10. Addressing Adolescent Sexual and Reproductive Health Needs during Inpatient Psychiatric Admission

Abstract

Background

Both adolescents and people with psychiatric disorders are disproportionately affected by adverse sexual and reproductive health (SRH) outcomes but little is known about their specific SRH needs. Inpatient settings provide a unique opportunity to address SRH concerns because adolescents often miss out on school-based SRH education when hospitalized. The primary objective was to identify adolescent patients’ perceptions of the SRH services they are receiving at an inpatient adolescent psychiatric unit in Honolulu, Hawai'i.

Methods

The Queen's Medical Center Institutional Review Board (IRB; protocol RA-2020-26) approved this qualitative research study. We identified patients aged 14-19 admitted to the inpatient psychiatric unit who had received SRH care during their current admission. Permission to approach patients was obtained from the patient's primary attending and written informed consent was obtained at the time of each interview. We conducted semi-structured interviews with participants about their experiences with SRH care until thematic saturation was reached. The interviews were recorded, transcribed, and analyzed through the iterative process of content analysis to identify themes and relationships between ideas.

Results

Eleven adolescents were interviewed from 2022-2023. We collected patient demographics and clinical characteristics, including race, diagnosis, and type of SRH services received. Six themes were identified: 1) patients value healthcare providers’ experience and expertise, 2) inpatient hospitalization is an appropriate time to address SRH needs, 3) interaction between mental health and decision making for SRH choices is complex, 4) access to SRH care in the outpatient setting is variable and dependent on social factors, 5) female family members play a key role in SRH care, and 6) most patients received SRH education in school and deemed school is an appropriate place to learn this information despite some negative aspects of the school-based setting.

Conclusions

This study revealed the important role of healthcare providers in the inpatient setting and female family members in the outpatient setting in supporting adolescents with psychiatric disorders and their SRH needs. Healthcare providers are accessible to adolescents during an inpatient admission while access in the outpatient setting can be highly dependent on social support factors. The inpatient setting is a valuable place to address adolescents’ SRH needs and should be linked to outpatient resources for continuity of care following hospital discharge.