Prevalence of Psychiatric Disorders Among Children and Adolescents in Child Welfare Custody Admitted to the Hospital: A Nationwide Inpatient Sample Analysis.

Objective: To assess the prevalence of psychiatric disorders among children and adolescents in child welfare custody admitted to the hospital.Methods: Data were collected from the 2016-2017 National Inpatient Sample of the US population of general hospital admissions. Data for patients aged 12-17 years who were in child welfare custody were obtained using the ICD-10 diagnosis code Z6221: child in welfare custody. The control group comprised patients not in child welfare custody. Groups were compared for demographic, clinical, and hospital characteristics.Results: The study group included 879 child welfare patients, of whom 38.9% were male, with a mean age of 14.7 years. The control group comprised 222,494 patients, of whom 41.2% were male, with a mean age of 14.9 years. In the study group, 69.4% of patients had mood disorders compared to 28.6% in the control group. Half of the patients in the study group had anxiety disorders and almost 44% had ADHD and other conduct disorders compared to 19.3% and 14.2%, respectively, in the control group. Prevalence of suicidal ideation/attempt was almost 3 times higher in the study group compared to controls (41.0% vs 14.8%), and 18.3% of study group patients had a substance use disorder compared to 8.3% of controls. Mood disorders were the most common reason for hospitalization (44.8% vs 19.2%), followed by ADHD/other conduct disorders (5.3% vs 1.1%) and anxiety disorders (4.9% vs 0.9%).Conclusions: Children and adolescents in the child welfare system are associated with a higher risk of mental health problems. More studies are needed to identify the factors that contribute to psychiatric comorbidities in this population and to determine and address the factors that can prevent mental health issues.Prim Care Companion CNS Disord 2023;25(6):22m03238. Author affiliations are listed at the end of this article.

Sexual Abuse and Its Impact on Suicidal Ideation and Attempts and Psychiatric Illness in Children and Adolescents With Posttraumatic Stress Disorder.

Objective: Sexual abuse in minors aged 6-17 years is a significant public health concern. Victims of sexual abuse are at risk of developing complex psychopathology and chronic suicidal thoughts. Posttraumatic stress disorder (PTSD) develops in one-third of minors with a history of sexual abuse. The primary objective of this study was to assess the baseline characteristics of minors with PTSD and a history of sexual abuse (PTSD+S) compared with minors with PTSD without sexual abuse (PTSD only). The secondary objective was to evaluate the psychiatric comorbidities and suicidal ideation/attempts between the groups.Methods: The National Inpatient Sample database from 2006 to 2014 was analyzed using the ICD-9 code for PTSD and history of sexual abuse. PTSD+S (n = 251) subjects were compared with those with PTSD only (n = 24,243) using t test and χ2 test. Univariate and multivariate logistic regression analyses were performed with suicidal behavior (suicidal ideation/attempt) as the outcome and PTSD with and without sexual abuse, sex, age, and other psychiatric comorbid conditions as independent variables.Results: More patients in the PTSD+S group were nonwhite (52% vs 42%, P < .001) and female (81% vs 66%, P < .001) compared to PTSD only patients. Also, more patients were Hispanic in the PTSD+S group compared to the PTSD only group (28% vs 13%). Major depressive disorder (MDD; 23% vs 14%, P < .001) and substance use disorder (SUD; 20% vs 11%) were more commonly diagnosed psychiatric comorbidities in the PTSD+S group (P < .001). Suicidal behavior (suicidal ideation/attempt) was higher in the PTSD+S group than in PTSD only patients (36% vs 30%, P = .05). Overall, the risk of suicidal behavior was 29% higher in the PTSD+S group than in PTSD only patients (odds ratio [OR] = 1.29, P = .05). In the multivariate analysis, after controlling for age and sex, comorbid diagnosis of MDD (OR = 1.66, P < .001) and SUD (OR = 1.18, P < .001) was associated with increased suicidal behavior. However, PTSD+S showed no association with suicidality (OR = 1.16, P = .29) in the multivariate analysis.Conclusions: Sexual abuse is associated with PTSD and higher risk of comorbid psychiatric illnesses, including MDD, SUD, and suicidal behavior. In-depth research on the relationship between child and adolescent sexual abuse and chronic suicidality is warranted.

Trends for Electroconvulsive Therapy Utilization in Children and Adolescents in the United States From 2002 to 2017: A Nationwide Inpatient Sample Analysis.

