Mental Health in Hospitalized Kids

In my job as a hospital pediatrician, I recently helped care for a teenage boy with asthma. In my conversations with him, I learned that he was feeling severely depressed and had stopped taking his daily asthma medications. His depression had helped trigger the asthma flare that brought him to the hospital, demonstrating just how important mental health is to physical well-being. My experiences taking care of patients like this boy inspired me to do research to improve alignment between physical and mental health treatments in hospitalized children.

At least one in five children or teens experiences a mental health condition at some point during childhood or adolescence. Mental health conditions include a range of disorders that affect behaviors, physical health and emotional well-being such as autism, anxiety, depression and substance abuse. Symptoms from this group of conditions can improve with treatments from a mental health clinician such as a psychologist, psychiatrist, therapist or counselor. However, not enough mental health clinicians are available to treat all the patients who have symptoms.

At least one in five children or teens experiences a mental health condition at some point during childhood or adolescence.

Children and teens who have physical health conditions, like asthma and diabetes, have especially high risk of experiencing mental health conditions. The stresses of having a physical illness, like using daily medications, receiving painful treatments and experiencing unpleasant physical symptoms, can trigger mental health symptoms. For example, my patients with asthma tell me that being unable to catch a breath during an asthma attack can trigger symptoms of anxiety or panic. Other teens with sickle cell disease have shared with me that missing out on experiences with family and friends because of a hospitalization for a painful sickle cell crisis can cause feelings of depression.

Hospitals use different strategies to help address patients’ mental health needs. For instance, teens hospitalized for injuries from a car crash are screened for substance abuse that might have contributed to the injury and, if they screen positive, receive initial substance abuse treatments. Children hospitalized with cancer commonly receive supportive counseling from a psychologist or therapist to help them cope with the stresses of cancer treatment.

Outside the hospital, researchers have found that collaborative care between psychiatrists and pediatricians reduces adolescent depression.

While doctors, nurses and other health care professionals recognize that the mind and body are connected, health care teams –  including doctors, nurses and others – are still learning how to ensure that care of the mind and body are given equal attention in medical treatments. My recent research shows that when children with a mental health condition are hospitalized for a physical illness, like pneumonia, they have longer hospital stays and more complications. Many children and their families have difficulty coping with the stresses of hospitalization. Because of the shortage of mental health clinicians, families often ask for my help to make sure their children receive mental health treatments after they leave the hospital.

My recent research shows that when children with a mental health condition are hospitalized for a physical illness, like pneumonia, they have longer hospital stays and more complications.

Much work remains to be done to promote optimal mental health in children who have chronic physical conditions, particularly during times of stress like hospitalization. My colleagues and I are working on research to improve hospital care to address children’s mental health needs. We are trying new collaborations between mental health clinicians and pediatricians, looking for ways to support children in positive coping and working on how to help children and families connect with mental health care in the community after they leave the hospital.