Psychiatric Diagnoses and the Use of Psychiatric Medication in Pediatric Ventricular Assist Device Recipients

Abstract

Purpose Mental health issues in the pediatric VAD population are poorly understood. Data from the adult VAD population suggests a high prevalence of psychiatric distress, often resulting in prophylactic or adjunctive treatment with psychiatric medications. We investigated the prevalence of psychiatric diagnosis and psychiatric medication usage in pediatric VAD recipients. Methods and Materials A retrospective study of the Pediatric Health Information System, a large administrative database of 43 US children’s hospitals, was performed for patients 6-20 years of age undergoing VAD placement from 2000-2010. Results 70 of 238 patients (29.4%) with VADs had documented psychiatric diagnoses, most commonly adjustment disorders (n=24). 59 of 238 (24.8%) patients with VADs received psychiatric medication (excluding benzodiazepines) during hospitalization, most commonly antidepressants (n=41). Of the patients who received psychiatric medication, 34 of them (56%) had documented psychiatric diagnoses. Of the 70 patients with documented psychiatric diagnoses, 33 of them (47%) received psychiatric medication. None of the patients who received antidepressant medication had documented diagnoses of depression. Patients who had a stroke were more likely to have been treated with psychiatric medications (p=0.04). Hospital length of stay (LOS) and total charges were greater among patients treated with psychiatric medications (p Conclusions One quarter of pediatric VAD patients received psychiatric diagnoses and one quarter were treated with psychiatric medications. Nearly half of patients receiving psychiatric medication did not have documented psychiatric diagnoses. Psychiatric diagnoses and medications were associated with longer hospital LOS and greater hospital charges. Further research is needed to understand patterns of and indications for psychiatric medication usage, as well as the burden and treatment of psychiatric disorders in this population.