title: The Influence of Comorbid Mood and Anxiety Disorders on Outcomes of Pediatric Patients Hospitalized for Pneumonia.
abstract: OBJECTIVE
  Mood and anxiety disorders are associated with greater inpatient care utilization in children with chronic illness. We sought to investigate the association of mood or anxiety disorders and outcomes for hospitalized pediatric patients, using pneumonia as a model.
  
  
  METHODS
  We conducted a retrospective, cross-sectional study of pneumonia hospitalizations in patients 5 to 20 years old, using the nationally representative Healthcare Cost and Utilization Project's 2012 Kids' Inpatient Database. We used multivariable logistic and linear regression models stratified by age group to determine the independent association of mood or anxiety disorders with complications and length of stay, adjusted for clinical, demographic, and hospital characteristics.
  
  
  RESULTS
  Of 34,794 pneumonia hospitalizations, 3.5% involved a patient with a comorbid mood or anxiety disorder. Overall incidence of complications was 13.1%. Mean length of stay was 4.5 days. In adjusted models, comorbid mood or anxiety disorders were associated with greater odds of pneumonia complications in school-aged children (odds ratio 1.80; 95% confidence interval, 1.20-2.71) and adolescents (odds ratio 1.63; 95% confidence interval, 1.31-2.02). Hospitalizations with an associated mood or anxiety disorder were longer than those without, by 11.2% in school-aged children and 13.6% in adolescents (P < .001). The association of mood and anxiety disorders with longer hospital stay was not modified by the presence of pneumonia complications.
  
  
  CONCLUSIONS
  In pediatric patients hospitalized for pneumonia, a comorbid mood or anxiety disorder is associated with greater odds of complications and longer hospital stay. The presence of pneumonia complications did not influence the relationship between mood or anxiety disorders and length of stay.
authors.affiliation: Division of General Pediatrics and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Leonard Davis Institute, doupniks@chop.edu.
authors.forename: Stephanie K
authors.initials: SK
authors.lastname: Doupnik
authors.affiliation: Leonard Davis Institute, Departments of Biostatistics and Epidemiology, and.
authors.forename: Nandita
authors.initials: N
authors.lastname: Mitra
authors.affiliation: Division of General Pediatrics and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Leonard Davis Institute, Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and Department of Medical Ethics and Health Policy, and.
authors.forename: Chris
authors.initials: C
authors.lastname: Feudtner
authors.affiliation: Leonard Davis Institute, Center for Health Equity Research and Promotion, Philadelphia, Virginia Medical Center, Philadelphia, Pennsylvania School of Social Policy and Practice, University of Pennsylvania, Philadelphia, Pennsylvania;
authors.forename: Steven C
authors.initials: SC
authors.lastname: Marcus
mesh_terms: D000293:Adolescent; D001008:Anxiety Disorders / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D019964:Mood Disorders / Q000453:epidemiology*; D011014:Pneumonia / Q000150:complications / Q000453:epidemiology* / Q000523:psychology*; D012189:Retrospective Studies; D055815:Young Adult