64 - The Impact of COVID-19 Pandemic on Mental-Health Presentations to Pediatric Emergency Department: A Rise in New Onset Psychiatric Illness or Worsening of Pre-existing Ones?

Children presenting with mental health disorders to emergency departments (ED) have increased during the COVID-19 pandemic. Nonetheless, it's unclear what percentage of the visits is due to worsening symptoms in children with pre-existing mental health diagnoses compared to those with new onset mental health disorders.

Objective:

The objective of this study was to identify changes in presentations with new onset mental illness compared to children with a pre-existing mental health disorder diagnosis during the COVID-19 pandemic in a pediatric ED

Design/Methods:

A retrospective chart review of children treated for mental health disorders in the ED was conducted from March 1,2019 to September 29,2022. Demographics, pre-existing conditions, presentation and disposition information were collected and analyzed to compare patients presenting during the pre-pandemic year to those who came during first 3 years of pandemic

Results:

There were 6431 ED visits by 5092 patients during the study period. Of them 4084(63.5%) were biological females. 125(1.94%) identified as non-binary or transgender. The percentage of children presenting for a new onset mental health complaint in pre-pandemic year out of all ED visits was 852/78378 (1.09%), this increased significantly to 735/45158 (1.63%) in the first year (P < 0.0001), to 1054/63858(1.65%) in the second year (P < 0.0001) and decreased to 617/48293 (1.28%) in the third year (P = 0.0021). Mental health related visits for those with preexisting psychiatric diagnoses increased significantly from 746/78378 (0.95%) of the total ED department visits to 772/45158 (1.71%) in the first year (P < 0.0001), to 1180/63858 (1.85%) in the second (P < 0.0001) and decreased back to baseline 475/48293 (0.98%) in the third year (P = 0.5739).

The percentage of patients with previously diagnosed suicidal ideation presenting to the ED significantly increased from 15.4% during the pre-pandemic period to 22.7% in first year (p< 0.0001, chi=26.92), and to 23.4% (p< 0.0001, chi=36.945) in second year and declined slightly in the third year to 21.7% (p< 0.0001, chi=17.53). Admission rate was significantly higher in patients with previously diagnosed mental health disorders compared to new onset symptoms (45.3% vs. 4.1%) (p< 0.0001, Chi=1479.1).Patient with known mental health disorders who are treated with medications were not more likely to be admitted compared to those without(43.9% vs 46.7%) (p=0.106 chi 2.61)

Conclusion(s):

Paediatric ED visits increased significantly for both new onset mental health disorders and previously diagnosed mental health disorders in children.