From Vital and Health Statistics of the National Center for Health Statistics Number 70 � May 22, 1981 

PROPERTY OF l’ffF 

PUBLICATIONS BRANCh 

Utilization of Short-Stay Hospitals in the Treatrd#~k?WBRARY 

Mental Disorders: 1974-1978 

by Edmund Graves, Division of Health Care Statistics, and Chris Lovato, formerly with this Division 

Introduction 

This report presents national estimates on the utilization of non-Federal short-stay hospitals by patients 

discharged with a diagnosis of mental disorder. Included in the report are data on patients whose firstIisted diagnosis is psychosis, neurosis, personality 

disorder (including alcoholism and drug dependence), 

or other nonpsychotic mental disorder coded according to the Eighth Revision International Classification 

of Diseases, Adapted for Use in the United States. 1 

Information on the number of mental disorder discharges, average length of stay, and most frequent diagnostic categories are presented according to patient 

* characteristics for 1974-78. Also included are data on 

the average length of stay according to patient’s expected source of payment for 1978. Discharges of 

newborn infants are excluded from this report. 

The statistics presented are based on data collected 

through the National Hospital Discharge Survey, a 

continuous survey which has been conducted since 

1965 by the National Center for Health Statistics. A 

brief description of the sample design, source of data, 

and definitions of terms used in this report can be 

found in the technical notes. Several factors should 

be kept in mind in using the data discussed in this 

report. It should be noted that the survey does not 

include persons discharged from long-stay psychiatric 

facilities. Also, statistics are presented on discharges, 

not individual patients, since an individual may have 

been discharged from a hospital more than once. 

Since the data presented in this report are based 

on a sample of all discharges, they are subject to 

sampling error. See the technical notes for further 

discussion of sampling error. 

Findings 

— Generaltrends 

From 1974 to 1978 an average of 1.5 million 

persons with a fust-listed diagnosis of mental disorder were discharged each year from short-stay 

hospitals in the United States. The incidence of 

discharges increased from 1974 to 1978 (table 1). 

There were an estimated 1.3 million such discharges 

in 1974 and 1.7 million in 1978, an increase of 28 

percent. 

When the number of mental disorder discharges 

are compared with the number of all patients discharged from short-stay hospitals, an average annual 

mental disorder discharge rate of 44 per 1,000 is 

indicated across 5 years of data. This rate increased 

slightly from 41 per 1,000 discharges in 1974 to 48 

in 1978. For a given hospital subpopulation, the 

mental disorder discharge rate is the number of 

mental disorder discharges divided by the total 

number of discharges multiplied by 1,000. The rate 

can be expressed as: 

number of first-listedmental 

disorderdischargesx 1,000 

MDDR = 

total number of discharges 

Table 1 also presents the average length of stay 

for all mental disorder discharges for each year from 

1974 to 1978. During this period, the average length 

of stay for patients diagnosed as having a mental disorder was 11.0 days, compared with 7.5 days for all 

other diagnoses. 

Table 1. Number of patients with a diagnosed mental disorder and 

average length of stay: United States, 1974-78 

[Discharges from non-Federel short-stay hospitals. Excludes 

newborn infants] 

Average 

‘umber ‘f length Year discharges of stay in thousands in days 

1978 . . . . . . . . . . . . . . . . . . . . . . . . . 1,713 11.2 

1977 . . . . . . . . . . . . . . . . . . . . . . . . . 1,613 10.9 

1976 . . . . . . . . . . . . . . . . . . . . . . . . . 1,471 10.5 

1975 . . . . . . . . . . . . . . . . . . . . . . . . . 1,476 11.1 

1974 . . . . . . . . . . . . . . . . . . . . . . . . . 1,338 11.3 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service, Office of Health Research. Statistics. and Technoloav 
2 acklncedata 

Patient characteristics 

As indicated in figure 1, the mental disorder 

discharge rate was higher for all other patients than 

for white patients. The largest difference is seen for 

1975, in which there was a mental disorder discharge 

rate of 40 for white patients discharged and 52 for 

all other patients. It should be noted that color was 

not stated in a large number of cases (approximately 

15 percent). As a result, interpretations should be 

made with caution. 

