Postacute Care after Pediatric Hospitalizations for a Primary Mental Health Condition

J Pediatr. 2018 Feb;193:222-228.e1. doi: 10.1016/j.jpeds.2017.09.058. Epub 2017 Nov 20.


Objectives: To determine the proportion of US children hospitalized for a primary mental health condition who are discharged to postacute care (PAC); whether PAC discharge is associated with demographic, clinical, and hospital characteristics; and whether PAC use varies by state.

Study design: Retrospective cohort study of a nationally representative sample of US acute care hospitalizations for children ages 2-20 years with a primary mental health diagnosis, using the 2009 and 2012 Kids' Inpatient Databases. Discharge to PAC was used as a proxy for transfer to an inpatient mental health facility. We derived adjusted logistic regression models to assess the association of patient and hospital characteristics with discharge to PAC.

Results: In 2012, 14.7% of hospitalized children (n = 248 359) had a primary mental health diagnosis. Among these, 72% (n = 178 214) had bipolar disorder, depression, or psychosis, of whom 4.9% (n = 8696) were discharged to PAC. The strongest predictors of PAC discharge were homicidal ideation (aOR, 24.9; 96% CI, 4.1-150.4), suicide and self-injury (aOR, 15.1; 95% CI, 11.7-19.4), and substance abuse-related medical illness (aOR, 5.0; 95% CI, 4.5-5.6). PAC use varied widely by state, ranging from 2.2% to 36.3%.

Conclusions: The majority of children hospitalized primarily for a mood disorder or psychosis were not discharged to PAC, and safety-related conditions were the primary drivers of the relatively few PAC discharges. There was substantial state-to-state variation. Target areas for quality improvement include improving access to PAC for children hospitalized for mood disorders or psychosis and equitable allocation of appropriate PAC resources across states.

Keywords: depression; mood disorders; psychiatric hospitalization; psychosis; suicidal ideation.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Cohort Studies
  • Databases, Factual
  • Female
  • Hospitalization / statistics & numerical data*
  • Humans
  • Male
  • Mental Disorders / epidemiology*
  • Mental Disorders / therapy
  • Mental Health / statistics & numerical data
  • Patient Discharge / statistics & numerical data
  • Patient Transfer / statistics & numerical data
  • Retrospective Studies
  • Subacute Care / statistics & numerical data*
  • United States / epidemiology
  • Young Adult