Impact of COVID-19 on Pediatric Mental and Behavioral Health Visits to the Emergency Department
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Published on: December 6, 2024
Jacqueline Bolt1, Faisalmohemed Patel2, Laura Stone3
1From the Division of Emergency Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center/Children's Medical Center Dallas, Dallas.
Insights
The COVID-19 pandemic increased the proportion of pediatric mental and behavioral health (MBH) emergency department (ED) visits, particularly among adolescent girls. These visits were more likely to involve suicidality, self-harm, or substance use, leading to higher rates of inpatient psychiatric care.
Area of Science:
- Pediatric Emergency Medicine
- Mental and Behavioral Health (MBH)
- Epidemiology of Infectious Diseases
Background:
- The COVID-19 pandemic significantly altered healthcare utilization patterns globally.
- Pediatric mental and behavioral health (MBH) conditions represent a growing concern in emergency departments (EDs).
- Understanding the impact of the pandemic on pediatric MBH ED visits is crucial for resource allocation and intervention planning.
Purpose of the Study:
- To describe changes in pediatric emergency department (ED) mental and behavioral health (MBH) visits before and during the early COVID-19 pandemic.
- To compare patient demographics, diagnosis categories, and ED disposition for MBH visits between pre-pandemic (2019) and pandemic (2020) periods.
Main Methods:
- Retrospective review of medical records for patients aged 5-17 years with MBH concerns presenting to a pediatric ED.
- Data collected from March 2017 to September 2020, with specific comparison between 2019 (pre-COVID) and 2020 (COVID) periods.
- Statistical analysis included pairwise Pearson chi-squared tests and odds ratios (ORs) using SAS software.
Main Results:
- The proportion of MBH-related ED visits increased from 3.8% to 7.5% during the study period (P < 0.0001).
- Despite a 17.3% decrease in total MBH visits from 2019 to 2020, the proportion of MBH-to-total-ED visits rose by 42.8%.
- In 2020, MBH visits disproportionately affected females, older adolescents, and non-Hispanic patients, with increased likelihood of suicidality/self-harm (OR, 1.2) and substance use (OR, 1.4).
Conclusions:
- The early COVID-19 pandemic significantly impacted pediatric MBH ED visits, increasing their proportion relative to total ED visits.
- Older adolescent females, particularly non-Hispanic individuals, were disproportionately affected, with a rise in visits for suicidality/self-harm and substance use.
- A higher proportion of MBH visits in 2020 resulted in admission or transfer for inpatient psychiatric care compared to 2019.
Objectives:
This study aimed to describe changes in pediatric emergency department (ED) mental and behavioral health (MBH) visits before and during the early COVID-19 pandemic.
Methods:
We 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 χ 2 analyses with reported odds ratios (ORs) in SAS statistical software version 9.4 (SAS Institute Inc, Cary, NC).
Results:
Of 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.
Conclusions:
Our 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.
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