Table 2 shows, by age and sex group, the number 

and rate of patients diagnosed as having a mental 

disorder who were discharged from short-stay hospitals. From 1974 through 1978, the number of 

_ White 

m All other 

r 

1974 1975 1976 1977 1978 

Figure 1. Mental disorder discharge rate, by color: United Stetes, 1974-78 

males and females hospitalized with a mental disorder was about the same. The rate of hospitalization per 1,000 civilian noninstitutionalize # 

population was higher in 1978 than in 1974. The \ 

rates for males were 8.3 and 6.6, respectively, and 

those for females were 7.8 and 6.3. 

In 1974-78 a total of 3 million patients in the ~ 

age groups 25-34 and 35-44 with a diagnosed mental 

disorder were discharged from short-stay hospitals. 

Together these age groups accounted for 39 percent, ~ 

or almost 4 out of every 10 patients with a mental 

disorder. The age groups 15-24 and 45-54 accounted 

for 33 percent, or a little over 3 out of every 10 

patients with a mental disorder. The remaining 30 

percent was distributed among the other three age 

groups, with the under 15 years group accounting 

for less than 5 percent of the discharges during this 

period. 

Most frequent diagnostic categories 

During 1974-78, the two most frequent diagnostic 

categories for all mental ‘disorder discharges were 

alcoholism and neurosis (table 3). Together these two 

categories accounted for almost 6 out of every 10 

persons diagnosed with a mental disorder (56 percent). Schizophrenia and effective psychosis ranked 

third and fourth, respectively, over the 5-year period. 

These two diagnostic categories accounted for an *

average of 18 percent of these discharges. 

Of the four most common diagnoses described 

above, affective psychosis and schizophrenia had the 

two longest average lengths of stay, with an average 

of 17.5 and 16.6 days, respectively. The average 

length of stay for neurosis and alcoholism was 9.9 

and 8.2 days, respectively. 

For females, neurosis was the most common 

diagnosis for each of the 5 years from 1974 through 

1978. This diagnostic category accounted for approximately 38 percent of all females diagnosed with a 

mental disorder. Alcoholism and schizophrenia were 

the next two leading categories of female discharges 

in the 5-year period under discussion. Together 

these two categories accounted for approximately 

26 percent of all diagnoses of mental disorders for 

females. For males, alcoholism was the leading 

mental disorder diagnostic category for each year 

of data analyzed. Approximately 45 percent of all 

males with a ~mental disorder diagnosis were discharged with a diagnosis of alcoholism. The second 

and third most frequent diagnoses were neurosis 

and schizophrenia, respectively. Together these two 

diagnostic categories accounted for 29 percent of 

all males diagnosed with a mental disorder. 

Q 

Expected source of payment 

In 1977, the National Hospital Discharge Survey 

began collecting data on patient’s expected principal 
adwlncedata 3 

Table 2. Number and rate of patients with a diagnosed mental disorder discharged from short-stay hospitals, by sex and age: United Statas, 1974-78 

@ [Discharges from non-Federal short-stay hospitals. Excludes newborn infanta] 

Sex and age 

All mental conditions (except mental retardation) . . . . . . . . . 

Sex 

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Age 

Under 15years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

15-24years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

25-34years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

35-44years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

45-54years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

55-64years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

65yearsand over . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

All mental conditions (except mental retardation) . . . . . . . . . 

