Patterns of adolescent psychiatric hospitalization: Implications for social policy.

Mason, Mary Ann; Gibbs, Jewelle Taylor

doi:10.1037/h0079361

Cited by 27 publications

(13 citation statements)

References 8 publications

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“…In part, this shift is associated with the prominent (two-to four-fold) increase in the diagnosis of mood disorders during the last two decades (Rosenstock 1985, Stoll et al 1993. For both child and adult inpatients, depressive disorders are now the most frequently applied diagnosis (Kiesler andSimpkins 1993, Mason andGibbs 1992). In the seven child psychiatry inpatient units in metropolitan Baltimore during the 1988 to 1994 period, the initiation of antidepressant treatment (usually tricyclic antidepressants) was associated with the diagnosis of a mood disorder in nearly 90% of cases.…”

Section: Discussionmentioning

confidence: 99%

Changing Patterns of Psychotropic Medications Prescribed by Child Psychiatrists in the 1990s

Safer¹

1997

Journal of Child and Adolescent Psychopharmacology

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The active (1994) and closed (1988 to 1992) outpatient records of youths seen in four separate community mental health centers (CMHC) in Baltimore County, Maryland were reviewed in mid-1994 to document recent changes in the medication-prescribing practices of local child psychiatrists. Inpatient summaries of previously hospitalized CMHC youths were also reviewed to supplement the outpatient medication assessment with hospital data. This regional survey of medication treatments in child psychiatry revealed that, during the half decade before 1994, there was an increase in overall psychotropic medication treatment, multiple concurrent medication treatments (polypharmacy), and antidepressant treatment with serotonin reuptake inhibitors (SRIs). Inpatient youths were consistently prescribed more psychotropic medications and diagnosed more frequently with major depressive disorder than outpatients. Medications typically used to first treat mood disorders became the predominant medication prescribed for both outpatients and inpatients by child psychiatrists in 1994, leading to a proportional decline in prescribed stimulant treatment. The shift from tricyclic antidepressants to SRI antidepressants in the 1990s by child psychiatrists matches the same recent practice shift by adult psychiatrists. Likewise, the increased prescription of drugs to treat mood disorders and the increased rate of polypharmacy notable of late among child psychiatrists now also mirrors adult psychiatry practice. Wide geographic variations in neuroleptic and antidepressant medication patterns were noted, even among facilities in the same metropolitan region. After psychiatric hospitalization, most youths who continued treatment at a CMHC outpatient clinic discontinued their inpatient medications within 3 months; the sole exception were children who had been placed on psychostimulants.

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Section: Discussionmentioning

confidence: 99%

Changing Patterns of Psychotropic Medications Prescribed by Child Psychiatrists in the 1990s

Safer¹

1997

Journal of Child and Adolescent Psychopharmacology

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“…It has been suggested that African-American men may be more likely to be referred to the juvenile justice system than to mental health facilities (Cohen et al 1990;Mason and Gibbs 1992). There is, however, little direct evidence of biased referral practices that identify and channel youth differently into mental health versus informal or juvenile systems .…”

