Youth Emergency Department Visits for Mental Health Increased During Pandemic
• Research Highlight
Hospital visits for mental health care increased among children and teens in the second year of the COVID-19 pandemic, according to a study supported by the National Institute of Mental Health. Analyses of insurance claims data for more than 4.1 million children showed an especially notable increase in acute mental health care visits—including emergency department visits—among teen girls.
The study was led by Lindsay Overhage , an M.D.-Ph.D. student at Harvard Medical School, and Haiden Huskamp, Ph.D. , the Henry J. Kaiser Professor of Health Policy at Harvard Medical School. Overhage, Huskamp, and colleagues examined national, deidentified commercial health insurance claims for youth aged 5 to 17 years over the following periods:
- Baseline year: March 2019 to February 2020
- First year of the pandemic: March 2020 to February 2021
- Second year of the pandemic: March 2021 to February 2022
The researchers defined mental health-related emergency department visits as visits in which a mental health condition was recorded as the primary diagnosis for the visit. They then sorted the diagnoses into categories, which included depression; suicidal ideation, suicide attempt, or self-injury; anxiety disorder; and eating disorder. Visits with a primary diagnosis of substance use disorder were not included.
From these data, the researchers identified 88,665 mental health-related emergency department visits. Relative to the pre-pandemic baseline year, the proportion of youth with at least one mental health visit decreased by 17.3% in the first year of the pandemic. In contrast, the proportion of youth with a mental health visit increased by 6.7% in the second pandemic year relative to the baseline year. The proportion of youth with multiple visits in the same year remained similar over time.
Further analyses revealed notable differences according to age and sex. Relative to baseline, mental health-related emergency visits in the second year of the pandemic increased by 22.1% among teen girls (aged 13 to 17), while these visits decreased by 15.0% among boys aged 5 to 12 and 9.0% among teen boys (aged 13 to 17).
The data also showed that girls’ visits increased considerably for specific diagnostic categories. For example, among girls, there was a 43.6% increase in visits for suicidal ideation, suicide attempt, or self-injury and a 120.4% increase in visits for eating disorders in the second year of the pandemic. Among boys, mental health-related visits decreased or stayed the same across diagnostic categories in both pandemic years. The researchers note that these findings are consistent with other studies indicating that the pandemic has taken a greater toll on girls’ mental health.
Inpatient psychiatry admissions also increased during the pandemic. After a mental health-related emergency department visit, youth were more likely to be admitted for inpatient psychiatric care and stayed in inpatient psychiatric care longer in both pandemic years compared to the baseline year.
Importantly, during both years of the pandemic, youth were more likely to spend two or more nights in a medical unit waiting to be admitted to a psychiatric unit, a practice the researchers call “prolonged boarding.” Relative to the baseline year, prolonged boarding increased by 27.1% in the first year of the pandemic and 76.4% in the second year of the pandemic. The increase in the second year of the pandemic was especially high (87.2%) among teens aged 13 to 17.
According to the researchers, the increase in prolonged boarding could be due to two factors: increased demand and reduced capacity. In other words, more children needed urgent mental health care, but there were also fewer inpatient psychiatric beds and fewer qualified staff to meet those needs. The researchers note that this underscores the importance of expanding the capacity of psychiatric services for youth.
Although the study focused only on youth with commercial insurance, the findings shed light on the broad need for appropriate, responsive mental health care for children and teens. The researchers suggest that educating and supporting primary care providers in delivering mental health care could help address youth mental health concerns before they require more acute, hospital-based care. At the same time, they note that supporting existing mental health care providers and increasing the pipeline of qualified staff are critical steps in addressing the provider shortage.
Reference
Overhage, L., Hailu, R., Busch, A. B., Mehotra, A., Michelson, K. A., & Huskamp, H. A. (2023). Trends in acute care use for mental health conditions among youth during the COVID-19 pandemic. JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2023.2195