Abstract
Research has focused on changes in the psychiatric treatment of youth in outpatient settings, but less is known about trends
in inpatient care. This study documents changes in the lengths of stay (LOS), clinical profiles of youth, and medication use
within an inpatient setting in Massachusetts between 1991 and 2008. A chart review of 233 medical records of psychiatrically
hospitalized youth was conducted at three points in time (1991, 1998, and 2008). Sample includes youth between ages 4 and
18. Clinical data, including LOS, diagnoses and other clinical variables, and number and type of medications prescribed were
compared across sample years. Findings indicate a significant decrease in the LOS coupled with a concurrent increase in psychotropic
medication use between each successive sample year. The prescription of anti-psychotic medications, in particular, increased
significantly. On clinical indices, findings show that there was an increase in the diagnosis of bipolar spectrum disorders
and a concurrent decrease in unipolar diagnoses in the 2008 sample. Attention-deficit and developmental disorders showed little
change. Trauma-related disorders were significantly less frequently diagnosed in 2008. Children hospitalized in 1998 and 2008
had more prior hospitalizations and presented with greater acuity than those in the 1991 sample. Results highlight important
changes that have occurred in child/adolescent inpatient settings over the past two decades. Data suggest that these changes
have not resulted in decreased rates of inpatient hospitalization for youth with more severe psychiatric disorders.
in inpatient care. This study documents changes in the lengths of stay (LOS), clinical profiles of youth, and medication use
within an inpatient setting in Massachusetts between 1991 and 2008. A chart review of 233 medical records of psychiatrically
hospitalized youth was conducted at three points in time (1991, 1998, and 2008). Sample includes youth between ages 4 and
18. Clinical data, including LOS, diagnoses and other clinical variables, and number and type of medications prescribed were
compared across sample years. Findings indicate a significant decrease in the LOS coupled with a concurrent increase in psychotropic
medication use between each successive sample year. The prescription of anti-psychotic medications, in particular, increased
significantly. On clinical indices, findings show that there was an increase in the diagnosis of bipolar spectrum disorders
and a concurrent decrease in unipolar diagnoses in the 2008 sample. Attention-deficit and developmental disorders showed little
change. Trauma-related disorders were significantly less frequently diagnosed in 2008. Children hospitalized in 1998 and 2008
had more prior hospitalizations and presented with greater acuity than those in the 1991 sample. Results highlight important
changes that have occurred in child/adolescent inpatient settings over the past two decades. Data suggest that these changes
have not resulted in decreased rates of inpatient hospitalization for youth with more severe psychiatric disorders.
- Content Type Journal Article
- Category Original Paper
- Pages 1-10
- DOI 10.1007/s11126-012-9235-1
- Authors
- Susan M. Meagher, Departments of Psychiatry and Pediatrics, Tufts Medical Center/Tufts University School of Medicine, 800 Washington Street #1007, Boston, MA 02111, USA
- Anjana Rajan, Department of Psychiatry, Cambridge Health Alliance/Harvard Medical School, Cambridge, MA, USA
- Grace Wyshak, Departments of Biostatistics and Global Health and Population, Harvard University’s School of Public Health, Cambridge, MA, USA
- Joel Goldstein, Department of Psychiatry, Cambridge Health Alliance/Harvard Medical School, Cambridge, MA, USA
- Journal Psychiatric Quarterly
- Online ISSN 1573-6709
- Print ISSN 0033-2720