Predictors of Prolonged Length of Stay in Suicidal Children Transferred to Psychiatric Facilities

OBJECTIVES: To determine if sociodemographic factors or underlying mental health conditions serve as predictors for prolonged length of stay (pLOS) in children hospitalized for suicidal ideation (SI) or suicide attempt (SA) requiring transfer to psychiatric facilities. We hypothesized an association between certain patient and hospital characteristics and pLOS.

METHODS: For this retrospective cross-sectional study, we used the National Inpatient Sample. We included children <18 years old hospitalized with a primary or secondary International Classification of Diseases, 10th Edition, Clinical Modification diagnosis of SI or SA who were dispositioned to psychiatric facilities from 2016 to 2017. Exposures were patient sociodemographics, underlying mental health diagnoses, and hospital characteristics. Our outcome was pLOS. Adjusted prevalence ratios with 95% confidence intervals (CIs) were generated with log binomial regression.

RESULTS: Of 12 715 hospitalizations meeting inclusion criteria, 5475 had pLOS. After adjusting for sociodemographics and hospital characteristics, predictive factors for pLOS were public insurance use (prevalence ratio: 1.40; CI: 1.12–1.78), urban nonteaching hospital location (prevalence ratio: 4.61; CI: 2.33–9.12), urban teaching hospital location (prevalence ratio: 3.26; CI: 1.84–5.76), and underlying diagnosis of mood disorder (prevalence ratio: 1.98; CI: 1.63–3.42). Hispanic patients had decreased probability of pLOS (prevalence ratio: 0.69; CI: 0.52–0.93). Otherwise, age, zip income, sex, and hospital region were not predictive of pLOS.

CONCLUSIONS: Among children hospitalized for SI or SA requiring transfer to psychiatric facilities, public insurance, urban hospital location, and diagnoses of mood disorder, depression, and bipolar disorder were predictive of pLOS. Further research is needed on how to decrease disparities in length of stay among this vulnerable population.