SAN DIEGO – Between 1996 and 2004, the rate of psychiatric hospitalization for children increased 40% while the rate for adolescents increased 39%, according to an analysis of National Hospital Discharge Survey data.
At the same time, the hospitalization rate for adults increased by 10%, Joseph C. Blader, Ph.D., reported during a poster session at the annual meeting of the American Academy of Child and Adolescent Psychiatry.
The findings are surprising, said Dr. Blader, considering efforts over the past decade by health insurers and advocacy groups to reduce reliance on restrictive settings that separate children from their families to address psychiatric emergencies and psychiatric illness.
“I think there's a tendency to regard psychiatric inpatient care as kind of old school and say, 'it's really not something that we should be devoting a lot of resources to studying or learning about outcomes. We should be devoting attention to community resources,'” Dr. Blader, of the department of psychiatry at Stony Brook (New York) University School of Medicine, said in an interview. “That's a very worthy goal, but the reality is, utilization of inpatient hospitalization continues to proliferate. In some respects it's still a broken system [for] the very ill.”
In a study funded by the National Institute of Mental Health, Dr. Blader and his associate Dr. Gabrielle A. Carlson examined National Hospital Discharge Survey data between 1998 and 2004 to compare the rates of psychiatric admission among children aged 5–13 years, adolescents aged 14–19 years, and adults aged 20–64 years. They grouped their analysis into three time periods: 1996–1998, 1999–2001, and 2002–2004.
Among children, the rate of psychiatric hospitalization, averaged over the three time periods, rose 40% from 18 per 10,000 in 1996–1998 to 25 per 10,000 in 2002–2004. The mean length of hospital stay dropped 12% from 12 days in 1996–1998 to 11 days in 2002–2004.
Among adolescents, the rate of psychiatric hospitalization rose 39% from 62 per 10,000 in 1996–1998 to 86 per 10,000 in 2002–2004. The mean length of stay dropped 8% from 8 days in 1996–1998 to 7 days in 2002–2004.
Among adults, the rate of psychiatric hospitalization rose 10% from 112 per 10,000 in 1996–1998 to 123 per 10,000 in 2002–2004. The mean length of stay dropped 14% from 8 days in 1996–1998 to 7 days in 2002–2004.
Dr. Blader and Dr. Carlson also noted that increased hospitalization rates corresponded with an increasing number of bipolar disorder diagnoses made in children and adolescents. “Whereas in 1996 the most common diagnostic combination was ADHD plus disruptive disorder, by 2003 bipolar disorder plus either ADHD or a disruptive disorder was most common,” they wrote in their poster.
“One inference is that the bipolar diagnosis has supplanted one element of the earlier ADHD plus [opposition defiance disorder/conduct disorder] constellation to denote similar clinical phenomenology.
This shift may reflect greater appreciation of the importance of affective dysregulation in this patient group or 'upcoding' to putatively more severe conditions for reimbursement.”