4

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfact

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfact

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfact

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfact bookfactbookfactbookfactbookfactbookfactbookfactbookfact

ookf act bookfa ctbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactboo kfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactb ook fact bookfactbookfactbookfactbookfactbookfactbookfactbookfact

ookfactbookfa ctbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfact

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfact

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfact

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfact

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfact

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfact

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfact

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfact

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfact

fact

book 10

Care of Adults With Mental Health

and Substance Abuse Disorders in

U.S. Community Hospitals, 2004

Care of Adults With Mental Health

and Substance Abuse Disorders in

U.S. Community Hospitals, 2004
kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Care of Adults With Mental Health 

and Substance Abuse Disorders in 

U.S. Community Hospitals, 2004

Care of Adults With Mental Health 

and Substance Abuse Disorders in 

U.S. Community Hospitals, 2004

Pamela Owens, Ph.D. ■ Megan Myers, M.S.W. ■ Anne Elixhauser, Ph.D. ■ Cindy Brach, M.P.P.

FACTS ON: 

■ OVERVIEW OF HOSPITALS

■ COMMON DISORDERS 

■ GENDER AND AGE CHARACTERISTICS

■ SOURCE OF ADMISSIONS

■ LENGTH OF STAY

■ HOSPITAL COSTS

■ EXPECTED PAYERS OF CARE

■ DISCHARGE STATUS

■ SPECIAL TOPICS AHRQ Publication No. 07-0008

January 2007

t

t

t

t

t

t

t

t

t

t

t

t

t

t
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

ii

Suggested Citation

Owens P, Myers M, Elixhauser A, Brach C. Care of Adults With Mental

Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004.

Agency for Healthcare Research and Quality, 2007. HCUP Fact Book No.

10. AHRQ Publication No. 07-0008. ISBN 1-58763-229-2.

Acknowledgments

The authors acknowledge the following individuals for their

contributions to this Fact Book: Gail Eisen, Nancy Jordan and Amanda

Mummert (Thomson Medstat) and DonnaRae Castillo (AHRQ) for

editorial services; and The Madison Design Group (MDG) for design

and layout.

HCUP Fact Book Series

1. Hospitalization in the United States, 1997 (AHRQ Pub. No. 00-0031)

2. Procedures in U.S. Hospitals, 1997 (AHRQ Pub. No. 01-0016)

3. Care of Women in U.S. Hospitals, 2000 (AHRQ Pub. No. 02-0044)

4. Care of Children and Adolescents in U.S. Hospitals, 2000 

(AHRQ Pub. No. 04-0004)

5. Preventable Hospitalizations: A Window Into Primary and Preventive

Care, 2000 (AHRQ Pub. No. 04-0056)

6. Hospitalizations in the United States, 2002 (AHRQ Pub. No. 05-0056)

7. Procedures in U.S. Hospitals, 2003 (AHRQ Pub. No. 06-0039)

8. Safety-Net Hospitals: Serving the Uninsured, 2003

(AHRQ Pub No. 07-0006)

9. Ambulatory Surgery in U.S. Hospitals, 2003 (AHRQ Pub No. 07-0007)

Previously published HCUP Fact Books are available online

(http://www.ahrq.gov/data/hcup) and from the AHRQ Publications

Clearinghouse. To order by telephone, please call (800) 358-9295 with

the title and publication number; or request these materials via e-mail

at AHRQPubs@ahrq.hhs.gov.

Pamela Owens, Megan Myers, Anne Elixhauser, and Cindy Brach are from the Agency for Healthcare Research and

Quality, Rockville, MD.
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Summary

iii

Executive Summary

Mental health and substance abuse (MHSA) disorders place a

substantial burden on individuals, families, the health care system,

and the economy. Beyond the personal costs of these conditions, mental

illness and substance abuse result in lost productivity, increased medical

expenditures, and other costs including those resulting from law

enforcement activities.

Community hospitals play an important role in the treatment of

individuals with MHSA disorders. For some of these patients, the

MHSA disorder is the principal diagnosis, or the main reason for the

hospital stay. For others, the MHSA disorder complicates a principal

non-MHSA diagnosis and is listed on the hospital record as a secondary

diagnosis. In 2004, 24 percent of stays in community hospitals were for

patients with principal and/or secondary MHSA diagnoses.

This Fact Book examines community hospital care

for adults 18 years of age and older with MHSA

diagnoses. Community hospitals are non-Federal,

short-term (or acute care) general and specialty

hospitals. They include any type of hospital that 

is open to the public, such as academic medical

centers, medical specialty hospitals, and public

hospitals, but they do not include specialty

psychiatric or substance abuse treatment facilities.

This Fact Book provides an overview of hospital

stays involving MHSA disorders and addresses these

key questions:

■ What are the common reasons for hospitalization, by type 

and diagnosis?

■ How do stays vary by gender and age?

■ How are patients admitted to the hospital?

■ What is the mean length of stay?

■ How much do hospital stays cost?

■ What percentage of hospital resource use is attributable to 

MHSA disorders?

■ Who is billed for hospital stays?

■ Where do patients go after they are discharged? 

In addition, this Fact Book presents detailed statistics on three special

topics related to MHSA hospitalizations:

■ Dual diagnosis stays (i.e., the patient has both a substance-related

and a mental health disorder).

■ Stays related to suicide or attempted suicide.

■ Maternal stays complicated by a mental health or substance 

abuse disorder.

Eleven mutually exclusive categories of MHSA disorders are 

examined in this Fact Book: mood disorders; substance-related

disorders; delirium, dementia, and amnestic and cognitive disorders;

anxiety disorders; schizophrenia and other psychotic

disorders; personality disorders; adjustment disorders;

disruptive behavior disorders; impulse control

disorders; disorders usually diagnosed in infancy,

childhood, and adolescence; and miscellaneous

mental disorders.

WHAT ARE THE COMMON REASONS 

FOR HOSPITALIZATION, BY TYPE 

AND DIAGNOSIS?

In 2004, nearly 1 out of 4 hospital stays for adults in U.S. community

hospitals involved MHSA disordersi

—about 7.6 million hospitalizations.

Of these, 1.9 million hospitalizations (6 percent of adult hospital stays)

had a principal MHSA diagnosis and 5.7 million (18 percent) were

primarily for non-MHSA diagnoses but had a secondary mental health

or substance abuse diagnosis.

In 2004, adults with a 

mental health and/or

substance abuse diagnosis

accounted for 1 out of 4 stays

at U.S. community hospitals—

7.6 million hospital stays.

i

Based on all-listed diagnoses
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Summary

iv

The top 5 MHSA diagnosesii seen in the hospital were mood disorders,

substance-related disorders, delirium/dementia, anxiety disorders, and

schizophrenia. One out of every 10 hospital stays

included a diagnosis of mood disorders (over 3.3

million stays). One out of every 14 hospital stays

included substance-related disorders (2.3 million

stays). One out of every 20 stays was related to

delirium/dementia (1.7 million stays).

HOW DO STAYS VARY BY GENDER AND AGE?

Gender

There were more MHSA-related hospital stays for

women than for men. Although women comprised

51 percent of the U.S. adult population, they

accounted for 58 percent of MHSA-related stays 

and 62 percent of non-MHSA stays. The most

frequent MHSA diagnosis among hospitalized

women was mood disorders. Substance abuse was

the most frequent MHSA diagnosis in the hospital

for men. Substance-related disorders were 3 times

more common among hospitalized men than women.

Age

Older age groups accounted for a disproportionate

share of hospital stays for MHSA disorders in 2004.

For example, adults 80 and older comprised 5

percent of the U.S. adult population, yet they

accounted for nearly 21 percent of MHSA hospital

stays. In contrast, adults ages 18 to 44 comprised

over half the total U.S. population, but accounted 

for 30 percent of MHSA hospital stays.

Among adults younger than 80, the most common

MHSA diagnosis was mood disorders. Overall, 11

percent of stays for people 18–44 years of age, 13 percent of those 

45–64 years of age, and 8 percent of those 65–79 years of age included 

a diagnosis of mood disorders. For adults 80 and

older, delirium/dementia was the most common

MHSA diagnosis; this disorder was noted in 21 

percent of hospital stays for this age group, but 

mood disorders ranked second for this age group 

(8 percent of stays).

The second most common MHSA diagnosis for

adults ages 18–64 was substance-related disorders,

which was noted in about 10 percent of all hospital

stays for this age group.

The distribution of age varied by the top 5 most

common MHSA diagnoses. Almost half of all

substance-related stays were for adults ages 

18–44 while nearly all (93 percent) of the stays 

related to dementia/delirium were for adults 

age 65 and older.

HOW ARE PATIENTS ADMITTED TO 

THE HOSPITAL?

Nearly 61 percent of MHSA-related admissions 

occur through the emergency department (ED)

compared to only 45 percent of admissions with 

no MHSA diagnosis.

Adults with only secondary MHSA diagnoses were

the most likely to be admitted through the ED—64

percent—compared with 51 percent for admissions

with principal MHSA diagnoses only.

One out of every 10 

hospital stays included a

diagnosis of mood disorders.

■ ■ ■

One out of every 14 

hospital stays involved 

substance-related disorders.

■ ■ ■

The most frequent MHSA

diagnosis among hospitalized

women was mood disorders.

■ ■ ■

The most frequent MHSA

diagnosis for men was

substance-related disorders.

Substance-related disorders

were 3 times more common

among hospitalized 

men than women.

■ ■ ■

Adults 80 and older 

comprised 5 percent of the U.S.

adult population, yet they

accounted for 21 percent of

MHSA hospital stays.

iiBased on all-listed MHSA diagnoses
the most expensive of the common principal MHSA diagnoses to

treat at $8,000 per stay.

WHO IS BILLED FOR HOSPITAL STAYS?

A large proportion of stays for the uninsured and 

for patients covered by Medicaid and Medicare were

related to MHSA disorders. About 33 percent of all

uninsured stays, 29 percent of Medicaid stays, and

26 percent of Medicare stays were related to MHSA

disorders. On the other hand, only 16 percent of

privately insured stays were related to MHSA disorders.

Expected Primary Payer, by Type 

Over 66 percent of adult hospital stays with MHSA

diagnoses were billed to the government in 2004.

Medicaid was billed for 18 percent of all MHSArelated stays and Medicare was billed for 49 percent

of all MHSA stays. In comparison, 57 percent of

hospital stays with non-MHSA diagnoses were 

billed to the government.

Stays for patients with MHSA diagnoses were 36

percent more likely to be billed as uninsured than

stays unrelated to MHSA diagnoses. Nearly 8 percent

of MHSA stays were uninsured compared with

about 5 percent of stays with non-MHSA diagnoses.

Patients with both principal and secondary MHSA

diagnoses were the most likely to be uninsured—nearly 13 percent

compared with 5 percent for patients with non-MHSA diagnoses.

Only about 23 percent of stays with MHSA diagnoses were billed to

private health insurance compared with about 37 percent of stays with

non-MHSA diagnoses.

HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Summary

v

WHAT IS THE MEAN LENGTH OF STAY?

Adults with any MHSA diagnosis (principal or

secondary) stayed in the hospital longer than adults

with non-MHSA diagnoses (5.8 versus 4.5 days).

The difference was even more pronounced for adults

with only a principal MHSA diagnosis—they stayed

in the hospital an average of 8 days compared with 5

days for patients with non-MHSA diagnoses.

HOW MUCH DO HOSPITAL STAYS COST?

Cost, by Type

The mean total cost for a hospital stay with any

MHSA diagnosis ($7,800) was $1,100 lower than for

stays with no MHSA diagnosis ($8,900). The mean

cost per day for MHSA hospitalizations also was

lower than for non-MHSA hospital stays—$1,600

per day compared with $2,300 per day—indicating

that MHSA stays were less resource intensive.

The difference in cost was even more pronounced 

for adults with only a principal MHSA diagnosis.

The mean total cost for a hospital stay with only a

principal MHSA diagnosis was 39 percent lower than

non-MHSA stays ($6,400 versus $8,900), and costs

per day were 171 percent lower ($900 versus $2,300).

Cost, by Principal Diagnosis

Hospitalizations for the 5 most common principal MHSA diagnoses—

mood disorder, schizophrenia, substance-related disorders,

dementia/delirium, and anxiety disorders—cost $9.9 billion nationally.

The most common principal MHSA diagnosis—mood disorders—had

the highest aggregate inpatient hospital costs of all MHSA diagnoses at

$3.4 billion nationally in 2004. On a per stay basis, schizophrenia was

Hospitalizations for 

the 5 most common principal

MHSA diagnoses cost 

$9.9 billion nationally.

■ ■ ■

About 33 percent of all

uninsured stays, 29 percent 

of Medicaid stays, and 26

percent of Medicare stays were

related to MHSA disorders,

compared with only 16 percent

of privately insured stays.

■ ■ ■

Over 66 percent of adult

hospital stays with MHSA

diagnoses were billed

to the government in 2004.
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

vi

home health care, compared with 11 percent of stays with only secondary

MHSA diagnoses and 10 percent of non-MHSA stays.

WHAT PERCENTAGE OF HOSPITAL

RESOURCE USE IS ATTRIBUTABLE TO 

MHSA DISORDERS?

MHSA disorders accounted for roughly one-fourth

of total resource use in 2004. MHSA disorders were

involved in about 24 percent of all adult hospital

stays, 29 percent of days in the hospital, and 22

percent of total hospital costs.

DUAL DIAGNOSIS STAYS

A person with both a substance-related problem

and a mental health disorder is considered to have

a dual diagnosis. In 2004, nearly 1 million adult

hospital stays involved a dual diagnosis—3 percent

of all hospital stays. About 13 percent of all MHSArelated hospital stays involved a dual diagnosis.

Among dual diagnosis stays, 34 percent of patients

had alcohol-related problems, 45 percent had 

drug-related problems, and 22 percent had both

alcohol- and drug-related problems. The most

frequent mental health disorder associated with

substance-related problems was mood disorders

(68 percent). All other mental health disorders

were much less frequent. Anxiety disorders were

seen in about 19 percent of hospital stays with 

a dual diagnosis and schizophrenia was seen in

about 18 percent of these stays.

Expected Primary Payer, by Principal Diagnosis

Hospital stays related to schizophrenia and those associated with

delirium/dementia were the most likely to be billed to the government.

Over 78 percent of hospital stays for schizophrenia

were billed to the government (35 percent to

Medicaid and 44 percent to Medicare). Similarly, 90

percent of hospital stays for delirium/dementia were

billed to the government (4 percent to Medicaid and

86 percent to Medicare). Schizophrenia is a qualifying

disorder for Medicaid, and delirium/dementia is more

frequent among the elderly who are covered by

Medicare. In contrast, 53 percent of hospital stays for

mood disorders and 52 percent of stays for substancerelated disorders were billed to government payers.

