Children Affected by Educational Disruptions Experience Mental Health Declines

During spring to fall 2020 related visits to emergency departments declined compared with a year earlier, study results show.

Children who were more vulnerable to missed detection related to mental health issues when school was disrupted during the COVID-19 pandemic were more likely to experience disproportionate mental health declines, the results of a study published in Psychiatric Research & Clinical Practice showed.

During spring to fall 2020 mental health-related emergency department (MH-ED) visits declined 25.5% compared with a year earlier. The greatest reduction was seen during spring at 42.8% and fall at 26.5%, with a lesser reduction during summer of 2.6%.

Investigators noted that EDs are typically the first point of contact for children suffering from mental health issues.

Additionally, there were greater declines among Black children, boys, and children aged 6 to 12 years-.

Visits among boys decreased 28.2% compared with 22.9% for girls. Among school-aged children, there was a larger decrease of approximately 28.6% compared with young children at 25.9% and adolescents at 22.9%.

Furthermore, there was a decrease for non-Hispanic children of approximately 26.6% compared with 22.3% for Hispanic children, and there was a decrease of approximately 34.8% for Black children and a decrease of between 17.7% and 24.9% for other races.

Investigators also saw a decline for developmental disorders and childhood-onset disorders, such as attention deficit and hyperactivity disorders.

However, suicide-related MH-ED visits rose during the summer of 2020 by 29.8% and fall 2020 by 20.4% but not significantly compared with 2019 when controlling for demographic shifts.

In addition, MH-ED visits between spring 2020 and fall 2020 fell significantly for individuals with childhood-onset and developmental disorders and intellectual disabilities.

Visits for developmental disorders saw a decrease of approximately 17%, while childhood onset disorders saw a decrease of approximately ­18%.

Furthermore, symptoms that involved appearance, behavior, and emotional state, decreased by approximately 17.7%.

Further examination of trends showed that in the spring of 2020, MH-ED visits for behavioral syndromes associated with physical factors and physiology decreased by approximately 51.6%, as well as developmental disorders by 51% and childhood-onset disorders by 49.1%.

Meanwhile, MH-ED visits rose in 2020 compared with 2019 for unspecified mental disorders by approximately 23.8%. In the summer, suicide-related diagnoses rose 29.8% and mood disorders rose 51.7%, while developmental disorders saw the greatest of approximately –13.8%.

In fall 2020, there was a rise in suicide related diagnoses by approximately 20.4% and a reduction of approximately 40.4% for developmental disorders.

Investigators gathered data from electronic health records from 4 academic health systems in California, Florida, Massachusetts, and New York. The data period was from March 18, 2019, through November 25, 2019, and March 16, 2020, to November 22, 2020.

Additionally, investigators excluded children who were younger than aged 3 years and aged 18 years or older to focus on how school closures affected the data. They used health systems from the National Center for Advancing Translational Sciences Accrual to Clinical Trials network.

The study population included all MH-ED visits, including discharges, hospitalization, and transfers. They compared the percent volume change and adjusted risk of MH-ED visits for children aged 3 to 17 years.

Additionally, these individuals were matched by 36-week periods and 12-week seasonal time intervals to adjust for seasonal trends. Investigators also calculated adjusted rate ratios using multivariate Poisson regression.

Reference

Edgcomb JB, Benson NM, Tseng, C-h, et al. Mental health-related emergency department visits among children during the early COVID-19 pandemic. Psych Res Clin Pract. 2022. doi: 10.1176/appi.prcp.20210036