OBJECTIVES: Electroconvulsive therapy (ECT) is controversial in children and adolescents (C/A). The primary objective of this study was to evaluate baseline characteristics of C/A in the utilization of ECT compared with the non-ECT group with the same primary indication. The secondary objective was to assess the trends in ECT utilization over 16 years and explore the predictors of length of stay. METHODS: Using the Nationwide Inpatient Sample database from the years 2002 to 2017, we identified patients (age ≤18 years) undergoing ECT in the United States using International Classification of Diseases, Ninth Revision and Tenth Revision, Clinical Modification/Procedure Coding System codes and compared with non-ECT C/A patients with the same primary diagnosis. Baseline clinical characteristics were assessed using descriptive analysis methods. Multilevel regression analysis and trend analysis were performed. RESULTS: Children and adolescent patients (n = 159,158) receiving (ECT: n = 1870) were more likely to be men (43.3% vs 36.7%) and of White race (58% vs 49%) (P < 0.001). The hospital stay was longer (19 days vs 6 days, P < 0.001) for the ECT group than controls. ECT receiving C/A patients were more likely to have private insurance (72% vs 42%, P < 0.001). African American patients undergoing ECT treatment increased in number over the course of years (2002 to 2017), whereas the privately insured C/A patients receiving ECT decreased over the same period (P < 0.001). There was an upward trend in ECT utilization for small bed size hospitals (P < 0.001). Length of stay for C/A receiving ECT was longer for males (P < 0.001) and patients with nonprivate insurance (p: 0.003). CONCLUSIONS: Electroconvulsive therapy is not optimally used in C/A; therefore, formulated treatment guidelines are required.

From Child Abuse to Developing Borderline Personality Disorder Into Adulthood: Exploring the Neuromorphological and Epigenetic Pathway.

Borderline personality disorder (BPD) is one of the most common personality disorders seen in the general population. Among multiple identified risk factors, one of the most influential elements is exposure to an adverse childhood experience in terms of emotional, physical, or sexual abuse. A cascade of neuromorphological and epigenetic changes occurs in response to these childhood stressors, which may have a strong link to the development of BPD. PubMed and Google Scholar were searched for articles relevant to child abuse and the development of BPD. The search was not restricted to any time frame or geographic location. Significant epigenetic and neuromorphological changes are seen with child abuse, contributing to the development of BPD. Chronic stressors lead to hypothalamic-pituitary axis (HPA) activation, releasing cortisol that acts on the prefrontal cortex, amygdala, and hippocampus, producing the behavioral patterns seen in BPD. Overstimulation of gray matter leads to permanent neuromorphological changes, which can be visualized in functional MRI/brain scans. Hypermethylation of messenger ribonucleic acid in various sites suggests the impact of child abuse on the genetic level. Interestingly, the prevalence of BPD is seen equally in both genders but is diagnosed more frequently in females because they tend to be more likely to seek help. Understanding the impact of early age life stressors into adulthood calls for serious focus on early diagnosis and intervention. This implies the need for more studies in patients with BPD with or without any childhood traumatic experience and a better understanding of the changes that occur biopsychologically and genetically in response to trauma.

Medical and Psychiatric Comorbidities in Bipolar Disorder: Insights from National Inpatient Population-based Study.

Objectives The objective of this study was to analyze the differences in the prevalence and association of medical and psychiatric comorbidities in bipolar disorder (BD) patients versus the general inpatient population. Methods A cross-sectional analysis was conducted using the national inpatient sample (NIS). Using the international classification of diseases, ninth revision (ICD-9) diagnostic codes, we extracted the BD inpatients and then obtained information about comorbidities. The odds ratio (OR) of comorbidities in BD inpatients were evaluated using a logistic regression model. Results Hypertension (31.1%), asthma (11.7%) and diabetes, obesity, and hypothyroidism (11% each) were the prevalent medical comorbidities found in BD inpatients. Hypothyroidism, asthma, and migraine were seen in BD inpatients (OR 1.59, OR 1.37 and OR 1.23; respectively) compared to general inpatients. Drug abuse (33.5%), anxiety disorders (31.8%), and alcohol abuse (18.3%) were the most prevalent psychiatric comorbidities in BD inpatients. They had a seven-fold higher likelihood of comorbid borderline personality disorders compared to general inpatients. Among other psychiatric comorbidities, the odds of the association were higher for drug abuse (OR 4.33), ADHD (OR 3.06), and PTSD (2.44). Conclusion A higher burden of medical and psychiatric comorbidities is seen in BD inpatients compare to the general inpatient population. A collaborative care model is required for early diagnosis and management of these comorbidities to improve the health-related quality of life.

Exploring the Link Between Emotional Child Abuse and Anorexia Nervosa: A Psychopathological Correlation.

Eating disorders (ED) are well known psychiatric disorders associated with dysregulated eating behaviors and related thoughts and emotions. Common eating disorders are bulimia nervosa (BN), anorexia nervosa (AN), and binge eating disorders (BED). There is an active link between child abuse and eating disorders, emotional child abuse being the important subtype of CA and has a strong comorbid psychopathological relationship with EDs, including AN. The PubMed database was searched for the related articles about child abuse, including emotional childhood maltreatment and their psychopathology associated with EDs, especially AN. No filters were used for the date of publication and article types. Childhood abuse, including physical, sexual, and emotional maltreatment, has an active link with psychopathology associated with dysregulated eating behaviors. However, emotional childhood maltreatment including emotional abuse, neglect, and/or exposure to intimate partner violence (IPV) has been least studied, but studies have shown a strong relationship with the symptoms of anorexia nervosa such as weight concern, negative self-image, and maladaptive emotional response. Emotional dysregulation is the crucial psychopathological factor involved in mediating the effects of emotional childhood maltreatment and symptoms of anorexia nervosa and is strongly associated with long-term morbidity in patients with AN. Conducting more clinical studies in the future would help explore the temporal causation, and this association may help the practitioners to develop new diagnostic and therapeutic strategies in the management of AN.

