Mental Health-Related Emergency Department Visits Among Children During The Early COVID-19 Pandemic

Abstract

Objective: To measure univariate and covariate-adjusted trends in children's mental health-related emergency department (MH-ED) use across geographically diverse areas of the U.S. during the first wave of the Coronavirus-2019 (COVID-19) pandemic. Method: This is a retrospective, cross-sectional cohort study using electronic health records from four academic health systems, comparing percent volume change and adjusted risk of child MH-ED visits among children aged 3–17 years, matched on 36-week (3/18/19–11/25/19 vs. 3/16/20–11/22/20) and 12-week seasonal time intervals. Adjusted incidence rate ratios (IRR) were calculated using multivariate Poisson regression. Results: Visits declined during spring-fall 2020 (n = 3892 vs. n = 5228, −25.5%) and during spring (n = 1051 vs. n = 1839, −42.8%), summer (n = 1430 vs. n = 1469, −2.6%), and fall (n = 1411 vs. n = 1920, −26.5%), compared with 2019. There were greater declines among males (28.2% vs. females −22.9%), children 6–12-year (−28.6% vs. −25.9% for 3–5 years and −22.9% for 13–17 years), and Black children (−34.8% vs. −17.7% to −24.9%). Visits also declined for developmental disorders (−17.0%) and childhood-onset disorders (e.g., attention deficit and hyperactivity disorders; −18.0%). During summer-fall 2020, suicide-related visits rose (summer +29.8%, fall +20.4%), but were not significantly elevated from 2019 when controlling for demographic shifts. In contrast, MH-ED use during spring-fall 2020 was significantly reduced for intellectual disabilities (IRR 0.62 [95% CI 0.47–0.86]), developmental disorders (IRR 0.71 [0.54–0.92]), and childhood-onset disorders (IRR 0.74 [0.56–0.97]). Conclusions: The early pandemic brought overall declines in child MH-ED use alongside co-occurring demographic and diagnostic shifts. Children vulnerable to missed detection during instructional disruptions experienced disproportionate declines, suggesting need for future longitudinal research in this population.