WHERE DO PATIENTS GO AFTER THEY ARE

DISCHARGED?

Adults with MHSA disorders were more likely to be

transferred to non-acute health care facilities (which

include psychiatric facilities, nursing homes, and

rehabilitation centers) compared to those with nonMHSA diagnoses. Although only 11 percent of

non-MHSA stays ended in transfers to non-acute

facilities, 16 percent of stays for a principal MHSA

diagnosis ended with such a transfer in 2004.

Because of the large proportion of elderly patients

with dementia as a secondary diagnosis, 27 percent

of hospital stays with only secondary MHSA diagnoses

ended with transfer to non-acute health care facilities.

Hospital stays that were principally for MHSA

disorders were the least likely to be discharged to

home health care. Only 2 percent of hospital stays for

principal MHSA diagnoses ended in discharge to

Over 78 percent of hospital

stays for schizophrenia and 90

percent of hospital stays for

delirium/dementia were billed

to the government.

■ ■ ■

Hospital stays related to 

MHSA disorders accounted for

roughly one-fourth of total

resource use: 24 percent of all

adult stays, 29 percent of days

in the hospital, and 22 percent 

of total hospital costs.

■ ■ ■

About 3 percent of all hospital

stays (nearly 1 million

hospitalizations) involved dual

diagnosis—both substancerelated and mental health disorder.

■ ■ ■

Men and adults 18–44 are 

most likely to have a dual

diagnosis—55 percent and 

60 percent, respectively.

Summary
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Summary

vii

Most dually diagnosed inpatients were men and 

were younger. Fifty-five percent of stays with a dual

diagnosis were for men, even though 41 percent of

other MHSA stays and 38 percent of non-MHSA

stays were for men. Similarly, nearly 60 percent of

all dually diagnosed inpatients were ages 18–44, even

though this age group comprised only 26 percent of

other MHSA stays and 33 percent of adult nonMHSA hospital stays.

Hospital stays for dual diagnosis were more likely to

be billed as uninsured or billed to Medicaid than to

any other payer.

SUICIDE-RELATED STAYS

In 2004, nearly 179,000 adult hospital stays were

related to suicide or suicide attempts. By far, the

most frequent mechanism of injury for suiciderelated hospitalizations was poisoning. Nearly

two-thirds of hospital stays for suicide attempts were

a result of poisoning, while 1 in 10 hospital stays for

suicide attempts was a result of cutting/piercing.

Firearms were implicated in only 1 percent of

suicide-related hospital stays.

Nearly all suicide-related hospital stays involved

MHSA disorders (93 percent). The single most

common MHSA diagnosis related to attempted

suicide was mood disorders, which accounted for

nearly 70 percent of all suicide-related stays.

Adults hospitalized for suicide attempt were younger

than other patients. Most suicide-related hospital

stays occurred among adults ages 18–44 

(72 percent), followed by adults ages 45–64 (24

percent). Patients ages 65 and older made up less

than 4 percent of all suicide-related stays. Uninsured

stays and stays billed to Medicaid made up nearly

half of all suicide-related hospitalizations. Even

though only 5 percent of non-MHSA hospital stays

were uninsured, 22 percent of suicide-related stays

were uninsured. Nearly 13 percent of non-MHSA

hospital stays were billed to Medicaid compared

with 23 percent of suicide-related stays.

MATERNAL STAYS

In 2004, nearly 4.6 million hospital stays were 

for women with maternal conditions and of

these, 240,000 (5 percent) were complicated by 

at least one MHSA disorder. Women with MHSA

disorders complicating a maternal stay were

disproportionately younger, ages 18–24. Even

though this group accounted for only 32 percent 

of non-MHSA-related maternal stays, they were

responsible for 40 percent of all MHSA-related

maternal stays.

Medicaid was much more likely to be billed for

maternal stays complicated by MHSA disorders

compared with all other payers. Medicaid was billed

for 38 percent of non-MHSA-related maternal 

stays but almost 57 percent of maternal stays with

MHSA disorders.

There were nearly 179,000 

adult hospital stays related to

suicide or suicide attempts.

■ ■ ■

Poisoning accounted for 2 out

of 3 suicide-related stays—

the most frequent 

mechanism of injury.

■ ■ ■

Most suicide-related stays (72

percent) were among adults 18–44.

■ ■ ■

Although only 5 percent of

non-MHSA hospital stays 

were uninsured, 22 percent 

of suicide-related 

stays were uninsured.

■ ■ ■

Five percent of maternal

hospital stays involved at least

one MHSA disorder.

■ ■ ■

Medicaid was billed for 38

percent of non-MHSA-related

maternal stays but almost 

57 percent of MHSA-related

maternal stays.
HCUP Fact Book No. 10 ■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

viii
HCUP Fact Book No. 10 ■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

1

Table of Contents

Table of Contents Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii

Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Part I: Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

What Are the Common Reasons for Hospitalization, by Type 

and Diagnosis?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

How Do Stays Vary by Gender and Age? . . . . . . . . . . . . . . . . . . . . . . . 10

How Are Patients Admitted to the Hospital? . . . . . . . . . . . . . . . . . . . . 17

What Is the Mean Length of Stay? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

How Much Do Hospital Stays Cost? . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Who Is Billed for Hospital Stays? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Where Do Patients Go After They Are Discharged? . . . . . . . . . . . . . . 26

What Percentage of Hospital Resource Use Is Attributable 

to MHSA Disorders?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Part II: Special Topics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Dual Diagnosis Stays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Suicide-Related Stays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Maternal Stays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Source of Data for This Report. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Methods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

For More Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Appendix A: Mapping ICD-9-CM Codes Into the Mental Health and

Substance Abuse Clinical Classification Software (CCS-MHSA). . . . 50

Appendix B: Adult Stays in U.S. Community Hospitals, Principal

Diagnosis of Mental Health or Substance Abuse Disorder, 2004. . . . 52

Appendix C: Adult Stays in U.S. Community Hospitals, Most Common

Principal And Secondary Diagnoses of Mental Health or Substance

Abuse Disorder, by Gender and Age, 2004 . . . . . . . . . . . . . . . . . . . . . . 54
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Foreword

2

Foreword

The mission of the Agency for Healthcare Research and Quality

(AHRQ) is to improve the quality, safety, efficiency, and effectiveness

of health care for all Americans. To help fulfill this mission, AHRQ

develops a number of powerful databases, including those created 

by the Healthcare Cost and Utilization Project (HCUP). HCUP is a

Federal-State-Industry partnership designed to build a standardized,

multi-State health data system; HCUP features databases, software 

tools, and statistical reports to inform policymakers, health system

leaders, and researchers.

For data to be useful, they must be disseminated in a timely,

accessible way. To meet this objective, AHRQ launched HCUPnet,

an interactive, Internet-based tool for identifying, tracking, analyzing,

and comparing statistics on hospital utilization, outcomes, and charges

(http://www.hcupnet.ahrq.gov/). Menu-driven HCUPnet guides users 

in tailoring specific queries about hospital care online; with a click of a

button, users receive answers within seconds.

To make HCUP data even more accessible, AHRQ disseminates 

HCUP Statistical Briefs, an online publication series that presents

simple, descriptive statistics on a variety of specific, focused topics

(http://www.hcup-us.ahrq.gov/reports/statbriefs.jsp). Statistical

Briefs are made available regularly throughout the year and have

covered topics such as hospitalizations among the uninsured, the national

bill for hospital care by payer, and hospitalizations related to childbirth.

In addition, AHRQ produces the HCUP Fact Books to highlight

statistics about hospital care in the United States in an easy-to-use,

readily accessible format. Each Fact Book provides information about

specific aspects of hospital care—the single largest component of our

health care dollar. These national estimates are benchmarks against

which States and others can compare their own data.

This Fact Book examines inpatient care of mental health and substance

abuse (MHSA) disorders. Because HCUP nationwide databases do not

include data from long-term care facilities, specialty psychiatric

hospitals, or substance-abuse treatment facilities, this report provides 

a detailed analysis of the treatment of these disorders in short-term,

non-Federal, community hospitals. This Fact Book considers MHSA

disorders among adults ages 18 and older and offers comprehensive

statistics on special topics related to MHSA hospitalizations.

We invite you to tell us how you are using this Fact Book and other

HCUP data and tools and to share suggestions on how HCUP products

might be enhanced to further meet your needs. Please e-mail us at

hcup@ahrq.gov or send a letter to the address below.

Irene Fraser, Ph.D.

Director

Center for Delivery, Organization, and Markets

Agency for Healthcare Research and Quality

540 Gaither Road

Rockville, MD 20850
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Contributors

3

Contributors

HCUP is based on data collected by individual 

State Partner organizations (including State 

departments of health, hospital associations,

and private agencies). These organizations 

provide the data to AHRQ where the data are 

converted to uniform data products. Without 

the participation of the following Partner 

organizations, HCUP and the 2004 Nationwide 

Inpatient Sample (NIS) would not be possible:

Arkansas Department of Health & Human Services

Arizona Department of Health Services

California Office of Statewide Health Planning & Development

Colorado Health and Hospital Association

Connecticut Integrated Health Information (Chime, Inc.)

Florida Agency for Health Care Administration

Georgia Hospital Association (GHA) 

Hawaii Health Information Corporation

Illinois Department of Public Health

Indiana Hospital&Health Association

Iowa Hospital Association

Kansas Hospital Association 

Kentucky Cabinet for Health and Family Services 

Maryland Health Services Cost Review Commission

Massachusetts Division of Health Care Finance and Policy

Michigan Health & Hospital Association

Minnesota Hospital Association

Missouri Hospital Industry Data Institute

Nebraska Hospital Association

Nevada Department of Human Resources

New Hampshire Department of Health and Human Services

New Jersey Department of Health & Senior Services

New York State Department of Health

North Carolina Department of Health and Human Services

Ohio Hospital Association

Oregon Association of Hospitals and Health Systems

Rhode Island Department of Health

South Carolina State Budget & Control Board

South Dakota Association of Healthcare Organizations

Tennessee Hospital Association

Texas Department of State Health Services

Utah Department of Health

Vermont Association of Hospitals and Health Systems

Virginia Health Information

Washington State Department of Health

West Virginia Health Care Authority

Wisconsin Department of Health & Family Services

Alabama 

Arizona Arkansas

California Colorado 

Connecticut 

Delaware 

Florida 

Georgia 

Idaho 

Illinois Indiana 

Iowa 

Kansas 

Kentucky 

Louisiana 

Maine

Maryland 

Massachusetts 

Michigan 

Minnesota 

Mississippi 

Missouri 

Montana 

Nevada Nebraska 

New Hampshire 

New Jersey 

New Mexico 

New York 

North Carolina 

North 

Dakota 

Ohio 

Oklahoma 

Oregon 

Pennsylvania

Rhode Island 

South 

Carolina 

South 

Dakota 

Tennessee 

Texas 

Utah 

Vermont 

Virginia 

Washington 

West 

Virginia 

Wisconsin 

Wyoming 

Hawaii 

Alaska 
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Introduction

4

Introduction

F

or those diagnosed with mental health and/or substance abuse

(MHSA) disorders, social relationships are strained, and the ability 

to perform at school and work is impaired. Many are too debilitated to

work. The loss of wages is a burden on families and the loss of labor

negatively impacts the economy. Moreover, the financial burden of

treatment for these chronic conditions is substantial.1, 2

Although an untold number of individuals who suffer from MHSA

disorders will go untreated, for those who do receive care, treatment

settings are varied. Some will seek care in outpatient or ambulatory

settings, where the majority of specialty MHSA care takes place. Others

will need more intense treatment in an inpatient setting—community

hospitals or long-term, residential facilities. With the continued drop 

in psychiatric beds in specialty facilities, community hospitals have

become the primary source of short-term inpatient care.1, 3

This Fact Book examines community hospital stays for adults with

MHSA disorders in 2004. MHSA disorders examined in this Fact 

Book include: mood disorders; substance-related disorders; delirium,

dementia, and amnestic and cognitive disorders; anxiety disorders;

schizophrenia and other psychotic disorders; personality disorders;

adjustment disorders; disruptive behavior disorders; impulse control

disorders; disorders usually diagnosed in infancy, childhood or

adolescence; and miscellaneous mental disorders. In addition, several

special topics are addressed, such as dual diagnosis, hospitalizations for

suicide attempt, and maternal stays complicated by MHSA disorders.

Information on data sources and methods are available at the end of

the Fact Book. A glossary contains MHSA terms used in this Fact Book.

Appendix A provides information on the mapping of diagnostic codes

to MHSA disorders. Appendix B provides more detailed information

on hospital stays for specific principal MHSA disorders. Appendix C

highlights common principal and secondary diagnoses by gender 

and age.
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Introduction

5

Treatment in Community Versus Specialty Hospitals

This Fact Book presents information on MHSA stays in U.S.

community hospitals, which are defined by the American Hospital

Association as “all non-Federal, short-term (or acute care) general and

specialty hospitals.”4 Although community hospitals include any type 

of hospital that is open to the public, such as academic medical centers,

medical specialty hospitals, and public hospitals, they do not include

specialty psychiatric or substance abuse treatment facilities.

■ In 2004, nearly all community hospitals in the United States 

(98.0 percent) provided care to patients with MHSA disorders.

■ Almost one-fourth of adult stays in community hospitals 

(23.8 percent) involved a MHSA disorder.

■ Almost 10 times as many patients with MHSA disorders—7.6 million

—were seen in community hospitals as in psychiatric facilities.

■ Although specialty psychiatric facilities provided nearly 27 million

days of care annually, community hospitals provided over 44 million

days of care to patients with MHSA disorders.

■ Stays in community hospitals were considerably shorter than stays in

specialty facilities. The mean length of stay for MHSA disorders was

5.8 days in community hospitals compared to 33.0 days in specialty

psychiatric facilities.

