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The past decade saw an increase in mental health-related hospitalizations for most age groups, particularly children, according to a national study.

However, the trend reversed among seniors, reported Joseph C. Blader, PhD, of Stony Brook University School of Medicine in Stony Brook, N.Y., online in the Archives of General Psychiatry.

Adults age 65 and older saw a steep decline in acute psychiatric admissions from 977.63 per 100,000 in 1996 to 807.55 in 2007 (P<0.001).

Teens saw equally dramatic numbers in the opposite direction, with rates rising from 683.60 to 969.03 per 100,000 over the same period (P=0.001).

Psychiatric stays among children, ages 5 to 13, also rose substantially from 155.54 to 283.04 per 100,000 from 1996 to 2007 (P=0.003).

Adults younger than 65 showed a small rise from 921.35 to 995.51 over the period (P=0.003).

These findings from annual National Hospital Discharge Survey data occurred against a backdrop of no significant change in medical stays across age groups.

Rather, the psychiatric hospitalization trends likely reflected several movements afoot in mental health care, Blader explained.

From the 1970s to the mid-1990s, the goal had been to shift care for psychiatric disorders to the outpatient setting because of the “restrictiveness and negative stigma of psychiatric hospitalization,” he wrote.

That led many hospitals to cut back on resources allocated to long-term care.

The growth in adult psychiatric hospitalizations seen in the study could plausibly have been accounted for by the same “frequent fliers” being admitted more often per year, according to a sensitivity analysis.

From the mid-1990s on, insurers progressively restricted acute-care hospitalization through more stringent criteria to authorize admission and continued stay and by reducing reimbursement, Blader noted.

That may have explained why length of stay was consistently shorter and fell faster for children on private insurance compared with those in government programs like Medicaid (both P<0.001).

Total inpatient days increased for children from 1,845 to 4,370 days per 100,000 over the prior decade at ages 5 to 13 (P=0.02) and from 5,882 to 8,247 days per 100,000 at ages 14 to 19 (P<0.001).

This appeared to be an increase in incidence, rather than more frequent readmission, that Blader called likely due to clinical need, not overuse.

Public funding may have “filled the vacuum of declining commercial funding of psychiatric inpatient care,” particularly in pediatric cases, Blader suggested.

Private insurers also payed for a declining proportion of inpatient days for adults (35% in 1996 to 23% in 2007, P<0.001).

For adults 65 and older, the reasons behind the decline in psychiatric stays and fewer total inpatient days (10,348 days per 100,000 in 1996 versus 6,517 in 2007, P<0.001) were less clear.

Blader pointed out that better outpatient mental health care could have reduced need for acute care, but reduced Medicare reimbursement leading to “an overall constriction of geriatric mental health services” was also possible.

He cautioned that the administrative data used in the study could have been inaccurate or incomplete and didn’t provide the specific reason for admission.

The discharge database also didn’t indicate actual reimbursement for claims and excluded centers with average length of hospitalization greater than 30 days.

Blader was supported in part by an award from the National Institute of Mental Health. He reported having no conflicts of interest to disclose.

Primary source: MedPage Today; Archives of General Psychiatry

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