Acute Inpatient Care for Psychiatric Disorders in the United States, 1996 Through 2007

Context: Data from facility-level surveys indicate that US inpatient psychiatric admissions rose in 2004, from their trough in 1998 to 2000, mainly in acute care settings. Patient-level factors, including age, admission type, diagnoses, length of stay, and payment source, are vital to understanding hospitalization trends. Objective: To evaluate trends in acute care hospitalizations for primary psychiatric diagnoses between 1996 and 2007 in relation to patient-level variables. Design, Setting, and Participants: The yearly National Hospital Discharge Survey furnished demographic, clinical, and payment data on a probability sample of discharges from short-stay facilities (mean [SD], 448.33 [19.66]), along with weights for extrapolation to population estimates. Discharges with a primary psychiatric diagnosis (mean [SD], 19 535 [2615]) were identified among children (aged 5-13 years), adolescents (aged 14-19 years), adults (aged 20-64 years), and elderly individuals (>= 65 years). Main Outcome Measures: Annual rates of discharges and total days of inpatient care associated with primary psychiatric diagnoses for each age group. Results: Psychiatric discharges increased for children from 155.54 per 100 000 children in 1996 to 283.04 per 100 000 in 2007 (P=.003); for adolescents, from 683.60 to 969.03 per 100 000 (P=.001); and for adults, from 921.35 to 995.51 per 100 000 (P=.003) but declined for elderly individuals from 977.63 to 807.55 per 100 000 (P<.001). Total inpatient days increased for children (1845 days per 100 000 in 1996 to 4370 days in 2007; P=.02) and for adolescents (5882 days per 100 000 in 1996 to 8247 days in 2007; P<.001) but decreased for elderly patients (10 348 days per 100 000 in 1996 to 6517 days; P<.001). The proportion of inpatient days paid by private sources declined among children (36%-21%), adolescents (52%-22%), and adults (35%-23%; all P<.001). Conclusions: Inpatient discharges in short-stay facilities with a primary psychiatric diagnosis rose between 1996 and 2007, most dramatically for youth, but decreased among elderly individuals. Private funding bore a declining share of costs.