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More U.S. kids in hospital for mental illness

By Frederik Joelving

NEW YORK (Reuters Health) - American kids are increasingly likely to be admitted to the hospital for mental problems, although rates of non-psychiatric hospitalizations have remained flat, a new study shows.

From 1996 to 2007, the rate of psychiatric hospital discharges rose by more than 80 percent for 5-13-year-olds and by 42 percent for older teens.

"This occurs despite numerous efforts to make outpatient services for the more vulnerable kids more widely available," said Joseph C. Blader of Stony Brook State University of New York, whose findings appear in the Archives of General Psychiatry.

He said hospitalization is the last resort, because it's so disruptive for normal life.

"It's a pretty traumatic thing for a family when your child is admitted to a psych unit," he told Reuters Health.

Overall, short-term hospital admissions for mental illness rose from 156 to 283 per 100,000 children per year over the ten-year study period, based on data from the National Hospital Discharge Survey.

For adolescents, the rate increased from 683 to 969 per 100,000, while it went up from 921 to 996 for adults and dropped from 978 to 808 for people 65 and older.

The change for the elderly was expected, Blader said, because of cuts in Medicare reimbursement for inpatient hospitalizations.

For youngsters, bipolar disorder showed the steepest increase, while anxiety diagnoses dropped.

Although there have been concerns about overdiagnosis of bipolar disorder and other mental problems among children, Blader said that was unlikely to be hiking the rates.

That's because hospitalizations are based on whether or not people are considered a danger to themselves or others, not on psychiatric labels.

"Most typically it's volatile and aggressive behavior, or overreaction to minor provocations that lead to assaults on family members or peers," Blader told Reuters Health.

There was also a decline in the proportion of hospital stays paid for by private insurers. But whether that reflects a growing quality gap in mental health care or is a consequence of increased government coverage is unclear.

"There is no way these kinds of data are going give you the answers on a silver platter," Blader said.

He believes the rate hikes are real and alarming and says now is the time to study the underlying reasons.

"Whereas before we had hoped that more outpatient services would lead to a decrease in hospitalizations, the findings suggest a pressing need to learn what might have reversed that trend," Blader said.

SOURCE: http://bit.ly/nMGkLp Archives of General Psychiatry, online August 1, 2011.

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