Pediatric psychiatric ED visits decreased significantly in COVID-19 lockdown's early phase

Children and adolescent psychiatric ED visits decreased significantly during the first 8 weeks of COVID-19 lockdown, according to results of a study conducted in Italy and published in Journal of Clinical Psychiatry.

“Monitoring psychiatric visits to hospital EDs can inform on trends in acute psychopathology and may help identify specific clinical needs of the most vulnerable patients,” Chiara Davico, MD, of the department of public health and pediatric sciences at the University of Turin in Italy, and colleagues wrote. “A general decrease in ED visits was reported with the onset of the COVID-19 pandemic. A decrease in adult psychiatric ED visits has been reported by some, but not others.”

The researchers also noted recent reports of reductions in pediatric general and mental health ED visits. In the current study, they sought to assess whether and how child and adolescent psychiatric visits to hospital EDs changed after implementation of the COVID-19 lockdown in Italy on Feb. 24, 2020. They evaluated all ED visits at two urban university hospitals by patients aged younger than 18 years in the 7 weeks before Italy’s lockdown and in the subsequent 8 weeks following its introduction. They used Poisson regression modeling to compared ED visits during the corresponding periods of 2019. Further, the researchers assessed as an index of clinical severity the clinician’s decision to hospitalize the patient or discharge them home following the ED visit.

Results showed a 72% decrease in the number of all 3,395 pediatric ED visits during the lockdown vs. the corresponding period in 2019, which saw 12,128 visits. They noted a 46.2% decrease in psychiatric visits, for 50 vs. 93 in 2020 vs. 2019, respectively. Psychiatric patients during the COVID-19 had a higher mean age of 15.7 years vs. 14.1 years in 2019. Davico and colleagues observed that hospitalization rate and the prevalence distribution of the primary reason for the psychiatric ED visit did not significantly change.

“Such an abrupt decline in ED use is unlikely to be due to a sudden reduction in psychopathology but may reflect alternative ways of dealing with acute psychiatric needs,” the researchers wrote. “Further research on psychiatric needs during emergency situations such as the COVID-19 pandemic may help identify more efficient approaches to managing acute psychopathology than resorting to hospital ED.”