61 - Pediatric Mental Health Emergency Department Visits During COVID-19: A Multicenter Study

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 61
Publication Number: 61.112

Jennifer A. Hoffmann, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Camille P.. Carter, University of Utah School of Medicine, Salt Lake City, UT, United States; CODY S. OLSEN, University of Utah School of Medicine, Salt Lake City, UT, United States; David W.. Ashby, Baylor College of Medicine / Texas Children's Hospital, Spring, TX, United States; Kamali Bouvay, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Susan J. Duffy, Brown University, Providence, RI, United States; James Chamberlain, Children's National Health System, Washington, DC, United States; Sofia Chaudhary, Emory University School of Medicine/Children's Healthcare of Atlanta, Decatur, GA, United States; Nicolaus W. Glomb, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Jacqueline Grupp-Phelan, University of California, San Francisco, Mill Valley, CA, United States; Maya Haasz, University of Colorado School of Medicine, Aurora, CO, United States; Erin P.. O'Donnell, Children's Hospital of Wisconsin, Whitefish Bay, WI, United States; Mohsen Saidinejad, University of California, Los Angeles David Geffen School of Medicine, Torrance, CA, United States; Bashar S. Shihabuddin, Nationwide Children's Hospital/ OSUCOM, Columbus, OH, United States; Leah Tzimenatos, University of California, Davis, School of Medicine, Sacramento, CA, United States; Neil G. Uspal, University of Washington School of Medicine, Seattle, WA, United States; Joseph J. Zorc, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Lawrence J. Cook, University of Utah, Salt Lake City, UT, United States; Elizabeth Alpern, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States

Presenting Author(s)

Jennifer A. Hoffmann, MD, MS (she/her/hers)

Assistant Professor of Pediatrics
Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine
Northwestern University Feinberg School of Medicine
Chicago, Illinois, United States

Background: The COVID-19 pandemic adversely affected children’s mental health and changed patterns of emergency department (ED) utilization for mental health crises.

Objective: To assess how the pediatric mental health ED visit rate differed from expected rates during the COVID-19 pandemic compared with pre-pandemic trends.

Design/Methods: We retrospectively studied mental health ED visits by children ages 5 to < 18 years old at nine U.S. hospitals participating in the Pediatric Emergency Care Applied Research Network Registry. We assessed mental health ED visits per 30 days during three time periods: pre-pandemic (January 2017-February 2020), early pandemic (March 2020-February 2021), and late pandemic (March 2021-December 2021). We used multivariable Poisson regression models to estimate expected 30-day visit rates during the pandemic, based on pre-pandemic data. We calculated the rate ratio of observed to expected mental health ED visits per 30 days, overall and stratified by mental health diagnosis. As a secondary outcome, we compared ED visit lengths of stay by pandemic period.

Results: During the study period, 146,193 pediatric mental health ED visits (69.9% by adolescents 12 to < 18 years old, 51.7% female) occurred at participating hospitals. Before pandemic onset, there were 2407 mental health visits per 30 days. During the early pandemic, visits decreased to 2054 per 30 days (observed to expected visit rate ratio 0.82, 95% CI 0.79-0.85). During the late pandemic, visits increased to 2595 per 30 days (rate ratio 1.03, 95% CI 0.98-1.09). During the late pandemic, visit rates per 30 days were higher than expected for bipolar and related disorders (rate ratio 1.77, 95% CI 1.40-2.41), schizophrenia spectrum disorders (rate ratio 1.63, 95% CI 1.24-2.38), feeding and eating disorders (rate ratio 1.53, 95% CI 1.19-2.16), substance-related and addictive disorders (rate ratio 1.32, 95% CI 1.09-1.67), and anxiety disorders (rate ratio 1.18, 95% CI 1.02-1.40]) (Figure 1). ED visit length varied by time period (P< 0.001), with length of stay exceeding 12 hours for 7.3% of pre-pandemic visits, 9.5% of early pandemic visits, and 15.2% of late pandemic visits.

Conclusion(s): Mental health ED visits by children initially decreased and then returned to expected levels based on pre-pandemic trends; however, trends differed by mental health diagnosis group. Increased ED visit lengths of stay may reflect an imbalance between need for mental health services and available resources. These findings may inform efforts to manage mental health crises in children during future public health emergencies.