Inpatient Psychiatry Patient Reported Outcomes: Adolescent Emotional Distress, Suicidal Thoughts and Behaviors

Abstract

Objective

The youth mental health crisis, exacerbated by the COVID‐19 pandemic, has increased the demand for pediatric inpatient psychiatry units (IPUs) in the United States despite critical bed shortages, yet they remain an understudied treatment model. This study examines patient‐reported outcomes (PROs) of clinical symptoms and functioning for adolescents treated on a pediatric IPU from September 1, 2021 to September 1, 2023.

Methods

Retrospective reviews of 218 adolescent admissions (12–17 years) were conducted. Adolescents completed PROs upon admission and discharge measuring depression, suicidal thoughts and behaviors (STBs), anxiety, emotion dysregulation, family functioning, and quality of life. Paired t‐tests on admission and discharge scores were used to determine treatment effects.

Results

Most adolescents (93%) had depressive disorders; 76% reported a lifetime history of suicide attempts, and 68% endorsed suicidal ideation within the past 2 weeks on admission PROs. Discharge PRO scores revealed improvements in depression, STBs, anxiety, emotional regulation, family functioning and quality of life from admission to discharge (p < 0.01 for all measures). Effect size was large for depression (d = 1.00) with improvement on all depression subscales (all p < 0.01), and robust effect sizes related to mood (d = 0.724) and suicidal ideation (d = 0.682) symptoms.

Conclusions

Pediatric IPU is a vital and effective treatment model whose importance in delivering life‐saving care suggests further resources—including increased research and improved access to care—are warranted.

Relevance to Clinical Practice

These findings support the use of IPU care for adolescents experiencing severe mental health crises, particularly depression and STBs.

Highlights

• Pediatric inpatient psychiatry units (IPUs) have been in high demand and short supply in the United States, and a surge in IPU demand followed the onset of the COVID‐19 pandemic.

• A retrospective review of 218 adolescent admissions at a pediatric IPU from September 1, 2021 to September 1, 2023 revealed high illness severity; over three‐quarters of adolescents endorsed a lifetime history of suicide attempts and 68% endorsed suicidal ideation within the past 2 weeks upon admission.

• Adolescents reported positive clinical outcomes from their hospitalization, with improvement in depression, suicidal ideation, anxiety, emotional regulation, and quality of life between admission and discharge.

• This study highlights psychiatric hospitalization as a potentially life‐saving intervention for severely ill youth with depression and suicidal thoughts and behaviors.

There has been a significant demand for pediatric inpatient psychiatric units (IPUs) in the United States (US) for over a decade, with pediatric mental health hospitalizations increasing by more than 25% from 2009 to 2019 and the proportion of hospitalizations related to suicide or self‐injury more than doubling (1). Despite increases in pediatric mental health emergency visits, national pediatric IPU bed capacity did not change from 2017 to 2020 (2). This youth mental health crisis reached a fever pitch during the COVID‐19 pandemic, with surging emergency department (ED) encounters for suicidal thoughts and behaviors (STBs) among adolescents ages 12–18 years, higher volumes of IPU referrals, and increased symptom severity of youth presenting for IPU care (3, 4, 5). In 2022, the highest suicide death rates reported by the Centers for Disease Control and Prevention were in rural states like Alaska, which had no pediatric IPU beds prior to the COVID‐19 pandemic, and the lowest suicide death rates were in urban areas with high pediatric IPU bed capacity (2, 6).

Boarding lengths of stay for youth awaiting psychiatric hospitalization in EDs and/or medical floors doubled after the pandemic onset and caused significant disruptions in healthcare systems across the country (4, 7, 8). Further, data from 33 EDs in Minnesota in 2023 showed the top reason for ED transfer and discharge delays was a lack of IPU beds (9), and similar findings were reported in Massachusetts (10). Recent research shows that strategies to address boarding that include expanding IPU bed capacity are effective in reducing boarding volumes and length of stay (LOS) and increasing access to care for youth in need of psychiatric hospitalization (11, 12).

Despite the increasing reliance on pediatric IPUs, they remain an understudied treatment model (13). While some studies highlighting outcomes of pediatric IPU care have been conducted (14, 15), research examining effectiveness and outcomes of IPU care for youth hospitalized during the COVID and post‐COVID era is lacking, and the underdeveloped literature and growing demand for pediatric IPU care in recent years render studies of clinical outcomes, particularly outcomes regarding adolescent STBs, more important than ever.

