US Pediatric Emergency Department Visits for Mental Health Conditions During the COVID-19 Pandemic

Krass, Polina; Dalton, Evan; Doupnik, Stephanie K.; Esposito, Jeremy

doi:10.1001/jamanetworkopen.2021.8533

Cited by 134 publications

(160 citation statements)

References 6 publications

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“…Consistent with existing literature, our study showed an initial decrease in the number of mental health–related ED visits at the onset of the pandemic followed by a significant increase in the proportion of mental health–related ED visits out of all adolescent ED visits starting in July 2020 [ [11] , [12] , [13] , [14] ]. The frequency of ED visits related to eating disorders increased markedly during the year 2020, though we did not see such an increase in other mental health diagnoses, such as substance use and other mental health conditions (which included depression and anxiety), a finding that has also been reported in the United States [ 13 , 14 ].…”

Section: Discussionsupporting

confidence: 90%

“…Similarly, a retrospective study from 10 European countries found a significant decrease in the number of psychiatric emergency visits between March and April 2020 versus 2019 with a smaller proportion of youths admitted to an observation unit [ 10 ]. However, a small number of studies analyzing ED visits across the United States during the year 2020 showed a significant increase in the proportion of mental health–related visits among all adolescent visits in the second half of 2020 [ 11 , 12 ], with some studies reporting increases in the proportion of some (i.e., eating disorders, suicidality) but not all types of mental health visits [ 13 , 14 ]. In this report, we compare the frequency of mental health–related ED visits and hospitalization rates in adolescents before and after onset of COVID-19.…”

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confidence: 99%

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Mental Health–Related Emergency Department Visits in Adolescents Before and During the COVID-19 Pandemic: A Multicentric Retrospective Study

Chadi

Piano

Osmanlliu

et al. 2021

Journal of Adolescent Health

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Purpose The purpose of this study was to compare pre/post-COVID-19 changes in mental health–related emergency department visits among adolescents. Methods We conducted a retrospective analysis of all mental health–related emergency department visits in two large tertiary pediatric hospital centers between January 2018 and December 2020. We described monthly pre/post-COVID-19 changes in frequency and proportion of mental health visits as well as changes in hospitalization rates for eating disorders, suicidality, substance use, and other mental health conditions. Results We found an increase in the proportion of mental health–related emergency department visits during the months of July–December 2020 ( p < .01). There was a 62% increase in eating disorder visits between 2018–2019 and 2020 ( p < .01). No pre pandemic/postpandemic changes were found in the proportion of visits resulting in hospitalization for any of the four diagnostic categories. Conclusions Our study suggests significant impacts of COVID-19 on adolescent mental health and a need for further longitudinal research work in this area.

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Section: Discussionsupporting

confidence: 90%

mentioning

confidence: 99%

Mental Health–Related Emergency Department Visits in Adolescents Before and During the COVID-19 Pandemic: A Multicentric Retrospective Study

Chadi

Piano

Osmanlliu

et al. 2021

Journal of Adolescent Health

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“…The increased risk has been attributed to several factors, including economic losses and unemployment [ 3 ], fear of infection [ 2 ], and isolation and confinement [ 2 ]. Youth have been especially vulnerable to these impacts as family stress, prolonged isolation and confinement, separation from peers, home-schooling, fear of infection, grief over the loss of family members, and a profound sense of loss have contributed to elevated rates of depression, anxiety, and substance use [ 5 , 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of the COVID-19 Pandemic on Child and Adolescent Mental Health Policy and Practice Implementation

