Outpatient Therapy and Risk of Rehospitalization for Youth With Eating Disorders

Eating disorders (EDs) are serious mental illnesses that affect youth of all socioeconomic backgrounds. However, low-income, publicly insured youth with EDs face substantial barriers to adequate treatment and often experience repeated hospitalizations with significant costs to families and care systems. We examined whether increased outpatient psychotherapy following hospitalization could break these "revolving door" cycles of admissions.

Participants were California Medicaid enrollees aged 7 to 18 years with diagnosed EDs who were hospitalized at least once (N = 920). We used Cox proportional hazard models to examine whether the amount of outpatient therapy youth received in the 90 days after hospitalization predicted rehospitalization in the subsequent 90 days, covarying demographic characteristics, ED diagnosis, admission length and type (primarily medical/psychiatric), and amount of outpatient therapy in the 90 days preceding admission.

Relative to youth who received 0 to 3 sessions of outpatient therapy in the 90 days after hospitalization, those who received 4 to 7 sessions had significantly reduced readmission risk in the subsequent 90 days (hazard ratio [HR] = 0.46; 95% CI, 0.23-0.91; P = .026). Risk was further reduced for youth who received 8 or more sessions (nearly weekly) (HR = 0.04; 95% CI, 0.004-0.34; P = .003). Cost savings associated with 8 or more therapy sessions were estimated at nearly $70 000 per youth. However, only a small minority of the population (4.5%) received at least 8 sessions, with the modal number of sessions being zero.

Even a moderate amount of outpatient therapy may substantially reduce rehospitalization in publicly insured youth with EDs, decreasing morbidity and costs.