title: Hospitalized youth and child abuse: a systematic examination of psychiatric morbidity and clinical severity.
abstract: Many children and adolescents who require psychiatric hospitalization have been physically or sexually abused, yet the association between reported histories of abuse and the complexity and severity of mental illness among psychiatrically hospitalized youth is poorly described with regard to current inpatient psychiatric practice. We sought to determine the association between histories of abuse and psychiatric complexity and severity in psychiatrically hospitalized youth including comorbidity patterns, psychotropic medication use, reason for admission and length of hospitalization. A systematic chart review was performed on 1433 consecutive psychiatric hospitalizations of children and adolescents that occurred over a 10-month period. Children with a history of abuse were more likely to be diagnosed with multiple DSM-IV-TR disorders than non-traumatized children. A history of sexual abuse was associated with more medication use than in their non-traumatized peers and a higher likelihood of treatment with antipsychotic medications, both at admission and discharge. Physical and sexual abuse were independently associated with increased length of stays, with exposure to both physical and sexual abuse associated with a 2-day increase in duration of hospitalization compared to non-traumatized patients. The findings from this study draw attention to the adverse impact of abuse on psychiatric morbidity and complexity and suggest the need for trauma-informed treatment in psychiatric hospital settings.
authors.affiliation: Cincinnati Children's Hospital Medical Center, United States.
authors.forename: Brooks R
authors.initials: BR
authors.lastname: Keeshin
authors.affiliation: University of Cincinnati College of Medicine, United States.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Strawn
authors.affiliation: Miami University, United States.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Luebbe
authors.affiliation: Intermountain Primary Children's Medical Center, United States.
authors.forename: Shannon N
authors.initials: SN
authors.lastname: Saldaña
authors.affiliation: University of Cincinnati College of Medicine, United States.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Wehry
authors.affiliation: University of Cincinnati College of Medicine, United States.
authors.forename: Melissa P
authors.initials: MP
authors.lastname: DelBello
authors.affiliation: University of North Carolina, United States.
authors.forename: Frank W
authors.initials: FW
authors.lastname: Putnam
mesh_terms: D000293:Adolescent; D014150:Antipsychotic Agents / Q000627:therapeutic use; D002648:Child; D002649:Child Abuse / Q000523:psychology*; D002650:Child Abuse, Sexual / Q000523:psychology; D002675:Child, Preschool; D005260:Female; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D001523:Mental Disorders / Q000209:etiology*; D012189:Retrospective Studies
chemical_list: D014150:Antipsychotic Agents
keywords: Comorbidity; Inpatient hospitalization; Length of stay; Physical abuse; Sexual abuse