Kids’ Mental Health Hospitalizations Surged Over Past Decade

Pediatric hospitalizations for mental health diagnoses increased significantly from 2009 to 2019, with most cases in 2019 involving attempted suicide or self-injury, a retrospective analysis showed.

Among over 200,000 pediatric hospitalizations, the proportion of those involving attempted suicide, suicidal ideation, or self-injury diagnoses significantly increased from 30.7% in 2009 to 64.2% in 2019, reported Mary Arakelyan, MPH, of Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire, and co-authors in JAMA.

The overall number of mental health hospitalizations increased by 25.8% over this time period, and accounted for an increasing proportion of:

• Pediatric hospitalizations: 11.5% in 2009 vs 19.8% in 2019
• Hospital days: 22.2% vs 28.7%, respectively
• Interfacility transfers: 36.9% vs 49.3%

These increases underscore the rapidly growing mental health crisis for children and adolescents in the U.S., Arakelyan said, during an ongoing shortage of trained mental health professionals to care for these patients.

According to co-author JoAnna K. Leyenaar, MD, PhD, MPH, also of Dartmouth Hitchcock Medical Center, this trend became more stark when considering the database used to conduct the analysis — the Kids’ Inpatient Database, a nationally representative database of U.S. acute care hospital discharges — which does not include emergency department visits that do not lead to inpatient stays.

“If you envision that most of these hospitals contained in this study are the hospitals that are accessible to anyone in our communities … [this] suggests a potential shortage of resources and communities and schools to address mental health conditions before they are so severe that families feel that the emergency department at an acute care hospital is the right place for them to go,” Leyenaar told MedPage Today.

These findings suggest that the reasons for pediatric admission to hospitals is changing, she added, while training for mental health care continues to fall behind the increasing community needs.

“There’s minimal mental health training for most pediatric residents,” she said. “That really speaks to the gap between the needs of our patients and our current educational system.”

In addition to the increased caseload, the authors highlighted the significant increase in the severity of cases, with the number of children hospitalized with four or more unique mental health disorders increasing from 19.7% in 2009 to 42.4% in 2019 (P<0.001).

Of note, the proportion of hospitalizations among girls also significantly increased, from 51.8% in 2009 to 61.1% in 2019 (P<0.001).

“We see that across all years, depressive disorders are the most common primary diagnosis among these mental health hospitalizations,” Arakelyan told MedPage Today. “Those hospitalizations with the primary diagnosis of depressive disorders also involved suicide attempt, suicidal ideation, or self-injury, so that’s really important to call out [to show] the severity of the crises that are bringing children and adolescents into acute care hospitals.”

Jacob Ballon, MD, MPH, of Stanford University in California, who was not involved with the study, told MedPage Today that these trends show the challenges that mental health care professionals face in trying to meet the needs of these patients.

“This article shines a light on what clinicians have all become aware of — that there’s a shortage of child psychiatrists overall, that the kids who come into care are increasingly acute, and with increasingly complex and serious problems, and the resources that folks would turn to for support in the community and in hospitals are vanishingly rare as the need has continued to increase substantially,” Ballon said.

He added that primary care pediatricians, nurse practitioners, and physician assistants will be needed to help address this significant gap in care.

For this retrospective analysis, Arakelyan and colleagues included data from 2009, 2012, 2016, and 2019 from the Kids’ Inpatient Database, including 4,767,840 weighted hospitalizations among children ages 3 to 17 years. Hospitalizations with primary mental health diagnoses were identified using the Child and Adolescent Mental Health Disorders Classification System, which classified diagnoses into 30 mutually exclusive disorder types.

Of the 201,932 pediatric mental health hospitalizations in 2019, 61.1% were in girls, 49.5% were in adolescents ages 15 to 17 years, and 51.3% were covered by Medicaid.

One notable limitation to the analysis was that two key diagnostic tools were updated during the study period — ICD-9 to ICD-10 and DSM-IV to DSM-5 — which may have influenced some of the total counts for specific disorders, Arakelyan and team said.

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