Key points How have hospitalizations for pediatric mental health conditions in acute care hospitals changed from 2009 to 2019? Findings In this retrospective analysis of a national data set representing approximately 4,767,840 pediatric hospitalizations, annual hospitalizations for mental health diagnoses increased from 160,499 in 2009 to 201,932 in 2019. Hospitalizations with a diagnosis of attempted suicide or self-harm increased from 49,285 in 2009 to 129,699 in 2019 and comprised 64% of mental health hospitalizations in 2019. Mental health hospitalizations accounted for more than a quarter of all hospitalization days and half of all inter-facility transfers for children and adolescents ages 3 to 17 in 2019. Meaning Mental health diagnoses, including suicide attempts and self-harm, accounted for an increasing number and proportion of pediatric acute care hospitalizations between 2009 and 2019. |
Importance
About 1 in 6 youth in the U.S. has a mental health condition, and suicide is a leading cause of death among this population. Recent national statistics describing acute care hospitalizations for mental health conditions are lacking.
Goals
To describe national trends in pediatric mental health hospitalizations between 2009 and 2019, compare utilization between mental health and non-mental health hospitalizations, and characterize variation in utilization across hospitals.
Design, environment and participants
Retrospective analysis of the 2009, 2012, 2016, and 2019 Children’s Inpatient Database, a nationally representative database of US acute care hospital discharges. The analysis included 4,767,840 hospitalizations weighted between children from 3 to 17 years of age.
Exhibitions
Hospitalizations with primary mental health diagnoses were identified using the Child and Adolescent Mental Health Disorders Classification System, which classified mental health diagnoses into 30 mutually exclusive disorder types.
Main results and measures
Measures included the number and proportion of hospitalizations with a primary mental health diagnosis and with a suicide attempt, suicidal ideation, or self-harm; number and proportion of inpatient days and inter-facility transfers attributable to mental health hospitalizations; mean length of stay (days) and transfer rates between mental health and non-mental health hospitalizations; and variation in these measures between hospitals.
Results
Of 201,932 pediatric mental health hospitalizations in 2019, 123,342 (61.1% [95% CI, 60.3%-61.9%]) were female, 100,038 (49.5% [95% CI, 48.3%]) were female. -50.7%]) were in adolescents aged 15 to 17 years, and 103,456 (51.3% [95% CI, 48.6%-53.9%]) were covered by Medicaid.
Between 2009 and 2019, the number of pediatric mental health hospitalizations increased by 25.8% , and these hospitalizations represented a significantly higher proportion of pediatric hospitalizations (11.5% [95% CI, 10.2%-12.8 %] vs. 19.8% [95% CI, 17.7%-21.9%]), days of hospitalization (22.2% [95% CI, 19.1%-25.3%] vs. 28.7% [95% CI, 24.4%-33.0%]) and inter-facility transfers (36.9% [95% CI, 24.4%-33.0%]) CI, 33.2 %-40.5%] versus 49.3% [95% CI, 45.9%-52.7%]).
The percentage of mental health hospitalizations with a diagnosis of suicide attempt, suicidal ideation, or self-harm increased significantly from 30.7% (95% CI, 28.6%-32.8%) in 2009 to 64.2% (95% CI 95%, 62.3%-66.2%) in 2019.
Length of stay and inter-facility transfer rates varied significantly between hospitals. Across all years, mental health hospitalizations had significantly longer mean lengths of stay and higher transfer rates compared to mental health hospitalizations.
Conclusions and relevance
- Between 2009 and 2019, the number and proportion of pediatric acute care hospitalizations due to mental health diagnoses increased significantly.
- The majority of mental health hospitalizations in 2019 included a diagnosis of suicide attempt, suicidal ideation or self-harm, underscoring the growing importance of this concern.
