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Open Access 10-03-2025 | Child and Adolescent Psychiatry | Research

Comparison of the long-term outcome of home vs. inpatient treatment: 18–24 months follow-up of a non-randomized controlled trial

Authors: Daniel Graf, Stefan Lerch, Ulrich Böhnke, Corinna Reichl, Michael Kaess

Published in: European Child & Adolescent Psychiatry

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Abstract

Home Treatment (HT) in child and adolescent psychiatry is an increasingly important topic in the current context of global crises and strained mental health systems. We implemented a HT program provided by a multiprofessional treatment team and compared long-term outcomes of 27 patients (48% female, Ø15.15 ± 2.77 years) with those of 48 patients (69% female, Ø16.35 ± 2.87 years) who received inpatient treatment as usual (I-TAU). Psychopathology was assessed using the Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA[-SR]) and psychosocial functioning was assessed using the Global Assessment of Functioning (GAF) at admission, discharge, and 18–24 months after discharge. Treatment outcomes were analyzed using mixed models. The results showed that patients in the HT arm had significantly lower HoNOSCA scores at follow-up (β = -4.25 [95%CI: -7.64 to -0.86], SE = 1.73, p = 0.014) and higher GAF scores (β = 12.09 [95%CI: 4.48 to 19.70], SE = 3.88, p = 0.002) compared to those in the I-TAU arm. No significant differences were observed in HoNOSCA-SR scores (β = -2.46 [95%CI: -9.16 to 4.30], SE = 3.43, p = 0.48) and readmission rates (OR = 1.23 [95%CI = 0.47 to 3.20], p = 0.67). These results highlight the potential of HT in improving long-term functional and psychopathological outcomes in youth mental health. HT may be an equally effective and even more sustainable type of treatment for child and adolescent mental disorders. The trial was preregistered at the German Clinical Trials Register (DRKS00025424, 05/27/2021).
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Literature
5.
go back to reference Thorisdottir IE, Asgeirsdottir BB, Kristjansson AL, Valdimarsdottir HB, Jonsdottir Tolgyes EM, Sigfusson J, Halldorsdottir T (2021) Depressive symptoms, mental wellbeing, and substance use among adolescents before and during the COVID-19 pandemic in Iceland: a longitudinal, population-based study. Lancet Psychiat 8(8):663–672. https://doi.org/10.1016/s2215-0366(21)00156-5CrossRef Thorisdottir IE, Asgeirsdottir BB, Kristjansson AL, Valdimarsdottir HB, Jonsdottir Tolgyes EM, Sigfusson J, Halldorsdottir T (2021) Depressive symptoms, mental wellbeing, and substance use among adolescents before and during the COVID-19 pandemic in Iceland: a longitudinal, population-based study. Lancet Psychiat 8(8):663–672. https://​doi.​org/​10.​1016/​s2215-0366(21)00156-5CrossRef
6.
go back to reference Trafford AM, Carr MJ, Ashcroft DM, Chew-Graham CA, Cockcroft E, Cybulski L, Mok PLH (2023) Temporal trends in eating disorder and self-harm incidence rates among adolescents and young adults in the UK in the 2 years since onset of the COVID-19 pandemic: a population-based study. Lancet Child Adolesc Health 7(8):544–554. https://doi.org/10.1016/S2352-4642(23)00126-8CrossRefPubMed Trafford AM, Carr MJ, Ashcroft DM, Chew-Graham CA, Cockcroft E, Cybulski L, Mok PLH (2023) Temporal trends in eating disorder and self-harm incidence rates among adolescents and young adults in the UK in the 2 years since onset of the COVID-19 pandemic: a population-based study. Lancet Child Adolesc Health 7(8):544–554. https://​doi.​org/​10.​1016/​S2352-4642(23)00126-8CrossRefPubMed
10.
11.
12.
go back to reference Ougrin D, Corrigall R, Poole J, Zundel T, Sarhane M, Slater V, Taylor E (2018) Comparison of effectiveness and cost-effectiveness of an intensive community supported discharge service versus treatment as usual for adolescents with psychiatric emergencies: a randomised controlled trial. Lancet Psychiat 5(6):477–485. https://doi.org/10.1016/s2215-0366(18)30129-9CrossRef Ougrin D, Corrigall R, Poole J, Zundel T, Sarhane M, Slater V, Taylor E (2018) Comparison of effectiveness and cost-effectiveness of an intensive community supported discharge service versus treatment as usual for adolescents with psychiatric emergencies: a randomised controlled trial. Lancet Psychiat 5(6):477–485. https://​doi.​org/​10.​1016/​s2215-0366(18)30129-9CrossRef
