title: Psychotropic medication changes, polypharmacy, and the risk of early readmission in suicidal adolescent inpatients.
abstract: 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.
authors.affiliation: College of Social Work, The Ohio State University, Columbus, OH 43210, USA. fontanella.4@osu.edu
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Fontanella
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Bridge
authors.forename: John V
authors.initials: JV
authors.lastname: Campo
mesh_terms: D000293:Adolescent; D000928:Antidepressive Agents / Q000627:therapeutic use; D018692:Antimanic Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D002648:Child; D015331:Cohort Studies; D003657:Decision Making; D004359:Drug Therapy, Combination; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008396:Maryland; D008484:Medicaid; D010359:Patient Readmission / Q000706:statistics & numerical data*; D019338:Polypharmacy; D010818:Practice Patterns, Physicians' / Q000592:standards; D016016:Proportional Hazards Models; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000627:therapeutic use*; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D013406:Suicide, Attempted / Q000517:prevention & control* / Q000523:psychology; D014481:United States
chemical_list: D000928:Antidepressive Agents; D018692:Antimanic Agents; D014150:Antipsychotic Agents; D011619:Psychotropic Drugs