The shifting demographics of adolescent inpatients
A recent report1 from the United States Centers for Disease Control and Prevention (CDC) put adolescent mental health under a spotlight, with emerging trends raising significant concerns particularly among teenage females. The reveals an alarming surge in indicators of poor mental health among adolescents over the past decade. Feelings of sadness, anxiety, hopelessness, and suicidal tendencies seem to have been at an all-time high in the year 2021. Consequently, MHO set out to investigate whether our own adolescent inpatient data reflects these troubling trends.
We found a 21% increase in female adolescent inpatient admissions from 2019 to 2023 (Figure 1). In stark contrast, admission rates for other demographic groups (not shown) have remained stable or slightly decreased.
Figure 1. Females account for a growing share of adolescent inpatient admissions from 2019 to 2023.
Many of MHO’s adolescent inpatient client programs use the Child and Adolescent Behavioral Assessment – Youth (The CABA-Y) to measure patient outcomes. The CABA-Y is a 32 item patient self-report tool assessing problem behaviors over the past week on a scale ranging from 0 ‘not a problem’ to 3 ‘a big problem’. Several CABA-Y items are similar to those reported by the CDC. On these similar items, we too found a consistent elevation in the percent of patients endorsing 3 ‘a big problem’ over the last few years, with a notable spike in 2021 (Figure 2). More than 1 in 3 adolescent females self-reported the highest possible severity for at least one of these items compared to 1 in 4 males. The percentage of adolescent inpatients self-reporting the highest severity for “Better off dead” increased 6 and 7 percentage points from 2019 to 2023 for males and females, respectively. While both adolescent sexes showed this trend, females exhibited a higher likelihood of reporting the most severe symptoms across time and in all items.
Figure 2. Percent of adolescent inpatients self-reporting the highest possible severity on admission, by item and sex
So, what does this mean for BH facilities?
The implications of these findings are substantial, suggesting thoughtful consideration and proactive measures are needed by facilities and institutions dealing with adolescent mental health. Importantly, behavioral health inpatient programs should remain abreast of ongoing research examining trends in mental health and potential contributing factors, allowing them to better prepare and align their treatment efforts. Current trends signal the need for increased attention and resources to address the escalating severity of symptoms related to negative mood and suicidal ideation among teenagers, and especially females. This entails strengthening preventive interventions at the outpatient level and improving availability and support at the inpatient acute care level. Additionally, it will be important to closely monitor and evaluate treatment outcomes and patient satisfaction for female adolescents receiving treatment in behavioral health inpatient and outpatient programs.
1 Centers for Disease Control and Prevention (CDC). (2023). U.S. Teen Girls Experiencing Increased Sadness and Violence. Retrieved from U.S. Teen Girls Experiencing Increased Sadness and Violence | CDC Online Newsroom | CDC