Section: Provider Variablesmentioning

confidence: 96%

Treatment of Culturally Diverse Children and Adolescents with Depression

Stewart

Simmons²,

Habibpour

2012

Journal of Child and Adolescent Psychopharmacology

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This article is written for the practitioners treating depression in ethnic minority youth. It will review the context in which services are delivered to these youth: Researchers have recognized persistent ethnic differences in terms of utilization of services and unmet need. Furthermore, when ethnic minority youth do receive pediatric mental health care, the services that they receive may differ from those given to White patients. The reasons for these discrepancies have been examined in numerous studies, and have included contextual variables (economics, availability, and accessibility of services), patient variables (differences in prevalence or manifestation of the disorder, cultural beliefs and attitudes, preferential use of alternative or informal services, health literacy, and adherence), and provider variables (referral bias and patient-provider communication). Information about the differences between White and minority youth in the pharmacodynamics and pharmacokinetics of the antidepressant response is still limited. There are significant challenges for developing evidence-based guidelines that inform practice with these youth, hinging on both the underrepresentation of ethnic minority groups in clinical trials, and the great variability in biological and cultural characteristics of individuals in ethnic minority categories. Awareness on the part of the practitioner of the cultural variables that influence help-seeking and ongoing utilization of mental health services may aid in the engagement, effective treatment, and retention of ethnic minority children and adolescents with depression. However, given the great heterogeneity that exists within any cultural grouping, clinicians will need to integrate information about cultural patterns with that obtained from the individual patient and family to inform optimal practices for each patient. This article is written to enhance awareness on the part of the practitioner as to the variables that influence psychiatric care for depression in culturally diverse youth. The mental health needs of minority youth are not well served: They are treated less frequently, and when they are treated, the services they receive are less frequently adequate. The reasons that have been proposed for the disparities in their care, particularly with regard to diagnosis and treatment for depression, will be reviewed. They include contextual factors (such as economics, insurance, and other variables affecting the availability of services) patient and family factors (such as prevalence, symptom presentation, and values and beliefs that influence whether patients are referred to and avail themselves of services), and provider factors (such as referral bias and patient-provider communication, which affect whether patients engage and stay in treatment). The implications for the practitioner treating ethnic minority youth with depression will be discussed. Culture, as used in this article, refers to the common values, beliefs, and social behaviors of individuals with a shared heritage. S...

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“…Regarding inpatient treatment, those who are younger, are boys, have a history of previous hospitalizations, or have higher parent-reported illness severity are each more likely to experience longer LOS, an indicator of poor treatment response for hospitalized youth (Leon et al, 2006;Pavkov, George, & Czapkowizc, 1997). Ethnicity findings are mixed, with some studies showing longer LOS for ethnic minority populations compared to European-Americans (Leon et al, 2006;Pavkov et al, 1997), whereas others show longer LOS for European American compared to African American and Hispanic youth (Mason & Gibbs, 1992;Pottick, McAlpine, & Andelman, 2000). Beyond these variables, however, variation in two different biobehavioral regulatory systems may also contribute to children's treatment response and LOS: the behavioral regulation system (BRS) and the stress response system (SRS).…”

mentioning

confidence: 91%

Cortisol Predicts Behavioral Dysregulation and Length of Stay Among Children Admitted for Psychiatric Inpatient Treatment

Luebbe

Elledge

Kiel

et al. 2012

Journal of Clinical Child & Adolescent Psychology

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Individual differences in behavioral regulation system (BRS) and stress response system (SRS) functioning may reflect greater biological sensitivity to context. The current study tested whether children's cortisol, a measure of the SRS, was related to observed dysregulated behavior, an indicator of the BRS, in a sample of children admitted for acute psychiatric inpatient care. In addition, cortisol and dysregulated behavior were tested as unique predictors of length of hospitalization over and above demographic factors, prior treatment history, and caretaker-reported psychiatric symptoms. The latter variables were tested as potential moderators of the relations of BRS and SRS functioning to length of hospitalization. Plasma cortisol was collected on the morning following hospital admission for 544 children (ages 6-12; 73% boys; 61% ethnic minority). Dysregulated behavior was operationalized as the mean number of timeouts administered by staff for noncompliant behavior per day of hospitalization. Caretakers reported on youth internalizing and externalizing symptomatology. Higher cortisol was modestly associated with greater dysregulated behavior. In a model including both cortisol and dysregulated behavior, each predicted longer hospitalization. Cortisol was positively related to length of stay only for children previously hospitalized, and the relation of dysregulated behavior to length of stay was stronger for older children. Dysregulated behavior and cortisol are related but independent predictors of acute psychiatric hospitalization duration. Direct measures of the SRS can add to the clinical picture regarding hospitalization in ways that observed behavior and caretaker report alone cannot.

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Patterns of adolescent psychiatric hospitalization: Implications for social policy.

Cited by 27 publications

References 8 publications

Changing Patterns of Psychotropic Medications Prescribed by Child Psychiatrists in the 1990s

Changing Patterns of Psychotropic Medications Prescribed by Child Psychiatrists in the 1990s

Treatment of Culturally Diverse Children and Adolescents with Depression

Cortisol Predicts Behavioral Dysregulation and Length of Stay Among Children Admitted for Psychiatric Inpatient Treatment

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