Sex 

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Age 

Under 15years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

15-24 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

25-34years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

35-44 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

45-54yaars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

55-64years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

65yearsand over . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

1974 

1,338 

657 

680 

41 

230 

270 

248 

230 

167


153 

6.5 

6.6 

6.3 

0.8 

6.1 

9.3 

11.1 

9.8 

8.7 

7.4 

7975 1976 1977 

Number of discharges in thousands 

1,476 1,471 1,613 

712 713 810 

765 758 803 

42 46 47 

223 236 260 

294 294 347 

281 270 293 

264 254 272 

178 185 200 

192 187 193 

Rate of discharges per 1,000 population 

7.1 7.0 7.6 

7.1 7.0 7.9 

7.1 7.0 7.3 

0.8 0.9 0.9 

5.8 6.0 6.5 

9.8 9.4 10.8 

12.6 11.9 12.7 

11.2 10.9 11.7 

9.1 9.3 9.9 

9.0 8.6 8.7 

1978 

1,713 

853 

860 

42 

278 

364 

319 

274 

207 

229 

8.0 

8.3 

7.8 

0.8 

7.0 

11.0


13.3 

11.9 

10.1 

10.0 

source of payment. This section describes these data 

for patients with and without mental disorders who 

were discharged in 1978. 

Figure 2 depicts the percent distribution offirstIisted diagnosis by source of payment for those patients with and without mental disorders. Approximately 50 percent of all patients without mental 

disorders and 43 percent of patients with mental 

disorders listed private or commercial insurance as 

their principal source ofpayment. Thesecond leading 

payment catego~ for patients with and without 

mental disorders was Medicare. For patients without 

mental disorders it was 26.1 percent, while for 

patients with a mental disorder it was 16.6 percent. 

Together these two payment sources were used by 

75.6 percent of all patients without a mental disorder, and 58.8 percent of all patients with amental 

disorder. At the other end of the spectrum, Workmen’s Compensation was a source of payment for 

1.6percentofaU patients without amental disorder, 

and 0.3 percent with a mental disorder. “Other” 

was a source of payment for 1.4 percent of all patients without a mentaI disorder, and 2.3 percent 

with a mentaJ disorder. There was no charge for 

0.1 percent of all patients without amental disorder, 

and 0-2 percent with a mental disorder. Fourteen 

percent of the patients with mental disorders and 6 

percent of the patients without mental disorders did 

not state their source of payment. 

As shown in table 4, the distribution of days of 

care by source of payment was similar to the distribution of discharges. Individuals with a diagnosed 

mental disorder expecting to pay hospital charges 

through private or commercial insurance carriers 

used the largest proportion of days of care (45.6 

percent, or approximately 8.8 million days)- Medicare 

patients utilized the second highest percent of total 

days of care ( 19.3 percent, or 3.7 million days). Of 

the major sources of payment, the smallest proportion of days of care was utilized by patients with 

Workmen’s Compensation (0.2 percent, or 46,000 

days of care). 

Overall, there was little significant variation in 

length of stay by source of payment. The most 

noticeable difference was that patients using private 

or commercial insurance carriers as a method of 

payment stayed an average of 3.8 days longer than 

those utilizing their own resources as a source of 

payment. 
4 dmcedaa ! 

Table 3. Number of patients with a diagnosed mental disorder discharged from short-stay hospitals and averaga length of stay, by selected first-listed 

diagnostic categories and sex: United States, 1974-78 

[Discharges from non-FederaI short-stay hospitals. Excludes newborn infants] # 

Selected first-listad diagnostic categories, 1974 1975 1976 1977 1978 1974 1975 1976 1977 1978 ICDA code, 1 and sex 

Number of discharges in thousands Average length of stay in days 

All mental disorders (290-309) 

Both sexes . . . . . . . . . . . . . . . . . . . . . . 1,338 1,476 1,471 1,613 1,713 11.25 11.06 10.50 10.85 11.23 

Male . . . . . . . . . . . . . . . . . . . . . . . . . 657 711 713 810 853 10.36 9.90 10.18 10.30 10.49 

Female . . . . . . . . . . . . . . . . . . . . . . . . 680 765 758 803 860 12.10 12.14 10.80 11.42 11.96 

Alcoholism (303) 

