Rebecca T. Leeb, PhD1; Rebecca H. Bitsko, PhD1; Lakshmi Radhakrishnan, MPH2; Pedro Martinez, MPH3; Rashid Njai, PhD4; Kristin M. Holland, PhD5 (View author affiliations)
Summary
What is already known about this topic?
Emergency departments (EDs) are often the first point of care for children’s mental health emergencies. U.S. ED visits for persons of all ages declined during the early COVID-19 pandemic (March–April 2020).
What is added by this report?
Beginning in April 2020, the proportion of children’s mental health–related ED visits among all pediatric ED visits increased and remained elevated through October. Compared with 2019, the proportion of mental health–related visits for children aged 5–11 and 12–17 years increased approximately 24%. and 31%, respectively.
What are the implications for public health practice?
Monitoring indicators of children’s mental health, promoting coping and resilience, and expanding access to services to support children’s mental health are critical during the COVID-19 pandemic.
Published reports suggest that the coronavirus disease 2019 (COVID-19) pandemic has had a negative effect on children’s mental health (1,2). Emergency departments (EDs) are often the first point of care for children experiencing mental health emergencies, particularly when other services are inaccessible or unavailable (3). During March 29–April 25, 2020, when widespread shelter-in-place orders were in effect, ED visits for persons of all ages declined 42% compared with the same period in 2019; during this time, ED visits for injury and non-COVID-19–related diagnoses decreased, while ED visits for psychosocial factors increased (4). To assess changes in mental health–related ED visits among U.S. children aged <18 years, data from CDC’s National Syndromic Surveillance Program (NSSP) from January 1 through October 17, 2020, were compared with those collected during the same period in 2019. During weeks 1–11 (January 1–March 15, 2020), the average reported number of children’s mental health–related ED visits overall was higher in 2020 than in 2019, whereas the proportion of children’s mental health–related visits was similar. Beginning in week 12 (March 16) the number of mental health–related ED visits among children decreased 43% concurrent with the widespread implementation of COVID-19 mitigation measures; simultaneously, the proportion of mental health–related ED visits increased sharply beginning in mid-March 2020 (week 12) and continued into October (week 42) with increases of 24% among children aged 5–11 years and 31% among adolescents aged 12–17 years, compared with the same period in 2019. The increased proportion of children’s mental health–related ED visits during March–October 2020 might be artefactually inflated as a consequence of the substantial decrease in overall ED visits during the same period and variation in the number of EDs reporting to NSSP. However, these findings provide initial insight into children’s mental health in the context of the COVID-19 pandemic and highlight the importance of continued monitoring of children’s mental health throughout the pandemic, ensuring access to care during public health crises, and improving healthy coping strategies and resiliency among children and families.
CDC analyzed NSSP ED visit data, which include a subset of hospitals in 47 states representing approximately 73% of U.S. ED visits.* Mental health–related ED visits among children aged <18 years was a composite variable derived from the mental health syndrome query of the NSSP data for conditions likely to result in ED visits during and after disaster events (e.g., stress, anxiety, acute posttraumatic stress disorder, and panic).† Weekly numbers of mental health–related ED visits and proportions of mental health–related ED visits (per 100,000 pediatric ED visits§) were computed overall, stratified by age group (0–4, 5–11, and 12–17 years) and sex, and compared descriptively with the corresponding weekly numbers and proportions for 2019. Numbers and proportions of visits were compared during calendar weeks 1–11 (January 1–March 14, 2020) and weeks 12–42 (March 15–October 17, 2020) (before and after a distinct decrease in overall ED visits reported beginning in week 12 in 2020)¶ (4). Analyses are descriptive and statistical comparisons were not performed.
The number of children’s mental health–related ED visits decreased sharply from mid-March 2020 (week 12, March 15–21) through early April (week 15, April 5–11) and then increased steadily through October 2020. (Figure 1). During the same time, the overall proportion of reported children’s ED visits for mental health–related concerns increased and remained higher through the end of the reporting period in 2020 than that in 2019 (Figure 1). The proportion of mental health–related ED visits among children increased 66%, from 1,094 per 100,000 during April 14–21, 2019 to 1,820 per 100,000 during April 12–18, 2020 (Supplementary Figure 1, stacks.cdc.gov/view/cdc/96609). Although the average reported number of children’s mental health–related ED visits overall was 25% higher during weeks 1–11 in 2020 (342,740) than during the corresponding period in 2019 (274,736), the proportion of children’s mental health–related visits during the same time was similar (1,162 per 100,000 in 2020 versus 1,044 per 100,000 in 2019). (Table). During weeks 12–42, 2020 (mid-March–October) however, average weekly reported numbers of total ED visits by children were 43% lower (149,055), compared with those during 2019 (262,714), whereas the average proportion of children’s mental health–related ED visits was approximately 44% higher in 2020 (1,673 per 100,000) than that in 2019 (1,161 per 100,000).
Adolescents aged 12–17 years accounted for the largest proportion of children’s mental health–related ED visits during 2019 and 2020 (Figure 2). During weeks 12–42, 2020, the proportion of mental health–related visits for children aged 5–11 years and adolescents aged 12–17 years increased approximately 24% and 31%, respectively compared with those in 2019; the proportion of mental health–related visits for children aged 0–4 years remained similar in 2020. (Table.) The highest weekly proportion of mental health–related ED visits occurred during October for children aged 5–11 years (week 42; 1,177 per 100,000) and during April (week 16) for adolescents aged 12–17 years (4,758 per 100,000) (Figure 2).
During 2019 and 2020, the proportion of mental health–related ED visits was higher among females aged <18 years than it was among males (Supplementary Figure 2, stacks.cdc.gov/view/cdc/96610). Similar patterns of increasing proportions of mental health–related ED visits were observed in 2020 for males and females, with increases beginning mid-March and continuing through October.
www.cdc.gov/mmwr/volumes/69/wr/mm6945a3.htm?s_cid=mm6945a3_w