Has Anything Changed in the Frequency of Emergency Department Visits and the Profile of the Adolescent Seeking Emergency Mental Care during the COVID-19 Pandemic?

Abstract

We described changes caused by the COVID-19 pandemic in the frequency of Emergency Department (ED) visits for mental health disorders (MHDs) in adolescents on a wider temporal range—that is, not just “the waves” of the pandemic—and characterized the profile of the adolescent seeking emergency psychiatric care. We conducted a retrospective longitudinal study by analyzing ED visits for MHDs from 10 March 2019 to 10 March 2021. A total of 1407 ED visits for MHDs were registered: 702 in the pre-COVID-19 and 707 in the COVID-19 period. The cumulative incidence of ED visits for MHDs was 1.22% in the pre-COVID-19 period and 1.77% in the COVID-19 period, with a statistically significant difference (p < 0.001). The principal characteristics of the adolescent with MHDs during the pandemic period: the odds of comorbidities decreased by 26% (p = 0.02), and the odds of transfer from other hospitals decreased by 71% (p < 0.001), while the odds of the ED presentation as first psychiatric episode were twice greater (p < 0.001). The risk of hospitalization increased by 54% (p = 0.001). Regarding psychopathology, the likelihood of attempted suicide increased by 74% during the pandemic (p = 0.02). The rate of mood and eating disorders grew significantly during the COVID-19 pandemic period (p = 0.005 and p = 0.031, respectively). Monitoring ED visits for MHDs and understanding changes in the profile of adolescents presenting to ED helps to reinforce the role of ED in identifying special clinical needs for these vulnerable patients in case of a future public health crisis.

SARS-CoV-2 and Adolescent Psychiatric Emergencies at the Tübingen University Hospital: Analyzing Trends, Diagnoses, and Contributing Factors

“…For disruptive, impulse control, and conduct disorders, Ferro et al [34] did not find any differences over time, whereas Shankar et al [35] found an increase. Anxiety disorders could cautiously be concluded to have declined in emergency presentations [34,35]. However, anxiety disorders seemed to increase during the pandemic in children and adolescents [36,37].…”

“…For expansive disorders, results have again been heterogenous, with studies finding a decrease in aggressive behavior [34] and a consistent appearance of agitation [33]. For disruptive, impulse control, and conduct disorders, Ferro et al [34] did not find any differences over time, whereas Shankar et al [35] found an increase. Anxiety disorders could cautiously be concluded to have declined in emergency presentations [34,35].…”

“…For the change in emergencies in CAPs for affective disorders during the pandemic, results have been heterogenous, ranging from no differences in comparison with prepandemic times in an earlier study [33] to a significant increase in a rather new study [34]. For expansive disorders, results have again been heterogenous, with studies finding a decrease in aggressive behavior [34] and a consistent appearance of agitation [33]. For disruptive, impulse control, and conduct disorders, Ferro et al [34] did not find any differences over time, whereas Shankar et al [35] found an increase.…”

“…However, anxiety disorders seemed to increase during the pandemic in children and adolescents [36,37]. For the area of substance abuse disorders, studies have described a decrease [38], a consistent appearance [35,38,39], or an increase [34]. For psychoses, previous results have been mixed with studies identifying a consistent appearance [35] or a decline [40].…”

“…For some disorders, such as EDs, an exaggeration associated with the SARS-CoV-2 pandemic is evident [47]. For other disorders (e.g., OCDs, affective disorders, expansive disorders, substance abuse disorders, and psychoses), results have been heterogenous [31][32][33][34][35]38,39].…”