Impact of COVID-19 on Pediatric Mental and Behavioral Health Visits to the Emergency Department

Abstract

ObjectivesThis study aimed to describe changes in pediatric emergency department (ED) mental and behavioral health (MBH) visits before and during the early COVID-19 pandemic.MethodsWe retrospectively reviewed medical records of patients aged from 5 to 17 years presenting to the pediatric ED of a major tertiary care hospital with MBH-related concerns from March 2017 to September 2020. We evaluated trends in MBH ED visits over the study period, specifically comparing patient demographics, diagnosis categories, and ED disposition between the pre-COVID (2019) and COVID (2020) periods using pairwise Pearson χ2 analyses with reported odds ratios (ORs) in SAS statistical software version 9.4 (SAS Institute Inc, Cary, NC).ResultsOf 8093 MBH-related visits, 58.5% were females, 85.4% were adolescents, and 62.7% self-identified as non-Hispanic. The proportion of MBH-related ED visits increased from 3.8% to 7.5% over the study period (P < 0.0001). Although total MBH visits decreased by 17.3% from 2019 to 2020, there was a proportionate increase in MBH-to-total-ED visits, representing a 42.8% increase through 2019. Compared with 2019, there was a proportionate increase in MBH-related ED visits by females (10.6%, P < 0.0001), older adolescents (18.2%, P < 0.0001), and non-Hispanic patients (6.1%, P = 0.017) in 2020. The MBH visits in 2020 were more likely related to suicidality/self-harm (OR, 1.2; confidence interval [CI], 1.1–1.4) or substance use (OR, 1.4; CI, 1.1–1.9). Compared with 2019, there were significantly higher odds of admission (OR, 1.6; CI, 1.3–2.1) or transfer for inpatient psychiatric care (OR, 1.8; CI, 1.6–2.1) in 2020.ConclusionsOur data suggest that the early COVID-19 pandemic had a significant impact on MBH-related ED visits. Compared with 2019, we observed a significant increase in the proportion of MBH-to-total-ED visits primarily affecting older adolescent, non-Hispanic girls with suicidality/self-harm and substance-related disorders in 2020, despite an overall decrease in the number of MBH visits during this period. There was also an increase in the proportion of visits resulting in admission or transfer for inpatient psychiatric care in 2020.

Diagnostic testing for chest pain in a pediatric emergency department and rates of cardiac disease before and during the COVID-19 pandemic: a retrospective study

“…This is in line with the decreased number of pediatric ED visits across the U.S. during the pandemic (17). Despite overall declines in ED visits, we found that the percentage of ED visits for chest pain increased during the pandemic, similar to findings that ED visits for certain types of injuries (e.g., drug poisonings, self-harm, and firearm injuries) and mental health complaints increased during the pandemic (17,18). A large retrospective study did not find differences in the relative proportion of pediatric ED visits for chest pain during the pandemic, however, the study was limited to the first year of the pandemic (19).…”

Suicidality Prevalence in a Pediatric Psychiatric Clinic: Relation to Social and Environmental Risk Factors

“…An increase in admissions has been also recorded, affecting adolescents with suicidality/self-harm and substance-related disorders [ 6 ]. Importantly, 78.2% of adolescent admissions were due to suicidal behavior associated with family risk factors and life stressors [ 7 ].…”