(O-I2) Changes in Emergency Department Pediatric Psychiatric Visits Following the Arrival of COVID

Objectives: The goal of our study was to determine whether there was a change in the proportion of pediatric ED visits for depression and/or suicidal ideation or attempts (DS) and anxiety following the arrival of COVID.

Background: In March of 2020, COVID arrived in the New York Metropolitan area. Total ED visits decreased markedly, likely because of fear of exposure to the virus as well as social isolation mandates. School closings, isolation from peers, quarantining within families and job disruptions triggered mental health struggles. A CDC study showed that compared to 2019, the proportion of ED mental health related visits for children increased in 2020 by 44%.

Methods:

Design: Retrospective cohort. Setting: EDs of 8 hospitals within 150 miles of New York City, with total ED volumes in 2019 of 30,000 to 120,000. Hospitals were teaching and non-teaching, in rural, suburban and urban areas. Population: Consecutive patients ages 5-21 years between March 1 and November 30 in 2019-2022, as COVID arrived in March 2020. Data analysis: We identified patients with DS and anxiety using International Classification of Disease codes (version 10), choosing those with at least 25 visits over the four years. We tallied the number of DS and anxiety ED visits in 2019 - 2022. We calculated the proportion of these visits to total ED visits in this age group in 2019 - 2022. We report the changes in these proportions from the base year of 2019 to 2020-2022, along with 95% confidence intervals (CIs).

Results: The database contained 1,542,684 total ED visits, of which 251,993 were for patients age 5-21 years (72,872, 39,037, 46,103 and 93,981 in 2019-2022, respectively), The mean ages were 13, 14, 14 and 9 years; females comprised 49%, 50%, 51% and 47% of patients in 2019-2022, respectively. In 2019-2022, the numbers diagnosed with DS were 2033, 1379, 1453 and 1206, and, with anxiety, 955, 667, 856 and 971, respectively. The changes in the proportions of DS in 2020, 2021 and 2022, compared to the baseline of 2019, were +27% (95% CI: +18%, 35%), +13% (95% CI: +6%, 21%) and -54% (95% CI: -57%, -51%); and for anxiety, +30% (95% CI: +18%, 44%), +42% (95% CI: +29%, 55%) and -21% (95% CI: - 28%, -14%), respectively.

Conclusions: Following the arrival of COVID, the proportion of pediatric ED visits for depression and/or suicidal ideation or attempts and anxiety increased in 2020 - 2021 but decreased in 2022. These changes may reflect changing concerns about COVID over time.

References (Optional):

Funding (Optional): None