Both sexes . . . . . . . . . . . . . . . . . . . . . . 339 424 429 468 519 7.98 7.90 8.08 8.54 8.50 

Male . . . . . . . . . . . . . . . . . . . . . . . . . 274 324 328 362 397 7.69 7.71 8.22 8.66 8.06 

Female . . . . . . . . . . . . . . . . . . . . . . . . 65 100 102 106 122 9.19 8.53 7.65 8.13 9.93 

Neuroses (300) 

Both sexes . . . . . . . . . . . . . . . . . . . . . . 424 421 391 426 437 10.12 10.22 9.37 9.29 10.25 

Male . . . . . . . . . . . . . . . . . . . . . . . . . 131 123 118 133 136 10.30 9.91 10.43 8.99 10.20 ‘ 

Female . . . . . . . . . . . . . . . . . . . . . . . . 293 298 273 293 301 10.05 10.34 8.92 9.43 10.27 

Schizophrenia (295) 

Both sexes . . . . . . . . . . . . . . . . . . . . . . 153 165 179 221 222 18.17 17.21 15.99 15.69 16.59 

Male . . . . . . . . . . . . . . . . . . . . . . . . . 71 73 84 101 108 16.61 14.46 14.96 13.88 16.61 

Female . . . . . . . . . . . . . . . . . . . . . . . . 82 93 95 120 114 19.51 19.36 16.91 17.22 16.56 

Affective psychosis (296) 

Both sexes . . . . . . . . . . . . . . . . . . . . . . 77 83 85 97 124 19.35 18.71 16.71 16.71 16.73 

Male . . . . . . . . . . . . . . . . . . . . . . 

Female . . . . . . . . . . . . . . . . . . . . . 

. 

. 

. . 25 26 24 35 41 

. . 52 56 62 62 83 

19.62 

19.22 

20.31 

17.97 

16.51 

16.76 

18.02 

15.97 

15.84 

17.17 � 

lEighth Revision international Classification of Diseases, Adapted for Useinthe United States, 1965. 

Table4. Days of care, number of first-listed diagnosis, and average length of stay for inpatients with and without mental disorders discharged from 

short-stay hospitals, by sources of payment: United States, 1978 

[Discharges from non-Faderal short-stay hospitals. Excludes newborn infants] 

With mental disorders Without menial disorders 

Source of payment Numberof Average Numberof Average 

Days of care first-listed length Daysofcare first-listed length 

diagnosis of stay diagnosis of stay 

In thousands In days In thousands In days 

Allsources ofpayment . . . . . . . . . . . . . . . . . . . . . 19,232 1,714 11.2 242,736 33,902 6.9 

Selfpay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,204 144 8.3 9,920 1936 5.1 

Workmen’scompensation . . . . . . . . . . . . . . . . . . . 46 5 9.7 3,689 556 6.6 

Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,714 284 13.1 93,778 8,834 10.6 

Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,753 181 9.7 16,142 2,547 6.3 

Othergovernmant payments. . . . . . . , . . . . . . , . . . 812 91 9.0 4,484 783 5.7 

Blue Cross, other private orcommercial insurance . . . . . 8,772 723 12.1 97,283 16,787 5.8 

No charge . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 3 10.1 254 38 6.7 

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413 40 10.2 2,870 461 6.2 

Notstated . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,487 243 10.2 14,316 1,861 7.3 
----

ackmecw5 

50 

40 

10 

0 

Insuranca Medicare Medicaid Self pay Other govern- Other Workmen’s No charge 

ment payments Compensation 

Source of payment 

Figure 2. Percent distribution of first-listed diagnosis, by source of payment: United States, 1Y/b 

References 

1National Center for Health Statistics: Eighth Revision International Classification of Diseases, Adapted for Use in the 

United States. PHS Pub. No. 1693. Public Health Service. 

Washington. U.S. Government Printing Office, 1967. 