COMMUNITY HOSPITALS, COMMUNITY HOSPITALS WITH MHSA STAYS, SPECIALTY PSYCHIATRIC FACILITIES,

ALL ADULT STAYSa ADULT MHSA-RELATED STAYSa ALL STAYSb, c, d

(percentage of all community hospitals/stays/days)

Number of hospitals 4,919 4,821 (98.0%) 476

Number of inpatient stays 31,929,000 7,592,000 (23.8%) 807,000

Number of inpatient days 154,786,000 44,295,000 (28.6%) 26,698,000

Mean length of stay, in days 4.8 5.8 33.0e

a Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS), 2004. b Source: American Hospital Association, AHA Hospital Statistics, 2006 ed., Table 2: 2004 U.S. registered hospitals: utilization, personnel and finances. c Specialty psychiatric hospital is based on self-report of American Hospital Association registered hospitals and on the following AHA definition of psychiatric inpatient care: ”providing acute or long-term care to emotionally disturbed

patients, including patients admitted for diagnosis and those admitted for treatment of psychiatric problems, on the basis of physicians’ orders and approved nursing care plans. Long-term care may include intensive supervision to the

chronically mentally ill, mentally disordered, or other mentally incompetent persons.” Data include facilities with substance abuse treatment services but do not represent all substance abuse treatment facilities. d Data include discharges for both adults and children. 

e Mean length of stay was calculated by dividing the number of inpatient days by the number of admissions. 
HCUP Fact Book No. 10 ■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

6

obaobaobaobaobaobaobaobaobaobaobaobaobaob
kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

PART I:

Overview

PART I:

Overview
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Common Disorders

8

This report compares the following types of hospital stays for adults 

(18 years and over)—

Stays with at least one MHSA diagnosis: Stays related to mental health

or substance abuse disorders.iii This type is further divided into these

three subtypes:

■ Principal MHSA only: The principal reason for hospitalization was

a MHSA disorder and no additional MHSA diagnoses were indicated

on the discharge record. iv

■ Principal and secondary MHSA: The principal reason for

hospitalization was a MHSA disorder and at least one additional

MHSA diagnosis was indicated on the discharge record.

■ Secondary MHSA only: One or more MHSA diagnoses were listed

as secondary or complicating conditions, but the principal reason 

for the hospital stay was not a MHSA disorder.

Stays with no MHSA diagnosis: Stays related to medical, surgical 

or obstetric conditions that did not have a MHSA diagnosis on the

discharge record.

Common Reasons, by Type

■ In 2004, 24 percent of hospital stays for adults in U.S. community

hospitals were related to MHSA disorders—almost 7.6 million

hospitalizations.

■ Nearly 6 percent of adult hospital stays (about 1.9 million) had 

a principal MHSA diagnosis and 18 percent of adult stays (5.7

million) were primarily for a non-MHSA condition but had a

secondary MHSA diagnosis.

■ Among MHSA hospital stays, nearly 25 percent had a principal

MHSA diagnosis listed on the discharge record. The remaining

three-fourths were for non-MHSA disorders with a secondary

MHSA diagnosis.

What are the 

common reasons

for hospitalization, 

by type and diagnosis?
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Common Disorders

9

Mental Health and Substance Abuse-Related Hospital 

Stays, by Type 

No MHSA diagnosis 

76.2% 

N=24,333,000 

Principal MHSA 

only, 1.8% 

N=569,000 

Principal 

and secondary 

MHSA, 4.1% 

N=1,299,300 

Secondary 

MHSA only 

17.9% 

N=5,723,400 

Common Reasons, by Diagnosis

■ The most common MHSA disorders seen in hospital stays were

mood disorders, substance-related disorders, delirium/dementia,

anxiety disorders, and schizophrenia.

■ One out of every 10 hospital stays was related to mood disorders

(over 3.3 million stays).

■ One out of every 14 hospital stays was related to substance-related

disorders (2.3 million stays).

■ One out of every 20 stays was related to delirium/dementia (1.7

million stays).

iii All MHSA diagnoses were classified into 11 mutually exclusive categories. Details on the classification scheme

can be found in the Methods, Glossary, and Appendix A.

iv “Principal” diagnosis is the main reason for hospitalization after evaluation during the stay. “Secondary”

diagnosis is an additional, complicating condition that is present on admission or develops during the stay. 

ALL-LISTED MHSA DIAGNOSES TOTAL NUMBER OF HOSPITAL STAYS PERCENTAGE OF ALL HOSPITAL STAYS

(in thousands)

Mood disorders including bipolar disorders and depressive disorders 3,311 10.4

Substance-related disorders including drug and alcohol abuse disorders 2,253 7.1

Delirium, dementia, and amnestic and cognitive disorders 1,691 5.3

Anxiety disorders 1,153 3.6

Schizophrenia and other psychotic disorders 821 2.6

Miscellaneous mental disorders 334 1.1

Personality disorders 253 0.8

Adjustment disorders 123 0.4

Disruptive behavior disorders 51 0.2

Impulse control disorders 25 0.1

Disorders usually diagnosed in infancy, childhood, and adolescence 11 0.0

Note: “All-listed MHSA diagnoses” refers to all MHSA diagnoses listed on the discharge record. Patients can have more than 1 MHSA diagnosis; thus, the sum of the number and percentage of hospital stays do not match the pie chart. 

“0.0” percent indicates < .05 percent.
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Gender and Age Characteristics

10

Gender 

■ Women made up a disproportionate share of patients hospitalized

for MHSA disorders in 2004. Although women comprised 51

percent of the U.S. adult population, they accounted for 58 percent

of MHSA stays and 62 percent of non-MHSA stays. The top 5

MHSA diagnoses for women were:

1. Mood disorders (11.1 percent) 

2. Delirium/dementia (5.5 percent)

3. Substance-related disorders (4.1 percent) 

4. Anxiety disorders (4.0 percent) 

5. Schizophrenia (2.0 percent)

■ Men comprised 49 percent of the U.S. adult population in 2004,

but they accounted for only 43 percent of MHSA stays and 38

percent of non-MHSA stays. The top 5 MHSA diagnoses for 

men were:

1. Substance-related disorders (11.8 percent)

2. Mood disorders (9.2 percent)

3. Delirium/dementia (5.1 percent)

4. Schizophrenia (3.4 percent)

5. Anxiety disorders (3.1 percent)

■ Hospital stays associated with substance-related disorders were

nearly three times more common among men than women.

How do stays vary by

gender and age?
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

11

Hospital Stays and U.S. Population, by Gender Percent of Adult Hospital Stays or U.S. Adult Population

Male

Gender

Female

MHSA-related 

stays

Non-MHSA

related stays

U.S. adult

population,

2004

57.5%

62.3%

51.4%

42.6%

37.7%

48.6%

0

10

20

30

40

50

60

70

80

Source for U.S. population figures: Population Division, U.S. Census Bureau, Table 1: Annual Estimates of the Population 

by Sex and Five-Year Age Groups for the United States: April 1, 2000 to July 1, 2005 (NC-EST2005-01) and related data 

file; released May 10, 2006.

Gender and Age Characteristics

ALL-LISTED MHSA DIAGNOSES FEMALE MALE

NUMBER OF ALL-LISTED DIAGNOSES, IN THOUSANDS

(percentage of all gender-specific hospital stays)

Mood disorders including bipolar disorders and depressive disorders 2,169 (11.1) 1,139 (9.2)

Substance-related disorders including drug and alcohol abuse disorders 794 (4.1) 1,457 (11.8)

Delirium, dementia, and amnestic and cognitive disorders 1,063 (5.5) 628 (5.1)

Anxiety disorders 774 (4.0) 378 (3.1)

Schizophrenia and other psychotic disorders 398 (2.0) 420 (3.4)

Miscellaneous mental disorders 294 (1.5) 40 (0.3)

Personality disorders 149 (0.8) 104 (0.8)

Adjustment disorders 70 (0.4) 53 (0.4)

Disruptive behavior disorders 23 (0.1) 29 (0.2)

Impulse control disorders 9 (0.1) 16 (0.1)

Disorders usually diagnosed in infancy, childhood, and adolescence 3 (0.0) 8 (0.1)

Note: “All-listed MHSA diagnoses” refers to all MHSA diagnoses listed on the discharge record; patients can have more than 1 MHSA diagnosis. “0.0” percent indicates < .05 percent.
HCUP Fact Book No. 10 ■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Gender and Age Characteristics

12

Age ■ Overall, the mean age for adults hospitalized with any MHSA

disorder was similar to that of all other patients—58 and 56 

years, respectively. Hospitalizations for principal MHSA disorders

(i.e., principal MHSA only plus principal and secondary MHSA)

occurred more often among younger adults (mean age = 46 years);

hospitalizations for only secondary MHSA disorders occurred more

often among older adults (mean age = 62 years).

■ Older age groups accounted for a disproportionate share of hospital

stays for MHSA disorders overall in 2004. Adults 65–79 years

comprised 12 percent of the U.S. adult population, but they

accounted for nearly 20 percent of MHSA hospital stays and 

26 percent of non-MHSA stays.

70

Mean Age, by Type

Mean Age (in years)

No MHSA 

diagnosis

At least one

MHSA diagnosis

Presence of MHSA diagnosis Subtype of MHSA stays

Principal

MHSA only

Principal

and secondary

MHSA

Secondary

MHSA only

56.0 57.

9

47.2

44.9

61.9

0

10

20

30

40

50

60
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Gender and Age Characteristics

13

■ Adults 80 and older comprised 5 percent of the U.S. adult

population, yet they accounted for nearly 21 percent of MHSA

hospital stays and 15 percent of non-MHSA stays.

■ In contrast, adults ages 18 to 44 comprise over half the total 

U.S. adult population, but they accounted for only 30 percent 

of MHSA hospital stays and 33 percent of hospital stays with 

no MHSA diagnosis.

■ While adults ages 45 to 64 represented nearly one-third (32.1

percent) of the U.S. adult population, they accounted for slightly

fewer hospital stays for MHSA disorders (29.7 percent) and nonMHSA conditions (25.9 percent).

Hospital Stays and U.S. Population, by Age Percent of Adult Hospital Stays or U.S. Adult Population

45–64

Age Group (in years)

18–44 65–79 80+

MHSA-related 

stays

Non-MHSA

related stays

U.S. adult

population,

2004

30.1%

33.0%

51.4%

29.7%

25.9%

32.1%

19.6%

25.7%

11.8%

0

10

20

30

40

50

60

20.6%

15.4%

4.7%

Source for U.S. population figures: Population Division, U.S. Census Bureau, Table 1: Annual Estimates of the Population by Sex and Five-Year Age Groups for the United States: April 1, 2000 to July 1, 2005 (NC-EST2005-01) and related 

data file; released May 10, 2006.
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Gender and Age Characteristics

14

ALL-LISTED MHSA DIAGNOSES AGE GROUP

18–44 YEARS 45–64 YEARS 65–79 YEARS 80+ YEARS

NUMBER OF ALL-LISTED DIAGNOSES, IN THOUSANDS 

(percentage of age-specific hospital stays)

Mood disorders including bipolar disorders and depressive disorders 1,128 (10.9) 1,130 (13.2) 631 (8.1) 423 (8.0)

Substance-related disorders including drug and alcohol abuse disorders 1,104 (10.7) 862 (10.1) 226 (2.9) 61 (1.1)

Delirium, dementia, and amnestic and cognitive disorders 23 (0.2) 90 (1.1) 487 (6.3) 1,090 (20.6)

Anxiety disorders 365 (3.5) 394 (4.6) 252 (3.3) 141 (2.7)

Schizophrenia and other psychotic disorders 319 (3.1) 289 (3.4) 129 (1.7) 84 (1.6)

Miscellaneous mental disorders 265 (2.6) 36 (0.4) 20 (0.3) 13 (0.2)

Personality disorders 168 (1.6) 70 (0.8) 11 (0.2) 4 (0.1)

Adjustment disorders 65 (0.6) 31 (0.4) 17 (0.2) 11 (0.2)

Disruptive behavior disorders 34 (0.3) 12 (0.1) 3 (0.0) 3 (0.1)

Impulse control disorders 19 (0.2) 5 (0.1) 1 (0.0) 1 (0.0)

Disorders usually diagnosed in infancy, childhood, and adolescence 8 (0.1) 2 (0.0) < 1 (0.0) < 1 (0.0)

Note: “All-listed MHSA diagnoses” refers to all MHSA diagnoses listed on the discharge record; patients can have more than 1 MHSA diagnosis. “0.0” percent indicates < .05 percent.

■ The most common MHSA diagnosis for adults younger than age 

80 was mood disorders, seen in 11 percent of stays for patients ages

18–44, 13 percent of stays for patients ages 45–64, and 8 percent of

stays for patients ages 65–79. Mood disorder was seen in 8 percent 

of stays for patients 80 and older, second to delirium/dementia 

(20.6 percent) as the most common diagnosis for this age group.

■ The second most common MHSA diagnosis for adults ages 18–64

was substance-related disorders (about 10 percent).

■ Anxiety disorders were the third most common group of MHSA

disorders for all age groups—ranging from about 3 percent of

inpatients age 80 and older to 5 percent of inpatients ages 45–64.
Hospital Stays Related to Mood Disorders

18–44 years

45–64 years

65–79 years

80+ years 19.0%

Note: The sum of pie percentages may not total 100 percent, due to rounding.

12.8%

34.2%

34.1%

Hospital Stays Related to Substance-Related Disorders

18–44 years

45–64 years

65–79 years

80+ years

38.3%

Note: The sum of pie percentages may not total 100 percent, due to rounding.

10.0%

2.7%

49.0%

Hospital Stays Related to Delirium/Dementia

18–44 years

45–64 years

65–79 years

80+ years

64.5%

Note: The sum of pie percentages may not total 100 percent, due to rounding.

1.4% 5.3%

28.8%

HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Gender and Age Characteristics

15

Distribution of Age for the Top 5 Most Common MHSA Diagnoses

■ The distribution of age varied by the top 5 most common MHSA

diagnoses. Almost half of all substance-related stays were for

patients ages 18 to 44 (49.0 percent), but almost all stays related to

dementia/delirium were for adults age 65 and older (93.3 percent).

■ Mood and anxiety disorders affected every age group. About 

one-third of stays for mood or anxiety disorder involved patients

18–44, one-third of patients were 45–64 and one-third were age 

65 and older.
HCUP Fact Book No. 10 ■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Gender and Age Characteristics

16

Hospital Stays Related to Anxiety Disorders

18–44 years

45–64 years

65–79 years

21.9%

80+ years

Note: The sum of pie percentages may not total 100 percent, due to rounding.

12.3%

34.2%

31.7%

Hospital Stays Related to Schizophrenia and Other 

Psychotic Disorders

18–44 years

45–64 years

65–79 years

80+ years

15.8%

Note: The sum of pie percentages may not total 100 percent, due to rounding.

