Changes in pediatric emergency department visits for mental health during the COVID-19 pandemic: A cross-sectional study

Background: Limited early results indicate that the COVID-19 outbreak has had a significant impact on the mental health of children and adolescents. Pediatric emergency departments (PED) play a pivotal role in the identification, treatment, and coordination of care for children with mental health disorders, however, there is a dearth of literature evaluating the effects of the COVID-19 pandemic on mental health care provision in the PED. Objectives: We sought to evaluate whether changes in frequency or patient demographics among children and adolescents presenting to the PED has occurred. Methods: This is a cross-sectional study conducted at the Yale New Haven Children's Hospital (YNHCH) PED. Data representing the early COVID-19 pandemic period was abstracted from the electronic medical record and compared using descriptive statistics to the same time period the year prior. Patient demographics including patient gender, ED disposition, mode of arrival, race-ethnicity, and insurance status were assessed. Results: During the pandemic period, 148 patients presented to the YNHCH PED with mental health-related diagnoses, compared to 378 in the pre-pandemic period, a reduction of 60.84%. Compared to white children, black children were 0.55 less likely to present with a mental health condition as compared to the pre-pandemic study period (p = 0.002; 95% CI 0.36-0.85). Conclusions: Children with mental and behavioral health disorders who seek care in PEDs may be at risk for delayed presentations of mental health disorders. African American children may be a particularly vulnerable population to screen for mental health disorders as reopening procedures are initiated and warrants further study.