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PSYCHIATRY

Psychotropic Medication Changes, Polypharmacy, and the Risk of Early Readmission in Suicidal Adolescent Inpatients

Assistant Professor, College of Social Work, The Ohio State University, Columbus, OH

Jeffrey A Bridge, PhD

Assistant Professor of Pediatrics, College of Medicine, The Ohio State University and the Research Institute at Nationwide Children's Hospital, Columbus, OH

John V Campo, MD

Chief, Child and Adolescent Psychiatry; Medical Director, Pediatric Behavioral Health, The Ohio State University and Nationwide Children's Hospital

Reprints: Dr. Fontanella, College of Social Work, The Ohio State University, 1947 College Rd., Columbus, OH 43210; fax 614/292-6940, fontanella.4{at}osu.edu

BACKGROUND: Adolescents with acute suicidal ideation and attempts are frequently treated with psychotropic medications in psychiatric hospitals. However, little is known about whether pharmacologic interventions used to stabilize suicidal adolescents within inpatient settings are effective in reducing early readmission.

OBJECTIVE: To examine whether psychotropic medication changes and polypharmacy are associated with 30-day readmission rates for suicidal adolescents.

METHODS: We conducted a retrospective cohort study of 318 Medicaid-enrolled adolescents admitted for suicidal behaviors to 3 major inpatient psychiatric hospitals in Maryland. Comprehensive data on patient demographics, clinical factors, service history, and inpatient treatment practices were collected from hospital medical records. Medications prescribed prior to admission and during the hospital stay were matched and compared with regard to drug, dosage, and frequency of administration to identify the different types of medication changes. Multivariate Cox proportional hazard analysis was used to examine the association of medication changes and polypharmacy with readmission.

RESULTS: At least one medication change was made in 78% of suicidal adolescent inpatients, typically the addition of an antidepressant, mood stabilizer, or antipsychotic. At discharge, nearly one quarter (23%) of youths were prescribed 3 or more medications from different drug classes. Controlling for demographic and clinical factors, the addition of an antidepressant was associated with an 85% lower risk of readmission (HR 0.15; 95% CI 0.03 to 0.68). However, the use of 3 or more medications from different drug classes was associated with a 2.6 times higher risk of readmission (95% CI 1.03 to 6.52).

CONCLUSIONS: In this sample of suicidal adolescents, antidepressant treatment was associated with a lower risk of readmission and polypharmacy was associated with a higher risk of readmission. Study findings highlight the need for quality improvement efforts that optimize pharmacologic treatment and physician decision making.

Key Words: antidepressant, polypharmacy, psychotropic medication, suicidal adolescents

Published Online, November 24, 2009. www.theannals.com, DOI 10.1345/aph.1M326

Related articles in The Annals:

Suicidal Behavior and Psychotropic Medications for Adolescents: An Uneasy Association, as Yet Not Clarified

Christopher P Alderman
The Annals 2009 43: 2093-2095. [Abstract] [Full Text]  

This article has been cited by other articles:

				C. P Alderman Suicidal Behavior and Psychotropic Medications for Adolescents: An Uneasy Association, as Yet Not Clarified Ann. Pharmacother., December 1, 2009; 43(12): 2093 - 2095. [Abstract] [Full Text] [PDF]