10.2%

35.2%

38.9%
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Source of Admissions

17

Hospital Admissions, by Type Percent

0

20

40

60

80

100

No MHSA diagnosis At least one MHSA diagnosis

Presence of MHSA diagnosis Subtype of MHSA stays

Principal MHSA only Principal and secondary MHSA Secondary MHSA only

Routine

Court/law

enforcement

Other health

facilities

Another

hospital

Emergency

department

50.2%

31.7%

38.1% 38.3%

29.6%

0.0%

3.5%

1.4%

45.0%

0.6%

2.9%

4.3%

60.6%

2.2%

5.7%

3.4%

50.7%

2.1%

5.1%

3.1%

51.4%

0.1%

2.8%

63.6%

4.0%

■ In 2004, nearly 61 percent of admissions with a MHSA diagnosis

were admitted through the emergency department (ED) compared

to 45 percent of admissions with no MHSA diagnosis.

■ Adults with only secondary MHSA diagnoses were the most likely 

to be admitted through the ED (63.6 percent). They were 1.4 times

more likely to be admitted through the ED than those with no

MHSA diagnosis (45.0 percent) and 1.3 times more likely than 

those with only a principal MHSA diagnosis (50.7 percent).

■ Hospital admissions through courts or law enforcement comprised

less than 1 percent of all hospitalizations, but more than 83 percent

of these admissions had a principal MHSA diagnosis and an

additional 6 percent had a secondary MHSA diagnosis (data 

not shown).

How are patients

admitted to the

hospital?
HCUP Fact Book No. 10 ■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Length of Stay

18

Length of Hospitalization, by Type 

Mean Number of Days in Hospital 

No MHSA 

diagnosis 

At least one 

MHSA diagnosis 

Presence of MHSA diagnosis Subtype of MHSA stays 

Principal 

MHSA only 

Principal 

and secondary 

MHSA 

Secondary 

MHSA only 

4.5

5.8

8.3

6.7

5.4

02468

10

Length of Stay, by Type ■ On average, hospital stays involving MHSA disorders were 29

percent longer than stays for non-MHSA conditions (5.8 versus 4.5

days) in 2004.

■ Adults with only a principal MHSA diagnosis stayed in the hospital

an average of 8 days compared with 5 days for patients with no

MHSA condition.

■ Adults with both principal and secondary MHSA diagnoses had

shorter lengths of stay than those with only a principal MHSA

diagnosis (6.7 versus 8.3 days).

■ Hospital stays for adults with only secondary MHSA diagnoses were

20 percent longer than adults with no MHSA diagnosis (5.4 versus

4.5 days).

What is the mean

length of stay

?
Length of Stay, by Principal Diagnosis ■ Among patients with a principal MHSA diagnosis, those with

schizophrenia had the longest length of stay— over 11 days.

■ When disorders typically diagnosed in childhood (such as pervasive

development disorders and tic disorders) required hospitalization in

adulthood, stays averaged about 10 days.

■ An additional three MHSA disorders had average lengths of stay 

of 1 week or longer—impulse control disorders (9.6 days),

delirium/dementia (8.6 days), and mood disorders (7.0 days).

HCUP Fact Book No. 10 ■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Length of Stay

19

PRINCIPAL MHSA DIAGNOSIS MEAN LENGTH OF STAY (in days)

Schizophrenia and other psychotic disorders 11.1

Disorders usually diagnosed in infancy, childhood, and adolescence 9.7

Impulse control disorders 9.6

Delirium, dementia, and amnestic and cognitive disorders 8.6

Mood disorders including bipolar disorders and depressive disorders 7.0

Disruptive behavior disorders 5.8

Personality disorders 5.6

Miscellaneous mental disorders 3.6

Substance-related disorders including drug and alcohol abuse disorders 4.6

Anxiety disorders 3.8

Adjustment disorders 3.3
Cost per Stay and Cost per Day of Hospitalization, by Type Mean Cost per Stay and Cost per Day (in dollars)

No MHSA 

diagnosis

At least one

MHSA diagnosis

Presence of MHSA diagnosis Subtype of MHSA stays

Principal

MHSA only

Principal

and secondary

MHSA

Secondary

MHSA only

Mean cost 

per stay

Mean cost

per day

$8,900

$2,300

$7,800

$1,600

$6,400

$900

$5,000

$900

$8,500

$1,900

0

2,000

4,000

6,000

8,000

10,000

HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Hospital Costs

20

Per-Stay and Per-Day Cost, by Type

■ The mean total cost for a hospital stay with any MHSA diagnosis

($7,800) was 14 percent lower than for stays with no MHSA diagnosis

($8,900). The mean cost per day for MHSA hospitalizations was 42 percent

lower than for non-MHSA hospital stays—$1,600 per day compared with

$2,300 per day—indicating that MHSA stays were less resource intensive.

■ The mean total cost for a hospital stay with only a principal MHSA

diagnosis was 39 percent lower than non-MHSA stays ($6,400 versus

$8,900), and costs per day were 171 percent lower ($900 versus $2,300).

■ Stays that involved principal and secondary MHSA diagnoses were

the least expensive ($5,000), but the cost per day ($900) was identical

to stays for principal MHSA diagnoses only.

■ The costs of stays with only secondary MHSA diagnoses were slightly

less than stays with no MHSA diagnosis ($8,500 versus $8,900).

How much do hospital

stays cost?
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Hospital Costs

21

Total Aggregate and Per-Stay Cost, by Principal Diagnosis

■ In 2004, hospitalizations principally for MHSA disorders cost a 

total of $10.2 billion.

■ Hospitalizations for the 5 most common principal MHSA 

diagnoses—mood disorders, schizophrenia, substance-related

disorders, dementia/delirium, and anxiety disorders—cost $9.9

billion nationally in 2004.

■ The most common principal MHSA diagnosis—mood disorders—

also had the highest aggregate inpatient hospital costs of all MHSA

diagnoses at $3.4 billion nationally in 2004.

■ On a per stay basis, schizophrenia was the most expensive 

of the common principal MHSA diagnoses to treat at $8,000 

per stay.

■ Disorders of childhood are rarely recorded as the principal

diagnoses in adults, accounting for only 773 stays in 2004

(Appendix B). When hospitalization did occur, stays were 

expensive. The mean cost per stay for disorders of childhood 

in adults was $7,200, almost as high as that for schizophrenia.

PRINCIPAL MHSA DIAGNOSIS AGGREGATE TOTAL COSTS MEAN TOTAL COST PER STAY

Mood disorders including bipolar disorders and depressive disorders $3,438,589,800 $4,800

Schizophrenia and other psychotic disorders $3,316,145,400 $8,000

Substance-related disorders including drug and alcohol abuse disorders $2,006,342,800 $4,300

Delirium, dementia, and amnestic and cognitive disorders $974,618,500 $6,700

Miscellaneous mental disorders $164,157,600 $3,700

Anxiety disorders $137,655,800 $3,500

Adjustment disorders $100,878,900 $2,700

Impulse control disorders $54,937,100 $7,200

Personality disorders $19,700,600 $4,500

Disorders usually diagnosed in infancy, childhood, and adolescence $5,544,500 $7,200

Disruptive behavior disorders $4,637,800 $4,400
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Expected Payers of Care

22

■ About 33 percent of all uninsured stays, 29 percent of Medicaid

stays, and 26 percent of Medicare stays were related to MHSA

disorders. This compares to about 16 percent of privately 

insured stays.

■ Roughly 12 percent of uninsured stays and 12 percent of Medicaid

stays were for principal MHSA diagnoses (i.e., principal MHSA only

plus principal and secondary MHSA). On the other hand, only

about 4 percent of Medicare and privately insured stays were

principally for MHSA diagnoses.

■ Focusing on those stays with only secondary MHSA diagnoses,

nearly twice as many hospital stays were billed to Medicare or were

considered uninsured than were billed to private insurance (about

21 percent versus 12 percent).

Who is billed for

hospital stays?

Uninsured or Self-Pay Hospital Stays

Principal MHSA only

Principal and

secondary MHSA

Secondary

MHSA only

No MHSA diagnosis

67.2%

Note: The sum of pie percentages may not total 100 percent, due to rounding.

2.9%

9.5%

20.5%

Hospital Stays Billed to Medicaid

Principal MHSA only

Principal and

secondary MHSA

Secondary

MHSA only

No MHSA diagnosis

70.6%

Note: The sum of pie percentages may not total 100 percent, due to rounding.

3.4%

8.5%

17.6%
HCUP Fact Book No. 10 ■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Expected Payers of Care

23

Hospital Stays Billed to Medicare

Principal MHSA only

Principal and

secondary MHSA

Secondary

MHSA only

No MHSA diagnosis

73.6%

Note: The sum of pie percentages may not total 100 percent, due to rounding.

1.5% 2.

8%

22.1%

Hospital Stays Billed to Private Insurance

Principal MHSA only

Principal and

secondary MHSA

Secondary

MHSA only

No MHSA diagnosis

83.8%

Note: The sum of pie percentages may not total 100 percent, due to rounding.

1.2%2.7%

12.3%
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Expected Payers of Care

24

2.8%

22.7%

54.3%

6.3%

13.9%

3.1%

13.1%

4.9%

36.5%

42.5%

3.4%

17.5%

22.6%

7.6%

48.9%

5.0%

22.5%

26.6%

37.1%

8.9%

5.2%

22.4%

12.9%

30.1%

29.4%

Expected Primary Payer, by Type Percent of Hospital Stays

0

20

40

60

80

100

No MHSA diagnosis At least one MHSA diagnosis

Presence of MHSA diagnosis Subtype of MHSA stays

Principal MHSA only Principal and secondary MHSA Secondary MHSA only

Uninsured

or self-pay

Medicaid

Medicare

Private

Other

Note: The sum of bar percentages may not total 100 percent, due to rounding.

Expected Primary Payer, by Type

■ Over 66 percent of adult hospital stays with MHSA diagnoses were

billed to the government—about 18 percent to Medicaid, a joint

State and Federal Government program, and 49 percent to the

Federal Medicare program. In comparison, 56 percent of hospital

stays with no MHSA diagnosis were billed to the government.

■ Adults with MHSA diagnoses were 36 percent more likely to be

uninsured than those without MHSA diagnoses. Nearly 8 percent 

of MHSA stays were uninsured compared with about 5 percent of

stays without MHSA diagnoses.

■ Patients with both principal and secondary MHSA diagnoses 

were the most likely to be uninsured or require self-pay—nearly 

13 percent compared with 5 percent for patients with no 

MHSA diagnosis.

■ Only about 23 percent of stays with MHSA diagnoses were billed to

private health insurance compared with about 37 percent of stays

with no MHSA diagnosis.

■ Between 30 and 37 percent of hospital stays with principal MHSA

diagnoses were billed to Medicare and about 22 percent were billed

to private insurers.

■ About 54 percent of stays with only secondary MHSA diagnoses

were billed to Medicare, compared with 43 percent of non-MHSA stays.
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Expected Payers of Care

25

■ In contrast, 53 percent of hospital stays for mood disorders and 

52 percent of stays for substance-related disorders were billed to

government payers.

■ About 1 in 5 hospital stays principally for adjustment disorders 

and substance-related disorders was uninsured. About 1 in 10 

stays principally for anxiety disorders, personality disorders,

mood disorders, and impulse control disorders was uninsured.

■ The only MHSA diagnoses for which private insurers covered more

than other payers were mood, anxiety, and adjustment disorders.

Expected Primary Payer, by Principal Diagnosis

■ The majority of hospital stays for 2 of the 4 most frequent MSHA

diagnoses—schizophrenia and delirium/dementia—were billed to

government payers. Over 78 percent of hospital stays for schizophrenia

were billed to the government (35.0 percent to Medicaid and 43.5

percent billed to Medicare). Similarly, more than 90 percent of

hospital stays for delirium/dementia were billed to the government

(3.6 percent to Medicaid and 86.1 percent to Medicare). This most

likely was because schizophrenia is a qualifying disorder for

Medicaid and delirium/dementia is more frequent among the 

elderly who are covered by Medicare.

PRINCIPAL MHSA DIAGNOSIS EXPECTED PRIMARY PAYER

UNINSURED OR SELF-PAY’S SHARE MEDICAID’S SHARE MEDICARE’S SHARE PRIVATE INSURER’S SHARE

NUMBER OF HOSPITAL STAYS, IN THOUSANDS

(percentage of disorder-specific hospital stays)

Mood disorders including bipolar disorders and depressive disorders 76 (10.8) 174 (24.7) 197 (27.9) 217 (30.8)

Substance-related disorders including drug and alcohol abuse disorders 96 (20.5) 170 (36.1) 74 (15.7) 109 (23.2)

Schizophrenia and other psychotic disorders 24 (5.9) 144 (35.0) 178 (43.5) 39 (9.6)

Delirium, dementia, and amnestic and cognitive disorders 2 (1.5) 5 (3.6) 125 (86.1) 11 (7.4)

Miscellaneous mental disorders 3 (7.4) 19 (43.7) 6 (13.2) 14 (31.9)

Anxiety disorders 5 (13.8) 7 (18.0) 12 (30.4) 13 (33.1)

Adjustment disorders 8 (22.6) 9 (22.8) 5 (12.9) 12 (32.6)

Impulse control disorders 1 (10.5) 3 (36.8) 2 (31.7) 1 (14.6)

Personality disorders 1 (13.7) 1 (30.1) 1 (28.0) 1 (20.0)

Disruptive behavior disorders * < 1 (33.0) < 1 (28.9) < 1 (26.1)

Disorders usually diagnosed in infancy, childhood, and adolescence * < 1 (36.5) < 1 (34.3) < 1 (24.6)

Note: Percentages represent row percents. Other insurance coverage is excluded; thus, the sum of row percentages does not equal 100. Statistics based on estimates with a relative standard error (standard error/weighted estimate) 

greater than 0.30 or with standard error = 0 are not reliable. These statistics are suppressed and are designated with an asterisk (*).
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Discharge Status

26

Where do patients 

go after they are

discharged?

■ In 2004, about 60 percent of discharges for adults with any MHSA

diagnosis were routine; that is, they were discharged to their homes.

In contrast, 73 percent of adults with no MHSA diagnosis had

routine discharges.

■ Adults with MHSA disorders were more likely to be discharged to 

a non-acute care facility (including psychiatric facilities, nursing

homes, and rehabilitation centers) compared with those with no

MHSA disorder. About 16 percent of hospital stays for principal

MHSA diagnoses (i.e., principal MHSA only or principal and

secondary MHSA) resulted in a transfer to a non-acute care health

facility, while over 27 percent of hospital stays for those with only

secondary MHSA diagnoses ended with such a transfer. This is

primarily attributable to the larger proportion of elderly patients

with dementia as secondary diagnoses (see Appendix C).

