Mental Health Emergency Department Visits and Hospitalizations Among Alabama Publicly Insured Youth During COVID-19

Increases in the proportion of pediatric emergency department (ED) visits due to mental illness (MI) or intentional self-harm (ISH) in early months of the COVID-19 pandemic have been documented. Less is known about hospitalizations, or trends during later months of the pandemic. This study assessed changes in MI/ISH-related ED visits and hospitalizations among enrollees in Alabama's Children's Health Insurance Program, ALL Kids, during the pandemic.

Administrative claims data from ALL Kids, were used for enrollees aged 6-17 from 2017 to 2022. The study-period was divided into pre-COVID (January 2017-March 2020), early COVID (April 2020-May 2021), and late COVID (June 2021-December 2022). Multivariate logistic regressions were employed to estimate the probabilities that ED visits and hospitalizations were MI/ISH related.

The study sample included 72,870 ED visits and 8205 hospitalizations for all causes. After adjusting for covariates, the proportion of MI/ISH-related ED visits increased from 2.5% pre-COVID to 4.1% in early COVID (p < 0.01), then declined to 2.8% in late COVID. MI/ISH-related hospitalizations rose from 26.3% pre-COVID to 31.3% in early COVID and remained elevated at 30.2% in late COVID. Increases were more pronounced among females and older enrollees.

The COVID-19 pandemic was associated with increased MI/ISH-related ED visits and hospitalizations among publicly-insured youth, with hospitalizations remaining elevated later into the pandemic. Shifts in healthcare-seeking behaviors or admission criteria during the pandemic may have impacted these findings.

Findings on pediatric mental health during the COVID-19 pandemic can inform efficient health resources allocation for future public health crises. Our findings highlight the need for ensuring adequate access to health care for youth with severe mental health conditions during public health emergencies.