Adolescents are critical stakeholders in reporting their symptoms and determining improvements related to treatment. The Center for Medicaid and Medicare Services (CMS) defines patient‐reported outcomes (PROs) as “any report of the status of a patient's health condition or health behavior coming directly from the patient, without interpretation of the patient's response by a clinician or anyone else” (16). CMS and the American Academy of Child and Adolescent Psychiatry recommend PROs as patient‐centered measures of performance and clinical outcomes, which provide a rich data source related to symptoms, symptom burden and health‐related quality of life (16, 17).

The current study aims to (1) describe symptoms from adolescent PROs upon admission to a pediatric IPU during a 2 year period after the COVID‐19 pandemic onset and (2) evaluate adolescent PROs upon discharge and changes related to depression, STBs and other symptoms.

METHODS

Setting and Model of Care

This study was conducted on a 16‐bed, child and adolescent IPU located in an urban general pediatric hospital in the US Northeast. It is the only medical‐psychiatric unit in the state for youth with comorbid psychiatric and medical concerns, such as diabetes, seizures, and eating disorders. Exclusion criteria for admission to the IPU include patients with moderate to severe autism and/or intellectual disabilities who are better served in specialized neurodevelopmental programs.

The IPU provides patient‐ and family‐centered care guided by an interdisciplinary Focal Inpatient Treatment Planning model (18). Upon admission, IPU clinicians conduct a comprehensive multidisciplinary psychiatric assessment and make diagnoses based on Diagnostic and Statistical Manual of Mental Disorders (DSM‐5) criteria (19). Treatment includes ongoing risk assessments, symptom monitoring, diagnostic review and updates, individual psychotherapy, group psychotherapy (led by recreation therapists, psychologist, and others), milieu‐based therapy, pharmacotherapy, and family psychotherapy.

All IPU patients are seen daily by attending child psychiatrists, five times a week by licensed clinical social workers, have access to an average of six group sessions a day (e.g., skills‐based groups, psychotherapy groups, recreational groups, psychoeducation groups, etc.), school tutoring several hours a day, and as‐needed consultation with an attending psychologist. There is a full‐time pediatric nurse practitioner, 24‐h pediatric hospitalist on call coverage, and consultation by subspecialty medical or surgical teams as needed. Recreation therapists, physical and occupational therapists, nutritionists, and chaplaincy also provide IPU consultation and services. The unit is staffed 24 h a day, 7 days a week with psychiatric nurses and behavioral health counselors who provide milieu‐based supportive care and safety monitoring.

The IPU implemented two quality improvement (QI) initiatives in 2021 focused on enhancing suicide focused care and implementing PROs to inform care and assess clinical outcomes.

Standardized Suicide Screening, Assessment, and Management

A standardized suicide screening assessment and management protocol was implemented as part of a system‐wide effort focused on suicide prevention. The process aligned with the Joint Commission National Patient Safety goals (20) and core elements of the Zero Suicide framework for suicide care (21).

The Columbia Suicide Severity Rating Scale (C‐SSRS) (22) is used for suicide screening and assessment upon IPU admission and reassessments are conducted twice a week until discharge. The Suicide Assessment Five‐step Evaluation and Triage (SAFE‐T) protocol (23) is also used as part of the suicide risk assessment. A Safety and Coping Plan for Suicidal Adolescents (24) uses an IPU specific safety scale administered daily as part of the ongoing risk assessments to inform the development and implementation of safety and coping plans.

Specific psychotherapeutic interventions targeting depressive disorders and STBs include Cognitive Behavioral Therapy and Dialectical Behavioral Therapy, which are effective for adolescents at risk of suicide (25, 26). Elements of these interventions are used, including behavior chain analysis, distress tolerance skills, behavioral activation, cognitive restructuring, and problem solving around the safety concerns and stressors that contributed to the hospitalization. The Stanley Brown Safety Planning Intervention components are also used as part of the IPU safety and discharge planning process (27).

Patient Centered Measurement‐Based Care

The IPU also began implementing PRO measures in 2021 to facilitate measurement‐based care and inform care delivery through a patient centered lens. Patients of all ages, who are clinically and developmentally able and who provide assent, complete PROs upon admission to and discharge from the IPU as part of routine care, and the domains measured by the PROs cover common IPU presenting problems. While not specifically an exclusion criteria, only English speaking patients were able to complete the PROs.