■ Home health care was a more common followup to stays for those

with non-MHSA principal diagnoses—10 percent of those with 

no MHSA diagnosis and 11 percent of those with only secondary

MHSA diagnoses were discharged to home health care. In contrast,

only 2 percent of hospital stays for principal MHSA diagnoses were

discharged to home health care.

■ Adults with a principal MHSA diagnosis (i.e., principal MHSA only

or principal and secondary MHSA) were 5 to 8 times more likely to

leave the hospital against medical advice than those without MHSA

diagnoses. They were also 2 to 3 times more likely to leave the

hospital against medical advice than those with only secondary

MHSA diagnoses.

■ Adults with principal MHSA diagnoses were less likely to die 

in the hospital than those with non-MHSA principal diagnoses 

(<1 percent versus 2.6 percent).
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

27

Discharge Status

Discharge Status, by Type Percent of Hospital Stays 

No MHSA 

diagnosis 

At least one 

MHSA diagnosis 

Presence of MHSA diagnosis Subtype of MHSA stays 

Principal 

MHSA only 

Principal and 

secondary MHSA 

Secondary 

MHSA only 

Other 

Routine 

discharge 

home 

24.7% 24.6% 

45.7% 

26.9% 

73.1% 

40.5% 

59.5% 

75.3% 75.4% 

54.3% 

0

20

40

60

80

100

Discharge Status Other Than “Home,” by Type Percent of Hospital Stays

No MHSA diagnosis Principal MHSA only Principal and secondary MHSA Secondary MHSA only

Other acute

care hospital

Non-acute care

health facility

Home health care

Against medical

advice

Died

2.4%

11.2%

10.1%

0.6%

2.6%

16.3%

0

10

20

30

2.5% 2.4% 3.2%

0.3%

2.0%

15.5%

1.9%

5.0%

0.2%

2.4%

27.4%

11.3%

1.7%

3.0%
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

28

Total Hospital Resource Use Percent of Resources

0

20

40

60

80

100

Stays Total days Total costs

No MHSA

diagnosis

Principal

MHSA only

Principal and

secondary

MHSA

Secondary

MHSA only

Note: The sum of bar percentages may not total 100 percent, due to rounding.

76.2%

1.8%

4.1%

17.9%

71.4%

3.0%

5.6%

19.9%

78.0%

1.4%

2.5%

18.2%

All MHSA

stays=23.8%

All MHSA

stays=28.5% All MHSA

stays=22.0%

■ About 24 percent of all adult hospital stays, 29 percent of all days in

the hospital, and 22 percent of total hospital costs were attributable

to adults with a MHSA disorder in 2004.

■ Hospitalization for principal MHSA diagnoses (i.e., principal MHSA

only plus principal and secondary MHSA) accounted for 6 percent

of all adult stays, 9 percent of total days, and 4 percent of total

hospital costs, pointing to the relatively low resource intensity of

MHSA care in community hospitals.

■ Care for adults with only secondary MHSA diagnoses accounted for

roughly 18 percent of hospital stays and total hospital costs and 20

percent of all days in the hospital.

What percentage of

hospital resource use is

attributable to MHSA

disorders?

Hospital Resource Use
okfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

bookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbook

actbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

okfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

bookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbook

actbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

okfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

bookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbook

actbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

okfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

bookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbook

actbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

okfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

bookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbook

actbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

okfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

bookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbook

actbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

okfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

bookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbook

actbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

okfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

bookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbook

actbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

okfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

bookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbook

actbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

okfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

bookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbook

actbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

okfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

bookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbook

actbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

okfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

bookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbook

actbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

okfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

bookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbook

actbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

okfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

bookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbook

PART II:

Special Topics

PART II:

Special Topics
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Dual Diagnosis Stays

Dual Diagnosis Stays

30

A person with both a substance-related problem and a mental health

disorder is considered to have a dual diagnosis. According to studies

cited in the Surgeon General’s Mental Health Report,1 nearly half of

individuals with serious mental illness have associated alcohol or 

drug-related problems. For successful treatment, both problems 

must be addressed.

■ In 2004, over 1 million adult hospital stays were related to 

both substance-related disorders and mental health disorders 

(3.1 percent of all adult hospital stays).

■ Approximately 13 percent of the 7.6 million MHSA-related 

hospital stays involved both substance-related disorders and 

mental health disorders.

■ Among hospital stays with a dual diagnosis, 64 percent had a

principal and secondary MHSA diagnosis (44.9 percent with a

principal mental health disorder and secondary substance abuse

disorder, 19.2 percent with a principal substance abuse disorder 

and secondary mental health disorder). The remainder had 

a non-MHSA principal diagnosis and had both mental and

substance abuse disorders as secondary diagnoses (35.9 percent).

■ Among dual diagnosis stays, 34 percent of patients had alcoholrelated disorders, 45 percent had drug-related disorders, and 22

percent had both alcohol and drug-related disorders.

■ The most frequent mental health disorder associated with

substance-related disorders was mood disorders (67.8 percent).

All other mental health disorders occurred less frequently. Anxiety

disorders and schizophrenia were seen in about 19 percent and 18

percent, respectively, of dual diagnosis stays.

Dual MHSA Diagnosis: Principal and Secondary Diagnoses

Secondary

MHSA only

35.9%

N=359,400

Principal mental

health disorder

and secondary

substance abuse

44.9%

N=450,200

Principal substance 

abuse disorder and secondary

mental health disorders

19.2%

N=192,000
Dual MHSA Diagnosis Stays:

Type of Substance Abuse Disorder

Both alcohol

and drug-related

disorders

21.5%

N=215,000

Drug-related

disorders

44.5%

N=445,900

Alcohol-related disorders

34.0%

N=340,700

HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Dual Diagnosis Stays

31

ALL-LISTED MENTAL HEALTH DIAGNOSES TOTAL NUMBER OF HOSPITAL STAYS PERCENTAGE OF ALL DUAL

DIAGNOSIS HOSPITAL STAYS

Mood disorders including bipolar disorders and depressive disorders 679,336 67.8

Anxiety disorders 187,148 18.7

Schizophrenia and other psychotic disorders 183,584 18.3

Personality disorders 121,783 12.2

Miscellaneous mental disorders 66,231 6.6

Delirium, dementia, and amnestic and cognitive disorders 52,098 5.2

Adjustment disorders 33,619 3.4

Disruptive behavior disorders 16,013 1.6

Impulse control disorders 8,046 0.8

Disorders usually diagnosed in infancy, childhood, and adolescence 1,095 0.1

Note: “All-listed mental health diagnoses” refers to all mental health diagnoses listed on the discharge record; a patient can have more than 1 mental health diagnosis.
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Dual Diagnosis Stays

32

Dual Diagnosis Hospital Stays, by Gender and Age Percent of Adult Hospital Stays

Gender Age Group (in years)

Female Male 18–44 45–64 65–79 80+

Dual diagnosis

stays

Non-dual 

diagnosis, but

MHSA-related 

stays

Non-dual

diagnosis, 

non-MHSA stays

45.0%

59.4%

62.3%

55.0%

40.7%

37.7%

59.4%

25.6%

33.0%

0

10

20

30

40

50

60

70

80

32.2%

29.4%

25.9%

6.3%

21.7%

25.7%

2.2%

23.4%

15.4%

Gender and Age

■ Men accounted for disproportionately more dually diagnosed

inpatient stays than women. Although 38 percent of non-MHSA

stays and 41 percent of other MHSA stays were for men, 55 percent

of stays with dual diagnosis were for men.

■ Most dually diagnosed inpatients were younger. Patients ages 18–44

accounted for nearly 60 percent of all dual diagnosis stays, even

though these patients comprised only 26 percent of other MHSA

stays and 33 percent of non-MHSA hospital stays.
Dual Diagnosis Hospital Stays, by Expected Primary Payer Percent of Adult Hospital Stays

Expected Primary Payer

Note: Other insurance coverage is excluded from bar chart; thus, the sum of bar percentages does not equal 100.

Uninsured or Self-pay Medicaid Medicare Private

Dual diagnosis

stays

Non-dual 

diagnosis, but

MHSA-related 

stays

Non-dual

diagnosis, 

14.1% non-MHSA stays

6.7% 4.9%

23.8%

15.4%

31.6%

22.4%

36.5%

13.1%

24.9%

80

42.4%

52.5%

25.9%

0

10

20

30

40

50

60

70

HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Dual Diagnosis Stays

33

Expected Primary Payer

■ Uninsured stays and hospital stays billed to Medicaid were

disproportionately more likely to include both mental health and

substance abuse diagnoses. Over 14 percent of dual diagnosis stays

were uninsured—nearly three times higher than the rate for nonMHSA stays (4.9 percent) and over two times higher than the rate

for other MHSA stays (6.7 percent).

■ Similarly, nearly 32 percent of dual diagnosis stays were billed to

Medicaid, while 15 percent of other MHSA stays and 13 percent of

non-MHSA stays were billed to Medicaid.

■ Medicare was billed for smaller proportion of dual diagnosis stays than

other MHSA or non-MHSA stays, consistent with the findings on age.
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Suicide-Related Stays

34

Suicide-Related Hospital Stays, by Type

Secondary

MHSA only

60.8%

N=108,600

No MHSA diagnosis

7.4%

N=13,300

Principal MHSA only

7.0%

N=12,400

Principal and

secondary MHSA

24.8%

N=44,300

Suicide-Related Stays 

Suicide is the cause of death for approximately 30,000 people each 

year in the United States,5 but many more attempts are unsuccessful 

and result in hospitalization. Although men are 4 times more likely to 

die from suicide, women are 3 times more likely to attempt suicide.

Most suicide deaths result from the use of firearms. Known risk

factors for suicide include a history of mental disorders (predominately

depression) and a history of alcohol and substance abuse.

■ In 2004, nearly 179,000 adult hospital stays were related to suicide 

or suicide attempts.

■ By far, the most frequent mechanism of injury for suicide-related

hospitalizations was poisoning. Nearly two-thirds (61.1 percent) 

of hospital stays for suicide attempts were a result of poisonings,

while 1 in 10 hospital stays for suicide attempts was a result of

cutting/piercing. Firearms were implicated in only 1 percent of

suicide-related hospital stays.

■ Nearly all suicide-related hospital stays were related to MHSA

disorders (92.6 percent).

■ The single most common MHSA diagnosis related to attempted

suicide was mood disorders, which accounted for nearly 70 percent

of all suicide-related stays. Other common MHSA diagnoses

included substance-related disorders (49.1 percent), anxiety

disorders (15.5 percent), personality disorders (10.9 percent),

and schizophrenia (9.1 percent).

■ Although personality disorders and adjustment disorders were

uncommon in all MHSA hospital stays (less than 1 percent),

they accounted for about 11 and 7 percent of suicide-related 

stays, respectively.
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Suicide-Related Stays

35

ALL-LISTED MECHANISM OF INJURY TOTAL PERCENTAGE 

NUMBER OF ALL 

OF HOSPITAL SUICIDE-RELATED

STAYS HOSPITAL STAYS

Poisoning 143,512 61.1

Cut/pierce 23,298 9.9

Firearm 2,900 1.2

Suffocation 2,173 0.9

Fall 1,834 0.8

Note: “All-listed mechanisms of injury” refers to all external cause of injury codes (e-codes) listed on the

discharge record; a patient can have more than 1 e-code or mechanism of injury. 

ALL-LISTED MHSA DIAGNOSES TOTAL NUMBER OF HOSPITAL STAYS PERCENTAGE OF ALL SUICIDE-RELATED

HOSPITAL STAYS

Mood disorders including bipolar disorders and depressive disorders 124,519 69.7

Substance-related disorders including drug and alcohol abuse disorders 87,768 49.1

Anxiety disorders 27,734 15.5

Personality disorders 19,419 10.9

Schizophrenia and other psychotic disorders 16,324 9.1

Adjustment disorders 12,092 6.8

Miscellaneous mental disorders 3,770 2.1

Disruptive behavior disorders 2,583 1.5

Delirium, dementia, and amnestic and cognitive disorders 1,633 0.9

Impulse control disorders 1,440 0.8

Disorders usually diagnosed in infancy, childhood, and adolescence 332 0.2

Note: “All-listed MHSA diagnoses” refers to all MHSA diagnoses listed on the discharge record; a patient can have more than 1 MHSA diagnosis.
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Suicide-Related Stays

36

■ Although adults ages 18–44 accounted for 72 percent of suiciderelated stays, they accounted for only 29 percent of other MHSA

stays and 33 percent of non-MHSA stays.

■ Among the 45–64 age group, the rate of hospitalizations related to

suicide attempt was consistent with the rate of all other

hospitalizations.

■ In contrast, patients 65 to 79 years of age accounted for only 3

percent of suicide-related hospital stays while they accounted 

for 20 percent of MHSA stays and 26 percent of non-MHSA stays.

Similarly, only 1 percent of suicide-related stays were for patients 

80 and older.

Gender and Age

■ Women accounted for disproportionately more hospital stays of all

kinds—57 percent of stays related to suicide attempts, 58 percent of

stays for non-suicide-related MHSA disorders, and 62 percent of

non-MHSA stays.

■ The mean age for adults hospitalized for suicide attempts was 

about 30 years, compared with 46 years for all other patients (data

not shown).

■ The majority of hospital stays for suicide attempts occurred among

patients ages 18–44 (71.6 percent), followed by patients 45–64 (24.4

percent). Inpatients in the older age categories, 65 and older, made

up less than 4 percent of all stays for suicide.

Suicide-Related Hospital Stays, by Gender and Age Percent of Adult Hospital Stays

Gender Age Group (in years)

Female Male 18–44 45–64 65–79 80+

Suicide-related

stays

Non-suicide

related MHSA

stays

Non-suicide, 

non-MHSA 

related stays

57.1% 57.5%

62.3%

42.9% 42.6%

37.7%

71.6%

29.1%

33.0%

0

10

20

30

40

50

60

70

80

24.4%

29.8%

25.9%

2.8%

20.0%

25.7%

1.1%

21.0%

15.4%
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Suicide-Related Stays

37

Suicide-Related Hospital Stays, by Expected Primary Payer Percent of Adult Hospital Stays

Expected Primary Payer

Note: Other insurance coverage is excluded from bar chart; thus, the sum of bar percentages does not equal 100.

Uninsured or Self-pay Medicaid Medicare Private

Suicide-related

stays

Non-suicide

related MHSA

stays

Non-suicide, 

non-MHSA 

related stays

21.5%

7.3%

4.9%

32.3%

17.4%

23.2% 22.4%

36.5%

13.1%

16.1%

70

42.5%

49.6%

0

10

20

30

40

50

60

Expected Primary Payer

■ Uninsured stays and stays billed to Medicaid made up nearly half

of all suicide-related hospitalizations. Even though only 5 percent 

of non-MHSA hospital stays were uninsured, 22 percent of suiciderelated stays were uninsured. Nearly 13 percent of non-MHSA

hospital stays were billed to Medicaid compared with 23 percent 

of suicide-related stays.

