New 2022 data: Pediatric mental health hospitalizations decline overall, increase for females | Image Credit: © Lumos sp - © Lumos sp - stock.adobe.com.

According to newly published data in JAMA from 2022, the number of female pediatric mental health hospitalizations increased, despite the total number of pediatric mental health hospitalizations having decreased for the first time since 2009. Findings could reflect sex-related differences in mental health symptoms, diagnoses, and reporting among adolescent girls.¹

Study design and participants

Study investigators, led by JoAnna Leyenaar, MD, PhD, MPH, of the Department of Pediatrics at Dartmouth Health Children's, noted that 1 in 5 children in the United States have a mental health diagnosis, with an increase of 25.8% in pediatric mental health hospitalizations at acute care hospitals from 2009 to 2019.^1,2

With the COVID-19 pandemic, social changes and noted worsening of mental health symptoms were observed, especially among adolescent females. Postpandemic, however, a lack of studies have examined sex-based differences in mental health hospitalizations among the pediatric populations, according to the study authors. In a cross-sectional study design, the investigative team expanded on the previous 2009 to 2019 mental health hospitalization analysis by "evaluating how the number of pediatric mental health and suicide/self-harm–related hospitalizations changed in 2022 and characterizing sex-based differences over time," they wrote.¹

Data analyzed was from the 2009 to 2022 Kids' Inpatient Database (KID), which is released every 3 years by the Agency for Healthcare Research and Quality. The database represents inpatient pediatric discharges from an estimated 4000 short-term non-psychiatric hospitals, including discharge weights to generate national estimates. With sex recorded for each encounter, the analysis included hospitalizations of children aged 3 to 17 years.

Results: Pediatric mental health hospitalizations in 2022

There were an estimated 914,260 mental health hospitalizations in all study years, of which 543,887 were among female youth (59.5%; 95% CI, 59.0%-59.9%), 461,937 (50.5%; 95% CI, 49.5%-51.8%) were insured by government payers, and 467,684 (51.2%; 95% CI, 50.6%-51.7%) were for adolescents aged 15 to 17 years. Overall, the mean age of the cohort was 14 years (SD, 3.2 years).

In 2022, an estimated 191,710 mental health hospitalizations were observed, a decrease from 2019, the first observed decline in the study period. The estimated number of mental health and suicide/self-harm-related hospitalizations reached highs of 128,105 and 97,432 in 2022, respectively, which increased each study year. The 63,522 observed mental health hospitalizations among male youth were the fewest of all other study years. In 2022, proportionally, female youth experienced 66.8% (95% CI, 66.2%-67.5%) of the mental health hospitalizations and 71.0% 95% CI, 70.5%-71.5%) of suicide/self-harm–related hospitalizations, the authors found.

"For both female and male youth, depressive disorders were the most common principal diagnoses," wrote the authors. "Male youth more often had principal diagnoses of disruptive, impulse control, and conduct disorders or neurodevelopmental disorders; there were fewer hospitalizations for these conditions in 2022 than in any other study year."

The authors noted there were limitations in the study, including that the KID is released every 3 years, not annually, meaning it is not possible to observe individuals across encounters. Additionally, psychiatric, long-term, and rehabilitation hospitals are not included in the KID, nor were emergency department visits.

"These findings may reflect sex-related differences in mental health symptoms, reporting, and diagnoses, with adolescent girls more often seeking care for internalizing disorders, particularly after the COVID-19 pandemic," wrote the study authors. "Biological and social factors may contribute, including sex-based differences in age of pubertal onset and greater susceptibility among female youth to stressors related to family functioning, peer relationships, and social media. However, adolescent boys remain at higher risk of suicide death, indicating that sex-based differences in prevention strategies, screening, and treatment may be warranted."

References:

1. Leyenaar JK, Freyleue S, Arakelyan M, Schaefer AP, O’Malley AJ. Sex-based differences in pediatric mental health hospitalizations at US acute care hospitals. JAMA. Published online June 23, 2025. doi:10.1001/jama.2025.7741
2. Arakelyan M, Freyleue S, Avula D, McLaren JL, O’Malley AJ, Leyenaar JK. Pediatric mental health hospitalizations at acute care hospitals in the US, 2009-2019. JAMA. 2023;329(12):1000-1011. doi:10.1001/jama.2023.1992