Beyond the Bed: What Clinical and Non-clinical Factors Drive Length of Stay in Pediatric Psychiatry?

Abstract

Background

Rates of psychiatric disorders and related hospitalizations among youth in the United States have risen substantially over recent decades. Despite evidence supporting outpatient care, fewer than half of youth receive treatment. When outpatient management is insufficient, inpatient psychiatric hospitalization is required, though it is costly, disruptive, and limited in availability. Prior research on predictors of inpatient length of stay has been dated and heterogenous, highlighting the need to identify current clinical and non-clinical factors associated with prolonged stays among youth populations.

Method

This IRB-approved retrospective study reviewed the medical records of 1,101 child and adolescent patients admitted to an inpatient psychiatric unit between June 1, 2018, and November 30, 2021. Baseline sociodemographic and clinical data were collected, and LOS was categorized into three groups: below-average (0–6 days), average (7–14 days), and above-average (15+ days). Comparative statistics were performed, and linear regression was used to identify independent predictors of LOS.

Results

The average LOS was 10.5 days. Significant predictors of prolonged LOS included public insurance, admission for psychosis or suicide attempt, involvement of child protective services, number of prior hospitalizations, and number of medications prior to admission.

Conclusion

Prolonged LOS in psychiatrically hospitalized youth is associated with specific clinical and non-clinical factors. Identifying these predictors at admission can guide treatment planning and set realistic expectations for families. Further research is required to validate these findings and explore the impact of LOS on treatment outcomes.

Plain Language Summary

Rates of mental health problems and psychiatric hospitalizations among children and adolescents have risen sharply in recent decades. When outpatient treatment is not sufficient to ensure safety or stabilization, inpatient psychiatric care is sometimes necessary, though it can be costly, disruptive, and limited in availability. Understanding what factors contribute to longer hospital stays can help improve care planning and resource use. This study reviewed medical records from 1,101 youth admitted to an inpatient psychiatric unit between 2018 and 2021. The average length of stay was 10.5 days, with stays categorized as below average (0–6 days), average (7–14 days), or above average (15+ days). Researchers examined demographic, clinical, and social factors to identify predictors of longer stays. Prolonged hospitalization was associated with both clinical and non-clinical factors. Youth with public insurance, involvement with child protective services, admission for psychosis or a suicide attempt, multiple prior hospitalizations, or more psychiatric medications before admission had longer stays. These results suggest that illness severity and complex psychosocial circumstances both play major roles in determining length of stay. Identifying these factors at admission can help hospital teams anticipate which patients may need extended treatment, coordinate discharge planning earlier, and communicate more effectively with families about expected recovery timelines. The findings also highlight how social and systemic factors influence hospital use, suggesting opportunities to improve continuity of care and reduce unnecessary hospitalization days. Further research should confirm these results in other settings and examine how length of stay affects treatment outcomes and long-term recovery.