Dr. Egorova is with the Department of Population Health Science and Policy, and Dr. Shemesh is with the Department of Psychiatry and Pediatrics, Icahn School of Medicine at Mount Sinai, New York. Dr. Kleinman is with the Center for Child Health and Policy, University Hospitals Rainbow Babies and Children's Hospital, and the Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland. Dr. Pincus is with the Department of Psychiatry and with the Irving Institute for Clinical and Translational Research, Columbia University, New York.
Psychiatr Serv. 2018 Aug 1;69(8):910-918. doi: 10.1176/appi.ps.201700389. Epub 2018 Jun 1.
The study described rates and characteristics of U.S. children hospitalized with a behavioral (mental or substance use) disorder.
This cross-sectional analysis of data from the 2012 Kids' Inpatient Database included 483,281 hospitalizations in general and children's hospitals of persons under age 21 with a primary or secondary behavioral diagnosis.
The admission rate with any behavioral diagnosis was 5.5 per 1,000 children in the U.S. population, with 2.9 having a primary behavioral diagnosis. Common primary diagnoses included depression (34%), other mood (31%), psychotic (9%), and substance use (7%) disorders. The most common behavioral diagnoses secondary to a primary diagnosis that is not behavioral were depression (26%), attention-deficit disorder (26%), and substance use disorders (22%). Suicide or self-harm was rarely the primary diagnosis (.1%) but complicated 12% of admissions with a primary behavioral diagnosis. Variations in admissions (per 1,000 children in the U.S. population) with a primary behavioral diagnosis were noted by race-ethnicity (blacks, 3.2; whites, 2.9; and Hispanics, 1.4), insurance (public, 2.9; private, 2.0), and geographic region. Fifty-nine of every 1,000 peripartum admissions in the 12-20 age group had a secondary behavioral diagnosis. Patients with behavioral comorbidities were more likely to be transferred to another facility (8.0% versus 2.2%, p<.001). Behavioral disorders comorbid to nonbehavioral disorders increased length of stay (4.3 versus 3.3 days, p<.001) and costs ($12,742 versus $9,929, p<.001).
Nearly 500,000 pediatric admissions in 2012 included behavioral disorders. Comorbidities were associated with longer stays and an estimated $1.36 billion additional annual costs, which were disproportionately borne by public insurance.
本研究描述了美国因行为障碍（精神或物质使用障碍）住院的儿童的发生率和特征。
本研究采用 2012 年儿童住院数据库中的横断面数据分析方法，纳入了 483281 例年龄在 21 岁以下、主要或次要诊断为行为障碍的综合医院和儿童医院的住院患者。
美国人群中，任何行为障碍的住院率为每 1000 名儿童 5.5 例，其中 2.9 例为主要行为障碍诊断。常见的主要诊断包括抑郁（34%）、其他心境障碍（31%）、精神病性障碍（9%）和物质使用障碍（7%）。最常见的行为诊断是继发于非行为主要诊断的抑郁（26%）、注意力缺陷障碍（26%）和物质使用障碍（22%）。自杀或自残很少作为主要诊断（0.1%），但却使 12%的主要行为障碍诊断患者的住院复杂化。主要行为诊断的住院率（美国每 1000 名儿童的人数）因种族/族裔（黑人 3.2；白人 2.9；西班牙裔 1.4）、保险类型（公共保险 2.9；私人保险 2.0）和地理位置而有所不同。在 12-20 岁年龄组的每 1000 例围产期住院患者中，有 59 例存在次要行为诊断。合并行为障碍的患者更有可能被转至其他医疗机构（8.0%比 2.2%，p<.001）。非行为障碍合并行为障碍会增加住院时间（4.3 天比 3.3 天，p<.001）和费用（12742 美元比 9929 美元，p<.001）。
2012 年，近 50 万例儿科住院患者包括行为障碍。合并症与住院时间延长和估计每年增加 13.6 亿美元的额外费用相关，而这些费用主要由公共保险承担。
