Purpose
Utilization of inpatient hospital and acute care services by children and adolescents has become a growing issue in Canada and the United States (US) due to increases in hospital admissions and emergency room visits. Despite increasing rates of mental health-related hospitalizations among children and adolescents, little is known about the non-demographic or disease related factors that influence the likelihood of young people being admitted to hospital for mental health problems. The primary purpose of this study was to address this limitation in the literature by measuring seasonal variations in mental health-related hospitalizations by youth over a nine-year period using administrative health data from New Brunswick, Canada.
Methods
Hospital admissions records from January 2004 to March 2014 were obtained from the provincial Discharge Abstract Database (DAD). Seasonal trends in mental health-related hospitalizations were analyzed using regression curve estimation models on standardized rates of hospital admission by quarter. At the first stage of data analysis, we measured variations in hospital admissions per quarter for patients by age and disease type. In the second stage of data analysis, hospital admissions per quarter were further analyzed using curve estimation models to identify portions of the year with high or low rates of admissions using linear, quadratic, and cubic functions.
Results
Between 2004 and 2014, there were 57,730 mental health-related hospital admissions by 41,690 patients. The majority of mental health-related admissions to hospital were by adults 20 years of age and older (90.14%, N=52,040); however the odds of children and adolescents (aged 3-19 years) being admitted to hospital were 19% higher in 2014 compared to 2004, and there was a 36% decrease in the odds of mental health-related hospitalizations by adults aged 20 and over. Regression analysis found large variations in mental health-related hospital admissions by quarter for children and adolescents and no observable differences by quarter for adults 20 years and over. Youth aged 11 to 15 (R2=.381, F=7.58, p=.001), and 16 to 19 years (R2=.343, F=6.451, p=.001) had significantly greater admissions to hospital in the first quarter (January, February, March) in contrast to the third quarter (July, August, September). Hospital admissions for children and adolescents aged 3-19 years with neurosis (R2=.359, F=6.895, p=.001) and mood disorders (R2=.297, F=5.204, p=.004) had the greatest seasonal variation, whereas there were no identifiable seasonal differences in admissions attributed to substance use, behavioural disorders (i.e., eating disorders), personal disorders, or psychosis.
Conclusions
The results of this study indicate that mental health-related hospital admissions by children and adolescents are generally higher during the academic calendar. These findings support efforts to leverage opportunities in schools to prevent and detect emerging mental health problems among youth. In addition, the amount and range of community-based resources should complement the seasonal variations so that inpatient and acute services may be less utilized.
Sources of Support
Department of Health of the Province of New Brunswick, a New Brunswick Health Research Foundation and Canadian Institutes for Health Research (CIHR)-Strategy for Patient Oriented Research-Maritime SPOR SUPPORT Unit Post-Doctoral Fellowship award, and a CIHR-funded Community-Based Primary Health Care Team Grant.