A long-term follow-up study of adolescent psychiatric in-patients. Part III. Predictors of disability.
A total of 1095 adolescent psychiatric in-patients were followed up 15-33 years after hospitalization by record linkage to the National Register of Disability Benefits. On the basis of hospital records, all patients were rediagnosed according to DSM-IV and scored on data postulated to have predictive power with regard to disability. The factors were investigated by Kaplan-Meyer survival analysis and Cox regression. A psychotic or organic disorder, low score on DSM-IV Axis V (GAF) and the use of psychotropic medication at hospitalization were among the strong predictors of later disability, as were low IQ, poor achievement at school, somatic disorders, and self-harming behaviour (all P < 0.01). Cox analysis showed that, of these, the following factors remained strong and independent predictors of disability: psychotic and organic disorders (relative risk (RR)=3.1, 95% confidence interval (CI)=2.4-4.0), IQ < 90 (RR=1.8, CI=1.5-2.3); and GAF < 30 (RR=1.9, CI=1.5-2.4). Former adolescent psychiatric in-patients with a psychotic or organic disorder had a very high risk of later disability (71-81%), whereas those with other psychiatric diagnoses, and with IQ > or = 90 and GAF > or = 30 at hospitalization, had a relatively low risk of disability (22-29%).
Kjelsberg
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National Centre for Child and Adolescent Psychiatry, Department Group of Psychiatry, University of Oslo, Norway.
D000293:Adolescent; D000328:Adult; D002648:Child; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology*; D011237:Predictive Value of Tests; D013997:Time Factors