Study finds decrease in inpatient hospitalizations for the elderly with psychiatric diagnosis

Short-stay inpatient hospitalizations for children and adolescents with a psychiatric diagnosis increased significantly over a 12-year period (1996 to 2007) and decreased for the elderly, according to a report in the early online edition in Archives of General Psychiatry by Joseph C. Blader, Ph.D., Assistant Professor, Department of Psychiatry & Behavioral Science at Stony Brook University School of Medicine. The article describing the research, "Acute Inpatient Care for Psychiatric Disorders in the United States, 1996 Through 1997," will also appear in the journal's December 2011 print edition.

"The study is based on the annual National Hospital Discharge Survey (NHDS), a program of the Center for Disease Control's National Center for Health Statistics," said Dr. Blader. "The survey included all non-Federal general and children's hospitals, as well as other care facilities with a mean length of stay of less than 30 days. We used demographic, clinical and payment data from NHDS on a probability sample of discharges from short-stay facilities. Patients included in the study had a primary psychiatric diagnosis and were grouped as children (ages 5 to 13 years), adolescents (ages 14 to 19 years), adults (ages 20 to 64 years) or elderly individuals (ages 65 years and older). Payers were classified as private, government or other (self-pay, no charge and other payment)," added Dr. Blader, summarizing the study methodology.

The results of the study indicated that the rate on inpatient hospitalization for psychiatric disorders among children rose 81 percent during the period, from 156 per every 100,000 children in the general population to 283. The hospitalization rate for adolescents rose by almost 42 percent, from 684 to 969 per 100,000. The hospitalization rate for adults rose by only 8 percent but declined by 17.5 percent among elderly patients. By 2007, the rate of acute psychiatric hospitalization of adolescents was approaching the rate for adults.

"A substantial increase in acute care psychiatric hospitalization rates and inpatient occupancy for children and adolescents, a moderate increase in the hospitalization rate of adults, and a steep decline for elderly individuals represent significant developments in mental health treatment in the United States with potentially strong ramifications for quality of care and service financing," writes Dr. Blader. "Investigation of the clinical and organizational determinants of these trends, and their impact on patient outcomes, are vital to understanding their implications."

In describing the historical context for this study, Dr. Blader notes that inpatient care for psychiatric conditions in short-stay settings increased from 1970 through the 1990s as long-term psychiatric hospitalization decreased. Since then, however, payers have sought to reduce expenditures for these acute care settings, and mental health policy makers and advocates have emphasized development of less restrictive and stigmatizing alternatives to manage severe crises associated with many psychiatric disorders.

Accordingly, psychiatric admissions to U.S. acute inpatient services declined between 1990 and 2000, but surveys of mental health facilities hinted at an overall increase in more recent years, Dr. Blader noted. His study also endeavored to examine these trends in more detail for separate age groups.

"The fact that this recent rise occurred despite pressures toward minimizing hospitalizations for psychiatric illness suggests that rising hospitalization rates for youth more likely correspond to clinical need rather than overuse," emphasizes Dr. Blader.

Along with finding that youth and non-elderly adults spent more days in acute inpatient care for psychiatric disorders, Dr. Blader reports that the proportion of care reimbursed by private insurance dropped considerably, while payment from government sources rose.

The survey results also revealed 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 during the period, with approximately 30 percent of adult psychiatric patients receiving had a secondary diagnosis of substance abuse.