Pediatric Emergency Department Visits Associated with Mental Health Conditions Before and During the COVID-19 Pandemic — United States, January 2019–January 2022

Abstract

On February 18, 2022, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr).In 2021, a national emergency* for children's mental health was declared by several pediatric health organizations, and the U.S. Surgeon General released an advisory † on mental health among youths. These actions resulted from ongoing concerns about children's mental health in the United States, which was exacerbated by the COVID-19 pandemic (1,2). During March-October 2020, among all emergency department (ED) visits, the proportion of mental health-related visits increased by 24% among U.S. children aged 5-11 years and 31% among adolescents aged 12-17 years, compared with 2019 (2). CDC examined changes in U.S. pediatric ED visits for overall mental health conditions (MHCs) and ED visits associated with specific MHCs (depression; anxiety; disruptive behavioral and impulse-control disorders; attention-deficit/hyperactivity disorder; trauma and stressor-related disorders; bipolar disorders; eating disorders; tic disorders; and obsessive-compulsive disorders [OCD]) during 2019 through January 2022 among children and adolescents aged 0-17 years, overall and by sex and age. After declines in weekly visits associated with MHCs among those aged 0-17 years during 2020, weekly numbers of ED visits for MHCs overall and for specific MHCs varied by age and sex during 2021 and January 2022, when compared with corresponding weeks in 2019. Among adolescent females aged 12-17 years, weekly visits increased for two of nine MHCs during 2020 (eating disorders and tic disorders), for four of nine MHCs during 2021 (depression, eating disorders, tic disorders, and OCD), and for five of nine MHCs during January 2022 (anxiety, trauma and stressor-related disorders, eating disorders, tic disorders, and OCD), and overall MHC visits during January 2022, compared with 2019. Early identification and expanded evidence-based prevention and intervention strategies are critical to improving children's and adolescents' * https://www.aap.org/en/advocacy/child-and-adolescent-healthy-mentaldevelopment/aap-aacap-cha-declaration-of-a-national-emergency-inchild-and-adolescent-mental-health/ † https://www.hhs.gov/sites/default/files/surgeon-general-youth-mental-healthadvisory.pdf

A comparative analysis of pediatric mental health-related emergency department utilization in Montréal, Canada before and during the COVID-19 pandemic

“…These results coincide with those obtained in Australia and the US. (13,25) In fact, an increase in MHR ED utilization among adolescent girls aged 12-17 years was also seen in New South Wales during the first year of the pandemic (January 2020 to February 2021). ( 13) Weekly ED visits for adolescent girls also increased for eating and tic disorders in 2020-2021 and depression and obsessive-compulsive disorder in 2021 compared to 2019 in the US.…”

“…While both MHR and overall ED visits first decreased during 2020, (7-12, 14-17, 21-24) some studies have reported increased MHR ED utilization during 2021 and early 2022. (13,25) During this time, overall pediatric ED utilization has remained lower than pre-COVID-19 levels. (6,25) So far, the bulk of the evidence regarding changes in pediatric MHR ED utilization has originated from the United States, thereby limiting the generalisability of findings to other countries.…”

“…(13,25) During this time, overall pediatric ED utilization has remained lower than pre-COVID-19 levels. (6,25) So far, the bulk of the evidence regarding changes in pediatric MHR ED utilization has originated from the United States, thereby limiting the generalisability of findings to other countries. Potential regional and national differences could stem from varying COVID-19 epidemiology, public health responses, healthcare systems, socioeconomic and sociocultural factors, and availability of mental health services.…”

“…(13) The second study, which analyzed data from the National Syndromic Surveillance Program in the US, showed that adolescent girls aged 12-17 years accounted for the largest increases in both the number and proportion of MHR ED visits seen in 2020, 2021 and January 2022 when compared to 2019. (25) Additional research is required to prevent further exacerbation of intersectional inequalities in youth mental health, (27) and to inform effective service planning and resource allocation in pediatric emergency care.…”

Trends in emergency department visits related to acute alcohol consumption before and during the COVID-19 pandemic in the United States, 2018–2020

“…We assessed trends in the number of alcohol-related ED visits among people aged ≥15 years and weekly alcohol-related ED visit rates (per 10,000 ED visits) overall, by population characteristics, and by quarter (Q) during 2020 compared with corresponding quarters during 2018–2019. Because of fluctuations in facilities reporting to the NSSP over time, data were included from the facilities that were consistently reporting throughout the study period so that only facilities with more complete data were included ( Radhakrishnan et al, 2022 ) (where the facility-level average percentages for reporting diagnosis codes to the NSSP was ≥70%). Analyses focused on rates per 10,000 ED visits because of the substantial decline in total ED visits during the onset of the COVID-19 pandemic ( Adjemian et al, 2021 ; Hartnett et al, 2020 ).…”