Hospital Outcomes in Antepartum Mental Disorders: A Study on 897,397 Pregnant Inpatients.

OBJECTIVE: To evaluate the impact of antepartum mental disorders (AMD) in medical and psychiatric comorbidities, and inpatient outcomes during hospitalizations for pregnancy/birth-related complications. METHODS: We used the national inpatient sample (NIS) data and included 19,170,562 female patients (age, 12-40 years) with a principal diagnosis of pregnancy/birth-related complications and grouped by co-diagnoses of AMD (N = 897,397). We used a binomial logistic regression model to evaluate the odds ratio (OR) for major severity of illness and adjusted for demographic confounders. RESULTS: The hospitalizations with AMD increased by 22.1% (p < 0.001) from 2010 to 2014. White females (66.1%) and those from low-income families (<25th percentile, 31.8%) majorly had comorbid AMD. Depression (43.8%) and drug abuse (27%) were prevalent psychiatric disorders in AMD inpatients. Comorbid AMD inpatients had a higher likelihood for major severity of illness (OR 2.475, 95% CI 2.459-2.491, p < 0.001). They also had a longer hospitalization stay with a mean difference of 0.486 days (95% CI 0.480-0.491) and higher total charges by $1889.420 per admission (95% CI 1852.670-1926.170) than non-AMD inpatients. CONCLUSIONS: AMD is associated with worsening of severity of illness in pregnancy/birth-related complications and require acute inpatient care. Mental health assessment and treatment of AMD, and education about efficacy and safety of psychiatric medications may help to improve outcomes in these patients.

Comorbid Depression and Psychosis in Parkinson's Disease: A Report of 62,783 Hospitalizations in the United States.

Background Depression and psychosis are common comorbidities that significantly affects the quality of life and disease outcomes in Parkinson's disease (PD) patients. Objective The aim of this study was to analyze and discern the differences in the hospitalization outcomes, comorbidities, and utilization of deep brain stimulation (DBS) in PD patients with comorbid depression and comorbid psychosis. Methods We used the Nationwide Inpatient Sample (2010-2014) and identified PD as a primary diagnosis (N = 62,783), and depression (N = 11,358) and psychosis (N = 2,475) as co-diagnosis using the International Classification of Diseases, Ninth Revision (ICD-9) codes. Pearson's chi-square test and independent-sample t-test were used for categorical data and continuous data, respectively. Results White male, older age, and comorbid psychosis were significantly associated with higher odds of having major severity of illness in PD inpatients. The mean length of stay (LOS) was higher in PD patients with psychosis compared to PD with depression (7.32 days vs. 4.23 days; P < 0.001), though the mean total charges of hospitalization were lower in psychosis ($31,240 vs. $38,581; P < 0.001). Utilization of DBS was lower in PD patients with psychosis versus with depression (3.9% vs. 24.3%; P < 0.001). Conclusion Psychiatric comorbidities are prevalent in PD patients and are associated with more disease severity, impaired quality of life, and increased use of healthcare resources (higher LOS and cost). They should be considered an integral part of the disease, and a multidisciplinary approach to managing this disease is crucial to improve the health-related quality of life of PD patients.

Heroin Overdose-Related Child and Adolescent Hospitalizations: Insight on Comorbid Psychiatric and Substance Use Disorders.

OBJECTIVE: To evaluate the association between psychiatric comorbidities, substance use disorders and heroin overdose-related hospitalizations (HOD). Next, to understand the demographic trend of HOD hospitalizations and comorbidities. METHODS: Using the Nationwide Inpatient Sample (NIS), we included 27,442,808 child and adolescent hospitalizations, and 1432 inpatients (0.005%) were managed primarily for HOD. The odds ratio (OR) of the association of variables in HOD inpatients were measured using a logistic regression model. RESULTS: Adolescents had 56 times higher odds (95% CI 43.36-73.30) for HOD-related hospitalizations compared to 4.6% children under 11 years. About three-fifth of the HOD inpatients were male, and they had 1.5-fold higher odds (95% CI 1.30-1.64) compared to 43% females in the study population. Whites were considerably higher in proportion (81%) than other race/ethnicities. A greater portion of HOD inpatients (40%) were from high-income families. Most common comorbid psychiatric disorders were mood (43.8%) and anxiety (20.4%). The prevalent comorbid substance use disorders were opioid (62.4%), tobacco (36.8%) and cannabis (28.5%) use disorders. CONCLUSION: HOD-related hospitalizations were predominant in males, White and older adolescents (12-18 years). Prescription opioids are the bridge to heroin abuse, thereby increasing the vulnerability to other substance abuse. This requires more surveillance and should be explored to help reduce the heroin epidemic in children.