Adolescents’ Experiences During “Boarding” Hospitalization While Awaiting Inpatient Psychiatric Treatment Following Suicidal Ideation or Suicide Attempt

Diana Worsley; Emily Barrios; Marie Shuter; Amy R. Pettit; Stephanie K. Doupnik

doi:10.1542/hpeds.2019-0043

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FIGURE 1
Sample interview questions.

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TABLE 1

Sociodemographic Characteristics of Adolescents Boarding While Awaiting Inpatient Psychiatric Treatment of SI or SA (N = 27)

Characteristic^a	n (%)
Age group, y
9–14	18 (67)
15–18	9 (33)
19–21	0 (0)
Gender
Male	12 (44)
Female	11 (41)
Transgender or gender nonconforming	4 (15)
Race
White	12 (44)
African American	10 (37)
Other	2 (8)
>1 race	3 (11)
Hispanic ethnicity	1 (4)
Sexual orientation
Heterosexual	21 (77)
Bisexual	1 (4)
Lesbian	1 (4)
Queer	1 (4)
Other	3 (11)
School type
Public	21 (78)
Private	2 (7)
Technical	1 (4)
Not reported	3 (11)
Family owns a car	21 (78)
Family owns a home	16 (59)
Payer
Medicaid	16 (59)
Private insurance	11 (41)

↵a Information was self-reported by adolescents, with the exception of payer (obtained from electronic health record).

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TABLE 2

Treatment and Clinical Characteristics of Adolescents Awaiting Inpatient Psychiatric Treatment (N = 27)

Characteristic^a	Results
Reason for admission, n (%)
SI	22 (81)
SA	5 (19)
Length of stay, d, median (IQR)	2 (2–3)
Required acute medical treatment, n (%)	5 (19)
Previous inpatient psychiatric hospitalization, n (%)	10 (37)
Psychiatric condition, n (%)^b
Depressive disorder	20 (74)
Anxiety disorder	8 (30)
Attention-deficit/hyperactivity disorder	5 (19)
Bipolar disorder or schizophrenia	3 (11)
Oppositional defiant disorder	4 (15)
Health conditions, n (%)
Chronic, noncomplex^c	7 (26)
Complex chronic^d	3 (11)

↵a Data were obtained from the electronic health record.
↵b Categories are not mutually exclusive, so percentages do not sum to 100.
↵c Identified by using the Chronic Condition Indicator system,¹⁵ excluding complex chronic conditions.
↵d Identified by using the complex chronic condition classification system.¹⁶

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TABLE 3

Key Thematic Areas and Sample Statements From Adolescents’ Descriptions of Their Hospital Experiences While Awaiting Inpatient Psychiatric Treatment

Thematic Area	Sample Statements
Supportive clinical interactions	“I feel like the people who are here with me for hours on end [seem to understand me].… Even witnessing the way I interact with my parents and just listening, they understand my frustrations and everything because I am talking to them the entire day.”
	“The nurses just seem really nice. They’re not really patronizing or they’re not being like, ‘Oh, I’m so fed up.’ They actually seem to care.”
Information needs	“What’s taking so long to find me a bed? Why am I still here?”
	“Well, at my [previous hospitalization], they really sugarcoated it. I really wish that they would have told me what other types of kids were going to be there. I really wish they would have told me what the place was like, because when I got there it was definitely much, much worse than they made it out to be.”
Repetitive inquiries	“I guess it was a little bit overwhelming, especially when multiple people would come in the room at once. Like when there was three different people in there and it was kind of just a little nerve wracking.”
	“Everybody was asking me questions about…how I got here and stuff like that. It made me feel overwhelmed and bad about myself.”
Safety	“I feel better. Because at first, I was scared, but now, I’m not scared.”
	“They wanted to make sure I was safe. And they asked me if I felt safe going home and I was like as much as I probably want to go home, I don’t feel safe.”
Previous hospital experiences	“I don’t know if I’m gonna get needles or not. I am very scared of needles.”
	“I mean, I'm a little scared. But I mean, I feel okay about it because I’ve actually been in one [a psychiatric unit] before, so I know how it goes.”
Activities and boredom	“I am kind of bored and just like a lot of sitting and just like I know I can’t really get up and then just walk around. And I started thinking that I don’t want to be here then I just get upset and stuff.”
	“I enjoy doing some arts and crafts. I enjoy doing coloring, watching movies, watching TV, just talking, playing games.”
Physical comfort	“The blankets are like the thinnest. And I’ve gotten used to the temperature, but it’s really cold in here.”
	“I would wanna stay here because this is a very comfortable bed.”
Emotions	“I’ve been less stressed, which means no suicidal thoughts.”
	“I was way worse but I guess now that I feel safe and stuff, I guess it’s kinda relaxing me a little bit. But I’m still anxious. I don’t know what’s next.”