Nearly two-thirds of adolescent long stays in NSW hospitals for mental health

A study by University of Sydney researchers has shown that 63 percent of long-stay admissions to NSW hospitals for children aged 12 to 15 is for mental health care.

Reasons for admission for these children included eating disorders, anxiety and depression. This contrasts with children aged 8 to 11, for whom just 11.3 percent of long-stay admissions to hospital are for mental health reasons.

The findings also showed that children admitted to hospital for stays longer than a week were more commonly from disadvantaged backgrounds or lived further from hospitals in rural and regional NSW.

The study, published in Lancet Regional Health Western Pacific, found that the overwhelming majority (71.9 percent) of admissions to NSW hospitals in 2017-2019 for children was for day or overnight stays or for two to seven days (25.3 percent).

However, long-term stays of more than a week, while accounting for just 2.8 percent of admissions amounted to more than a quarter of total occupied bed days.

Joint senior author Professor Adam Guastella from the Brain and Mind Centre at the University of Sydney said: “The data on older children are very different to those for younger ones, which is more evidence that mental health in adolescents is a growing concern.”

This is reflected in a recent study finding that one in five young people suffer from an eating disorder. These statistics are comparable to international trends, particularly for eating disorders and depression, with onset mental health disorders most common between the ages of 14-19 and statistically higher for girls.

Professor Guastella, the Michael Crouch Chair in Child and Youth Mental Health in the Faculty of Medicine and Health, said: “A reason that may explain this trend includes limited community resources for post-discharge referral services.

“There are also unmet needs in primary care for intervention services that could mitigate symptom severity and prevent mental health hospitalisation, particularly for children and youth with additional vulnerabilities such as neurodevelopmental conditions.”

The University of Sydney study found that children aged 1 to 4 years had the highest proportion of admissions at 35 percent, with a majority lasting under seven days, whereas 45.6 percent of admissions of up to 22 days were for children aged under 12 years of age.

The most common reasons for hospitalisation were respiratory conditions, diseases of the digestive system and traumatic injuries.

Professor Guastella said: “Overall, our study shows that most paediatric hospitalisations are for acute conditions, many of which could be managed in primary health care.

“Further interventions, such as care coordination, tailored models of care and improved community treatment for high-risk groups and in regional areas, could help reduce extended length of stay for children, improving their health and wellbeing.”

Paediatric hospital length of stay is often used as a benchmark for resource use of hospitalisations. Previous studies have mostly focused on length of stay for specific conditions or medical specialties. This paper is the first comprehensive review of length of stay for age cohort in children.

The study assessed the 324,083 children who accounted for 518,768 admissions to NSW hospitals between 2017 and 2019. This amounted to 1,064,032 bed days in hospital. It evaluated children and teenagers admitted to hospitals, length of stays, and the reasons for their admission.

Declaration

The authors have no conflicts of interest in relation to this study. Authors acknowledge the support of Sydney Children’s Hospital Foundation and NSW Ministry of Health for use of the data. Further funding is from the Financial Markets Foundation for Children and the Australian National Health and Medical Research Council (NHMRC).