Mental health crises among children and adolescents requiring emergency department care skyrocketed during the pandemic and have stayed elevated despite a return to normalcy, according to a study by Weill Cornell Medicine and NewYork-Presbyterian investigators.

The study, published Oct. 20 in the journal Pediatrics, compared rates of pediatric mental health visits in the emergency departments of five New York City medical centers from a pre-pandemic period through five pandemic waves. Each wave saw elevated rates of youth mental health-related visits compared to before the pandemic.

They found no relationship, however, between pediatric mental health visits and COVID-19 prevalence or how strict mitigation measures were.

“The pattern we saw is different than other tragedies because even after the acute COVID-19 emergency was over, we saw that an elevated rate of mental health emergencies persisted,” said senior author Dr. Cori Green, vice chair of behavioral health in pediatrics, associate professor of clinical pediatrics at Weill Cornell Medicine and a pediatrician at NewYork-Presbyterian Komansky Children’s Hospital.

Youth mental health was already in a crisis, but “(t)he COVID-19 pandemic made the problems more pronounced,” noted first author Dr. Deborah Levine, associate professor of clinical emergency medicine, associate professor of clinical pediatrics at Weill Cornell Medicine and a pediatric emergency medicine physician at NewYork-Presbyterian/Weill Cornell Medical Center.

The data analyzed for the study came from the New York-based INSIGHT Clinical Research Network, part of the National Patient-Centered Clinical Research Network (PCORnet).

One of the early epicenters of the COVID-19 pandemic in the United States, New York City faced enormous challenges. As pandemic restrictions shut down many health clinics, schools and other youth services, emergency departments became the only option for those experiencing mental health crises. Consequently, emergency visits for a range of mental health issues increased dramatically:

• Eating disorder visits were significantly increased above predicted levels for all five waves, with the largest increase, 545% over the expected rate, in the first wave.
• Anxiety-related visits were about 75% and 66% higher in the first and second waves, respectively, and decreased to approximately 40% higher than expected in the fourth and fifth waves.
• Depression-related visits were 28% higher and suicidality-linked visits were up 53% in the second wave.
• Visits related to substance use disorder were elevated 62% in the second wave, 87% in the fourth wave and 131% in the fifth wave.

The researchers also observed that patients who were female, adolescents, Asian, or from communities with more resources were overrepresented compared to what would have been expected pre-pandemic. As this study focuses on New York City, Levine cautioned that the conclusions may not be universal. However, other studies within the United States and around the world have also demonstrated increased rates of mental health emergencies during the pandemic.

Levine and Green hope their analysis helps draw attention to the urgent need for greater pediatric mental health care resources. Post-pandemic families are still struggling to access pediatric mental health care. Many emergency departments must hold young people while they wait for beds to open on psychiatric units, and outpatient settings have limited openings. “Community mental health services have a three-to-six-month waitlist,” Green added.

The data may also help identify high-risk groups requiring greater attention. For example, Levine and Green found while children from communities with fewer resources did come for emergency mental health visits, there was not as drastic an increase in rates of their visits as expected considering the impact of the pandemic. “Youth from more historically marginalized populations may have been less likely to come to the emergency department to access care and silently suffered,” said Levine. While some of those patients are now being identified during routine primary care screening, their mental health conditions may have progressed to a more severe stage since they did not seek help earlier.

“We are trying to bring this crisis to people’s attention,” Levine said. “The more we study the problem, the more we may be able to identify solutions, bring them to policymakers and try to get more funding for youth mental health care.”

“This crisis has reached a point where you can’t ignore it,” Green added. “There has to be action and not everyone is acting as quickly as they need to.” 

This study was supported by a grant from the RTW Foundation.

Bridget Kuehn is a freelance writer for Weill Cornell Medicine.