Hospital admissions for stress-related presentations among school-aged adolescents during term time versus holidays in England: weekly time series and retrospective cross-sectional analysis.

Ruth Blackburn,Louise Mc Grath-Lone,Pia Hardelid,Linda Wijlaars,Roz Shafran,Omotomilola Ajetunmobi,Ruth Gilbert

doi:10.1192/bjo.2021.1058

Ruth Blackburn, Louise Mc Grath-Lone + Show 5 more

Open Access

https://doi.org/10.1192/bjo.2021.1058

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Journal: BJPsych open	Publication Date: Nov 1, 2021
Citations: 6	License type: CC BY 4.0

Affiliation: University College London

Abstract

Schools are a potential stressor for adolescents and may contribute to emergency hospital admissions. We describe rates of stress-related presentations (SRPs) among school-aged adolescents (11-17 years) during school terms and holidays, and explore differences by age and gender. Using national administrative hospital data, we defined an SRP as an emergency hospital admission with a primary diagnosis related to pain, psychosomatic symptoms (e.g. fatigue) or mental health problems, or with self-harm indicated in any diagnostic position. We estimated incidence rate ratios for weekly SRPs in term time versus holidays from 2014-2015 to 2017-2018, using negative binomial regression models, stratified by age and gender. We estimated the cumulative incidence of any SRP between 11 and 17 years by analysing prior hospital admission histories of adolescents with an SRP in 2017-2018. Over the 4-year study period, 305 491 SRPs in 171 013 school-aged adolescents accounted for 31% of emergency admissions for this group. SRPs were predominantly for mental health problems or self-harm (38%), or pain (35%). Weekly admission rates for SRPs were higher in term time than holidays for all ages (age-specific incidence rate ratios were 1.15-1.49 for girls and 1.08-1.60 for boys). Rates were highest for girls aged 14 and 15 years. The estimated cumulative incidence of any SRP between 11 and 17 years was 7.9% for girls and 4.1% for boys. Hospital admissions for SRPs are common among adolescents, affecting around two girls and one boy in every classroom. Higher rates in term time than holidays suggest that school factors may contribute.

Highlights

Schools are a potential stressor for adolescents and may contribute to emergency hospital admissions
Using national administrative hospital data, we defined an stress-related presentations (SRPs) as an emergency hospital admission with a primary diagnosis related to pain, psychosomatic symptoms or mental health problems, or with self-harm indicated in any diagnostic position
Over the 4-year study period, 305 491 SRPs in 171 013 schoolaged adolescents accounted for 31% of emergency admissions for this group

Summary

Methods

Using national administrative hospital data, we defined an SRP as an emergency hospital admission with a primary diagnosis related to pain, psychosomatic symptoms (e.g. fatigue) or mental health problems, or with self-harm indicated in any diagnostic position. The study population included all adolescents resident in England who were of secondary school age (i.e. aged 11–17 years) and had an emergency (i.e. unplanned) hospital admission between 1 September 2014 and 31 August 2018 (N = 591 576). We excluded adolescents who died in hospital because retrospective clinical coding at the time of hospital discharge may systematically differ for patients who died compared with those who were discharged alive. As one of the study objectives was to explore gender differences in rates of SRPs, we excluded adolescents with unrecorded gender and any pregnancy-related admissions.

Results

Discussion

Conclusion