Joseph Blader, PhD Identifies Major Changes in Acute Inpatient Care for Psychiatric Disorders

A recent article by Joseph Blader, PhD in the Archives of General Psychiatry describes a significant increase in the rates at which children and adolescents were hospitalized with a psychiatric diagnosis in the United States between 1996 and 2007.

The rate at which children aged 5 to 13 were hospitalized grew 81% during those years, from 156 for every 100,000 children in the general population to 283. The hospitalization rate for 14 to 19 year olds grew by almost 42%, from 684/100,000 to 969/100,000. During the same period, the rate for adults grew by only 8% and declined 17.5% for patients 65 or older. By 2007, the rate of hospitalization of adolescents was approaching the rate for adults and had surpassed the rate for the elderly.

The study was based on the annual National Hospital Discharge Survey, a program of the Center for Disease Control’s National Center for Health Statistics. The survey included all non-Federal general and children’s hospitals, as well as other care facilities with a mean length of stay less than 30.

Dr. Blader’s analysis suggested that the rise in hospitalization rates for children and adolescents was unlikely to result entirely from possible growth in rates of rehospitalizations,  but reflects an absolute rise in the number of individuals admitted to hospitals. It did appear, however, that a moderate rise in rehospitalization rates among adults might account for the growth in adult acute-care admissions.

While the average length of stay for all populations declined over this period, the sharp increase in hospitalization rates for children and adolescents resulted in an increase in the total annual days in the hospital for younger patients. Total hospital days stayed about the same for adults while the number of hospital days for the elderly declined significantly.

The growth of hospital days provided to children and adolescents was accompanied by a large increase in the proportion of days paid for by government sources (which accounted for 71% of the days for children and 62% of the days for adolescents in 2007) while the number of days paid by private sources declined significantly.

An increasingly higher percentage of patients of all ages were admitted through emergency rooms, although the slope of the increase was much steeper for children and adolescents than for adult and elderly patients. About 60% of psychiatric admissions came through an emergency room in 2007.

There were shifts in primary diagnosis as well. Diagnoses of bipolar disorder increased, while diagnoses of anxiety disorders declined. The rates of substance abuse disorders among psychiatric patients remained stable. Approximately  30% of all adult psychiatric patients had a secondary diagnosis of substance abuse.

Dr. Blader notes that the increases in hospital use by young people occurred despite pressures in the opposite direction—reductions in reimbursement, the growth of managed care and changes in public policy—suggesting that the increased use of hospital beds is based on clinical need rather than overuse.

Joseph Blader, PhD is an Assistant Professor in the Department of Psychiatry and Behavioral Science at Stony Brook University. His article, titled Acute Inpatient Care for Psychiatric Disorders in the United States, 1996 through 2007 was selected for early Online First release on August 1, 2011 in the Archives of General Psychiatry, a publication of the American Medical Association, and will appear in print in the December 2011 issue.