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), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality, from 2003-2009 to examine MHSA hospitalization patterns in children with comorbid epilepsy. Non-parametric 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; 3,280 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.

Validation and Feasibility of the ASQ Among Pediatric Medical and Surgical Inpatients

“…Patients with physical illness are at increased risk for suicide. [5][6][7] Suicide is the fourth most frequently reported sentinel event to The Joint Commission, with a significant percentage of these deaths occurring in nonbehavioral health care units, such as medical and surgical units, the ICU, and the emergency department (ED). 8 In 2016, The Joint Commission issued Sentinel Event Alert 56, recommending that all medical patients be screened for suicide risk because medical settings provide an optimal venue for identifying youth at risk.…”

Pediatric Consultation-Liaison Psychiatry: An Update and Review

“…2,60 As the psychological and neurobiological sequelae of chronic physical illness are increasingly recognized, the contribution from mental health care providers to medically ill pediatric patients is being increasingly recognized and formalized, particularly among certain illnesses, such as pediatric cancers, epilepsy, cystic fibrosis, and sickle cell disease. [60][61][62][63] For instance, the Cystic Fibrosis Foundation and European Cystic Fibrosis Society recently partnered to produce consensus guidelines on implementing developmentally appropriate psychoeducation and screening for anxiety and depression in cystic fibrosis patients and their caregivers, as well as recommendations for specific treatments, such as cognitive behavioral therapy, selective serotonin reuptake inhibitor medications, and benzodiazepines. 64 Kazak and colleagues composed a recent literature review demonstrating the need for routine, systematic assessments of psychosocial needs in children and caregivers with cancer, 65 while the international Posterior Fossa Society determined in a recent consensus meeting that identification and treatment of emotional and behavioral morbidities in this population is an important avenue for upcoming work.…”

Youth suicide and hospital-presenting suicide attempts: Examination of risk factors for multiple suicide attempts in adolescence

“…In adolescent studies, it is indicated that children with neurological diseases such as epilepsy had greater odds of bipolar disorder, psychosis and suicide attempt/ideation (Thibault et al, 2016). Moreover, there are studies showing that the presence of disease of any organ or physical system significantly increases the risk of subsequent suicide, regardless of gender, individual psychiatric background or socio-economic status (Qin et al, 2013).…”