Palinkas

Leon

Salinas

et al. 2021

IJERPH

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Background: The impact of the 2019 coronavirus pandemic on the mental health of millions worldwide has been well documented, but its impact on prevention and treatment of mental and behavioral health conditions is less clear. The COVID-19 pandemic also created numerous challenges and opportunities to implement health care policies and programs under conditions that are fundamentally different from what has been considered to be usual care. Methods: We conducted a qualitative study to determine the impact of the COVID-19 pandemic on implementation of evidence-based policy and practice by State Mental Health Authorities (SMHA) for prevention and treatment of mental health problems in children and adolescents. Semi-structured interviews were conducted with 29 SMHA representatives of 21 randomly selected states stratified by coronavirus positivity rate and rate of unmet services need. Data analysis with SMHA stakeholders used procedures embedded in the Rapid Assessment Procedure—Informed Community Ethnography methodology. Results: The need for services increased during the pandemic due primarily to family stress and separation from peers. States reporting an increase in demand had high coronavirus positivity and high unmet services need. The greatest impacts were reduced out-of-home services and increased use of telehealth. Barriers to telehealth services included limited access to internet and technology, family preference for face-to-face services, lack of privacy, difficulty using with young children and youth in need of substance use treatment, finding a Health Insurance Portability and Accountability Act (HIPAA)-compliant platform, training providers and clients, and reimbursement challenges. Policy changes to enable reimbursement, internet access, training, and provider licensing resulted in substantially fewer appointment cancellations or no-shows, greater family engagement, reduction in travel time, increased access for people living in remote locations, and increased provider communication and collaboration. States with high rates of coronavirus positivity and high rates of unmet need were most likely to continue use of telehealth post-pandemic. Despite these challenges, states reported successful implementation of policies designed to facilitate virtual services delivery with likely long-term changes in practice. Conclusions: Policy implementation during the pandemic provided important lessons for planning and preparedness for future public health emergencies. Successful policy implementation requires ongoing collaboration among policy makers and with providers.

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“…The relationship between the disease and delivery of mental health services found in this study is supported by several studies reporting an increase in the need or demand for mental health services as a consequence of pandemic-related prolonged isolation and confinement, fear of infection and of mortality once infected, and sudden unemployment or financial stress (Czeisler et al, 2020 ; Ettman et al, 2020 ; Gallagher et al, 2020 ; Holingue et al, 2020 ; Jia et al, 2020 ; Li et al, 2020 ; Pfefferbaum & North, 2020 ). These stressors, in turn, led to an increase in ED admissions for traumatic injury with mental health comorbidity (Krass et al, 2021 ; Yard et al, 2021 ), despite an overall decline in ED visits in general (Adjemian et al, 2021 ). The pandemic also led to an increase in efforts to control the spread of the coronavirus in the healthcare system through social distancing, use of PPE, and testing, and in the community through mandates to stay at home and shelter in place.…”

Section: Discussionmentioning

confidence: 99%

A Rapid Ethnographic Assessment of the Impact of the COVID-19 Pandemic on Mental Health Services Delivery in an Acute Care Medical Emergency Department and Trauma Center

Palinkas

Engstrom

Whiteside

et al. 2021

Adm Policy Ment Health

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A rapid ethnographic assessment of delivery of mental health services to patients at a Level I trauma center in a major metropolitan hospital undergoing a COVID-19 surge was conducted to assess the challenges involved in services delivery and to compare the experience of delivering services across time. Study participants were patients and providers who interacted with or otherwise were observed by three clinicians engaged in the delivery of care within the Emergency Department (ED) and Trauma Center at Harborview Medical Center from the COVID-19-related “surge” in April to the end of July 2020. Data were collected and analyzed in accordance with the Rapid Assessment Procedures-Informed Clinical Ethnography (RAPICE) protocol. Community and institutional efforts to control the spread of the coronavirus created several challenges to providing mental health services in an acute care setting during the April surge. Most of these challenges were successfully addressed by standardization of infection control protocols, but new challenges emerged including an increase in expenses for infection control and reduction in clinical revenues due to fewer patients, furloughs of mental health services providers and peer specialists in the ED, services not provided or delayed, increased stress due to fear of furloughs or increased workload of those not furloughed, and increases in patients seen with injuries due to risky behavior, violence, and substance use. These findings illustrate the rapidly shifting nature of the pandemic, its impacts on mental health services, and the mitigation efforts of communities and healthcare systems.

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US Pediatric Emergency Department Visits for Mental Health Conditions During the COVID-19 Pandemic

Cited by 134 publications

References 6 publications

Mental Health–Related Emergency Department Visits in Adolescents Before and During the COVID-19 Pandemic: A Multicentric Retrospective Study

Mental Health–Related Emergency Department Visits in Adolescents Before and During the COVID-19 Pandemic: A Multicentric Retrospective Study

Impact of the COVID-19 Pandemic on Child and Adolescent Mental Health Policy and Practice Implementation

A Rapid Ethnographic Assessment of the Impact of the COVID-19 Pandemic on Mental Health Services Delivery in an Acute Care Medical Emergency Department and Trauma Center

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