Unseen Impact of the Pandemic: Youth Mental Health Emergencies on the Rise

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The second year of the COVID-19 pandemic saw a rise in hospital visits for mental health care among children and teenagers, with teen girls particularly affected, as indicated by a study examining insurance claims of over 4.1 million children. Increases in psychiatric admissions, extended hospital stays, and issues such as “prolonged boarding” highlight growing demand and reduced capacity in youth mental health care services.

The second year of the COVID-19 pandemic saw an increase in hospital admissions for mental health issues among children and adolescents according to a study supported by the National Institute of Mental Health. The study, which analyzed insurance claims data from over 4.1 million kids, found a significant surge in urgent mental health care visits—including emergency department visits—among teen girls.

The research was spearheaded by Lindsay Overhage, an M.D.-Ph.D. candidate at Harvard Medical School, and Haiden Huskamp, Ph.D., who holds the Henry J. Kaiser Professorship of Health Policy at the same institution. Overhage, Huskamp, and their team analyzed national, anonymized commercial health insurance claims for children between the ages of 5 and 17 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: “Trends in Acute Care Use for Mental Health Conditions Among Youth During the COVID-19 Pandemic” by Lindsay Overhage, Ruth Hailu, Alisa B. Busch, Ateev Mehrotra, Kenneth A. Michelson, Haiden A. Huskamp, 12 July 2023, JAMA Psychiatry.
DOI: 10.1001/jamapsychiatry.2023.2195

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