Risk Factors for Psychiatric Hospitalization Among Adolescents

Background and Purpose

            Although much is known about psychiatric hospitalization among adults, focus on adolescents is seemingly absent. We studied risk factors for inpatient stay among youth with commonly occurring behavioral disturbances. Such disturbances included attention deficit hyperactivity, conduct, oppositional defiant, major depressive, anxiety, eating, alcohol use, and drug use disorders.

Methods

            We used 2007-2008 data on Medicaid beneficiaries in New York State (N=14,834: 65% male; 44% Caucasian) who met certain inclusion criteria (e.g., under age 20). Diagnostic categorization of individuals with behavioral disturbance was based on diagnoses assigned by service providers and recorded on claims using codes from the ICD-9-CM. We used logistic regression to predict psychiatric hospitalization (any stays in 2007-2008) from: (1) age, sex, and race; (2) presence versus absence of eight types of behavioral disturbance in youth (e.g., eating or alcohol use disorder); and (3) residence in foster care for the entire 2-year observation period.

Results

            Among the 14,834 Medicaid beneficiaries in our study population, 803 (5.4%) were admitted to psychiatric hospitals. Nine factors were significant predictors of inpatient stay after adjusting for all of our independent variables.

            First, relative to 12-year olds, adolescents of ages 18 and 19 were 2.04 times as likely (confidence interval or CI=1.46-2.86, p<.001) and 2.71 times as likely (CI=1.93=3.80, p<.001), respectively, to be hospitalized. Second, relative to females, males were 1.75 times as likely (CI=1.51-2.04, p<.001) to be hospitalized. Third, relative to Caucasians, African Americans and persons of other ethnicities were 1.23 times as likely (CI-1.01-1.50, p<.05) and 1.32 times as likely (CI=1.10-1.57, p<.01), respectively, to be admitted.

            Fourth, in addition to these demographic characteristics, youth with attention deficit hyperactivity disorder were 1.51 times as likely (CI=1.27-1.80, p<.001) as other youth to be hospitalized. Fifth, those with oppositional defiant disorder were 34% less likely (odds ratio or OR=.66, CI=.50-.88, p<.01) to need inpatient care. Sixth, youth with anxiety disorders were 1.70 times as likely (CI=1.41-2.04, p<.001) as other youth to be admitted, and seventh, those with eating disorders were 3.41 times as likely (CI=1.94-6.00, p<.001). Eighth, youth with drug use disorders were 3.15 times as likely (CI=2.63-3.78, p<.001) to be hospitalized. Ninth, in relation to youth outside of foster care, those in care were 40% less likely to be hospitalized (OR=.60, CI=.49-.74, p<.001).

Conclusions and Implications

            We found that certain behavioral disorders were associated with inpatient stay while other disorders were not. More specifically, risk of psychiatric hospitalization was elevated among youth with ADHD, with anxiety disorders, with eating disorders, and with drug use disorders. In addition, youth in foster care were less likely than other youth to be hospitalized, perhaps because child welfare involvement draws attention to mental health problems that might otherwise be overlooked. Finally, non-Caucasians and older adolescents were more likely than other youth to be admitted. In order to prevent psychiatric hospitalization among youth, special attention could be paid to non-Caucasions, to older youth, to those with the high-risk behavioral disturbances identified in our research, and to those who reside outside of foster care.