Instability, Clinical Severity Predict Hospitalization Risk for Psychiatric Illness

Article

Patients in the top half of the cohort for both clinical severity and instability were at an increased risk of hospitalization than those at the bottom half of both dimensions

Instability, Clinical Severity Predict Hospitalization Risk for Psychiatric Illness

Maxime Taquet, PhD

Credit: University of Oxford

Investigators have identified a pair of risk factors that can forecast the risk of hospitalization within 6 months for a psychiatric illness.1

A team, led by Maxime Taquet, PhD, Department of Psychiatry, University of Oxford, determined whether early trajectories of Clinical Global Impression Severity are predictors of 6 month risk of psychiatric hospitalization.

It remains crucial to identify patients at risk for psychiatric hospitalization to improve service provision and patient outcomes.However, a barrier to this is caused by existing predictors focused on specific clinical scenarios are not validated with real-world data, limiting their translational potential.

In the retrospective cohort study, the investigators collected data from an electronic health records network involving 25 mental health care providers in the US of 36,914patients with an ICD-9 or ICD-10 code of major depressive disorder, bipolar disorder, generalized anxiety disorder, post-traumatic stress disorder, schizophrenia or schizoaffective disorder, ADHD, or personality disorder.

They then assessed whether clinical severity and instability during a 2 month period could be used to forecast psychiatric hospitalization within the next 6 months. The mean age of the patient population was 29.7 years.

The results show the clinical severity and instability were independent risk predictors of hospitalization (adjusted hazard ratio [aHR]. 1.09; 95% confidence interval [CI], 1.07-1.10 for every SD increase in instability; 1.11, 1.09–1.12 for every SD increase in severity; P <0.0001 for both).

The associations were consistent across all diagnoses, age groups, and in both males and females. This was also true for in several robustness analyses, including when clinical severity and clinical instability based on the Patient Health Questionnaire-9 rather than Clinical Global Impression Severity measurements.

Patients in the top half of the cohort for both clinical severity and instability were at an increased risk of hospitalization than those at the bottom half of both dimensions (HR, 1.45; 95% CI, 1.39-1.52; P <0.0001).

“Clinical instability and severity are independent predictors of future risk of hospitalization, across diagnoses, age groups, and in both males and females,” the authors wrote. “These findings could help clinicians make prognoses and screen patients who are most likely to benefit from intensive interventions, as well as help health-care providers plan service provisions by adding additional detail to risk prediction tools that incorporate other risk factors.”

References:

Taquet, M., Griffiths, K., Palmer, E. O., Ker, S., Liman, C., Wee, S. N., Kollins, S. H., & Patel, R. (2023). Early trajectory of clinical global impression as a transdiagnostic predictor of psychiatric hospitalisation: A retrospective cohort study. The Lancet Psychiatry. https://doi.org/10.1016/s2215-0366(23)00066-4

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