Trends in Acute Care Use for Mental Health Conditions Among Youth During the COVID-19 Pandemic

Abstract

ImportanceUnderstanding how children’s utilization of acute mental health care changed during the COVID-19 pandemic is critical for directing resources.ObjectiveTo examine youth acute mental health care use (emergency department [ED], boarding, and subsequent inpatient care) during the second year of the COVID-19 pandemic.Design, Setting, and ParticipantsThis cross-sectional analysis of national, deidentified commercial health insurance claims of youth mental health ED and hospital care took place between March 2019 and February 2022. Among 4.1 million commercial insurance enrollees aged 5 to 17 years, 17 614 and 16 815 youth had at least 1 mental health ED visit in the baseline year (March 2019-February 2020) and pandemic year 2 (March 2021-February 2022), respectively.ExposureThe COVID-19 pandemic.Main outcomes and measuresThe relative change from baseline to pandemic year 2 was determined in (1) fraction of youth with 1 or more mental health ED visits; (2) percentage of mental health ED visits resulting in inpatient psychiatry admission; (3) mean length of inpatient psychiatric stay following ED visit; and (4) frequency of prolonged boarding (≥2 midnights) in the ED or a medical unit before admission to an inpatient psychiatric unit.ResultsOf 4.1 million enrollees, 51% were males and 41% were aged 13 to 17 years (vs 5-12 years) with 88 665 mental health ED visits. Comparing baseline to pandemic year 2, there was a 6.7% increase in youth with any mental health ED visits (95% CI, 4.7%-8.8%). Among adolescent females, there was a larger increase (22.1%; 95% CI, 19.2%-24.9%). The fraction of ED visits that resulted in a psychiatric admission increased by 8.4% (95% CI, 5.5%-11.2%). Mean length of inpatient psychiatric stay increased 3.8% (95% CI, 1.8%-5.7%). The fraction of episodes with prolonged boarding increased 76.4% (95% CI, 71.0%-81.0%).Conclusions and relevanceInto the second year of the pandemic, mental health ED visits increased notably among adolescent females, and there was an increase in prolonged boarding of youth awaiting inpatient psychiatric care. Interventions are needed to increase inpatient child psychiatry capacity and reduce strain on the acute mental health care system.

Increased Emergency Department Stays for Mental Health of Insured Youth in Year 2 of the COVID-19 Pandemic—Moving Forward

“…In addition, they found a 7% reduction in the percentage of youth with outpatient MH visits before their ED visit from the prepandemic period to the second pandemic year. 1 Further, they confirmed findings reported in other studies of pandemic year 1 that the percentage of youth with any MH ED visit decreased for that year relative to the period before. Given these findings, Overhage and colleagues 1 noted that other studies reported (1) relatively low rates of MH treatments provided while youth were in the ED, (2) parents expressing discomfort with ED experiences like long boarding periods, and (3) such ED experiences being a source of clinician burnout.…”

“…egory associated with increased visits, with increased suicidal ideation, particularly for female youth. 1 Overhage et al 1 found that youth from areas with a higher percentage of Asian, Black/African American, Hispanic, multiracial, and Native Hawaiian or Other Pacific Islander adolescents had a greater increase in ED MH visits than White adolescents. In addition, they found a 7% reduction in the percentage of youth with outpatient MH visits before their ED visit from the prepandemic period to the second pandemic year.…”

“…Given these findings, Overhage and colleagues 1 noted that other studies reported (1) relatively low rates of MH treatments provided while youth were in the ED, (2) parents expressing discomfort with ED experiences like long boarding periods, and (3) such ED experiences being a source of clinician burnout. 1 The authors made recommendations for system change, including addressing clinician burnout and having MH treatment provided by ED primary care physicians. Shortage of MH care professionals in EDs has been noted in this and other studies as an important challenge to address.…”

“…15 We note that in exploring these and other options, it will be important to track the process of development and implementation, as well as short-and long-term health and well-being outcomes, expanding as feasible reported health record data. This may involve using large-scale data resources on services used in many existing studies [1][2][3][4][5][6][7][8][9] as well as health outcomes, including validated measures of MH status and symptoms such as suicidality. Further, such efforts may potentially focus on diverse clinician capacity for implementation as well as clinician wellbeing and burnout.…”

“…This may be important for future lessons learned for diverse local areas and nationally for sustainable improvements in youth well-being. Further, it will be important to address the limitations noted by Overhage et al 1 and other data analyses focusing primarily on privately insured populations, to include racially and ethnically diverse youth with Medicaid, those who are uninsured, and other high-risk populations of youth.…”