Prevalence and Characteristics of Mental Health Interventions Following Pediatric Hospitalization

Abstract

BACKGROUND AND OBJECTIVES: As survival after pediatric critical illness improves, attention has shifted to post-intensive care syndrome and the long-term mental health of pediatric intensive care unit (PICU) survivors, who have high rates of posttraumatic stress, anxiety, and depression. The objective of this study is to examine the rates of new mental health follow-up and psychopharmacology use among publicly insured children following PICU hospitalization, compared with those hospitalized on acute care wards. METHODS: We performed a retrospective cohort study using 2016-2021 multistate Medicaid claims. The cohort comprised children aged 3 to 18 years discharged home after an index hospitalization. The primary exposure was PICU admission. The primary outcome was new mental health visits within 1 year after discharge. Secondary outcomes included visit clinician type, visit diagnoses category, and new psychiatric prescriptions. RESULTS: Among 144 763 Medicaid-insured pediatric hospitalizations (20.7% with PICU stays), only 5.2% initiated new mental health care. When compared with hospitalizations without PICU exposure, those with PICU exposure were more likely to complete new mental health visits (n = 1697 [6.1%] of PICU hospitalizations vs 5252 [4.9%] of non-PICU hospitalizations). PICU exposure was independently associated with a new mental health visit (odds ratio 1.07; 95% CI 1-1.14; P = .042). Older age, complex chronic conditions, and longer length of stay were associated with new mental health visits. CONCLUSIONS: New mental health follow-up after pediatric hospitalization is rare and independently associated with PICU exposure during hospitalization. Future studies should investigate barriers to care and identify effective methods for systematic screening and proactive referral.