■ Disproportionately fewer suicide-related stays were billed to

Medicare (16.1 percent) compared with all other payers.

■ Private insurance was billed for 32 percent of suicide-related stays,

37 percent of non-MHSA stays, and only 22 percent of MHSA stays

unrelated to suicide attempt.
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Maternal Stays

Maternal Stays 

38

There is evidence of unmet need among pregnant women with mental

health disorders. Some studies suggest that mental illness in pregnancy

is underdiagnosed and undertreated. Substance abuse, depression, and

high levels of stress are associated with high risk behavior, preterm

birth, and poor pregnancy outcomes. Certain conditions, such as

depression and eating disorders, are more common in women and 

can worsen during pregnancy. It has been suggested that 5 to 25 percent

of women experience depression during pregnancy or immediately

following birth, and that most of these women go untreated.6, 7

Examining maternal hospitalizations associated with MHSA disorders

can provide insight into the problem, although it is likely that MHSA

disorders will be underreported in hospital data.

■ In 2004, nearly 4.6 million hospital stays occurred for women with

maternal conditions. Of these, 240,000 (5.2 percent) involved at least

one MHSA diagnosis.

■ The top ranked MHSA diagnosis was “miscellaneous mental

disorders” which includes “other conditions in the mother classifiable

elsewhere, but complicating pregnancy” (ICD-9-CM code = 648.4x).

Specifically, “mental disorders during delivery” accounted for

173,900 cases, “mental disorders before delivery” accounted for

30,000 cases, and “mental disorders following delivery” accounted

for 5,700 cases.

■ Mood disorders were seen in 77,000 maternal stays (1.7 percent).

There were nearly 60,000 maternal hospital stays that included some

mention of substance-related disorders (1.3 percent). Over 21,000

maternal stays had a complicating diagnosis of anxiety disorders 

(0.5 percent) and over 4,000 maternal stays also had a diagnosis 

of schizophrenia (0.1 percent).

Maternal Hospital Stays, by Type

Secondary MHSA only

4.6%, N=209,500

Principal MHSA only

0.2%, N=8,800

Principal and

secondary MHSA

0.5%, N=21,700

No MHSA diagnosis

94.8%

N=4,334,300

Note: The sum of pie percentages may not total 100 percent, due to rounding.
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Maternal Stays

39

ALL-LISTED MHSA DIAGNOSES TOTAL NUMBER OF HOSPITAL STAYS PERCENTAGE OF ALL MATERNALRELATED HOSPITAL STAYS

Miscellaneous mental disorders 214,272 4.7

Mood disorders including bipolar disorders and depressive disorders 77,490 1.7

Substance-related disorders including drug and alcohol abuse disorders 58,935 1.3

Anxiety disorders 21,511 0.5

Schizophrenia and other psychotic disorders 4,074 0.1

Adjustment disorders 3,147 0.1

Personality disorders 1,884 0.0

Disruptive behavior disorders 1,065 0.0

Delirium, dementia, and amnestic and cognitive disorders 195 0.0

Impulse control disorders 109 0.0

Disorders usually diagnosed in infancy, childhood, and adolescence 192 0.0

Note: “All-listed MHSA Diagnoses” refers to all MHSA diagnoses listed on the discharge record; a patient can have more than 1 MHSA diagnosis. “0.0” percent indicates < .05 percent.
Maternal Hospital Stays, by Age Percent of Maternal Stays

Age Group (in years)

Note: Other insurance coverage is excluded from bar chart; thus, the sum of bar percentages does not equal 100.

18–24 25–34 35+

Maternal stays

with at least one

MHSA diagnosis

Maternal stays

with no MHSA

diagnosis

40.0%

13.7%

15.5%

46.3%

52.1%

0

10

20

30

40

50

60

32.4%

Age

■ Women with MHSA disorders complicating a maternal stay 

were disproportionately younger, ages 18–24. Although this 

group accounted for 32 percent of non-MHSA-related maternal

stays, they were responsible for 40 percent of all MHSA-related

maternal stays.

■ Women ages 25–34 accounted for almost half of maternal stays

complicated by MHSA disorders (46.3 percent) and over half of

all non-MHSA related maternal stays (52.1 percent).

■ Women age 35 and older accounted for nearly 14 percent of

maternal stays complicated by MHSA disorders and 16 percent 

of non-MHSA related maternal stays.

HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Maternal Stays

40
HCUP Fact Book No. 10 ■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Maternal Stays

41

Maternal Hospital Stays, by Expected Primary Payer

Percent of Maternal Stays

Expected Primary Payer

Note: Other insurance coverage is excluded from bar chart; thus, the sum of bar percentages does not equal 100.

Uninsured or Self-pay Medicaid Medicare

Maternal stays

with at least one

MHSA diagnosis

Maternal stays

with no MHSA

diagnosis

4.0% 1.

9% 0.3%

34.9%

56.6% 55.

9%

38.0%

3.5%

0

10

20

30

40

50

60

70

Private

Expected Primary Payer ■ Medicaid was much more likely to be billed for maternal stays

complicated by MHSA disorders. Medicaid was billed for 38 percent

of maternal stays with no MHSA disorders, but almost 57 percent of

maternal stays with MHSA disorders.

■ Private payers were disproportionately less likely to be billed for

maternal stays associated MHSA diagnoses. Private insurance was

billed for 56 percent of maternal stays with no MHSA disorders,

but only 35 percent of maternal stays with MHSA disorders.
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Source of Data

42

Source of Data for 

This Report

The results presented in this report are drawn from the Healthcare

Cost and Utilization Project (HCUP), a Federal-State-Industry

partnership to build a multi-State health care data system. This

partnership is sponsored by the Agency for Healthcare Research 

and Quality (AHRQ) and is managed by staff in AHRQ’s Center for

Delivery, Organization, and Markets (CDOM). HCUP is based on 

data collected by individual State Partner organizations (including 

State departments of health, hospital associations, and private agencies),

which provide the data to AHRQ. HCUP would not be possible without

statewide data collection projects and their partnership with AHRQ.

For the year 2004, 37 State Partner organizations contributed their data

to AHRQ, where all files were validated and converted into a uniform

format. The uniform HCUP databases enable comparative studies of

health care services and the use and cost of hospital care, including:

■ Effects of market forces on hospitals and the care they provide.

■ Variations in medical practice.

■ Effectiveness of medical technology and treatments.

■ Use of services by special populations.

HCUP includes short-term, non-Federal, community hospitals as

defined by the American Hospital Association (AHA). This definition

includes general hospitals and specialty facilities, such as pediatric,

obstetrics-gynecology, short-term rehabilitation, and oncology

hospitals. Long-term care and psychiatric hospitals are excluded,

as are substance abuse treatment facilities.

This report is based on data from the 2004 Nationwide Inpatient

Sample (NIS). The NIS is the largest all-payer inpatient care database

that is publicly available in the United States. The database contains

data from 8 million hospital stays from roughly 1,000 hospitals sampled

to approximate a 20-percent stratified sample of U.S. community

hospitals. The data are weighted to obtain estimates that represent 

the total number of inpatient hospital discharges in the United States.

Weighted discharges for adults approximate 31.9 million discharges.
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Methods

43

Methods

This Fact Book is based on data from the 2004 HCUP Nationwide

Inpatient Sample (NIS) database. The NIS data are weighted to

obtain estimates representing the total number of inpatient hospital

discharges in the United States; in 2004, this figure totaled 38,661,786.

The analyses presented here are limited to 31,928,948 discharges for

adults in U.S. community hospitals. Because the NIS is limited to

community hospital data, disorders treated in outpatient or ambulatory

care settings, long-term care facilities, psychiatric hospitals, and

substance-abuse treatment facilities are not reflected in this report.

In addition, due to concerns regarding reimbursement and stigma

associated with MSHA diagnoses, it is important to note that MHSA

diagnoses are likely under-coded in the hospital discharge records.

A brief discussion of selected methodological issues pertaining to 

this Fact Book follows.

Unit of Analysis

For this report, the unit of analysis is the inpatient stay in a community

hospital rather than the patient or the procedure. For example, a patient

admitted four times to the hospital is included four times in the NIS

data. Thus, the same individual can account for more than one hospital

stay. Frequencies and rankings of diagnoses are indicated as either

principal (first-listed) diagnosis, which is defined as “the condition

established after study to be chiefly responsible for occasioning the

admission of the patient to the hospital,”8 or secondary diagnosis, which

includes all additional diagnoses on the record. “All-listed diagnoses”

indicates that both principal and secondary diagnoses have been

included in the analysis. All discharges from the NIS have been 

weighted to produce national estimates.

Diagnoses, Clinical Classification Software (CCS), and Mental Health

and Substance Abuse Clinical Classification Software (CCS-MHSA)

Diagnoses are recorded within the NIS using the International

Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-

CM).9 Although ICD-9-CM codes may be used to provide descriptive

statistics, the granular nature of ICD-9-CM reporting is difficult to

summarize. Thus, for this Fact Book, the AHRQ-developed Mental

Health and Substance Abuse Clinical Classification Software (CCSMHSA) is applied. The CCS-MHSA, derived primarily from the

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition10

is used to aggregate ICD-9-CM MHSA diagnostic codes into a limited

number of clinically meaningful categories. As shown in Appendix A,

the CCS-MHSA assigns mental and substance-use ICD-9-CM codes 

to 1 of the 14 categories shown in the following table.
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Methods

44

CCS-MHSA CODE MENTAL HEALTH OR SUBSTANCE ABUSE DISORDERS

650 Adjustment disorders

651 Anxiety disorders

652 Disruptive behavior disorders including conduct disorder, oppositional defiant disorder, attention-deficit disorder and 

attention-deficit/hyperactivity disorder

653 Delirium, dementia, and amnestic and other cognitive disorders

654 Developmental disorders including communication disorders, developmental disabilities, intellectual disabilities, learning 

disorders and motor skills disorders*

655 Disorders usually diagnosed in infancy, childhood, or adolescence such as elimination disorders, separation anxiety disorders,

pervasive developmental disorders, and tic disorders

656 Impulse control disorders

657 Mood disorders including bipolar disorders and depressive disorders

658 Personality disorders

659 Schizophrenia and other psychotic disorders

660 Substance-related disorders including alcohol-related disorders and substance-related disorders (e.g., amphetamine-related 

disorders; cannabis-related disorders; cocaine-related disorders; hallucinogen-related disorders; inhalant-related disorders;

opioid-related disorders; phencyclidine-related disorders; sedative-, hypnotic-, or anxiolytic-related disorders; poly-substancerelated disorders)

661 Miscellaneous mental disorders including dissociative disorders, eating disorders, factitious disorders, psychogenic disorders,

sexual and gender identity disorders, sleep disorders, somatoform disorders, mental disorders due to general medical 

conditions not elsewhere classified, and other miscellaneous mental conditions

662 Suicide and intentional self-inflicted injury*

663 Screening and history of mental health and substance-related conditions*

*For the purposes of this Fact Book, developmental disorders, suicide and intentional self-inflicted injury, and screening and history of mental health and substance-related disorders were excluded from the definition of MHSA

disorders. Suicide and intentional self-inflicted injury, as defined in the CCS-MHSA, is examined as a co-occurring condition with mental health and substance-related disorders. 
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Methods

45

The groupings for MHSA stays are based on principal (or first-listed)

and secondary diagnoses with CCS-MHSA codes in the ranges of

650–653, 655–661. Stays are considered to have at least one MHSA

diagnosis if the discharge record includes only a “principal MHSA

diagnosis,” “principal and secondary MHSA diagnosis,” or only

“secondary MHSA diagnoses.” All other hospital stays are considered

unrelated to MHSA conditions and are classified as non-MHSA.

Additionally, hospital stays are classified as dual diagnosis if both a

substance abuse disorder (CCS-MHSA = 660) and a mental health

disorder (CCS-MHSA codes = 650–653, 655–661) are listed. Hospital

stays for maternal conditions were identified using the Clinical

Classifications Software (CCS) that encompasses all conditions (not just

MHSA disorders; CCS code = 176–196), Major Diagnostic Categories

(MDC) code 14, and a recorded gender of female. More detailed information

on CCS-MHSA and the CCS can be downloaded from the HCUP User

Support Web site at: http://www.hcup-us.ahrq.gov/tools_software.jsp.

Chronic Conditions

In Appendix B, non-MHSA conditions were classified as chronic or not

chronic, using the AHRQ-developed Chronic Condition Indicator. A

chronic condition is defined as a condition that lasts 12 months or

longer and meets one or both of the following tests: (a) it places

limitations on self-care, independent living, and social interactions; (b)

it results in the need for ongoing intervention with medical products,

services, and special equipment. More detailed information on the

Chronic Condition Indicator can be found at: http://www.hcupus.ahrq.gov/toolssoftware/chronic/chronic.jsp.

Expected Primary Payer

Each hospitalization and its related hospital bill are attributed to the

payer who was expected by the hospital to pay the major portion of the

bill (i.e., the expected primary payer). The expected primary source of

payment at admission may not be the ultimate primary payer. To make

coding uniform across all HCUP data sources, the payer variable

combines detailed payers into more general groups:

■ Medicaid includes fee-for-service and managed care Medicaid patients.

■ Medicare includes fee-for-service and managed care Medicare patients.

■ Private insurance includes Blue Cross, commercial carriers, and

private HMOs and PPOs.

■ Other includes Workers’ Compensation, TRICARE/VA, Title V, and

other government programs.

■ Uninsured includes an insurance status of “self-pay” and “no charge.”

This categorization of payer differs from previous Fact Books. Previous

Fact Books have assumed that payer is a proxy for socioeconomic status,

placing more emphasis on Medicaid as an expected source of payment.

This Fact Book relies only on expected primary payer, a decision based

on several important factors. Individuals with impairments related to

MHSA disorders may be eligible for disability and Medicaid, suggesting

that it would be important to account for dual eligibility rules. Claims

data such as HCUP, however, do not contain information about an

individual’s disability status. Therefore, it is not possible to determine

the reason a hospital bill was submitted to Medicaid. In addition,

expected secondary payer was missing in 62 percent of discharges,

making it difficult to determine if patients would quality for dual eligibility.