2National Center for Health Statistics: Utilization of shortstay hospitals, annual summary for the United States, 1974, 

by A. L. Ranof&y. Vital and Health Statistics. Series 13-No. 

26. DHEW Pub. No. (HRA) 76-1777. Health Resources Administration. Washington. U.S. Government Printing Office, 

Sept. 1976. 

3National Center for Health Statistics: Utilization of shortstay hospitala, annual summary for the United States, 1975, 

by A, L. Ranofsky. Vital and Health Statistics. Series 13-No. 

31. DHEW Pub. No. (HRA) 77-1782. Health Resources Administration. Washington. U.S. Government Printing Office, 

Apr. 1977. 

4National Center for Health Statistics: Utilization of shortstay hospitals, annual summary for the United States, 1976, 

by A. L. Rsnofsky. Vital and Health Statistics. Series 13-No. 

37. DHEW Pub. No. (PHS) 78-1788. Public Health Service. 

Washington. U.S. Government I%inting Office, June 1978. 

5National Center for Health Statistics: Utilization of shortstay hospitals, annual summary of the United States, 1977, 

by B. J. Haupt. Vital and Health Statistics. Series 13-No. 

41. DHEW Pub. No. (PHS) 79-1557. Public Health Service. 

Washington. U.S. Government Printing Office, Mar. 1979. 

6National Center for Health Statistics: Utilization of shortstay hospitals, annual summary for the United States, 1978, 

by B. J. Haupt. Vital and Health Statistics. Series 13-No. 

46. DHEW Pub. No. (PHS) 80-1797. Public Health Service. 

Washington. U.S. Government Printing Office, Mar. 1980. 

7National Center for Health Statistics: Utilization of shortstay hospitals, summary of nonmedical statistics, United 

States, 1973, by W. F. Lewis. Vital and Health Statistics. 

Series 13-No. 23. DHEW Pub. No. (HRA) 76-1774. Health 

Resources Administration. Washington. U.S. Government 

Printing Office, July 1976. 
I 

6 admncedata 

Technical Notes 

Survey methodology 

Source of data 

The scope of the National Hospital Discharge 

Survey encompasses patients discharged from shortstay noninstitutionalized hospitals, exclusive of 

military and Veterans Administration hospitals, 

located in the 50 States and the District of Columbia. 

Only hospitals with six beds or more and an average 

length of stay less than 30 days for all patients are 

included in the survey. 

The universe of the survey consisted of 6,965 

short-stay hospitals contained in the 1963 Master 

Facility Inventory of Hospitals and Institutions. New 

hospitals were sampled for inclusion into the survey 

in 1968, 1972, 1975, and 1977. 

The sample size and number of medical records 

provided for the survey are presented below. Detailed information in regard to the sample can be 

found in certain Vital and Health Statistics Series 

reports.2 -G 

Number of Number of 

Year participating records 

hospitals provided 

1978 . . . . . . . . . . . . . . . . . 413 219,000 

1977 . . . . . . . . . . . . . . . . . 423 224,000 

1976 . . . . . . . . . . . . . . . . . 419 223,000 

1975 . . . . . . . . . . . . . . . . . 432 232,000 

1974 . . . . . . . . . . . . . . . . . 426 227,000 

Sample design 

All hospitals with 1,000 beds or more in the universe of short-stay hospitals were selected with 

certainty in the sample. All hospitals with fewer than 

1,000 beds were stratified, the primary strata being 

24 size-by-region classes. Within each of these 24 

primary strata, the allocation of the hospitals was 

made through a controlled selection technique so 

that hospitals in the sample would be properly 

distributed with regard to type of ownership and 

geographic division. Sample hospitals were drawn 

with probabilities ranging from certainty for the 

largest hospitals to 1 in 40 for the smallest hospitals. 

