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Fanning C, Grooters R, Malas N. Pediatric Behavioral Health Nursing Consultation: An Innovative Approach to Mental Healthcare for Hospitalized Youth. J Acad Consult Liaison Psychiatry 2024:S2667-2960(24)00064-8. [PMID: 38880176 DOI: 10.1016/j.jaclp.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 06/02/2024] [Accepted: 06/08/2024] [Indexed: 06/18/2024]
Affiliation(s)
| | - Renee Grooters
- C.S. Mott Children's Hospital, Michigan Medicine, Ann Arbor, MI
| | - Nasuh Malas
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI; Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI
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Panagi L, Newlove-Delgado T, White SR, Bennett S, Heyman I, Shafran R, Ford T. Trends in comorbid physical and mental health conditions in children from 1999 to 2017 in England. Eur Child Adolesc Psychiatry 2024; 33:33-38. [PMID: 36418506 PMCID: PMC9685012 DOI: 10.1007/s00787-022-02112-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 11/13/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Children with long-term physical health conditions (pLTCs) are at increased risk of mental health conditions but less is known about time trends in the mental health of this group of children. METHODS We used data from three comparable, population-based surveys of children conducted in 1999, 2004, and 2017. We examined whether the proportion of children aged 5-15 years old with comorbid mental health conditions (measured using the multi-informant Development and Well-being Assessment tool) and pLTCs (measured using parental report) in England increased from 1999 to 2017 using linear regression analysis. RESULTS Our analysis used data from 8662 (1999), 6401 (2004) and 6219 (2017) children, respectively. The proportion of children with comorbid pLTCs and psychiatric disorders was 0.050 (95% CI = 0.045, 0.055) in 1999, 0.054 (95% CI = 0.049, 0.060) in 2004, and 0.059 (95% CI = 0.053, 0.065) in 2017. The linear regression model revealed a non-significant effect of time on the proportion of children with comorbid pLTCs and psychiatric disorders from 1999 to 2017 (B = 0.0004785; SE = 0.0001256; p = 0.163). CONCLUSION The estimated prevalence of school-aged children with comorbid pLTCs and mental health conditions in England remained stable since 1999, highlighting the need to prioritize mental health resources for children with physical health comorbidities.
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Affiliation(s)
- Laura Panagi
- Department of Psychiatry, University of Cambridge, The Clifford Allbutt Building, Biomedical Innovation Hub/Bay 13, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 OAH, UK.
| | - Tamsin Newlove-Delgado
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Simon R White
- Department of Psychiatry, University of Cambridge, The Clifford Allbutt Building, Biomedical Innovation Hub/Bay 13, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 OAH, UK
| | - Sophie Bennett
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Isobel Heyman
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, The Clifford Allbutt Building, Biomedical Innovation Hub/Bay 13, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 OAH, UK
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Yorke E, Toulany A, Chiu M, Gandhi S, Guttmann A, Emerson SD, Kurdyak P, Vigod S, Fung K, Saunders N. Population-Based Repeated Cross-Sectional Study of Hospitalizations for Comorbid Physical and Psychiatric Disorders in Young Adults in Ontario, Canada. J Adolesc Health 2023; 73:715-723. [PMID: 37410004 DOI: 10.1016/j.jadohealth.2023.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/06/2023] [Accepted: 05/28/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE To measure trends in the rates and costs of hospitalizations over a 15-year period among young adults with physical and/or psychiatric disorders. METHODS This population-based, repeated cross-sectional study identified all 18- to 26- year-olds hospitalized in Ontario, Canada from April 1, 2003 and March 31, 2018 (fiscal years 2003-2017). Using discharge diagnoses, we assigned hospitalizations to one of four categories: 1) psychiatric disorder only; 2) primary psychiatric disorder with comorbid physical illness; 3) primary physical with comorbid psychiatric disorder; and 4) physical illness only. We compared health service utilization and changes in rates of hospitalizations over time using restricted cubic spline regression. Secondary outcome measures included change in hospital costs for each hospitalization category over the study period. RESULTS Of 1,076,951 hospitalizations in young adults (73.7% female), 195,726 (18.2%) had a psychiatric disorder (either primary or comorbid). There were 129,676 hospitalizations (12.0%) with psychiatric disorders only, 36,287 (3.4%) with primary psychiatric and comorbid physical disorders, 29,763 (2.8%) with primary physical and comorbid psychiatric disorders, and 881,225 (81.8%) with physical disorders only. Rates of hospitalization for psychiatric disorders only increased 81% from 4.32 to 7.84/1,000 population, and those with physical health disorders with comorbid psychiatric disorders increased 172% from 0.47 to 1.28/1,000 population. Substance-related disorders were the most common comorbid psychiatric disorders among youth hospitalized for physical illness and increased 260% from 0.9 to 3.3/1,000 population. DISCUSSION Hospitalizations among young adults with primary and comorbid psychiatric disorders have increased significantly over the past 15 years. Health system resources should be adequately directed to meet the shifting and complex needs of hospitalized young adults.
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Affiliation(s)
- Elisabeth Yorke
- Department of General Academic Paediatrics, Children's Hospital of Western Ontario, London, Ontario, Canada
| | - Alene Toulany
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Edwin S. H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Maria Chiu
- ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sima Gandhi
- ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - Astrid Guttmann
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Edwin S. H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Scott D Emerson
- ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - Paul Kurdyak
- ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Simone Vigod
- ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Kinwah Fung
- ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - Natasha Saunders
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Edwin S. H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.
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Zima BT. Editorial: The Cost of Comorbid Child Psychiatric Disorders: A National Call to Achieve the Triple Aim for Child Mental Health Care. J Am Acad Child Adolesc Psychiatry 2021; 60:336-337. [PMID: 33310159 DOI: 10.1016/j.jaac.2020.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Abstract
The National Quality Strategy to transform the US health care system is predicated upon Donald Berwick et al.'s "Triple Aim" envisioning the simultaneous pursuit of improved care, better population health, and reduced costs.1 More recently, emphasis has been placed on improving the value of health care as defined by "achieving the best patient health outcomes (quality + experience) at the lowest cost."2 US health care expenditures are projected to grow at an average annual rate of 5.4% during this decade, reaching 19.7% of the gross domestic product or an estimated 6.1 billion dollars by 2028.3 Compared with 36 high-income countries, including Canada, the US spends nearly twice as much on health care yet has the lowest life expectancy and highest suicide rate.4 However, solely targeting reduction in mental health care costs is not a solution, because the mental and general health care systems are inextricably linked5 and for children span multiple care sectors (eg, schools, child welfare, juvenile justice). In this issue of the Journal, Ansari et al.6 validates the complexity of physically ill children with a comorbid psychiatric disorder among more than 50,000 admissions to an acute-care pediatric specialty hospital within Canada's publicly funded health care system. Almost one out of 10 admissions for a physical illness had a documented comorbid psychiatric disorder, which is consistent with US pediatric hospital discharges.7 Children who were older, more clinically complex, and with prior hospitalizations were more likely to be among inpatient admissions with a comorbid psychiatric disorder. With outstanding methodologic rigor, the data suggest that pediatric inpatient admissions with comorbid psychiatric disorders had a nearly 10% longer length of stay and higher costs per admission compared with inpatient admissions without a comorbid psychiatric disorder---a difference in total cumulative costs of more than CAN$11.3 million (equivalent of about US$8.4 million).
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Affiliation(s)
- Bonnie T Zima
- UCLA-Semel Institute for Neuroscience and Human Behavior, Los Angeles, California.
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