As survival after pediatric critical illness has improved, attention has shifted to longer-term outcomes including post-intensive care syndrome and mental health sequelae. Prior work has documented elevated rates of posttraumatic stress, anxiety, and depression among pediatric intensive care unit (PICU) survivors. This study aimed to compare rates of new mental health follow-up and initiation of psychotropic medications among publicly insured children following index hospitalizations with and without PICU exposure.
The investigators conducted a retrospective cohort study using multistate Medicaid claims from 2016 through 2021. The analytic sample included children aged 3 to 18 years who were discharged home after an index hospitalization. The primary exposure variable was whether the index hospitalization included a PICU stay. The primary outcome was any new mental health visit occurring within 1 year after discharge. Secondary outcomes included clinician type for the mental health visit, diagnostic categories recorded for visits, and new psychiatric prescriptions initiated after discharge.
The cohort comprised 144,763 Medicaid-insured pediatric hospitalizations recorded in the 2016–2021 multistate Medicaid claims dataset. Of these hospitalizations, 20.7% involved a PICU stay. All patients included were between 3 and 18 years old and discharged to home after their index hospitalization.
Primary outcome: initiation of any new mental health care visit within 1 year post-discharge.
Secondary outcomes (as specified in the abstract):
Overall, only 5.2% of hospitalizations in the cohort initiated new mental health care within 1 year of discharge.
Among hospitalizations with PICU exposure, 6.1% (n = 1,697) initiated a new mental health visit within 1 year.
Among hospitalizations without PICU exposure, 4.9% (n = 5,252) initiated a new mental health visit within 1 year.
In multivariable analysis, PICU exposure was independently associated with an increased likelihood of a new mental health visit: odds ratio (OR) 1.07, 95% confidence interval (CI) 1.00–1.14, P = .042.
Additional factors associated with initiating new mental health visits included older age, presence of complex chronic conditions, and longer hospital length of stay.
The adjusted association between PICU exposure and new post-discharge mental health visits was small but reached statistical significance (OR 1.07; 95% CI 1.00–1.14; P = .042). The abstract reports that older children, those with complex chronic conditions, and those with longer index hospital stays had higher odds of beginning mental health follow-up within the year after discharge. Specific effect sizes for age strata, chronic condition categories, and length-of-stay increments were not reported in the available text.
The provided source text is the article abstract and is truncated: the final portion of the Conclusions section and detailed results for secondary outcomes are missing.
The abstract did not report the absolute or relative rates of new psychopharmacologic prescriptions, nor did it provide a breakdown of clinician types (for example, psychiatry vs psychology vs primary care), diagnostic categories assigned at visits, or timing distribution of follow-up visits within the 1-year window.
The methods summary in the abstract does not detail covariates included in multivariable models, any sensitivity analyses, or approaches to address potential confounding and missing data; those details were not available in the supplied text.
Because only Medicaid claims were used, findings reflect patterns among publicly insured children and may not generalize to privately insured populations; this limitation is implicit but not elaborated in the provided abstract.
In this large multistate Medicaid cohort, initiation of new mental health care within a year after pediatric hospitalization was uncommon overall (5.2%), and slightly more frequent after hospitalizations that included a PICU stay (6.1% vs 4.9%). PICU exposure was associated with a modest independent increase in odds of new mental health visits. Older age, complex chronic conditions, and longer lengths of stay identified subgroups with higher post-discharge mental health follow-up.
These findings suggest low rates of new documented mental health engagement in the year after pediatric hospitalization among publicly insured children, despite concern for elevated psychiatric morbidity after critical illness. The abstract does not report detailed data on mental health diagnoses, clinician types, or psychopharmacology initiation; the full manuscript would be required to evaluate those outcomes, assess clinical significance, and inform targeted post-discharge screening or linkage strategies.
Note: The source abstract text provided here was truncated; additional conclusions, subgroup analyses, and secondary outcome details were not reported in the available text (they may appear in the full article).