title: Common and costly hospitalizations for pediatric mental health disorders.
abstract: OBJECTIVE
  Inpatient pediatric mental health is a priority topic for national quality measurement and improvement, but nationally representative data on the patients admitted or their diagnoses are lacking. Our objectives were: to describe pediatric mental health hospitalizations at general medical facilities admitting children nationally; to assess which pediatric mental health diagnoses are frequent and costly at these hospitals; and to examine whether the most frequent diagnoses are similar to those at free-standing children's hospitals.
  
  
  METHODS
  We examined all discharges in 2009 for patients aged 3 to 20 years in the nationally representative Kids' Inpatient Database (KID) and in the Pediatric Health Information System (free-standing children's hospitals). Main outcomes were frequency of International Classification of Diseases, Ninth Revision, Clinical Modification-defined mental health diagnostic groupings (primary and nonprimary diagnosis) and, using KID, resource utilization (defined by diagnostic grouping aggregate annual charges).
  
  
  RESULTS
  Nearly 10% of pediatric hospitalizations nationally were for a primary mental health diagnosis, compared with 3% of hospitalizations at free-standing children's hospitals. Predictors of hospitalizations for a primary mental health problem were older age, male gender, white race, and insurance type. Nationally, the most frequent and costly primary mental health diagnoses were depression (44.1% of all mental health admissions; $1.33 billion), bipolar disorder (18.1%; $702 million), and psychosis (12.1%; $540 million).
  
  
  CONCLUSIONS
  We identified the child mental health inpatient diagnoses with the highest frequency and highest costs as depression, bipolar disorder, and psychosis, with substance abuse an important comorbid diagnosis. These diagnoses can be used as priority conditions for pediatric mental health inpatient quality measurement.
authors.affiliation: Department of Pediatrics, University of California at San Francisco, San Francisco, California;
authors.forename: Naomi S
authors.initials: NS
authors.lastname: Bardach
authors.forename: Tumaini R
authors.initials: TR
authors.lastname: Coker
authors.forename: Bonnie T
authors.initials: BT
authors.lastname: Zima
authors.forename: J Michael
authors.initials: JM
authors.lastname: Murphy
authors.forename: Penelope
authors.initials: P
authors.lastname: Knapp
authors.forename: Laura P
authors.initials: LP
authors.lastname: Richardson
authors.forename: Glenace
authors.initials: G
authors.lastname: Edwall
authors.forename: Rita
authors.initials: R
authors.lastname: Mangione-Smith
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D005260:Female; D006760:Hospitalization / Q000191:economics*; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000191:economics* / Q000628:therapy*; D014481:United States; D055815:Young Adult
keywords: bipolar disorder; child mental health; costs; depression; pediatric hospitalization; psychosis