Established Outpatient Care and Follow-Up After Acute Psychiatric Service Use Among Youths and Young Adults

Psychiatr Serv. 2023 Jan 1;74(1):2-9. doi: 10.1176/ Epub 2022 Oct 12.


Objective: This study explored follow-up after hospitalization and emergency room (ER) use for mental health among youths and young adults with private insurance.

Methods: The IBM MarketScan commercial database (2013-2018) was used to identify people ages 12-27 with a mental health hospitalization (N=95,153) or ER use (N=108,576). Factors associated with outpatient mental health follow-up within 7 and 30 days of discharge were determined via logistic models with generalized estimating equations that accounted for state variation.

Results: Of those hospitalized, 42.7% received follow-up within 7 days (67.4% within 30 days). Of those with ER use, 28.6% received follow-up within 7 days (46.4% within 30 days). Type of established outpatient care predicted follow-up after hospitalization and ER use. Compared with people with no established care, the likelihood of receiving follow-up within 7 days was highest among those with mental health and primary care (hospitalization, adjusted odds ratio [AOR]=2.81, 95% confidence interval [CI]=2.68-2.94; ER use, AOR=4.06, 95% CI=3.72-4.42), followed by those with mental health care only (hospitalization, AOR=2.57, 95% CI=2.45-2.70; ER use, AOR=3.48, 95% CI=3.17-3.82) and those with primary care only (hospitalization, AOR=1.20, 95% CI=1.15-1.26; ER use, AOR=1.22, 95% CI=1.16-1.28). Similar trends were observed within 30 days of discharge.

Conclusions: Follow-up rates after acute mental health service use among youths and young adults were suboptimal. Having established mental health care more strongly predicted receiving follow-up than did having established primary care. Improving engagement with outpatient mental health care providers may increase follow-up rates.

Keywords: Acute care; Adolescents/adolescence; Hospitalization; Mental health; Primary care; Quality of care.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Ambulatory Care
  • Child
  • Emergency Service, Hospital
  • Follow-Up Studies
  • Hospitalization*
  • Humans
  • Mental Health Services*
  • Patient Discharge
  • Retrospective Studies
  • Young Adult