The relationship between school attendance and rehospitalization rates in preadolescent patients with suicidal behavior – initial experiences

Czech version

Authors: Markéta Holá; Katarína Jaššová; Tereza Podhorná
Authors‘ workplace: Oddělení dětské psychiatrie, Fakultní Thomayerova nemocnice, Praha
Published in: Čes. a slov. Psychiat., 121, 2025, No. 6, pp. 268-276.
Category: Original Article
doi: https://doi.org/10.48095/cccsp202522

Overview

Objective: The objective of this exploratory study was to highlight the clinically significant but understudied role of school attendance in preadolescent patients with suicidal behavior. We provide a brief initial literature review and share the first version of an original questionnaire designed to map the issues of rehospitalization and school attendance in patients hospitalized for suicidal behavior. Using this questionnaire, we attempted to map whether patients from our sample are able to maintain school attendance one year after discharge, whether maintaining school attendance has a positive impact on the rate of rehospitalization, and whether outpatient care is associated with lower rates of rehospitalization and maintained school attendance. Materials and methods: We examined a group of patients aged 10–14 years who were hospitalized in a child psychiatric ward in 2022 due to suicidal behavior (ranging from suicidal ideation to a suicide attempt). A total of 53 patients were included, of whom 9 were boys and 44 were girls, with a total average age of 12.77 ± 1.25 years. The primary source of data was a questionnaire for legal guardians, originally created for this study, administered via telephone interview. Key items included the number of rehospitalizations, school attendance, and outpatient care received during the study period. The questionnaire was collected during 2024. Fisher‘s exact test was used for the statistical analysis of categorical variables, and the Mann-Whitney U test was used for the analysis of the frequency of visits to an outpatient child psychiatrist. Results: Out of the 53 patients, according to their legal guardians, 34 (64.2%) were able to attend school one year after discharge, and 33 (62.3%) did not require rehospitalization during the monitored period. Patients who managed to attend school were 7.6 times less likely to be rehospitalized (P = 0.001). Patients who did not manage to attend school underwent family therapy 4.2 times more often (P = 0.020), and patients rehospitalized for mental health issues other than suicidal behavior attended family therapy more often than patients rehospitalized for suicidal ideation or suicide attempts compared to those patients who were not rehospitalized at all (P = 0.003). Higher patient age (13–14 years vs. 10–12 years) was associated with a 4.6-fold higher rate of rehospitalization (P = 0.036). At the same time, patients aged 13–14 years had a 4.2 times lower chance of maintaining school attendance, although the result did not reach the significance threshold (P = 0.068). No other outpatient care modalities were associated with school attendance or rehospitalization rates. Conclusion: Patients whose legal guardians reported regular school attendance had a significantly lower chance of rehospitalization during the follow-up period. Our conclusions regarding inpatient care are consistent with publications describing the protective role of school attendance against preadolescent suicidality. The design of this exploratory study does not allow us to determine causality and thus confirm school attendance as a protective factor, but it shows that it is associated with a lower number of rehospitalizations and family therapy. We call for cooperation in the further development of the methodology and research on this issue.

Keywords:

suicidal behavior – outpatient care – chronic absenteeism – preadolescent children – rehospitalization – school attendance

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MUDr. Markéta Holá

Oddělení dětské psychiatrie

Fakultní Thomayerova nemocnice

Vídeňská 800

140 59 Praha 4

e-mail: marketa.hola@ftn.cz