Covid-19 stress causes spike in mental health-related visits to emergency departments among US children: CDC
Some reports have suggested that the coronavirus pandemic has had a negative effect on children’s mental health due to disruptions in daily life, social isolation, and the stress of getting infected. Emergency departments (ED) are often the first point of care for children experiencing mental health emergencies, particularly when other services are inaccessible or unavailable. Researchers now say visits to emergency departments related to children’s mental health saw a sharp rise from March to October this year in the US as compared to the previous year. They found that compared with 2019, the proportion of mental health-related visits for children aged 5-11 and 12-17 years increased approximately by 24% and by 31%, respectively.
“Beginning in week 12 (March 16), the number of mental health-related ED visits among children decreased by 43%, concurrent with the widespread implementation of Covid-19 mitigation measures. Simultaneously, the proportion of mental health-related ED visits increased substantially 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,” write authors.
According to experts, the findings provide “initial insight” into children’s mental health in the context of Covid-19 and highlight the importance of continued monitoring of children’s mental health throughout the pandemic. The team from the US Centers for Disease Control and Prevention (CDC), which conducted the analysis, has called for ensuring access to care during public health crises and improving healthy coping strategies and resiliency among children and families. “Children’s mental health during public health emergencies can have both short- and long-term consequences to their overall health and well-being. Ongoing collection of a broad range of children’s mental health data outside the ED is needed to monitor the impact of Covid-19 and the effects of public health emergencies on children’s mental health, they recommend.
The investigators note that their definition of mental health focuses on symptoms and conditions — stress, anxiety — that might increase after a disaster in the US and might not reflect all mental health-related ED visits. “Still, these data likely underestimate the actual number of mental health-related health care visits because many mental health visits occur outside of EDs,” they add.
The findings
To assess changes in mental health-related ED visits among US children aged less than 18 years, the authors analyzed data from CDC’s National Syndromic Surveillance Program (NSSP) from January 1 through October 17, 2020, and compared it with those collected during the same period in 2019.
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. 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.
During weeks 12-42, 2020 (mid-March to October), 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, followed by children aged 5-11 years. The proportion of mental health-related visits for children aged 0-4 years remained similar in 2020. 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), reveals the study.
According to the researchers, many children receive mental health services through clinical and community agencies, including schools. They suggest that the increase in the proportion of ED visits for children’s mental health concerns might reflect increased pandemic-related stress and unintended consequences of mitigation measures, which reduced or modified access to children’s mental health services and could result in increased reliance on ED services for both routine and crisis treatment.
“Many mental disorders commence in childhood, and mental health concerns in these age groups might be exacerbated by stress related to the pandemic and abrupt disruptions to daily life associated with mitigation efforts, including anxiety about illness, social isolation, and interrupted connectedness to school. The majority of EDs lack adequate capacity to treat pediatric mental health concerns potentially increasing demand on systems already stressed by the Covid-19 pandemic,” says the team.
The study emphasizes that ensuring availability of and access to “developmentally appropriate” mental health services for children outside the in-person ED setting will be important as communities adjust mitigation strategies. The investigators also call for the implementation of technology-based, remote mental health services, and prevention activities to enhance healthy coping and resilience in children. “These findings demonstrate the continued need for mental health care for children during the pandemic and highlight the importance of expanding mental health services, such as telemental health and technology-based solutions, such as mobile mental health applications,” they recommend.