Predictors of adolescent psychiatric rehospitalization: A multi-level framework

Background: Adolescent psychiatric rehospitalization is a growing public health concern, with estimated readmission rates ranging from 12-38% worldwide. Despite its significant impact on youth development and long-term outcomes, limited research addresses the multifactorial determinants underlying readmission risk. The multilevel framework draws from ecological models to contextualize risk across the lifespan. Objectives: This paper aims to provide (1) an overview of the scope of psychiatric rehospitalization during adolescence and into adulthood (2) a multilevel theoretical foundation of predictors for psychiatric rehospitalization and (3) potential avenues for future research and clinical practice. Methods: Guided by a multilevel theoretical perspective, a descriptive analysis was conducted to identify potential individual, interpersonal, institutional and societal factors that may influence adolescent and future adult rehospitalization to inpatient psychiatric units. Results: Key predictors of rehospitalization include severe psychiatric diagnoses, prior hospitalizations, family dysfunction, placement in out-of-home care, and inadequate aftercare services. Biological influences such as intergenerational trauma and epigenetic changes may further predispose adolescents to poor outcomes. Life transitions during sensitive developmental periods, socioeconomic disadvantage and minority status, although understudied, also contribute to disparities in mental health outcomes and rehospitalization. Conclusions: Applying a multilevel theoretical perspective reveals that adolescent psychiatric rehospitalization is shaped by the intersection of biological, psychological, social, and structural factors. A comprehensive multilevel framework can inform future research, policy, and clinical interventions to promote long-term recovery and reduce psychiatric rehospitalization.