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Geographic Differences in Childhood Mental Health Hospitalizations: A Step Towards Intervention

May 5, 2023

Emergency department visits and hospitalizations for children and adolescents have increased over recent years, particularly during the COVID-19 pandemic. The need for more outpatient mental health resources and providers for children and adolescents is well-documented, particularly in rural US counties. Characterizing geographic differences in mental health hospitalizations by urban vs. rural counties can identify areas of need in an early step towards intervention.

This month, Pediatrics is early releasing a study, “Urban-Rural Hospitalization Rates for Mental Health,” where Dr. Corrie McDaniel and colleagues compared rates of mental health hospitalizations in 2019 by location of the child’s home residence, split into 6 categories based on the population size—large central metropolitan to rural (10.1542/peds.2023-061256). Using the Kids’ Inpatient Database, the authors found some similarities in mental health hospitalizations across geographic areas; for example, depressive disorders, including suicidal ideation, were the most frequent reason for hospitalization regardless of population size. However, compared with large central metropolitan areas, children from smaller metropolitan areas and rural counties had strikingly higher rates of hospitalization for suicide and self-injury, with lower rates of hospitalization for eating disorders.

What are the implications of these findings? First and foremost, more granular data is needed to understand the reasons for these differences. As the authors discuss, a large proportion of rural areas are designated as mental health professional shortage areas, and hospitalizations for certain conditions may be more frequent because of lack of access to outpatient resources and providers. The authors identify telehealth as an option to provide access to mental health care in rural areas, with a need for further study. Ultimately, though, the results of this study demonstrate the great need for mental health resources across geographic areas, and these results may be even more striking if the study were to be repeated during the COVID-19 pandemic. Continued focus on mental health care is needed not just in urban, metropolitan areas, where many children’s hospitals are located, but also in rural areas which have unique needs and challenges.

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