Mental Health Emergency Department Visits by Children Before and During the COVID-19 Pandemic

Abstract

Objectives: To describe pediatric mental health emergency department (ED) visit rates and visit characteristics before and during the COVID-19 pandemic.

Methods: We conducted a cross-sectional study of ED visits by children 5-17 years old with a primary mental health diagnosis from March 2018 to February 2021 at a 10-hospital health system and a children's hospital in the Chicago area. We compared demographic and clinical characteristics of children with mental health ED visits before and during the pandemic. We conducted an interrupted time series analysis to determine changes in visit rates.

Results: We identified 8,127 pediatric mental health ED visits (58.5% female, 54.3% White, Not Hispanic/Latino and 42.4% age 13-15). During the pandemic, visits for suicide or self-injury increased 6.69% (95% CI 4.73, 8.65), and visits for disruptive, impulse control, conduct disorders increased 1.94% (95% CI 0.85, 3.03). Mental health ED visits by children with existing mental health diagnoses increased 2.29% (95% CI 0.34, 4.25). Mental health ED visits that resulted in medical admission increased 4.32% (95% CI 3.11, 5.53). The proportion of mental health ED visits at community hospitals increased by 5.49% (95% CI 3.31, 7.67). Mental health ED visit rates increased at the onset of the pandemic (adjusted incidence rate ratio [aIRR] 1.27, 95% CI 1.06, 1.50), followed by a monthly increase thereafter (aIRR 1.04, 95% CI 1.02, 1.06).

Conclusion: Mental health ED visit rates by children increased during the COVID-19 pandemic. Changes in mental health ED visit characteristics during the pandemic may inform interventions to improve children's mental health.

Keywords: COVID-19; adolescent; child; emergency service; hospital; mental health.

Figure

Emergency Department Visit Rate by Children for Mental Health Conditions, March 2018–March 2021. Seasonally adjusted emergency department visit rate by children for mental health conditions from March 2018 to March 2021. Circles represent observed monthly rates. The gray shaded region represents the pandemic period (March 2020–February 2021). The solid line is the deseasonalized trend of modeled rates fitted to data.