Citation

Egorova NN, Pincus HA, Shemesh E, Kleinman LC. Psychiatr. Serv. 2018; 69(8): 910-918.

Affiliation

Dr. Egorova is with the Department of Population Health Science and Policy, and Dr. Shemesh is with the Department of Psychiatry and Pediatrics, Icahn School of Medicine at Mount Sinai, New York. Dr. Kleinman is with the Center for Child Health and Policy, University Hospitals Rainbow Babies and Children's Hospital, and the Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland. Dr. Pincus is with the Department of Psychiatry and with the Irving Institute for Clinical and Translational Research, Columbia University, New York.

Copyright

(Copyright © 2018, American Psychiatric Association)

DOI

10.1176/appi.ps.201700389

PMID

29852825

Abstract

OBJECTIVE: The study described rates and characteristics of U.S. children hospitalized with a behavioral (mental or substance use) disorder.

METHODS: This cross-sectional analysis of data from the 2012 Kids' Inpatient Database included 483,281 hospitalizations in general and children's hospitals of persons under age 21 with a primary or secondary behavioral diagnosis.

RESULTS: The admission rate with any behavioral diagnosis was 5.5 per 1,000 children in the U.S. population, with 2.9 having a primary behavioral diagnosis. Common primary diagnoses included depression (34%), other mood (31%), psychotic (9%), and substance use (7%) disorders. The most common behavioral diagnoses secondary to a primary diagnosis that is not behavioral were depression (26%), attention-deficit disorder (26%), and substance use disorders (22%). Suicide or self-harm was rarely the primary diagnosis (.1%) but complicated 12% of admissions with a primary behavioral diagnosis. Variations in admissions (per 1,000 children in the U.S. population) with a primary behavioral diagnosis were noted by race-ethnicity (blacks, 3.2; whites, 2.9; and Hispanics, 1.4), insurance (public, 2.9; private, 2.0), and geographic region. Fifty-nine of every 1,000 peripartum admissions in the 12-20 age group had a secondary behavioral diagnosis. Patients with behavioral comorbidities were more likely to be transferred to another facility (8.0% versus 2.2%, p<.001). Behavioral disorders comorbid to nonbehavioral disorders increased length of stay (4.3 versus 3.3 days, p<.001) and costs ($12,742 versus $9,929, p<.001).

CONCLUSIONS: Nearly 500,000 pediatric admissions in 2012 included behavioral disorders. Comorbidities were associated with longer stays and an estimated $1.36 billion additional annual costs, which were disproportionately borne by public insurance.

Language: en

Keywords

Adolescent Pregnancy; Child psychiatry/general; Epidemiology; Health Care Cost and Quality; Health Services Research; Pediatrics