title: Rehospitalization of Suicidal Adolescents in Relation to Course of Suicidal Ideation and Future Suicide Attempts.
abstract: OBJECTIVE
  Psychiatric hospitalization is essential in the clinical management of suicidal adolescents, and a considerable number of hospitalized adolescents are rehospitalized, yet little is known about how this experience may influence postdischarge outcomes. This study examined the association between rehospitalization within three months of index hospitalization and subsequent suicide attempts and suicidal ideation among adolescents.
  
  
  METHODS
  Participants were 373 youths (13-17 years old) hospitalized because of suicide risk, and they were followed for one year. Using Cox regression, the investigators examined rehospitalization within three months of index hospitalization as a predictor of time to suicide attempt during the subsequent nine months. Using latent-class growth modeling, they also examined whether rehospitalization predicted a change in the nine-month course of three suicidal ideation trajectories (subclinical, elevated but fast declining, and chronically elevated).
  
  
  RESULTS
  Rehospitalization was associated with greater risk of suicide attempts, above the effects of key covariates. Rehospitalization also predicted distinct changes in suicidal ideation trajectories: Within the elevated-fast declining and chronically elevated groups, rehospitalization predicted increases in ideation during the follow-up, with larger magnitude for the chronic group. In contrast, rehospitalization was associated with a decrease in follow-up suicidal ideation in the subclinical group.
  
  
  CONCLUSIONS
  Rehospitalization predicted a more severe course of suicide ideation for most of the adolescents, but it was protective for only a smaller subgroup with subclinical levels of ideation at index hospitalization. Our findings also suggest that rehospitalization is a strong indicator of future risk of suicide attempt. These findings have important implications for intervening with rehospitalized adolescents.
authors.affiliation: The authors were with the Department of Psychiatry and Department of Psychology, University of Michigan, Ann Arbor, at the time of the study (e-mail: ewac@umich.edu ). Dr. Czyz is now with the Department of Psychiatry at the university.
authors.forename: Ewa K
authors.initials: EK
authors.lastname: Czyz
authors.affiliation: The authors were with the Department of Psychiatry and Department of Psychology, University of Michigan, Ann Arbor, at the time of the study (e-mail: ewac@umich.edu ). Dr. Czyz is now with the Department of Psychiatry at the university.
authors.forename: Johnny
authors.initials: J
authors.lastname: Berona
authors.affiliation: The authors were with the Department of Psychiatry and Department of Psychology, University of Michigan, Ann Arbor, at the time of the study (e-mail: ewac@umich.edu ). Dr. Czyz is now with the Department of Psychiatry at the university.
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: King
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D003863:Depression / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D014481:United States