Study describes more severe pediatric mental health crises during pandemic

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Children visiting the emergency department (ED) for mental health crises during the pandemic had longer stays and more severe diagnoses, according to a new study in Academic Emergency Medicine.

The study was based on ED visits to nine US hospitals participating in the Pediatric Emergency Care Applied Research Network Registry from 2017 to 2022.

The authors looked at four periods: pre-pandemic (January 2017 through February 2020), early pandemic (March through December 2020), 2021, and 2022, and calculated rate ratios (RRs) of observed to expected visits per 30 days during each pandemic time period.

Overall, there were 175,979 mental health ED visits by children during the study period. Most (70.4%) of visits were by adolescents 12 to 18 years old, 52.4% by females, 51.8% by non-Hispanic White children.

Observed visits decreased, but lengths of visits increased

Visit length exceeded 12 hours for 7.3% of prepandemic visits, 8.4% of early pandemic visits, 15.0% of visits in 2021, and 19.2% of visits in 2022, the authors said.

However, duing the first year of the pandemic, observed visits per 30 days decreased relative to expected rates (RR 0.80; 95% confidence interval [CI], 0.78 to 0.84). Observed visits decreased further in 2022 (RR 0.92; 95% CI, 0.86 to 0.98).

Only in 2021 did visit rates match expected rates similar to expected rates during the pre-pandemic period (RR 1.01, 95% CI 0.96–1.07).

"Our data shows that pediatric emergency departments saw more severe mental health presentations during the pandemic, even while the actual number of visits decreased in 2022, " said lead author Jennifer Hoffman, MD, MS, of Northwestern University Feinberg School of Medicine in a press release from the Children's Hospital of Chicago.

"The dramatic increase in prolonged ED stays attests to the strain on the system and difficulties finding appropriate psychiatric care for children, whether in the hospital or in the community," Hoffman said.

The dramatic increase in prolonged ED stays attests to the strain on the system.

Teen girls see biggest spike in visits

In analyses that took into account age, sex, and race, the authors found that ED visit rates for girls increased in 2021 and 2022, but not for boys. The findings echo other studies from the Centers for Disease Control and Prevention that show teen girls experienced higher rates of depression and anxiety doing the pandemic.

Of note, there was no significant difference in return ED visits within 7 days in any time periods, nor any increase in visits for suicide attempts.

"Our study shows that mental health ED visits by children decreased during the early COVID-19 pandemic relative to expected levels based on prepandemic trends," the authors said. "ED visit length progressively increased, with nearly one in five mental health ED visits exceeding 12 h during the late pandemic."

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