1. The Interaction of Hospitalizations and Psychotropic Medications
in Response to Juvenile Runaway Attempts
Katrina M. Poppert, Amanda L. Moen, Laura B. Hasemann University of Nebraska-Lincoln
Introduction
Recent estimates approximate that 1.6 million adolescents run away from home each year and are therefore more likely to engage in substance abuse and delinquent behavior (Walsh & Donaldson, 2010). Research finds that adolescents are at a larger risk for runaway behavior when they experience increased problems at home and school and in peer relations (English & English, 1999), use of illegal substances excluding cannabis (Pages, Arvers, Hassler, & Choquet, 2004), and parental conflict (Hoshino, 1973), including poor parent-child relationships (Pages, Arvers, Hassler, & Choquet, 2004). Further, those attempting to escape are more likely to be living in a depressive or limited environment or have a distorted view of life (Hoshino, 1973).
Empirically-based research demonstrates a positive correlation between chemical dependency, longevity in the foster care system, and runaway attempts (Slesnick & Meade, 2001). Adolescents with a history of runaway attempts also engaged in high rates of substance abuse (Slesnick et al., 2009). Additionally, adolescents with familial chemical dependency were twice as likely to attempt suicide (Greene & Ringwalt, 1996). Although no connection between prior suicide attempts and system longevity has been found, adolescents did report taking more prescribed psychotropic medications the longer their involvement in the foster care system.
Studies find that adolescents staying in runaway shelters reported attempting suicide in the past (Stiffman, 1989). Groups at high risk for suicidal behavior include homeless and runaway adolescents (Spirito & Esposito-Smythers, 2006). Analyses indicate that substance abuse, behavior problems, family instability (Stiffman, 1989), depressive mood, low self-esteem, and poor-parent child relationships (Pages, Arvers, Hassler, & Choquet, 2004) play a significant role in prior suicide attempts. Adolescents who attempt suicide are at greater risk for hospitalization than other adolescents engaging only in runaway behavior (Pages, Arvers, Hassler, & Choquet, 2004). Further, adolescents who are suicidal are more likely to be receiving psychotropic medications (Pelkonen, Marttunen, Pulkkinen, Laippala, & Aro, 1997) and have longer hospital admissions (Dean, McDermott, Marshall, 2006).
The current study examined adolescent runaway attempts, chemical dependency, and age and their influence on prior hospitalizations. Also, the study investigated the use of psychotropic medications and their relation to runaway attempts, prior suicide attempts, and removal from treatment by the judicial system. Runaway attempts were found to be significantly related to prior hospitalizations and the prescription of psychotropic medications in adolescents.
Results
A 3-way between groups ANOVA was used to examine the main effects and interactions of Age, Chemical Dependency, and Runaway Attempts as they relate to the number of Hospitalizations (Figure 1). There was a significant 3-way interaction, F(1, 36) = 6.23, p = 0.017, MSe = Examination of the cell means (using LSDmmd = 1.173) reveals that, as hypothesized, adolescents with Chemical Dependency had an increased amount of Runaway Attempts. When examining Runaway Attempts, adolescents aged and years had more Hospitalizations when they were Chemically Dependent. For adolescents aged years, Chemical Dependency did not influence Hospitalizations. For individuals without prior Runaway Attempts, Chemical Dependency did not influence Hospitalizations for any ages. There were not any significant 2-way interactions when examining Age and Chemical Dependency, F(2, 36) = 1.70, p > 0.05, Age and Runaway Attempts, F(2, 36) = 2.764, p > 0.05, or Runaway Attempts and Chemical Dependency, F(1, 36) = 2.148, p > The pattern of the simple 2-way interactions was such that, all patterns were descriptive for adolescents with no Runaway Attempts, but misleading for those with Runaway Attempts.
A 3-way between groups ANOVA was used to examine the effects of Runaway Attempts, Removal from treatment by the judge, and Suicide Attempts as they relate to the use of Psychotropic Medications (Figure 2). There was a significant 3-way interaction, F(1, 38) =6.210, p = 0.017, MSe = For adolescents with prior Runaway Attempts, prescription of Psychotropic Medications was not influenced by Suicide Attempts or Removal from Treatment by the judicial system. For those without prior Runaway Attempts, there was no influence of previous Suicide Attempts. However, prescription of Psychotropic Medications was greater for those who were removed from Treatment by the judicial system. Examination of the cell means (using LSDmmd = 0.553) reveals that, contrary to the hypothesis, adolescents with prior Suicide Attempts would not have any Runaway Attempts and would be more likely to be removed from their treatment program by the judicial system. There were no significant 2-way interactions when examining Suicide Attempts and Removal from Treatment, F(1, 38) = 1.388, p > 0.05, Suicide Attempts and Runaway Attempts, F(1, 38) = 1.388, p > 0.05, or Removal from Treatment and Runaway Attempts, F(1, 38) = 0.183, p > In the simple 2-way interactions, all patterns were descriptive for adolescents with prior Runaway Attempts, but misleading for those without Runaway Attempts.
Figure 1.
Figure 2.
Discussion
Results indicate that there is a significant relationship between runaway attempts, age, chemical dependency and their relationship to prior hospitalizations. Adolescents ages were at greatest risk for runaway attempts, chemical dependency, and ultimately hospitalizations. The study also found a significant relationship between runaway attempts, suicide attempts, and removal from treatment by a judge and their relationship to prescription of psychotropic medications. Although runaway attempts did not significantly relate to the use of psychotropic medications, when examining their status of treatment, adolescents with and without suicide attempts were prescribed psychotropic medications at higher levels.
The results of this study are similar to findings by Pages, Arvers, Hassler, and Choquet in that, the use of illegal substances and chemical dependency are correlated with runaway attempts (Pages, Arvers, Hassler, & Choquet, 2004). Further, results indicate that adolescents at high risk for suicidal behavior are more likely to receive psychotropic medication in agreement with the findings by Pelkonen, Marttunen, Pulkkinen, Laippala, and Aro, Finally, the significant relationship between those at high risk for suicide attempts and prior runaway attempts supports previous research in this area (Spirito & Esposito-Smythers, 2006).
Methods
Information was collected from an ongoing treatment protocol. Participating adolescents ranged in age from 13 to 20 years (M=16.36, SD=1.55); 44.7% were male, and 55.3% were female. For the purposes of this study, participants were separated by age into three equal groups, with those between the ages of 13 and 15 in Group 1, those between the ages of 16 and 17 in Group 2, and those between the ages of 18 and 20 in Group 3. Participating adolescents were predominantly European American.