For adolescent patients (ages 12–17), the measures administered to assess clinical symptoms and functioning include:

• a) The DSM‐5 Self‐Rated Level 1 Cross‐Cutting Symptom Measure for Children (DSM‐5‐CCSM). The IPU uses DSM‐5 based criteria for diagnostic assessments, and this measure screens for patient‐reported concerns across various domains (28).
• b) Quick Inventory of Depressive Symptomatology, Adolescent 17‐item Self‐Report (QIDS‐A17). This tool is a multidimensional assessment that inquires about every criterion of major depressive episodes using anchored responses that specify the type and severity of the symptoms (29).
• c) Screen for Child Anxiety and Related Emotional Disorders (SCARED). This questionnaire screens for several anxiety disorders, including somatic or panic symptoms, generalized anxiety, separation anxiety, social anxiety, and school avoidance in addition to an overall total score (30).
• d) Difficulties in Emotion Regulation Scale Short Form (DERS‐SF). The DERS‐SF assesses for emotion dysregulation across multiple domains, including impulsivity, goals and coping strategies, awareness and clarity of emotional experiences (31).
• e) Family Assessment Device's General Functioning scale (FAD‐GF). This scale, though originating as one subscale of a larger measure, is valid as a standalone measure of overall perceived family functioning (32).
• f) The Brief Multidimensional Students' Life Satisfaction Scale (LSS). This is a quality of life measure that assesses satisfaction in several life domains, such as family, friendships, and living environment (33).

The PROs are administered upon admission and discharge via electronic tablet and maintained in secure, QI database. A summary and interpretation of the admission PRO results is documented in each patient's Electronic Medical Record (EMR) and used to inform their care in real time. Aggregate data from PRO scores collected longitudinally are also used to inform unit based care and quality metrics.

Study Design and Participants

The goals of the current study were to evaluate the prevalence and severity of symptoms reported by adolescents upon admission to the IPU after the first year of the COVID‐19 pandemic and to assess changes in their self‐reported clinical symptoms from admission to discharge, with a focus on depression and STBs. We conducted a retrospective review of adolescents (age 12–17) admitted to and discharged from the IPU between September 1, 2021 and September 1, 2023, representing a 2 year period of full implementation of the IPU QI initiatives for suicide prevention‐focused care and patient centered, measurement‐based care.

All patients were admitted to the IPU from the institution's ED or inpatient medical units after presenting to the hospital with mental health related crises.

There were 273 adolescent admissions to the IPU during the September 1, 2021 to September 1, 2023 study period (Figure 1). Scores on the PRO measures were completed at admission and discharge for 218 (80%) adolescent admissions, representing 207 unique patients. All 218 admissions with completed PRO scores were included in the sample to assess their outcomes.

FIGURE 1.

Sample selection flowchart.

The sample is described in Table 1; majority of patients were female sex (77%), mean age 14.6 years, White (51%), and had private insurance (61%). Variables were abstracted from the EMR and the IPU's QI database. Clinical variables of interest were psychiatric diagnoses (using ICD‐10 codes), LOS, and PRO admission and discharge scores. The Institutional Review Board of the children's hospital approved this study's retrospective review of data with a waiver of need for informed consent.

TABLE 1.

Demographics and diagnoses of 218 adolescent admissions. ^a

Demographic category	N	%
Sex
F	168	77.1
M	50	22.9
Age
12	19	8.7
13	35	16.1
14	50	22.9
15	54	24.8
16	38	17.4
17	22	10.1
Race/ethnicity
American Indian or Alaskan Native	0	0
Asian	11	5.0
Black or African American	27	12.4
Hispanic or Latino	29	13.3
Native American or Pacific Islander	0	0
White	112	51.4
Unknown	39	17.9
Insurance
Private	132	60.6
Public	86	39.4
DSM‐5 diagnoses
Depressive disorders	203	93.1
Anxiety disorders	158	72.5
Attention deficit hyperactivity disorder	73	33.5
Trauma and stressor‐related disorders	63	28.9
Feeding and eating disorders	28	12.8
Autism spectrum disorders	25	11.5
Other neurodevelopmental disorders	20	9.2
Disruptive, Impulse control and conduct disorders	14	6.4
Obsessive compulsive disorders	13	6.0
Substance use disorders	11	5.0
Schizophrenia spectrum disorders	8	3.7
Personality disorders	7	3.2
Gender dysphoria	7	3.2
Bipolar and related disorders	5	3.0
Somatic symptom and related	4	1.8
Dissociative disorders	1	0.005

^a DSM, Diagnostic and Statistical Manual of Mental Disorders.

