title: The impact of psychiatric comorbidities on readmissions for diabetes in youth.
abstract: OBJECTIVE
  Comorbid psychiatric disorders have been associated with poorer disease outcomes in diabetic youth. Less is known, however, about the relationship between psychiatric disorders and repeat hospitalizations for youth with diabetes.
  
  
  METHODS
  We performed a retrospective cohort study using data from the Pediatric Health Information System, which included detailed discharge data from 37 non-competing children's hospitals in the U.S. Using logistic regression, we examined whether the presence of coded diagnoses for internalizing or externalizing disorders at an index hospitalization for diabetes was associated with increased risk for rehospitalization during follow-up (duration of follow-up ranged from 3 to 24 months). The analysis was stratified by age-groups, and we controlled for potential confounders including sex, age, race/ethnicity, type 1 versus type 2 diabetes, Medicaid status, intensive care unit utilization, length of stay during index admission, and duration of follow-up.
  
  
  RESULTS
  Among adolescents aged 13-18, internalizing disorders were associated with significantly increased odds of rehospitalization (odds ratio 1.79 [95% CI 1.27-2.52]); the point estimate for externalizing disorders was similar, but the finding was not statistically significant at the alpha = 0.05 level (1.74 [0.96-3.15]). No significant association between psychiatric diagnoses and odds of repeat hospitalization was observed in diabetic children aged 5-12 years.
  
  
  CONCLUSIONS
  Internalizing disorders are associated with increases in repeat hospitalizations for diabetes among adolescents. Future research is needed to explore the reasons for this finding, such as degree to which treatment nonadherence mediates this relationship and whether appropriate treatment of internalizing disorders results in improved diabetes outcomes and decreased readmissions.
authors.affiliation: Child Health Institute, University of Washington, Box 354920, Seattle Washington 98195-4920, USA. garrison@u.washington.edu
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Garrison
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Katon
authors.forename: Laura P
authors.initials: LP
authors.lastname: Richardson
mesh_terms: D000293:Adolescent; D001007:Anxiety; D001008:Anxiety Disorders / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology*; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology* / Q000523:psychology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D007256:Information Systems; D008297:Male; D011618:Psychotic Disorders / Q000453:epidemiology*; D044469:Racial Groups; D012044:Regression Analysis; D012189:Retrospective Studies; D012917:Social Adjustment; D014861:Washington