14.
go back to reference Boege I, Corpus N, Weichard M, Schepker R, Young P, Fegert JM (2021) Long-term outcome of intensive home treatment for children and adolescents with mental health problems– 4 years after a randomized controlled clinical trial. Child Adolesc Ment Health 26(4):310–319. https://doi.org/10.1111/camh.12500CrossRefPubMed Boege I, Corpus N, Weichard M, Schepker R, Young P, Fegert JM (2021) Long-term outcome of intensive home treatment for children and adolescents with mental health problems– 4 years after a randomized controlled clinical trial. Child Adolesc Ment Health 26(4):310–319. https://​doi.​org/​10.​1111/​camh.​12500CrossRefPubMed
21.
24.
go back to reference American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington, DC: Author American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington, DC: Author
26.
go back to reference World Health Organization (WHO) (1992) The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. World Health Organization, Geneva World Health Organization (WHO) (1992) The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. World Health Organization, Geneva
27.
go back to reference Schmidt J, Lamprecht F, Wittmann WW (1989) Zufriedenheit Mit der stationären versorgung. Entwicklung eines Fragebogens und erste validitätsuntersuchungen. PPmP 39:248–255PubMed Schmidt J, Lamprecht F, Wittmann WW (1989) Zufriedenheit Mit der stationären versorgung. Entwicklung eines Fragebogens und erste validitätsuntersuchungen. PPmP 39:248–255PubMed
28.
go back to reference Salize HJ, Kilian R (2010) Gesundheitsökonomie in der psychiatrie: Konzepte, methoden, analysen. Kohlhammer, Stuttgart, DeutschlandCrossRef Salize HJ, Kilian R (2010) Gesundheitsökonomie in der psychiatrie: Konzepte, methoden, analysen. Kohlhammer, Stuttgart, DeutschlandCrossRef
37.
go back to reference Ougrin D, Corrigall R, Stahl D, Poole J, Zundel T, Wait M, Taylor E (2021) Supported discharge service versus inpatient care evaluation (SITE): a randomised controlled trial comparing effectiveness of an intensive community care service versus inpatient treatment as usual for adolescents with severe psychiatric disorders: self-harm, functional impairment, and educational and clinical outcomes. Eur Child Adolesc Psychiatry 30(9):1427–1436. https://doi.org/10.1007/s00787-020-01617-1CrossRefPubMed Ougrin D, Corrigall R, Stahl D, Poole J, Zundel T, Wait M, Taylor E (2021) Supported discharge service versus inpatient care evaluation (SITE): a randomised controlled trial comparing effectiveness of an intensive community care service versus inpatient treatment as usual for adolescents with severe psychiatric disorders: self-harm, functional impairment, and educational and clinical outcomes. Eur Child Adolesc Psychiatry 30(9):1427–1436. https://​doi.​org/​10.​1007/​s00787-020-01617-1CrossRefPubMed
42.
go back to reference Herpertz-Dahlmann B, Schwarte R, Krei M, Egberts K, Warnke A, Wewetzer C, Dempfle A (2014) Day-patient treatment after short inpatient care versus continued inpatient treatment in adolescents with anorexia nervosa (ANDI): a multicentre, randomised, open-label, non-inferiority trial. Lancet 383(9924):1222–1229. https://doi.org/10.1016/s0140-6736(13)62411-3CrossRefPubMed Herpertz-Dahlmann B, Schwarte R, Krei M, Egberts K, Warnke A, Wewetzer C, Dempfle A (2014) Day-patient treatment after short inpatient care versus continued inpatient treatment in adolescents with anorexia nervosa (ANDI): a multicentre, randomised, open-label, non-inferiority trial. Lancet 383(9924):1222–1229. https://​doi.​org/​10.​1016/​s0140-6736(13)62411-3CrossRefPubMed
43.
go back to reference Compton J, Glass N, Fowler T (2019) Evidence of selection Bias and Non-Response Bias in patient satisfaction surveys. Iowa Orthop J 39(1):195–201PubMedPubMedCentral Compton J, Glass N, Fowler T (2019) Evidence of selection Bias and Non-Response Bias in patient satisfaction surveys. Iowa Orthop J 39(1):195–201PubMedPubMedCentral
Metadata
Title
Comparison of the long-term outcome of home vs. inpatient treatment: 18–24 months follow-up of a non-randomized controlled trial
Authors
Daniel Graf
Stefan Lerch
Ulrich Böhnke
Corinna Reichl
Michael Kaess
Publication date
10-03-2025
Publisher
Springer Berlin Heidelberg
Published in
European Child & Adolescent Psychiatry
Print ISSN: 1018-8827
Electronic ISSN: 1435-165X
DOI
https://doi.org/10.1007/s00787-025-02677-x