Major Finding: In 1996-2007, hospitalizations for primary psychiatric diagnoses in children aged 5-13 years jumped from 15.6 per 10,000 population to 28.3. In the same period, hospitalization rates rose by 42% in adolescents aged 14-19 and 8% for adults aged 20-64.
Data Source: Representative, nationwide database maintained by the Centers for Disease Control and Prevention.
Disclosures: Dr. Blader had no disclosures.
NEW YORK — During the period 1996-2007, hospitalization rates for psychiatric disorders among American children aged 5-13 years rose dramatically, nearly doubling during that period.
Concurrently, psychiatric hospitalizations for U.S. adolescents (aged 14-19 years) also rose substantially, by 42%. During the same period, psychiatric hospitalizations rose modestly (by 8%) for adults aged 20-64 years, whereas psychiatric hospitalizations for Americans aged 65 or older fell dramatically, Joseph C. Blader, Ph.D., said while presenting a poster at the meeting.
The reasons behind these changes and their implications remain unclear, said Dr. Blader of the State University of New York at Stony Brook, but the shifts in hospitalization rates – especially the larger such shifts among children and adolescents – raise concerns that demand further analysis.
“It's not a good thing” that substantially more children and adolescents require hospitalization for psychiatric diagnoses, Dr. Blader said in an interview. The shifts “represent a significant development in mental health treatment in the United States,” he said in the poster.
The data Dr. Blader analyzed came from the Centers for Disease Control and Prevention's National Hospital Discharge Survey and also showed that in 1996-2007, payment for the psychiatric hospitalizations underwent a significant shift away from private insurance coverage and toward an increased share of the hospitalizations paid for by government agencies, most typically Medicaid.
According to Dr. Blader, the questions now are, Does the rise in hospitalizations result from “problems in the level of services provided by community care,” and has “more cost shifting” of patients into Medicaid from private insurance led to or resulted from the rise in hospitalizations?
“Beneficiaries of publicly funded inpatient care may have become disproportionately vulnerable to psychiatric emergencies,” or perhaps the effect “indicates better outpatient care among the privately insured,” he said in his poster. “In many states, privately insured patients with extended psychiatric hospitalizations become eligible for Medicaid coverage.”
He noted that during the period studied, the psychiatric field made a diagnostic shift: More children who engage in injurious behavior are being labeled with bipolar disorder. He also speculated that the increasingly complex polypharmacy treatment of psychiatric patients, including children, might be a factor boosting hospitalizations.
In 1996-2007, the rate of hospitalization for a primary diagnosis of a psychiatric disorder in children aged 5-13 years rose from 15.6 per 10,000 U.S. residents to 28.3. In adolescents aged 14-19 years, the rate rose from 68.4 per 10,000 to 96.9, while in those aged 20-64 years, the rate increased from 92.1 per 10,000 to 99.1. All of the changes were statistically significant. Dr. Blader's poster did not report rates for patients aged 65 or older, but in his analysis, this number fell “dramatically” from 1996 to 2007, he said.
During the period studied, private insurance coverage of these psychiatric hospitalizations among children fell from 36% of cases to 23%, while government-based sources of payment rose from 63% of cases to 71%. Among adolescents, private payment fell from 52% of cases to 22% while government coverage rose from 44% to 62%. Among adults, private coverage fell from 36% to 23%, while government coverage was flat, at 58% in 1996 and 59% in 2007.
The shifts 'represent a significant development in mental health treatment in the United States.'
Source DR. BLADER