This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (3)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Psychiatry, Other  • Alert me on articles by topic  Social Bookmarking   What's this?

Brady G. Case, MD; Mark Olfson, MD, MPH; Steven C. Marcus, PhD; Carole Siegel, PhD

Arch Gen Psychiatry. 2007;64(1):89-96.

Context  Previous work has demonstrated marked changes in inpatient mental health service use by children and adolescents in the 1980s and early 1990s, but more recent, comprehensive, nationally representative data have not been reported.

Objective  To describe trends in inpatient treatment of children and adolescents with mental disorders between 1990 and 2000.

Design and Setting  Analysis of the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, a nationally representative sample of discharges from US community hospitals sponsored by the Agency for Healthcare Research and Quality.

Patients  Patients aged 17 years and younger discharged from US community hospitals with a principal diagnosis of a mental disorder.

Main Outcome Measures  Changes in the number and population-based rate of discharges, total inpatient days and average length of stay, charges, diagnoses, dispositions, and patient demographic and hospital characteristics.

Results  Although the total number of discharges, population-based discharge rate, and daily charges did not significantly change between 1990 and 2000, the total number of inpatient days and mean charges per visit each fell by approximately one half. Median length of stay declined 63% over the decade from 12.2 days to 4.5 days. Declines in median and mean lengths of stay were observed for most diagnostic categories and remained significant after controlling for changes in background patient and hospital characteristics. Discharge rates for psychotic and mood disorders as well as intentional self-injuries increased while rates for adjustment disorders fell. Discharges to short-term, nursing, and other inpatient facilities declined.

Conclusions  The period between 1990 and 2000 was characterized by a transformation in the length of inpatient mental health treatment for young people. Community hospitals evaluated, treated, and discharged mentally ill children and adolescents far more quickly than 10 years earlier despite higher apparent rates of serious illness and self-harm and fewer transfers to intermediate and inpatient care.

Author Affiliations: Department of Psychiatry, New York University School of Medicine, New York (Drs Case and Siegel); New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University, New York (Dr Olfson); and University of Pennsylvania School of Social Policy and Practice, Philadelphia (Dr Marcus).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Review: limited evidence to support specialist mental health services as alternatives to inpatient care for young people with severe mental health disorders
Olfson
Evid. Based Ment. Health 2009;12:117-117.
FULL TEXT  

Reduction of Restraint and Seclusion Through Collaborative Problem Solving: A Five-Year Prospective Inpatient Study
Martin et al.
Psychiatr. Serv. 2008;59:1406-1412.
ABSTRACT | FULL TEXT  

Pediatric Bipolar Disorder
Leibenluft and Rich
Focus 2008;6:331-347.
ABSTRACT | FULL TEXT  

Increase in out-based physician diagnoses of bipolar disorder in youth in the USA
Blader
Evid. Based Ment. Health 2008;11:60-60.
FULL TEXT