Charges and Costs

Total hospital charges were converted to costs using HCUP Cost-toCharge Ratio Files based on hospital accounting reports from the

Centers for Medicare & Medicaid Services (CMS). Costs will tend to

reflect the actual costs of production, while charges represent what the

hospital billed for the case. For each hospital, a hospital-wide cost-tocharge ratio is used because detailed charges are not available across all

HCUP States. Hospital charges reflect the amount the hospital charged

for the entire hospital stay and do not include professional (physician)

fees. For the purposes of this Fact Book, costs are reported to the

nearest hundreds. More information on the HCUP Cost-to-Charge

Ratio Files can be found at: www.hcup-us.ahrq.gov/db/state/

costtocharge.jsp.
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

46

References

1. U.S. Department of Health and Human Services. Mental Health: A

Report of the Surgeon General. Rockville, MD: Substance Abuse and

Mental Health Services Administration, Center for Mental Health

Services and National Institutes of Health, National Institute of

Mental Health; 1999.

2. Institute of Medicine, Committee on Crossing the Quality Chasm.

Improving the Quality of Health Care for Mental and Substance-Use

Conditions. Washington, DC: National Academies Press; 2006.

3. U.S. Department of Health and Human Services. Mental Health,

United States, 2002. Rockville, MD: Substance Abuse and Mental

Health Services Administration, Center for Mental Health Services;

2004.

4. American Hospital Association. AHA Hospital Statistics, 2006

Edition. Chicago, IL: Health Forum; 2005.

5. Centers for Disease Control and Prevention, National Center for

Injury Prevention and Control. Suicide: Fact Sheet. Available at:

http://www.cdc.gov/ncipc/factsheets/suifacts.htm (Accessed

September 27, 2006).

6. Finkelman AW. Mental health policy: Implications for newborns,

infants and families. Newborn and Infant Nursing Reviews 2003;3(1):

18–26.

7. Agency for Healthcare Research and Quality. Evidence

Report/Technology Assessment No. 119, Prenatal Depression:

Prevalence, Screening, Accuracy, and Screening Outcomes. Rockville,

MD: Agency for Healthcare Research and Quality; 2005.

8. Centers for Medicare & Medicaid Services and National Center 

for Health Statistics. ICD-9-CM Official Guidelines for Coding 

and Reporting, Effective April 1, 2005. Available at:

http://www.cdc.gov/nchs/data/icd9/icdguide.pdf

(Accessed October 16, 2006).

9. International Classification of Diseases, Ninth Revision, Clinical

Modification (ICD-9-CM). Reno, NV: Channel Publishing, 2003.

10. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition

(DSM-IV). Washington, DC: American Psychiatric Association; 1994.

References
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

47

Glossary

Adjustment disorders—A group of diagnoses characterized by emotional 

or behavioral symptoms beyond what would be expected in response to an

identifiable event or stressful situation. (CCS-MHSA code = 650)

Anxiety disorders—A group of diagnoses characterized by overwhelming

apprehension and fear in response to a perceived threat. Symptoms are

physical as well as psychological. (CCS-MHSA code = 651)

Attention-deficit and attention-deficit/hyperactivity disorder (ADD, ADHD)—

Persistent inattention and/or hyperactive, impulsive behavior that is more

frequent and more severe than that typical of age or developmental level.

Symptoms must be present in at least two settings, typically home and school.

ADD and ADHD are included in the CCS-MHSA code 652 or “Disruptive

behavior disorders.”

Bipolar disorders—A group of mood disorders characterized by extreme

swings between emotional highs and lows. Highs, or manic episodes, are

periods of elevated energy, increased activity, and distractible or irritable

mood. Lows, or depressive episodes, are characterized by periods of depressed

mood, disinterest, lethargy, and fatigue. Bipolar disorders are included in the

CCS-MHSA code 657 or “Mood disorders.”

Conduct disorder—An inappropriate and persistent pattern of behavior that

violates others. This includes aggression to people and animals, destruction of

property, deceitfulness, theft, and a serious violation of rules. Conduct disorder

is included in the CCS-MHSA code 652 or “Disruptive behavior disorders.”

Delirium, dementia and amnestic and other cognitive disorders—The

development of multiple cognitive disturbances and deficits, including

memory impairment, and occurring as a result of a general medical condition

or substance use. Dementia represents a loss of previous functioning and is

characterized by gradual onset and continuing decline. Delirium is characterized

by a short, fluctuating disturbance of mental status and amnestic disorders

entails memory impairment not occurring during dementia or delirium.

(CCS-MHSA code = 653)

Depressive disorders—A group of mood disorders characterized by a

persistent low mood, profound sadness, and a lack of interest in enjoyable

activities. Physical symptoms including weight loss or gain, fatigue, and sleep

disturbances are common. Depressive disorders are included in the CCS code

657 or “Mood disorders.”

Disorders usually diagnosed in infancy, childhood, or adolescence—A group

of diagnoses characterized by the time period in which first diagnosis typically,

although not necessarily, occurs. Disorders include elimination disorders,

separation anxiety disorders, pervasive development disorders, tic disorders,

feeding and eating disorders of early childhood, mutism, and stereotypic

movement disorder. (CCS-MHSA code = 655)

Disruptive behavior disorders—A group of diagnoses including attentiondeficit disorder, attention-deficit/hyperactivity disorder, conduct disorder, and

oppositional defiant disorder. (CCS-MHSA code = 652) 

Dissociative disorders—A group of diagnoses characterized by a

disintegration of consciousness, memory, identity, and/or perception. The

presentation may be sudden or gradual, transient or chronic. Symptoms do

not occur in the course of another mental disorder or as a result of a general

medical condition or substance use. Dissociative disorders are included in the

CCS-MHSA 661 or “Miscellaneous mental disorders.”

Dual diagnosis—The presence of both a substance-related diagnosis and a

mental health diagnosis.

Eating disorders—A group of diagnoses characterized by a severe disturbance

in eating behavior. This includes anorexia nervosa (excessive weight loss),

bulimia nervosa (repeated episodes of binging and purging), pica (persistent

eating of nonnutritive substances), and rumination disorder (repeated

regurgitation and re-chewing of food). Eating disorders are included in the

CCS-MHSA 661 or “Miscellaneous mental disorders.”

Elimination disorders—Repeated urination (enuresis) or defecation

(encopresis) in inappropriate places beyond an appropriate developmental age.

Episodes may be intentional or involuntary. Elimination disorders are included

in the CCS-MHSA 655 or “Disorders typically diagnosed in childhood.”

Factitious disorders—A group of diagnoses characterized by intentionally

producing or feigning physical or psychological symptoms in the absence of

external incentives such as economic gain or avoiding legal responsibility.

Factitious disorders are included in the CCS-MHSA 661 or “Miscellaneous

mental disorders.”

Impulse control disorders—A group of diagnoses characterized by the

repeated failure to resist the urge to perform an act that is harmful to the self

or others. This includes assault, theft, fire-setting, pathological gambling, and

hair-pulling. Increased arousal is usually experienced before acting, and

pleasure, gratification, or relief are felt while committing the act.

(CCS-MHSA code = 656)

Glossary
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Glossary

48

Mental disorders due to general medical condition, not elsewhere classified—

Includes personality changes, anxiety disorders, and unspecified transient

mental health disorders where the disturbance is the result of a general

medical condition. These disorders are included in the CCS-MHSA 661 or

“Miscellaneous mental disorders.”

Miscellaneous mental disorders—A group of diagnoses that include

dissociative disorders, eating disorders, factitious disorders, mental disorders

due to general medical condition, not elsewhere classified, psychogenic disorders,

sexual and gender identity disorders, sleep disorders, somatoform disorders,

and other miscellaneous mental health disorders. (CCS-MHSA code = 661)

Mood disorders—A group of diagnoses including bipolar disorders and

depressive disorders. (CCS-MHSA code = 657)

Oppositional defiant disorder—A pattern of negative, angry, defiant, disobedient

behaviors directed toward authority figures. These behaviors are more frequent

than that typical of age or development level. Oppositional defiant disorder is

included in the CCS-MHSA 652 or “Disruptive behavior disorders.”

Other disorders of infancy, childhood, or adolescence—Includes emotional,

attachment, and movement related conditions impairing specific

developmental tasks of childhood but not meeting diagnostic conditions for

disorders classified elsewhere. These disorders are included in the CCS-MHSA

655 or “Disorders typically diagnosed in childhood.”

Personality disorders—A group of diagnoses characterized by a pattern of

cognitions, emotional responses, interpersonal relations, and impulse control

that deviates noticeably from cultural expectations. This pattern of cognitions

and behaviors is inflexible, pervasive, and lasts over time. (CCS-MHSA code = 658)

Pervasive developmental disorders—A group of childhood diagnoses

characterized by severe and pervasive impairment in social, communication,

or motor skills or by the presence of stereotyped behavior, interests, and

activities. The impairments represent a loss of previously acquired skills or are

significantly atypical of age or developmental level. Pervasive developmental

disorders are included in the CCS-MHSA 655 or “Disorders typically

diagnosed in childhood.”

Psychogenic disorders—Refers to diagnoses where physical symptoms 

occur as a result of other diagnosed mental disorders. Symptoms may be

musculoskeletal, respiratory, cardiovascular, of the skin, gastrointestinal,

genitourinary, endocrine, or unspecified. Psychogenic disorders are included 

in the CCS-MHSA 661 or “Miscellaneous mental disorders.”

Schizophrenia—A chronic, severe, and disabling brain disease that affects

cognition, speech, emotional expression, social relations, and behavior.

Symptoms include delusions (bizarre thoughts with no basis in reality);

hallucinations (experiencing sensations that have no source); disordered

thinking and nonsensical speech that impair effective communication;

disorganized and agitated behavior; and negative symptoms including social

withdrawal, extreme apathy, and blunted affect. Other psychotic disorders

include conditions that have delusions, hallucinations, and paranoia in their

presentation. (CCS-MHSA code = 659)

Sexual and gender identity disorders—A group of diagnoses including

psychologically based sexual dysfunctions, paraphilias (intense and unusual

sexual fantasies or behaviors), and gender identity disorders (a strong crossgender identification and persistent discomfort with one’s biological sex). These

disorders are included in the CCS-MHSA 661 or “Miscellaneous mental disorders.”

Sleep disorders—A group of diagnoses characterized by disturbances to

healthy, normal sleep patterns that are not to the result of another mental

disorder, a general medical condition, or substance use. Sleep disorders are

included in the CCS code “Miscellaneous mental disorders.”

Somatoform disorders—A group of diagnoses characterized by the presence

of physical symptoms suggesting a general medical condition but not accounted

for by a medical diagnosis, mental health disorder, or substance use. Symptoms

are not intentional or under voluntary control. Somatoform disorders are

included in the CCS-MHSA 661 or “Miscellaneous mental disorders.”

Substance-related disorders—A group of diagnoses related to the abuse,

dependence or withdrawal from alcohol or drugs. Abuse and dependence

disorders are characterized by maladaptive patterns of use leading to increased

tolerance and physical symptoms of withdrawal in the absence of the

substance. (CCS-MHSA code = 660)

Suicide and intentional self-inflicted injury—Includes external cause of

injury codes that indicate an attempt to voluntarily and intentionally take

one’s own life or to voluntarily and intentionally cause physical harm to

oneself. (CCS-MHSA code = 662)

Tic disorders—A group of diagnoses characterized by the presence of sudden,

rapid, recurrent, non-rhythmic, stereotyped movements or vocalizations that

are not the result of a general medical condition or substance use. Tic

disorders are included in the CCS-MHSA 655 or “Disorders typically

diagnosed in childhood.”
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

For More Information

49

For More Information

More information regarding HCUP data is available at

www.ahrq.gov/data/hcup, as well as on the HCUP User Support

Web site at www.hcup-us.ahrq.gov.

Additional descriptive statistics can be viewed through HCUPnet

(http://www.hcupnet.ahrq.gov/), a Web-based tool providing easy

access to information on hospital stays.

NIS data are available for the following data years:

2004 data

2003 data

2002 data

2001 data

2000 data

1999 data (PB 2002-500020)

1998 data (PB 2001-500092)

1997 data, Release 6 (PB 2000-500006)

1996 data, Release 5 (PB 99-500480)

1995 data, Release 4 (PB 98-500440)

1994 data, Release 3 (PB 97-500433)

1993 data, Release 2 (PB 96-501325)

1988-1992 data, Release 1 (PB 95-503710)

NIS data can be purchased for research through the HCUP Central

Distributor sponsored by AHRQ: Social Scientific Systems, Inc.,

telephone: 866-556-4287 (toll-free), fax: 301-628-3201, or e-mail:

hcup@s-3.com.

Price of the data is $322 for Release 1; $160 per year for 1993 to 1999;

and $200 per year for 2000 to 2004. The student price is $20 per

database. Prices may be higher for customers outside the United States,

Canada, and Mexico.

AHRQ is always looking for ways in which AHRQ-funded research,

products, and tools have influenced clinical practice, improved

policies, affected patient outcomes, and changed people’s lives.

Impact case studies describe AHRQ research findings in action.

These case studies have been used in testimony, budget

documents, and speeches. If you are aware of any impact AHRQfunded research or products, such as HCUP, have had on health

care policy, clinical practice, or patient outcomes, please let us

know by using the contact information below.