Analysis

Data analysis included four parts: First, to describe the patient population served, we calculated frequencies of nominal demographic and clinical characteristics. Second, to examine changes from admission to discharge, we conducted paired t‐tests of the five PROs with composite scores (QIDS‐A17, SCARED, DERS‐SF, FAD‐GF, and LSS) using Cohen's d to measure effect sizes. Positive effect sizes reflect a decrease in symptom severity at discharge for all measures, except the LSS. The effect size for the LSS is negative due to the directionality of the change, with a negative effect size reflecting an increase in satisfaction score at discharge. Third, since depressive disorders are the most common diagnoses for adolescents admitted to IPU care (34), we analyzed subscales and symptom clusters from the QIDS‐A17 in more detail via paired t‐test between admission and discharge to understand what specific symptoms and symptom domains changed between the time points. The QIDS‐A17 variables with more than one item (sleep, mood, weight/appetite, psychomotor changes) include the value of only the highest endorsed item in the set, consistent with the measure's scoring guidelines. Fourth, to understand the effect of LOS on outcomes, we conducted a post‐hoc test by splitting the sample into dichotomous high/low groups based on whether they had an LOS above or below the median LOS. Then, we conducted a mixed model analysis of variance analyzing admission to discharge changes across all PROs by high versus low LOS.

All data analyses were conducted using SPSS version 27. Due to the total number of tests performed in our analysis, we applied the Holm–Bonferroni correction to the significance tests in a single correction for all t‐tests to minimize the risk of type I errors.

RESULTS

Demographic and clinical data for the 218 adolescent IPU admissions are provided in Table 1. All patients had more than one diagnosis, with a median of three diagnoses. Depressive disorders were highly prevalent (n = 203, 93%), and frequently comorbid with other diagnoses. Specifically, 148 (94%) of anxiety disorders, 63 (86%) of attention deficit hyperactivity disorders and 55 (87%) of trauma and stressor‐related disorders were all comorbid with depressive disorders. The mean LOS for the sample was 23.5 days and median 14.9 days (range 193.6, SD 27.7).

Table 2 describes DSM‐5‐CCSM positive screens upon admission. The majority of adolescents screened positive for symptoms of inattention (82.1%), depressed mood/anhedonia (80.7%), anxiety (79.8%), anger/irritability (72%), sleep problems (68.8%), suicidal ideation (68.3%), and repetitive thoughts and behaviors (57.8%). Additionally, 76.1% of adolescents reported a lifetime history of suicide attempts.

TABLE 2.

Admission percentages on DSM cross cutting screener by domain. ^a

DSM domain number	Name	Patients screening positive (N = 218)	Percent screening positive
I	Somatic	100	45.9
II	Sleep	150	68.8
III	Inattention	179	82.1
IV	Depression	176	80.7
V & VI	Anger/irritability	157	72
VII	Mania	107	49.1
VIII	Anxiety	174	79.8
IX	Psychosis	64	29.4
X	Repetitive thoughts and behaviors	126	57.8
XI	Substance use	63	28.9
XIIa	Suicidal ideation (last 2 weeks)	149	68.3
XIIb	Suicide attempt (lifetime)	166	76.1

^a DSM, Diagnostic and Statistical Manual of Mental Disorders.

Analyses of five PRO measures showed significant improvement in total scores from admission to discharge in the QIDS‐A17, SCARED, DERS‐SF, FAD‐GF, and LSS (Table 3). There was a large effect size for the QIDS‐A17 (d = 1.00), moderate effect size in for the DERS‐SF (d = 0.517), and smaller effect sizes for the SCARED (d = 0.406), LSS (d = −0.394) and FAD‐GF (d = 0.304). Analyses of the QIDS‐A17 subscales and symptom clusters revealed significant improvement in all domains of depression symptoms between admission and discharge scores (Table 4). The most robust effect sizes were in the QIDS‐A17 mood (d = 0.724) and suicidal ideation (d = 0.682) symptoms, followed by energy/fatigability (d = 0.599), weight/appetite (d = 0.561), interest (d = 0.546), and self‐outlook (d = 0.509).

