title: Hospital care for mental health and substance abuse in children with epilepsy.
abstract: BACKGROUND
  Reducing the burden of pediatric mental illness requires greater knowledge of mental health and substance abuse (MHSA) outcomes in children who are at an increased risk of primary psychiatric illness. National data on hospital care for psychiatric illness in children with epilepsy are limited.
  
  
  METHODS
  We used the Kids' Inpatient Database (KID), the Healthcare Cost and Utilization Project (HCUP), and the Agency for Healthcare Research and Quality from 2003 to 2009 to examine MHSA hospitalization patterns in children with comorbid epilepsy. Nonparametric and regression analyses determined the association of comorbid epilepsy with specific MHSA diagnoses and examined the impact of epilepsy on length of stay (LOS) for such MHSA diagnoses while controlling for demographic, payer, and hospital characteristics.
  
  
  RESULTS
  We observed 353,319 weighted MHSA hospitalizations of children ages 6-20; 3280 of these involved a child with epilepsy. Depression was the most common MHSA diagnosis in the general population (39.5%) whereas bipolar disorder was the most common MHSA diagnosis among children with epilepsy (36.2%). Multivariate logistic regression models revealed that children with comorbid epilepsy had greater adjusted odds of bipolar disorder (AOR: 1.17, 1.04-1.30), psychosis (AOR: 1.78, 1.51-2.09), sleep disorder (AOR: 5.90, 1.90-18.34), and suicide attempt/ideation (AOR: 3.20, 1.46-6.99) compared to the general MHSA inpatient population. Epilepsy was associated with a greater LOS and a higher adjusted incidence rate ratio (IRR) for prolonged LOS (IRR: 1.12, 1.09-1.17), particularly for suicide attempt/ideation (IRR: 3.74, 1.68-8.34).
  
  
  CONCLUSIONS
  Children with epilepsy have distinct patterns of hospital care for mental illness and substance abuse and experience prolonged hospitalization for MHSA conditions. Strategies to reduce psychiatric hospitalizations in this population may require disease-specific approaches and should measure disease-relevant outcomes. Hospitals caring for large numbers of children with neurological disease (such as academic centers) may have inaccurate measurements of mental health-care quality unless the impact of key comorbid conditions such as epilepsy is considered.
authors.affiliation: Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, United States; Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, United States.
authors.forename: Dylan P
authors.initials: DP
authors.lastname: Thibault
authors.affiliation: Temple University School of Medicine, United States.
authors.forename: Adys
authors.initials: A
authors.lastname: Mendizabal
authors.affiliation: Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, United States; The Children's Hospital of Philadelphia, United States.
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Abend
authors.affiliation: Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, United States; Penn Epilepsy Center, United States.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Davis
authors.affiliation: Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, United States; McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Canada.
authors.forename: James
authors.initials: J
authors.lastname: Crispo
authors.affiliation: Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, United States; Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, United States; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, United States.
authors.forename: Allison W
authors.initials: AW
authors.lastname: Willis
mesh_terms: D000293:Adolescent; D001714:Bipolar Disorder / Q000453:epidemiology* / Q000523:psychology; D002648:Child; D015897:Comorbidity; D003365:Costs and Cost Analysis; D004827:Epilepsy / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008603:Mental Health; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014481:United States; D055815:Young Adult
keywords: Addiction; Comorbidity; Epidemiology; Epilepsy; Length of stay; Psychiatry; Suicide