Mental health visits more common at pediatric EDs during pandemic

Pediatric mental health visits to the ED increased at community hospitals in Chicago during the COVID-19 pandemic, findings from a study in Academic Pediatrics reported.

The research, from authors at the Lurie Children’s Hospital of Chicago and the Northwestern University Feinberg School of Medicine, comes amid what the AAP deemed a “national emergency” over pediatric mental health that coincided with the pandemic’s onset.

Co-author Lavanya G. Shankar, MD, a hospital medicine specialist at Lurie Children’s, said in a Healio interview that the genesis for the study came from her and her colleagues working in emergency rooms during the pandemic’s initial few months.

“The pandemic led to a combination of physical, psychological, and economic stressors that adversely impacted the mental health of children and adolescents,” they wrote. “Due to multiple factors including social isolation, the transition to virtual schooling, and difficulty accessing usual sources of care, symptoms of depression and anxiety among children have increased.”

They added that although recent publications on ED mental health visits mainly focused on children’s hospitals, most children in the U.S. present to community hospitals for emergency care.

“Data from community hospital settings are needed,” they wrote. “Therefore, we aimed to describe changes in pediatric mental health ED visit rates before and during the COVID-19 pandemic in Chicago area EDs.”

The authors identified 8,127 pediatric mental health visits from a pool of ED visits to 12 Chicago area hospitals, including an independent children’s hospital, one academic medical hospital and nine community hospitals, beginning in March 2018 to establish a baseline trajectory. They divided patients into four age groups, from 5 to 8 years old, 9 to 12 years old, 13 to 15 years old and 16 to 17 years old.

The authors found that mental health ED visits by children with existing mental health diagnoses increased 2.29%, whereas mental health ED visits that resulted in medical admission increased 4.32%. Further, a proportion of mental health ED visits at community hospitals increased by 5.49% and mental health ED visit rates increased at the onset of the pandemic, followed by a monthly increase.

“We also noticed that a larger proportion of patients were coming in with self-harm and [suicidal behaviors] diagnoses in the pandemic period,” Shankar said.

The findings support past research that found that mental health visits to pediatric clinics, including for eating disorders, depression and bipolar disorders were more common during the COVID-19 pandemic and that children’s suicide attempts have increased during the pandemic, as have referrals from primary care providers to Pediatric Mental Health Care Access. Further, prevalence of anxiety and depression among children has reportedly doubled during the pandemic.

“I think it's important for clinicians who are working and taking care of pediatric patients to recognize that the pandemic has negatively influenced the mental health of children. I really hope that clinicians try their best to find resources for these families and children to the best of their ability,” Shankar said.

“It's very difficult right now because we just don't have the workforce and we don't have the number of providers that are needed, but I think if clinicians can recognize this and try their best to find any resource for these families, that would be great, whether it be psychology appointments or other counseling resources in the community or even tapping into the school resources or giving them telehealth resources, if those are available.”