# Adolescent psychiatric hospitalization: a naturalistic observational study of statistical and clinical outcomes and moderating factors

## TL;DR

This study examines mental health changes in hospitalized adolescents, finding limited clinical improvement despite statistical reductions in symptoms.

## Contribution

The study introduces a combined statistical and clinical analysis of adolescent psychiatric hospitalization outcomes using RCI and moderating factors.

## Key findings

- Statistically significant reductions in HoNOSCA scores were observed from admission to discharge.
- Only 20% of patients achieved clinically significant improvements (RCI > 1.96), with 65% showing stability.
- Moderators like sex, disorder type, and admission type influenced discharge outcomes.

## Abstract

Adolescents’ mental health issues may require psychiatric hospitalization, highlighting the need for effective interventions during hospitalization. This study explored statistical and clinical (through reliable change index; RCI) changes in mental health difficulties across hospitalization and their moderating factors potentially affecting clinical progress and discharge outcomes.

We examined retrospective socio-demographic and clinical data from 593 adolescents first hospitalized at the Adolescent Psychiatric Hospitalization Unit (UHPA) of the Lausanne University Hospital (CHUV) between 2014 and 2021. Statistical significance (analyzed via t-tests for paired samples) used scores on the Health of the Nation Outcome Scales for Children (HoNOSCA) at admission and discharge, whereas RCI was used to assess clinical significance. Moderating factors were examined through multivariate regression analyses on clinical changes and outcomes at discharge.

Statistically, we observed a significant reduction in mental health issues, as reflected by decreases in the “Total”, “Behavioral” and “Symptoms” HoNOSCA scores from admission to discharge. However, clinical improvements (RCI > 1.96) were reached in 20% of patients, while 65% remained stable. Finally, considering moderating factors, while clinical changes during hospitalization remained largely unexplained, moderators such as sex, behavioral and emotional disorders (F9x), antipsychotic intake, voluntary admission, pre-hospitalization occupation, patient-clinician discharge agreement, and length of stay accounted for a significant proportion of clinical outcomes at discharge.

While hospitalization may contribute to stabilizing acute crises, clinically meaningful improvements were limited for many patients. This highlights the importance of integrative and coordinated approaches tailored to adolescents’ heterogeneous profiles.

The online version contains supplementary material available at 10.1186/s13034-025-00972-8.