Use of Acute Mental Health Care in US Children's Hospitals Before and After Statewide COVID-19 School Closure Orders

Objective: This study aimed to examine changes in child emergency department (ED) discharges and hospitalizations for primary general medical (GM) and primary psychiatric disorders; prevalence of psychiatric disorders among acute care encounters; and change in acute mental health (MH) care encounters by disorder type and, within these categories, by child sociodemographic characteristics before and after statewide COVID-19-related school closure orders. Methods: This retrospective, cross-sectional cohort study used the Pediatric Health Information System database to assess percent changes in ED discharges and hospitalizations (N52,658,474 total encounters) among children ages 3-17 years in 44 U.S. children's hospitals in 2020 compared with 2019, by using matched data for 36- and 12-calendar week intervals. Results: Decline in MH ED discharges accounted for about half of the decline in ED discharges and hospitalizations for primary GM disorders (224.8% vs. 249.1%), and MH hospitalizations declined 3.4 times less (28.0% vs. 226.8%) in 2020. Suicide attempt or self-injury and depressive disorders accounted for.50% of acute MH care encounters before and after the statewide school closures. The increase in both ED discharges and hospitalizations for suicide attempt or self-injury was 5.1 percentage points (p,0.001). By fall 2020, MH hospitalizations for suicide attempt or self-injury rose by 41.7%, with a 43.8% and 49.2% rise among adolescents and girls, respectively. Conclusions: Suicide or self-injury and depressive disorders drove acute MH care encounters in 44 U.S. children's hospitals after COVID-19-related school closures. Research is needed to identify continuing risk indicators (e.g., sociodemographic characteristics, psychiatric disorder types, and social determinants of health) of acute child MH care.

Automated summary

This study examined the changes in child emergency department (ED) discharges and hospitalizations for primary general medical (GM) and primary psychiatric disorders before and after COVID-19-related school closures. The study found that suicide attempts or self-injury and depressive disorders were the main drivers of increased acute mental health care encounters. The number of ED discharges and hospitalizations for suicide attempts or self-injury increased after the school closures.