TABLE 3.

Paired T‐test for mean difference at admission and discharge. ^a

Instrument	Admission		Discharge		Paired T‐tests
	M	SD	M	SD	T	Sig. b	Effect size
QIDS‐A17	14.36	6.18	9.56	5.72	14.78	0.000*	d = 1.00
DERS‐SF	3.03	0.88	2.7	0.83	7.63	0.000*	d = 0.517
SCARED	37.25	18.26	32.21	18.64	6	0.000*	d = 0.406
LSS	3.08	0.96	3.37	0.9	−5.82	0.000*	d = −0.394
FAD‐GF	2.24	0.7	2.12	0.64	4.5	0.000*	d = 0.304

^a DERS‐SF, Difficulties in Emotion Regulation Scale, Short Form; FAD‐GF, Family Assessment Device, General Functioning Scale; LSS, Brief Multidimensional Students' Life Satisfaction Scale; M, mean; QIDS‐A17, Quick Inventory of Depressive Symptomatology, Adolescent 17 item self‐report; SCARED, Screen for Childhood Anxiety Related Emotional Disorders; SD, standard deviation; Sig, significance.

^b These p values are adjusted according to the Holm–Bonferroni correction.

p < 0.01

TABLE 4.

Paired T‐test for QIDS subscales and items. ^a

Instrument domain	Admission		Discharge		Paired T‐tests
	M	SD	M	SD	T	Sig. b	Effect size
QIDS‐A17 1–4 (sleep)	2.43	0.723	2.16	0.83	5.1	0.000*	d = 0.346
QIDS‐A17 5–6 (mood)	1.89	0.93	1.23	0.89	10.68	0.000*	d = 0.724
QIDS‐A17 7–10 (weight/appetite)	1.6	1.08	1.03	1.00	8.28	0.000*	d = 0.561
QIDS‐A17 11 (cognitive)	1.37	1.00	0.94	0.94	7.25	0.000*	d = 0.491
QIDS‐A17 12 (outlook [self])	1.72	1.12	1.11	1.17	7.51	0.000*	d = 0.509
QIDS‐A17 13 (suicidal ideation)	1.44	1.21	0.66	0.96	10.07	0.000*	d = 0.682
QIDS‐A17 14 (interest)	1.12	0.95	0.59	0.82	8.06	0.000*	d = 0.546
QIDS‐A17 15 (energy/fatigability)	1.43	1.06	0.81	0.89	8.85	0.000*	d = 0.599
QIDS‐A17 16–17 (psychomotor changes)	1.36	0.89	1.03	0.9	5.5	0.000*	d = 0.372

^a M, mean; QIDS‐A17, Quick Inventory of Depressive Symptomatology, Adolescent 17 item self‐report; SD, standard deviation; Sig, significance.

^b These p values are adjusted according to the Holm–Bonferroni correction.

p < 0.01

The post‐hoc mixed model analysis of variance for the interaction of admission to discharge PRO changes and LOS class was not significant (F _1,216 = 0.113, p = 0.737).

DISCUSSION

The current study revealed a very high prevalence of depression and STBs for adolescents admitted to the IPU over the 2‐year study period, with 93% having depressive disorder diagnoses, over three‐quarters reporting a lifetime history of at least one suicide attempt, and 68% endorsing suicidal ideation within the past 2 weeks, on their admission PROs. Given our sample mean age of 14.6 years, this is one of the highest lifetime rates of suicide attempt reported in a US adolescent inpatient psychiatry cohort and highlights the illness severity of adolescents admitted to our IPU during the second and third years after the pandemic onset. Studies conducted with adolescent IPU patients in the years leading up to the pandemic describe lifetime suicide attempt rates ranging from 30% to 54% and found more severe admission symptoms for adolescents with a lifetime history of suicide attempt compared to adolescents with no history of suicide attempts (14, 35, 36).

It is notable that our IPU implemented a protocol to enhance suicide assessment and treatment that aligned with the Zero Suicide framework during the first year of the pandemic, given the high prevalence of STBs in adolescents admitted during this period. Implementing standardized suicide risk assessments and daily safety scales throughout the admission, helped anchor the treatment to a suicide‐focused lens while concurrently implementing empirically supported treatments for depression and STBs.

