Acute Inpatient Care for Psychiatric Disorders in the United States, 1996 Through 2007

Abstract

Data from facility-level surveys indicate that US inpatient psychiatric admissions rose in 2004, from their trough in 1998 to 2000, mainly in acute care settings. Patient-level factors, including age, admission type, diagnoses, length of stay, and payment source, are vital to understanding hospitalization trends. To evaluate trends in acute care hospitalizations for primary psychiatric diagnoses between 1996 and 2007 in relation to patient-level variables. Design, Setting, and The yearly National Hospital Discharge Survey furnished demographic, clinical, and payment data on a probability sample of discharges from short-stay facilities (mean [SD], 448.33 [19.66]), along with weights for extrapolation to population estimates. Discharges with a primary psychiatric diagnosis (mean [SD], 19535 [2615]) were identified among children (aged 5-13 years), adolescents (aged 14-19 years), adults (aged 20-64 years), and elderly individuals (≥65 years). Annual rates of discharges and total days of inpatient care associated with primary psychiatric diagnoses for each age group. Psychiatric discharges increased for children from 155.54 per 100000 children in 1996 to 283.04 per 100000 in 2007 (P=.003); for adolescents, from 683.60 to 969.03 per 100000 (P=. 001); and for adults, from 921.35 to 995.51 per 100000 (P=.003) but declined for elderly individuals from 977.63 to 807.55 per 100000 (P<.001). Total inpatient days increased for children (1845 days per 100000 in 1996 to 4370 days in 2007; P=.02) and for adolescents (5882 days per 100000 in 1996 to 8247 days in 2007; P<.001) but decreased for elderly patients (10348 days per 100000 in 1996 to 6517 days; P<.001). The proportion of inpatient days paid by private sources declined among children (36%-21%), adolescents (52%-22%), and adults (35%-23%; all P<.001). Inpatient discharges in short-stay facilities with a primary psychiatric diagnosis rose between 1996 and 2007, most dramatically for youth, but decreased among elderly individuals. Private funding bore a declining share of costs.