Adolescents With Externalizing Disorders Requiring Inpatient Care: A Register-Based Follow-Up Study of Rehospitalizations, Diagnostic Stability, and Mortality Over 10 Years

We examined the need for rehospitalization, diagnostic stability, and mortality in severe externalizing disorders among adolescents aged 13 to 17 years who were admitted to psychiatric inpatient care for the first time in their lives. Adolescents with their first psychiatric inpatient admission between 1980 and 2010 in Finland were identified using a nationally representative care register and followed for 10 years in registers. Of the total of 17,112 adolescents, 3,611 had their initial admission due to externalizing disorders. Over the decades, the number of adolescents hospitalized for externalizing disorders increased, while their intake Global Assessment Scale scores declined. Nearly half of the young people first hospitalized due to externalizing disorders were rehospitalized. In readmissions, externalizing diagnoses were most commonly maintained; however, over one-third of those readmitted experienced a diagnostic shift to schizophrenia spectrum disorders. Adolescents initially hospitalized due to externalizing disorders showed higher mortality rates compared to those admitted due to other psychiatric conditions. Despite the increasing number of adolescents admitted for externalizing disorders over the decades, their symptom severity and prognosis regarding readmissions have not improved. These findings do not support the idea that the rise in inpatient admissions is related to the medicalization of phenomena previously considered normative or managed in different contexts.