761 - Are children’s hospitals bad for kids’ mental health? Analysis of national data

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 761
Publication Number: 761.306

Hannah R. Daughtrey, Children's National Hospital, Washington, DC, United States; Monica O. Ruiz, The Warren Alpert Medical School of Brown University, Providence, RI, United States; Olga Saynina, Stanford University School of Medicine, Palo Alto, CA, United States; Lee M. Sanders, Stanford University, Stanford, CA, United States

Presenting Author(s)

MR

Monica O. Ruiz, MD, MPH (she/her/hers)

Assistant Professor of Pediatrics in the Division of Pediatric Critical Care Medicine
The Warren Alpert Medical School of Brown University
North Providence, Rhode Island, United States

Background: As more children survive pediatric critical care hospitalizations with good short-term outcomes, some have voiced concern about iatrogenic risk for long-term mental health (MH) disorders, including acute stress, post-traumatic stress, anxiety, and depression. No population-level studies have examined the long-term risk of new child mental health diagnoses after acute care hospitalization.

Objective: To assess the relative rates of new outpatient mental health diagnoses during the 12 months after hospitalization, including the moderating effect of ICU exposure.

Design/Methods: We used the Truven Health Analytics insurance database to conduct a retrospective cohort study from 2004-2019. We extracted demographic variables, clinical variables, admission type, ICD-10 codes, and coordination of service variables. Inclusion criteria included child age 3-21, > 24 months of insurance enrollment (including > 12 months before and > 12 months after hospital admission). We excluded those with hospitalization during the 2 years prior to index hospitalization and those with prior MH diagnosis. We established age- and sex-matched cohorts of non-hospitalized children. The primary outcome was new MH diagnosis. Multivariable regression methods were used to examine risk of an incident MH disorder, and the cohort was the independent variable. Among hospitalized children, we further assessed effect modification from ICU (v. non-ICU) stay, medical complexity, admission year, length of stay, and geographic region.

Results: Among 252,533 hospitalized children, 16,315 (6%) had a new MH diagnosis in the year after hospitalization, compared with 4% among matched controls. The subgroup of ICU-hospitalized children had an incidence rate of 8%. Table 1 shows the incidence rates, stratified by subgroup, including the dose-response relationship with hospital length of stay. Table 2 shows the unadjusted relative incidence rates. The most common MH diagnoses were anxiety, depression, substance-use, and stress/trauma disorders (see Table 3). After adjusting for age, sex, geography and medical complexity, incident MH diagnosis was greater in hospitalized v. non-hospitalized children (aOR 1.28, 95% CI 1.25-1.31).

Conclusion(s):

Pediatric hospitalization is associated with higher, long-term risk of new mental health diagnoses, and ICU hospitalization further increases that risk. Hospitalization itself confers iatrogenic risk that warrants acute and long-term mental and behavioral health follow up.