Healthcare Cost and Utilization Project (HCUP)

Center for Delivery, Organization, and Markets

Agency for Healthcare Research and Quality

Phone: 866-290-HCUP (4287); E-mail: HCUP@AHRQ.gov
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Appendix A

50

Appendix A: Mapping ICD-9-CM Codes Into the

Mental Health and Substance Abuse Clinical

Classification Software (CCS-MHSA)

Adjustment disorders

3090 3091 30922 30923 30924 30928 30929 3093 3094 30982 30983 30989 3099

Anxiety disorders

29384 30000 30001 30002 30009 30010 30020 30021 30022 30023 30029 3003 3005 30089 3009 3080 3081 3082 3083 3084 3089 30981 3130 3131

31321 31322 3133 31382 31383

Disruptive behavior disorders

Attention-deficit disorder and Attention-deficit/hyperactivity disorder

31400 31401 3141 3142 3148 3149

Conduct disorder

31200 31201 31202 31203 31210 31211 31212 31213 31220 31221 31222 31223 3124 3128 31281 31282 31289 3129

Oppositional defiant disorder

31381

Delirium, dementia, and amnesic and other cognitive disorders

2900 29010 29011 29012 29013 29020 29021 2903 29040 29041 29042 29043 2908 2909 2930 2931 2940 2941 29410 29411 2948 2949 3100 3102

3108 3109 3310 3311 33111 33119 3312 33182 797

Developmental disorders*

Communication disorders

3070 3079 31531 31539 V401

Developmental disabilities

31501 31502 31509 31532 3155 3158

Intellectual disabilities

317 3180 3181 3182 319

Learning disorders

31500 3151 3152 3159 V400

Motor skill disorders

3154

Disorders usually diagnosed in infancy, childhood, or adolescence

Elimination disorders

3076 3077

Other disorders usually diagnosed in infancy, childhood or adolescence

3073 30921 31323 31389 3139

Pervasive developmental disorders

29900 29901 29910 29911 29980 29981 29990 29991

Tic disorders

30720 30721 30722 30723

Impulse control disorders

31230 31231 31232 31233 31234 31235 31239
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Appendix A

51

Mood disorders

Bipolar disorders

29600 29601 29602 29603 29604 29605 29606 29610 29611 29612 29613 29614 29615 29616 29640 29641 29642 29643 29644 29645 29646 29650 29651 29652 

29653 29654 29655 29656 29660 29661 29662 29663 29664 29665 29666 2967 29680 29681 29682 29689 29690 29699

Depressive disorders

29383 29620 29621 29622 29623 29624 29625 29626 29630 29631 29632 29633 29634 29635 29636 3004 311

Personality disorders

3010 30110 30111 30112 30113 30120 30121 30122 3013 3014 30150 30151 30159 3016 3017 30181 30182 30183 30184 30189 3019

Schizophrenia and other psychotic disorders

29381 29382 29500 29501 29502 29503 29504 29505 29510 29511 29512 29513 29514 29515 29520 29521 29522 29523 29524 29525 29530 29531 29532 29533 

29534 29535 29540 29541 29542 29543 29544 29545 29550 29551 29552 29553 29554 29555 29560 29561 29562 29563 29564 29565 29570 29571 29572 29573 

29574 29575 29580 29581 29582 29583 29584 29585 29590 29591 29592 29593 29594 29595 2970 2971 2972 2973 2978 2979 2980 2981 2982 2983 

2984 2988 2989

Substance-related disorders

Alcohol-related disorders

2910 2911 2912 2913 2914 2915 2918 29181 29189 2919 30300 30301 30302 30303 30390 30391 30392 30393 30500 30501 30502 30503

Drug related disorders

2920 29211 29212 2922 29281 29282 29283 29284 29289 2929 30400 30401 30402 30403 30410 30411 30412 30413 30420 30421 30422 30423 30430 30431 

30432 30433 30440 30441 30442 30443 30450 30451 30452 30453 30460 30461 30462 30463 30470 30471 30472 30473 30480 30481 30482 30483 30490 30491 

30492 30493 30510 30511 30512 30513 30520 30521 30522 30523 30530 30531 30532 30533 30540 30541 30542 30543 30550 30551 30552 30553 30560 30561 

30562 30563 30570 30571 30572 30573 30580 30581 30582 30583 30590 30591 30592 30593 64830 64831 64832 64833 64834 65550 65551 65553 76072 76073

76075 7795 96500 96501 96502 96509 V6542

Miscellaneous mental disorders

Dissociative disorders

30012 30013 30014 30015 3006

Eating disorders

3071 30750 30751 30752 30753 30754 30759

Factitious disorders

30016 30019

Mental disorders due to general medical condition not elsewhere classified

29389 2939 3101

Other miscellaneous mental conditions

316 64840 64841 64842 64843 64844 V402 V403 V409 V673

Psychogenic disorders

3060 3061 3062 3063 3064 30650 30652 30653 30659 3066 3067 3068 3069

Sexual and gender identity disorders

3021 3022 3023 3024 30250 30251 30252 30253 3026 30270 30271 30272 30273 30274 30275 30276 30279 30281 30282 30283 30284 30285 30289 3029

30651

Sleep disorders

30740 30741 30742 30743 30744 30745 30746 30747 30748 30749

Somatoform disorders

30011 3007 30081 30082 30780 30781 30789

Screening and history of mental health and substance abuse codes*

Mental health disorder related codes

33392 V110 V111 V112 V118 V119 V154 V1541 V1542 V1549 V1582 V663 V701 V702 V7101 V7102 V7109 V790 V792 V793 V798 V799

Substance-related disorder codes

3051 3575 4255 5353 5710 5711 5712 5713 76071 7903 V113 V791

Suicide and intentional self-inflicted injury*

E9500 E9501 E9502 E9503 E9504 E9505 E9506 E9507 E9508 E9509 E9510 E9511 E9518 E9520 E9521 E9528 E9529 E9530 E9531 E9538 E9539 E954 E9550 E9551

E9552 E9553 E9554 E9555 E9556 E9557 E9559 E956 E9570 E9571 E9572 E9579 E9580 E9581 E9582 E9583 E9584 E9585 E9586 E9587 E9588 E9589 E959

*Categories are not included in the definition of mental health and substance abuse disorders in this Fact Book 
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Appendix B

52

Appendix B: Adult Stays in U.S. Community Hospitals,

Principal Diagnosis of Mental Health or Substance

Abuse Disorder, 2004

Number of Stays, Mean Length of Stay, Mean Costs, Percent with Secondary Conditions, Percent Admitted from the Emergency Department (ED),

and Percent Discharged to Another Health Facility

PRINCIPAL MHSA DIAGNOSIS NUMBER OF MEAN LENGTH MEAN TOTAL PERCENT WITH PERCENT WITH PERCENT PERCENT 

HOSPITAL STAYS OF STAY, IN DAYS COST PER STAY, AN ADDITIONAL A SECONDARY ADMITTED TRANSFERRED TO 

IN DOLLARS MHSA DISORDER NON-MHSA FROM PSYCHIATRIC, NURSING 

CONDITION THE ED HOME, OR LONG-TERM 

CARE FACILITY

Adjustment disorders 37,444 3.3 $2,694 67.0 40.5 52.6 6.7

Anxiety disorders 39,124 3.8 $3,518 65.5 63.6 65.1 8.4

Delirium, dementia, and amnestic and cognitive disorders 145,261 8.6 $6,709 72.3 91.8 53.1 58.3

Disorders diagnosed in infancy, childhood, or adolescence 773 9.7 $7,171 74.7 48.2 59.1 14.8

Elimination disorders * * * * * * *

Other disorders of infancy, childhood, or adolescence * * * * * * *

Pervasive development disorders 600 11.5 $8,351 72.5 45.3 62.4 17.4

Tic disorders 158 3.2 $2,944 83.8 54.2 49.4 3.4

Disruptive behavior disorders 1,063 5.8 $4,363 78.4 48.8 54.0 18.1

Attention-deficit/hyperactivity disorders 457 6.1 $4,421 90.6 36.1 51.3 5.2

Conduct disorder 542 5.7 $3,571 67.4 60.6 55.5 29.6

Oppositional defiant disorder * * * * * * *

Impulse control disorders 7,589 9.6 $7,239 69.7 51.4 56.8 19.9
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Appendix B

53

PRINCIPAL MHSA DIAGNOSIS NUMBER OF MEAN LENGTH MEAN TOTAL PERCENT WITH PERCENT WITH PERCENT PERCENT 

HOSPITAL STAYS OF STAY, IN DAYS COST PER STAY, AN ADDITIONAL A SECONDARY ADMITTED TRANSFERRED TO 

IN DOLLARS MHSA DISORDER NON-MHSA FROM PSYCHIATRIC, NURSING 

CONDITION THE ED HOME, OR LONG-TERM 

CARE FACILITY

Mood disorder 707,126 7.0 $4,863 68.5 58.5 50.6 9.0

Bipolar disorders 269,902 7.9 $5,495 64.4 57.9 52.1 10.1

Depressive disorders 437,224 6.5 $4,473 71.0 58.9 49.6 8.4

Personality disorder 4,383 5.6 $4,495 84.4 52.0 53.5 10.4

Schizophrenia and other psychotic disorders 410,617 11.1 $8,076 54.1 59.7 53.0 20.6

Substance-related disorders 470,895 4.6 $4,261 84.4 52.2 50.2 10.9

Alcohol-related disorders 227,837 4.6 $4,232 82.6 57.4 59.5 11.1

Drug-related disorders 243,058 4.6 $4,288 86.0 47.4 41.6 10.7

Miscellaneous mental disorders 44,137 3.6 $3,719 67.2 39.4 34.1 5.4

Dissociative disorder 1,002 6.8 $4,972 84.3 63.9 48.0 6.7

Eating disorders 2,844 9.2 $6,946 74.0 60.2 31.4 7.6

Factitious disorder 393 4.0 $3,912 78.8 58.7 70.0 16.8

Mental disorders due to general medical condition 1,043 8.0 $6,951 68.4 76.2 41.4 29.3

Other miscellaneous mental conditions 27,364 2.9 $2,822 68.6 19.5 19.7 2.5

Psychogenic disorders 2,599 3.1 $4,504 65.2 80.2 74.2 13.7

Sexual and gender identity disorders 266 3.4 $7,991 22.4 59.2 15.5 3.9

Sleep disorders 107 2.9 $3,405 68.7 81.3 50.9 8.7

Somatoform disorders 8,520 3.3 $4,605 59.7 74.2 64.8 7.9

Note: Percents shown above are percentages of diagnosis-specific discharges. Weighted estimates from HCUP Nationwide Inpatient Sample (NIS), 2004, Agency for Healthcare Research and Quality, based on data collected by individual

States and provided to AHRQ by the States. The total number of weighted adult discharges in the U.S. is based on HCUP NIS=31,928,948. Statistics based on estimates with a relative standard error (standard error/weighted estimate)

greater than 0.30 or with standard error = 0 are not reliable. These statistics are suppressed and are designated with an asterisk (*). 
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Appendix C

54

Appendix C: Adult Stays in U.S. Community

Hospitals, Most Common Principal and Secondary

Diagnoses of Mental Health or Substance Abuse

Disorder, by Gender and Age, 2004 

PRINCIPAL MHSA DIAGNOSIS* TOTAL NUMBER OF ALL PRINCIPAL GENDER AGE GROUP

HOSPITAL STAYS MHSA STAYS FEMALE MALE 18–44 YRS 45–64 YRS 65–79 YRS 80+ YRS

(in thousands) PERCENTAGE OF HOSPITAL STAYS WITH PRINCIPAL MHSA DISORDER

Mood disorders including bipolar disorders 707 37.9 45.0 31.0 41.0 38.2 31.9 18.2

and depressive disorders

Substance-related disorders including drug 471 25.2 16.2 33.9 27.1 29.5 14.5 5.3

and alcohol abuse disorders

Schizophrenia and other psychotic disorders 411 22.0 19.7 24.0 22.2 25.7 17.2 9.7

Delirium, dementia, and amnestic and cognitive disorders 145 7.8 9.3 6.4 0.3 1.9 31.4 63.3

Miscellaneous mental disorders 44 2.4 4.3 0.5 3.6 0.9 1.1 0.7

Anxiety disorders 39 2.1 2.7 1.5 1.9 2.2 2.9 2.0

Adjustment disorders 37 2.0 2.1 2.0 2.8 1.3 0.8 0.5

Impulse control disorders 8 0.4 0.3 0.5 0.6 0.2 0.1 0.2

Personality disorders 4 0.2 0.3 0.2 0.3 0.2 0.1 0.0

Disruptive behavior disorders 1 0.1 0.0 0.1 0.1 0.0 0.0 0.1

Disorders usually diagnosed in infancy, childhood, 1 0.0 0.0 0.1 0.1 0.0 0.0 0.0

and adolescence

Note: Percentages represent column percents; “0.0” percent indicates < .05 percent.

*Includes stays principally for MHSA disorders regardless of whether a secondary MHSA disorder is present.
HCUP Fact Book No. 10 

■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

Appendix C

55

SECONDARY MHSA DIAGNOSIS** TOTAL NUMBER OF ALL SECONDARY GENDER AGE GROUP

HOSPITAL STAYS MHSA ONLY STAYS FEMALE MALE 18–44 YRS 45–64 YRS 65–79 YRS 80+ YRS

(in thousands) PERCENTAGE OF HOSPITAL STAYS FOR SECONDARY MHSA DISORDER

Mood disorders including bipolar disorders 2,330 40.7 46.9 31.3 44.7 49.0 41.7 26.6

and depressive disorders

Delirium, dementia, and amnestic and cognitive disorders 1,488 26.0 27.4 23.9 1.3 4.1 31.0 69.0

Substance-related disorders including drug 1,332 23.3 13.3 38.4 40.9 33.9 14.3 3.5

and alcohol abuse disorders

Anxiety disorders 873 15.3 17.6 11.8 15.6 18.4 17.6 9.1

Schizophrenia and other psychotic disorders 343 6.0 5.4 7.0 5.0 7.5 6.8 4.4

Miscellaneous mental disorders 258 4.5 6.7 1.2 16.4 1.3 1.2 0.8

Adjustment disorders 63 1.1 1.1 1.1 1.8 1.1 1.0 0.6

Personality disorders 43 0.8 0.8 0.7 1.8 0.9 0.3 0.1

Disruptive behavior disorders 25 0.4 0.3 0.6 1.2 0.5 0.1 0.1

Disorders usually diagnosed in infancy, childhood, 7 0.1 0.1 0.2 0.3 0.1 0.1 0.0

and adolescence

Impulse control disorders 3 0.1 0.0 0.1 0.2 0.1 0.0 0.0

Note: Percentages represent column percents. Secondary diagnoses are not mutually exclusive; therefore, the sum of column percent is greater than 100. “0.0” percent indicates < .05 percent.

**Includes only stays principally for non-MHSA diagnoses with a secondary MHSA disorder.
obaobaobaobaobaobaobaobaobaobaobaobaobaob

HCUP Fact Book No. 10 ■ Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004

56
kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf

ctbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbo

kfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfac

ookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookf
tbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactboo

factbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactb

okfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfa

tbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactboo

factbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactb

okfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfa

tbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactboo

factbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactb

okfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfa

tbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactboo

factbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactb

okfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfa

tbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactboo

factbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactb

okfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfa

tbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactboo

factbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactb

okfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfa

tbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactboo

factbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactb

okfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfa

tbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactboo

factbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactb

okfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfa

tbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactboo

factbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactb

okfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfa

tbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactboo

factbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactb

okfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfa

tbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactboo

factbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactb

okfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfa

tbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactboo

factbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactb

okfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfa

tbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactboo

factbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactb

okfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfa

tbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactboo

factbookfactbookfactbookfactbookfactbookfactbookfactbookfactbookfactb

AHRQ Publication No. 07-0008

January 2007

ISBN 1-58763-229-2

U.S. Department of Health and Human Services

Agency for Healthcare Research and Quality

540 Gaither Road

Rockville, MD 20850

www.ahrq.gov