Mental Health, Nonadherence, and Healthcare Utilization in Pediatric Solid Organ Transplantation: Evidence From a Multistate Cohort

Abstract

Background: This study examined the associations between mental health diagnoses, medication nonadherence, and healthcare utilization among pediatric solid organ transplant (SOT) recipients using a large, multistate electronic health record dataset. Methods: Data were drawn from 2037 pediatric SOT recipients (ages 0–25 years) within the OneFlorida+ Data Trust (2012–2018). Mental health conditions (depression, anxiety, post-traumatic stress disorder [PTSD], and attention-deficit/hyperactivity disorder [ADHD]), clinician-documented nonadherence, and healthcare utilization outcomes, emergency department (ED) and inpatient (IP) visits, were identified using ICD-9/10-CM codes. Logistic regression estimated predictors of nonadherence, while negative binomial regression models with log-offsets for follow-up time produced incidence rate ratios (IRRs) for utilization outcomes. Models adjusted for demographic and clinical covariates including age, sex, race, ethnicity, and organ type. Results: Mental health diagnoses were common: anxiety (21.6%), depression (15.3%), ADHD (13.7%), and PTSD (13.1%). Clinician-documented nonadherence occurred in 13.3% of patients and was associated with older age, non-White race, depression (OR = 2.85, 95% CI 1.75–4.62), and anxiety (OR = 2.29, 95% CI 1.62–3.23). Nonadherence independently predicted increased healthcare utilization, with approximately twice the rate of ED (IRR = 2.02, 95% CI 1.68–2.43) and IP (IRR = 2.00, 95% CI 1.67–2.40) visits. Anxiety and PTSD also remained significant predictors of elevated utilization across models. Conclusions: Mental health conditions and medication nonadherence are common and independently associated with higher acute care utilization among pediatric SOT recipients. Integrating standardized psychosocial assessment and adherence interventions into routine post-transplant care may help mitigate preventable hospitalizations and improve long-term outcomes.