Increased Emergency Department Stays for Mental Health of Insured Youth in Year 2 of the COVID-19 Pandemic—Moving Forward

Abstract

In this issue of JAMA Psychiatry, Overhage and colleagues 1 provide analyses of deidentified commercial insurance claims data from Optum Labs Data Warehouse for March 2019 to February 2022. Their goal was to describe changes in emergency department (ED) visits for mental health (MH) for children (5-13 years) and adolescents (14-17 years) covered by commercial insurance in the US in the second year of the COVID-19 pandemic (March 2021-February 2022), relative to before the pandemic (March 2019-February 2020). Their analysis occurred in the context of prior studies of health record and survey data from national and individual sites on changes before and during the transition into the pandemic. Substantial increases in ED visits for MH and suicidality in youth were reported from 2011 to 2020 unrelated to the pandemic. 2 Some studies that evaluated ED visits for any reason found general reductions during pandemic year 1 (likely due to efforts to avoid exposure to the SARS-CoV-2 virus and staffing issues) and reductions in ED visits for MH among youth-suggesting parallel issues to general ED reductions. [3][4][5] Some prior studies 6 found increased psychiatric admission rates for ED MH visits with longer length of stay. However, for some individual areas, such as Chicago, Illinois, there was evidence for increased ED MH visits during pandemic year 1. 7 Meanwhile, there has been increasing concern overall about the MH of children and youth from social isolation, school closures, and other stressors; an increase in suicidal ideation; and evidence for increased risk and ED visits for MH issues in adolescent girls, especially after school closures. 6,8-10 Such concerns have led to efforts nationally and in some states for a focus on youth MH and the development of resources such as peer networks and websites with a focus on prevention, treatment, and recovery resources, both across age groups and for youth/adults supporting youth, with 1 example being a California initiative. 11 In this context, in their analysis of data on commercial insurance members, Overhage and colleagues 1 found significant increases in the percentage of youth with at least 1 ED MH visit (defined by diagnosis) for pandemic year 2 relative to the year before the pandemic, accounted for by large increases in visits (22%) from female adolescents, with male adolescents trending toward declines in ED visits for MH. They also found increased rates of inpatient psychiatric admission from ED visits (by 8%), with increases in duration of admissions. They found a large increase in the percentage of youth in EDs for MH having long onboarding times (by 72%), with at least 2 overnight stays in the ED (or medical inpatient) before inpatient psychiatric admission. Depression was a main diagnostic cat-14. Cutler GJ, Bergmann KR, Doupnik SK, et al. Pediatric mental health emergency department visits and access to inpatient care: a crisis worsened by the COVID-19 pandemic.