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Adolescent inpatients with substance use disorder (SUD) and a history of child maltreatment (CM) present a vulnerable population at considerable risk of poor health and social outcomes. Addressing their specific clinical and psychosocial vulnerabilities through comprehensive treatment and discharge plans may reduce readmission and improve quality of life.
Of the 126 patients with substance use disorder, 80 (63.3%) had at least one characteristic of child maltreatment entered into the medical chart. In comparison to patients for whom there was no recording of any aspect of child maltreatment or exploitation (n = 46), there were no statistically significant differences in age (15.8; SD 1.1), but a greater proportion of youth who experienced maltreatment identified as female than male, had a greater number of admissions, and longer lengths of stay than youth for whom child maltreatment was not entered into the charts (Table 1). The most common psychiatric diagnosis for all patients was mood disorders. Patients with a history of child maltreatment had a statistically higher proportion of trauma/stress-related and eating disorders, self-harming behaviors, histories of physical and sexual assault, and experiencing homelessness or being precariously housed, than patients without a history of child maltreatment (Table 2).
Maltreatment | No Maltreatment | p Value | |
---|---|---|---|
Characteristic | (n = 80) | (n = 46) | |
Age, m (SD) | 15.7(1.1) | 15.9(1.1) | 0.410 |
Gender, n (%) 1 | |||
Female | 57 (72) | 24 (51) | 0.024 |
Male | 21 (27) | 23 (49) | |
Number of Admissions, m (SD) | 2.2 (1.6) | 1.6 (1.4) | 0.044 |
Length of 1st stay days, m (SD) | 10.6 (7.6) | 8.1 (3.1) | 0.029 |
Maltreatment | No Maltreatment |
p Value | Odds Ratio (95% CI) 1 |
|
---|---|---|---|---|
Characteristic | (n = 80) | (n = 46) | ||
Psychiatric Diagnoses, n (%) | ||||
Mood disorder | 52 (65.0) | 28 (61.0) | 0.643 | 0.934 (0.39–2.23) |
Trauma/stress disorder | 47 (58.8) | 18 (39.1) | 0.034 | 2.001 (0.88–4.55) |
Anxiety | 39 (48.8) | 21 (45.7) | 0.737 | 0.689 (0.84–0.37) |
Personality disorder | 11 (13.8) | 7 (15.2) | 0.820 | 0.172 (0.04–0.75) |
Parent–child conflict | 10 (12.5) | 4 (8.7) | 0.513 | 0.942 (0.19–4.73) |
Eating disorder | 7 (8.8) | 0 (0) | 0.047 | - |
Trauma Histories, n (%) | ||||
Parent with MI/SUD 2 | 64 (80) | 27 (59) | 0.011 | 1.685 (0.62–4.58) |
Self-harm behaviors | 60 (75) | 22 (47.8) | 0.002 | 2.847 (1.09–7.43) |
Suicidal behaviors | 50 (62.5) | 24 (52.2) | 0.257 | 0.674 (0.26–1.77) |
Sexual assault | 44 (55.0) | 10 (21.7) | 0.0003 | 2.882 (0.98–8.45) |
Physical assault | 43 (53.8) | 11 (23.9) | 0.001 | 2.645 (1.39–7.53) |
Victim of bullying | 38 (47.5) | 18 (39.1) | 0.362 | 0.998 (0.40–2.50) |
Homeless or precariously housed | 22 (31.3) | 3 (6.5) | 0.001 | 3.486 (0.82–14.79) |
Death of someone close | 21 (26.3) | 10 (21.7) | 0.571 | 0.887 (0.31–2.55) |