Clinical severity and instability independently predict future psychiatric hospitalization risk

Clinical severity and instability are the independent predictors for future psychiatric hospitalization risk across various age groups, sexes, and diagnoses as per a new study that was published in the journal The Lancet Psychiatry.  Predicting the risk of hospitalization was necessary as it identifies the individuals benefitting from intensive community care. 

 Identifying individuals who most likely require psychiatric hospitalization is critical for the optimal provision of services and for improving patient outcomes. Current predictors are limited in their translational potential since they are focused on certain clinical circumstances and have not been verified using real-world data. Hence researchers conducted a study to determine if early trajectories of Clinical Global Impression Severity are predictors of 6-month risk of hospitalization. 

A retrospective cohort study was carried out using data from the NeuroBlu database which is an electronic health records network from 25 US mental health-care providers. Eligibility criteria were patients 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. Using this cohort, clinical severity and instability, measured using operationalized Clinical Global Impression Severity measurements were assessed over 2 months to know if they were predictors of psychiatric hospitalization within the next 6 months. 

Key findings: 

• 36 914 patients were included with a mean age of 29·7 years.
• Of these 21 156 [57·3%] were female, and 15 748 [42·7%] were male.
• there were 20 559 [55·7%] White, 4842 [13·1%] Black or African American, 286 [0·8%] Native Hawaiian or other Pacific Islander, 300 [0·8%] Asian, 139 [0·4%] American Indian or Alaska Native, 524 (1·4%) other or mixed race, and 10 264 [27·8%] of unknown race.
• Clinical severity and instability were found to be independent predictors of hospitalization risk.
• There were consistent associations across all diagnoses, age groups, and in both sexes, as well as in several robustness analyses, even when Patient Health Questionnaire-9 was used for clinical severity and clinical instability rather than Clinical Global Impression Severity measurements.
• Increased hospitalization risk was high among patients in the top half of the cohort for both clinical severity and instability compared with those in the bottom half along both dimensions. 

Thus, clinical instability and severity are independent and robust predictors of future risk of hospitalization. These findings also help to develop prognostic models to identify patients likely to benefit from intensive community interventions. 

Further reading: Taquet M, Griffiths K, Palmer EOC, et al. Early trajectory of clinical global impression as a transdiagnostic predictor of psychiatric hospitalization: a retrospective cohort study [published online ahead of print, 2023 Mar 23]. Lancet Psychiatry. 2023;S2215-0366(23)00066-4. doi:10.1016/S2215-0366(23)00066-4