Elsevier

Biological Psychiatry

Volume 62, Issue 2, 15 July 2007, Pages 107-114
Biological Psychiatry

Original Article
Increased Rates of Bipolar Disorder Diagnoses Among U.S. Child, Adolescent, and Adult Inpatients, 1996–2004

https://doi.org/10.1016/j.biopsych.2006.11.006Get rights and content

Background

Volatile, aggressive behavior is the chief complaint that brings children to inpatient psychiatric care. These difficulties are increasingly conceptualized as bipolar disorder (BD). The impact of doing so on clinical diagnoses in clinical care is uncertain.

Methods

We extracted records from the annual National Hospital Discharge Survey (NHDS) for which a psychiatric diagnosis was primary and examined trends in the rates of hospitalization for BD.

Results

Population-adjusted rates of hospital discharges of children with a primary diagnosis of BD increased linearly over survey years. The rate in 1996 was 1.3 per 10,000 U.S. children and climbed to 7.3 per 10,000 U.S. children in 2004. Bipolar disorder related discharges also increased fourfold among adolescents. Adults showed a more modest, though still marked, rise of 56%. Bipolar disorder related hospitalization was more prevalent among female adolescents and adults, while male children had larger risk than female children. Children’s BD diagnoses tended not to specify a prevailing mood state, while depression and psychotic features were the most common codes for adults. Black individuals, especially men, had lower rates of BD diagnoses in early survey years, but more recently their rate of BD related hospitalizations has exceeded other NHDS race groups.

Conclusions

Higher rates of inpatient admissions among youth associated with BD may reflect greater appreciation of the importance of affective dysregulation in this patient group or “upcoding” to putatively more severe conditions for reimbursement or administrative reasons. Further study is warranted to examine this shift’s causes and implications for treatments and outcomes.

Section snippets

Data Source

The National Hospital Discharge Survey (NHDS) is a component of the National Health Care Survey, which the National Center for Health Statistics (NCHS), a branch of the U.S. Centers for Disease Control and Prevention (CDC), conducts annually. The NHDS captures patient-level information pertaining to discharges during the calendar year from non-Federal general hospitals and children’s hospitals, regardless of length of stay, and other, more specialized hospitals whose average length of stay is

Overall Psychiatric Hospitalizations

Over all survey years, the proportion of discharges of patients aged 5 to 64 for which a psychiatric diagnosis was primary was 6.91%.

Psychiatric disorders came to represent a slightly larger proportion of the total hospital discharges between 1996 (6.87%) and 2004 (7.06%). The linear trend over survey years was appreciable (r = .39), but adolescents and children accounted for most of the increase. Among adolescents, psychiatrically associated discharges constituted 13.64% of that group’s total

Discussion

A very large increase in the number of discharges from acute care settings with a primary diagnosis of BD occurred among children and adolescents between 1996 and 2004. Bipolar disorder was one of the least frequent diagnoses recorded among child inpatients in 1996 but was the most common in 2004. Among adolescents in 1996, there were twice as many discharges with a depressive disorder as with a BD diagnosis but by 2004 the rates were about equal. These increases significantly outpace the more

References (40)

  • E.M. Gutterman

    Is diagnosis relevant in the hospitalization of potentially dangerous children and adolescents?

    J Am Acad Child Adolesc Psychiatry

    (1998)
  • I.K. Lyoo et al.

    White matter hyperintensities on magnetic resonance imaging of the brain in children with psychiatric disorders

    Compr Psychiatry

    (2002)
  • M.N. Pavuluri et al.

    Child- and family-focused cognitive-behavioral therapy for pediatric bipolar disorder: Development and preliminary results

    J Am Acad Child Adolesc Psychiatry

    (2004)
  • J.M. Vivona et al.

    Self- and other-directed aggression in child and adolescent psychiatric inpatients

    J Am Acad Child Adolesc Psychiatry

    (1995)
  • S.G. Zimet et al.

    Home behaviors of children in three treatment settings: An outpatient clinic, a day hospital, and an inpatient hospital

    J Am Acad Child Adolesc Psychiatry

    (1994)
  • R.R. Althoff et al.

    Family, twin, adoption, and molecular genetic studies of juvenile bipolar disorder

    Bipolar Disord

    (2005)
  • Diagnostic and Statistical Manual of Mental Disorders

    (1994)
  • J.C. Blader

    Pharmacotherapy and postdischarge outcomes of child inpatients admitted for aggressive behavior

    J Clin Psychopharmacol

    (2006)
  • J.C. Blader

    Which family factors predict externalizing behavior among children discharged from inpatient psychiatric treatment?

    J Child Psychol Psychiatry

    (2006)
  • Blader JC, Foley CA (in press): Milieu-based treatment: Inpatient and partial hospitalization, residential treatment....
  • Cited by (0)

    View full text