399 - Risk Factors Associated with Anxiety in Children during the COVID-19 Pandemic

Anxiety has been reported at a prevalence of approximately 30% in children. Limited studies have been performed on screening for risk factors associated with anxiety in the pediatric emergency department (PED), even prior to the COVID-19 pandemic.

Objective:

To identify risk factors associated with anxiety in children presenting to the PED during the COVID-19 pandemic.

Design/Methods:

We conducted a cross-sectional survey-based study of children and adolescents between 8-17 years of age presenting to the PED from July 31 2021 through July 31 2022. We administered an electronic survey to English-speaking child-parent dyads. We developed survey questions to explore potential risk factors for anxiety based on available medical literature and postulated on observed sociologic effects of the COVID-19 pandemic on children. The survey also included the Screen for Child Anxiety Related Disorders (SCARED), a validated screening tool, answered independently by each child and parent. We excluded patients in critical condition or unable to complete the survey due to altered mental status or developmental delay. Multivariable logistic regression was used to detect independent risk factors.

Results:

Of 383 patients who completed the survey, 186 (48.5%) screened positive for anxiety. Independent risk factors significantly associated with a positive SCARED screen included: female gender, being scared about getting COVID-19, lower school grades, eating behavior changes, having experienced or witnessed racism, and family history of anxiety (Table 1). Children reported higher SCARED scores than their parents, with a median score of 23 (IQR 13-37) vs. 8 (IQR 5-18); p < 0.001. Assessing agreement on total SCARED scores, Lin's concordance correlation coefficient of 0.39 (95% CI: 0.32, 0.45) suggests poor agreement between child and parent.

Conclusion(s):

We identified six risk factors independently associated with a positive SCARED screen for anxiety in children presenting to the PED during the COVID-19 pandemic. The overall rate of anxiety in our study population was higher than reported in previous studies. Our study population is unique as New York City has been an epicenter of the pandemic. We found a significant difference in SCARED scores across child-parent dyads. These findings highlight the importance and usefulness of screening for anxiety in children during their emergency evaluation.