Subsamples of discharges were selected within 

the sample hospitals using the daily listing sheet of 

discharges as the sampling frame. These discharges 

were selected by a random technique, usually on the 

basis of the terminal digit(s) of the patient’s medical 

record number, a number assigned when the patient 

was admitted to the hospital. The within hospital 

sampling ratio for selecting sample discharges varied 

— 

* 

inversely with the probability of selection of the 

hospitals. 

Sampling errors 

Since the estimates for this report are based on a 

sample rather than the entire universe, they are subject to sampling variabilityy. The standard error is 

primarily a measure of the variability that is attributed to using a value obtained from a sample as an 

estimate of a population value. The value that would 

have been obtained had a complete enumeration of 

the population been made. will be contained in an 

interval represented by the sample estimate plus or 

minus 1 standard error about 68 out of 100 times, 

and plus or minus 2 standard errors about 95 out of 

100 times. 

The relative standard error is obtained by dividing 

the standard error by the estimate. The resulting 

value is multiplied by 100, which expresses the standard error as a percentage. The relative standard error 

applicable to patients discharged (or first-listed 

diagnosis) and days of care for 1978 data presented in 

this report are provided in table I. Relative standard 

error estimates for 1974 through 1977 can be found 

in earlier publications.z -s The formula used for 

computing the variance of average length of stay has 

also been published.T The two-tailed Bonferroni test 

for multiple comparisons was performed for testing , 

the difference between two estimates. 

Table 1. Approximate relative standard errors of estimated number of 

first-listed diagnoses and days of care 

First- Days 

Size of estimate in thousands listed of 

diagnoses care 

Relative standard error 

1 .370 ..-

10:::::::::::::::::::::: ::: .165 .290 

100 . . . . . . . . . . . . . . . . . . . . . . . . .080 .165 

1,000 . . . . . . . . . . . . . . . . . . . . . . . .050 .100 

10,000. . . . . . . . . . . . . . . . . . . . . . .035 .060 

Definition of terms 

Patient.–A person who is formally admitted to 

the inpatient service of a short-stay hospital for 

observation, care, diagnosis, or treatment. In this 

report the number of patients refers to the number 

o of discharges during the year including any multiple 

NOTE: A list of references follow text 

9 
achancedata 7 

discharges of the same individual from one or more 

shoti-stay hospitals. 

Discharge.–The formal release of a patient by a 

hospital; that is, the termination of a period of 

hospitalization by death or by disposition to place 

of residence, nursing home, or another hospital. 

“Discharges” and “patient discharges” are used 

synonymously. 

Days o.f Care.–The total number of patient days 

accumulated at the time of discharge by patients discharged from short-stay hospitals during a year. A 

stay of less than 1 day (patient admitted and discharged on the same day) is counted as 1 day in the 

summation of total days of care. For patients admitted 

and discharged on different days, the number of days 

of care is computed by counting all days from (and 

including) the date of admission to (but not including) the date of discharge. 

Average Length of Stay .–The total number of 

patient days accumulated at time of discharge by 

patients discharged during the year divided by the 

number of patients discharged. 

Mental Disorder Discharges. –Discharges discussed 

in this report are those designated with a first-listed 

diagnosis of mental disorder in the Eighth R-evision 

International Classification of Diseases, Adapted for 

Use in the United States.l Included are three-digit 

code numbers 290 through 309. Mental Retardation, 

code 310, is not included in this report. 

First-Listed Diagnosis.-The coded diagnosis identified as the principal diagnosis or else listed first on 

the face sheet of the medical record. The number of 

first-listed diagnoses is equivalent to the number of 

discharges. 

Age. –Patient’s age refers to age at birthday prior 

to admission to the hospital inpatient service. ‘ 

Color. –Patients are classified into two groups, 

“white” and “all other.” The all other classification 

includes all categories otll~i than white. 

NOTE: A list of referencesfollow text 

Symbols 

. . . Data not available 

. . . Category not applicable 

Quantity zero 

0.0 Quantity more than O but less than 0.05 

*	 Figure does not meet standards of 

reliability or precision 
8 aciwncedata 

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