Prior research has shown that depressive disorders are strongly associated with lifetime suicidal ideation and attempts (37), and the endorsement of severe depressive symptoms by our patients at admission is particularly remarkable in light of the large effect size in the QIDS‐A17, showing improved depression scores at discharge with greatest effect sizes in mood, suicidal ideation, and energy/fatigability symptoms. These symptoms are some of the most critical targets for depression: mood symptoms are the core of the diagnosis, suicidal ideation is critical in relation to safety and primary presenting concern for hospitalization, and the neurovegetative symptom of energy/fatigability is often one of the key targets in treating depressed persons from a behavioral perspective (38).

The presence of anxiety disorders increases the risk of STBs in adolescents, with specific symptoms like worry, poor sleep and anxiety interfering with daily activities associated with future suicide attempts (39). Given the high prevalence of anxiety disorders in our sample, it was encouraging that anxiety symptoms modestly improved from admission to discharge, along with improved depression and suicidal symptoms. Adolescents in our study also showed a reduction in emotion dysregulation from admission to discharge. While we did not assess post discharge outcomes, a longitudinal study from another institution revealed that adolescents with poor emotional regulation were more likely to have chronic suicidal ideation and suicide attempts within 6 months of discharge from inpatient or partial psychiatric hospitalization (40), therefore the improvement of emotion regulation in our suicidal adolescent cohort has potential long‐term implications.

Adolescents in our study perceived decreased family dysfunction by the time of discharge. Although the effect size of this was smaller than improvement in other symptoms, this is to be expected since the hospitalization is focused on individual treatment and family psychotherapy is typically limited to two sessions a week, focused primarily on how the family can support the care and safety for the adolescent during admission and upon discharge. Importantly, adolescents also reported an increase in their overall quality of life by the end of the admission. The improvement in quality of life is especially important as it reflects not only the reduction of symptoms but also an improvement in subjective well‐being, a separate dimension of health often understudied in acute psychiatric settings. Our evaluation of impact of LOS on PRO scores found no difference in outcomes for admissions with LOS greater than our median LOS of 2 weeks, suggesting that there may be a ceiling effect with IPU care and extended hospitalizations for adolescents may not convey additional benefits in clinical outcomes.

Limitations

This study has several limitations. Our study is from a single center, which limits generalizability especially given wide variability in IPU models of care, however, our findings are similar to pre‐pandemic studies that show improved clinical outcomes for youth after IPU care (14, 15). As with most research in IPU settings, our data is observational and without control. Therefore, we are unable to determine whether the changes in PRO scores from admission to discharge are in a causal relationship with specific treatment interventions, the passage of time, respite from stressors, or other possible factors. Given the severity of illness in our cohort, it would have been unethical not to provide the same standard of care and QI initiatives to all patients during this national crisis. Since we implemented the QI initiatives after the COVID‐19 pandemic onset, we have no pre‐pandemic or pre‐QI implementation PRO data for comparison. We were also not able to ascertain which specific elements and interventions within IPU care provided the most beneficial effects. The PROs were administered only to English‐speaking patients, which may have implications for potential disparities. Finally, similar to other pediatric IPU studies, our study only assessed changes from admission to discharge; future studies evaluating long‐term outcomes after psychiatric hospitalization are needed. It is important to note, however, that the goal of inpatient care is to provide acute stabilization in the context of safety concerns and severe functional impairment, therefore, strengthening outpatient and community supports after discharge from an inpatient stay is crucial to ensuring ongoing stabilization and positive long‐term outcomes.

CONCLUSION

Pediatric IPUs play a critical role in the treatment of youth with severe mental health disorders, particularly depression and STBs, with intensive interventions aimed at crisis containment, symptom stabilization and treatment monitoring in a safe setting. Our study enhances the existing literature by using PROs to provide a crucial snapshot of the profile of severely ill youth admitted to the IPU during the post‐COVID era and highlight psychiatric hospitalization as a potentially life‐saving intervention at a time when youth mental health across the nation has been in a state of crisis, with acute shortages of IPU beds. Our sample of hospitalized adolescents with high rates of depression and STBs reported positive outcomes and major improvement in symptoms at discharge. More research on IPU care is needed, and our hope is that the findings from this patient‐centered outcomes study will bolster the support for pediatric IPU QI and outcomes research and provide increased data on the impact and effectiveness of IPU treatment as a crucial part of the pediatric mental health spectrum of care.