Trends in mental health and related hospitalizations in the reproductive age population in California, 1991-2005

Almost one-third of America's adult population experienced a mental health disorder in the last year and more than half will experience a mental health disorder in their lifetime. The National Institute for Mental Health estimated that 67% of women and 76% of men in the mentally ill/substance abuse (MISA) population are parents. For California's reproductive age (15-44) population, this paper reports on almost 6 million acute care hospital discharges between 1991 and 2005 for 1.6 million people suffering from MISA. Over the 15-year life course covered by the study, we explore differences in acute care trends by gender and race/ethnicity, using 5-year age cohorts. During this period, men were significantly more likely than women to be treated inpatient for MISA. Whites and Blacks were disproportionately represented in the hospitalized population. Rates for White women 15-24 increased over time. For the group age 30 to 45 in 1991, a cohort effect shifted as a peak to age 40 to 55 by 2005. Over the 15 year span, the majority of patients with mental illness had other hospitalizations for injury and/or substance abuse, and other serious health conditions. We compare those only injured, only MISA, and those with MISA and injury. The number of admissions remained stable over the period as significant decreases occurred in the inpatient structural capacity to provide specialized care. This suggests the need for focused community level prevention and outpatient treatment to decrease the negative consequences for these adults and their families.