and children with a long initial length of stay have higher odds for readmission and represent a target for prevention and intervention.

Plain language summary

Hospital readmissions for mental health may reflect healthcare quality. This study examined data from the National Readmission Database in patients 5 to 17 years old with a primary diagnosis of a mental health condition in order to identify factors associated with readmissions. Results showed that 7.8% of youth were readmitted to the hospital within 30 days. A higher number of co-occurring primary mental health conditions, certain diagnostic groups, those with longer initial lengths of stay, and public insurance were associated with higher odds of readmission These factors represent important targets for prevention and intervention.

Diversity & Inclusion Statement

We worked to ensure that the study questionnaires were prepared in an inclusive way. Diverse cell lines and/or genomic datasets were not available. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science.