Seasonality in Mental Health-Related Hospitalizations by Children, Youth and Adults in New Brunswick David Miller, BA1, Amanda K. Slaunwhite, PhD,2,3 Scott T. Ronis, PhD1, Paul A. Peters, PhD4 1 Department of Psychology, University of New Brunswick 2 Centre for Addictions Research of British Columbia 3 Institute for Circumpolar Health Studies, University of Alaska 4Department of Sociology, University of New Brunswick  

Context Increases in hospital admissions across Canada and the United States Mental health-related hospital admissions among Canadian children and adolescents (5-24 years) rose by 45% from 2006/2007 through 2013/2014 (Bardach et al., 2014; Canadian Institute for Health Information, 2015) Implications: Significant implications for health care policy and spending Questionable efficacy of treating adolescents and youth in adult-oriented general hospital psychiatry departments

Contribution Seasonal variations in mental health-related hospital admissions have been understudied though identified as having “important implications for resourcing and prevention.” (Greenham and Persi, 2014) Measuring seasonality in mental health care utilization is critical for: Developing age-appropriate interventions in places where adolescents and youth frequent (i.e. schools) at certain points in the year Allocating health care resources in a manner that maximizes quality and restrains costs

Objective “ Measure seasonal variations in mental health-related hospitalizations by children and adolescents over a nine-year period using administrative hospital data from New Brunswick, Canada ”

Research Methods: Data New Brunswick’s Discharge Abstract Database (DAD) Data from January 1, 2004-December 31, 2014, inclusive, were used for this project In 2013-2014, 21 acute care and 15 day-surgery institutions in New Brunswick reported 142,551 hospital admissions The DAD contains information on all hospital separations (i.e., discharges, deaths, and transfers)

Research Methods: Measures Seasons: Each year was delineated as January 1 to December 31. Seasonality was examined using monthly data Children, Adolescents and Youth: Children were defined as being 3 to 10 years of age, adolescents were identified as 11 to 19 years of age, and adults were defined as 20 years and over Disease Types: All records were coded using the International Statistical Classification of Diseases and Related Health Problems, 10th Revision Canada (ICD-10-CA) Inclusive of all types of mental health problems, including depression, anxiety, schizophrenia, and eating disorders (full list of ICD codes is available by request)

Research Methods: Analysis Descriptive statistics General linear model (GLM) was fitted to a sinusoidal curve with Poisson distribution using the ‘Season’ package in R

Results: Age Distribution of Admissions From January 1, 2004 to March 31, 2014 there were 57,730 mental health-related hospital admissions by 41,690 residents in New Brunswick The majority of child and adolescent patients were aged 16-19 (60.88%, N=2,685), compared to the 11-15 years (34.92%, N=1,540) and 3-10 years age groups (4.19%, N=185).

Results: Disease types Admissions due to self-harm were higher among children and adolescents aged 3-19 (4.04% of admissions) compared to adults (1.74% of admissions) Behavioural disorders, including eating disorders, comprised 3.34% of admissions by children and adolescents, almost six times higher than the proportion of hospital admissions by adults (0.45% of hospitalizations)

Results: Time Series Trends in Admissions Psychiatric admissions by children and adolescents (aged 3-19) have increased over the ten-year period from 44 admissions per 100,000 in 2004 to 51 admissions per 100,000 in 2014. The opposite trend was observed for adults 20 years and older Admissions by Children and Adolescents (3-19 years) Admissions by Adults (20 years and older)

Results: Seasonality in Admissions (Children and Adolescents aged 3-19 years) Child and adolescent psychiatric admissions per 100,000 exhibited significant seasonality (p<.025) The highest rates were in February (as indicated using the phase parameter), and significantly more psychiatric admissions in November (RR=1.22, p=.003) and January (RR=1.74, p=.016) through April (RR=1.19, p=.012)

Results: Seasonality in Admissions (Adults aged 20 and over) Significant seasonality was detected (p<.025) Admissions peaked in early May (phase=5.3) with an amplitude of 9.7 There were significantly more admissions in April (RR=1.05, p=.049) and May (RR=1.05, p=.017), and fewer in the month of December (RR=0.89, p<.001)

Implications: Children and Youth Mental health-related hospital admissions by children and adolescents increased in the past 10 years, and rates of admission among children and adolescents are generally higher in the school year (September to May) Findings could be due a combination of increased stress and psychological distress; seasonal affective disorder, or increased detection of mental health problems by school staff The results of this study provide further rationale for investments in mental health services located in schools

Implications: Adults Psychiatric admissions to hospital by adults peaked in early May Consistent with many previous studies that have found that rates mental health-related hospital admissions and suicidality peak in the spring months Bolstering resources in the community and hospitals in the spring months could be necessary for meeting high demand for psychiatric services during this period

Conclusions Hospital admissions by children, adolescents and adults are highly variable by season in New Brunswick Psychiatric admissions to hospital peaked in the winter months for children and adolescents, whereas admissions by adults over 20 years of age were the highest in the spring (April and May) Our findings lend support to existing efforts to identify environmental factors that impact the likelihood of psychiatric admissions by children, adolescents and adults

Thank you! For further information please contact amanda.slaunwhite@unb.ca

References Bardach, N.S., Coker, T.R., Zima, B.T., Murphy, J.M., Knapp, P., Richardson, L.P., Edwall, G., Mangione-Smith, R., 2014. Common and costly hospitalizations for pediatric mental health disorders. Pediatrics 133, 602–9. doi:10.1542/peds.2013-3165. Canadian Institute for Health Information., 2015. Care for Children and Youth With Mental Disorders. Ottawa. Canadian Institute for Health Information., n.d. Discharge Abstract Database (DAD) Metadata | CIHI [WWW Document]. URL https://www.cihi.ca/en/types-of-care/hospital-care/acute-care/dad-metadata (accessed 2.4.16a). Canadian Institute for Health Information., n.d. ICD-10-CA [WWW Document]. URL https://www.cihi.ca/en/data-and- standards/standards/classification-and-coding/icd-10-ca (accessed 7.3.16b). Greenham, S.L., Persi, J., 2014. The State of Inpatient Psychiatry for Youth in Ontario: Results of the ONCAIPS Benchmarking Survey. J. Can. Acad. Child Adolesc. Psychiatry 23, 31–7. New Brunswick Institute for Research Data and Training., 2016. NB-IRDT | UNB [WWW Document]. URL http://www.unb.ca/fredericton/arts/nbirdt/ (accessed 2.4.16).