16.6 A Change in Trajectory for Psychiatric Hospitalization Rates Among Children and Adolescents: Insights From 6 Years of Data in a Large Hospital System

Abstract

Suicide is the second leading cause of death in US adolescents. Self-injurious behaviors, suicide ideation, and attempts make up nearly 27% of national emergency department visits. In California, there has been an increase in pediatric psychiatric hospitalizations since 2007. Several factors have been identified, including interpersonal and family problems, abuse history, and poor coping skills. In this study, we examined the trend in pediatric psychiatric hospitalization between 2015 and 2020. Data were collected from a large Northern California health system that includes 49,430 patients under age 18 years. The total number of hospitalizations was examined yearly between 2015 and 2020. Location prior to hospitalizations was divided into subcategories to include the Kaiser Permanente (KP) San Jose Emergency Department, non-KP emergency departments, outpatient KP services, and others. For analysis, χ2 tests were used to compare proportions of hospitalization rates. Between 2015 and 2018, yearly hospitalizations were 53, 78, 167, and 198, respectively. Hospitalizations decreased to 150 (2019) and 144 (2020). When adjusting for increases in patient numbers within our system, there was a significant difference between 2018 and 2020 (p < 0.005), indicating a statistically significant downward trend in hospitalizations. Although rates of adolescent psychiatric hospitalizations increased between 2014 and 2018, there has been a decrease in our catchment area between 2019 and 2020. This may be due to the implementation of family therapy into the intensive outpatient program (IOP) as well as a DBT skills course post-IOP preventing rehospitalizations. Other factors leading to a downward trajectory may include patient demographics, increased awareness, and addressing of mental health needs in this population. Future directions include an analysis of these factors.