Emergency Department Visits Involving Mental Health Conditions, Suicide-Related Behaviors, and Drug Overdoses Among Adolescents - United States, January 2019-February 2023

Abstract

The U.S. adolescent mental and behavioral health crisis is ongoing,* with high pre-COVID-19 pandemic baseline rates^† (1) and further increases in poor mental health (2), suicide-related behaviors (3), and drug overdose deaths (4) reported during 2020-2021. CDC examined changes in U.S. emergency department (ED) visits for mental health conditions (MHCs) overall and for nine specific MHCs,^§ suicide-related behaviors (including suspected suicide attempts), and drug-involved overdoses (including opioids) among children and adolescents aged 12-17 years (adolescents) during January 2019-February 2023, overall and by sex. Compared with fall 2021, by fall 2022, decreases in weekly ED visits were reported among all adolescents, and females specifically, for MHCs overall, suicide-related behaviors, and drug overdoses; weekly ED visits among males were stable. During this same period, increases in weekly ED visits for opioid-involved overdoses were detected. Mean weekly ED visits in fall 2022 for suicide-related behaviors and MHCs overall were at or lower than the 2019 prepandemic baseline, respectively, and drug overdose visits were higher. Differences by sex were observed; levels among females were at or higher than prepandemic baselines for these conditions. These findings suggest some improvements as of fall 2022 in the trajectory of adolescent mental and behavioral health, as measured by ED visits; however, poor mental and behavioral health remains a substantial public health problem, particularly among adolescent females. Early identification and trauma-informed interventions, coupled with expanded evidence-based, comprehensive prevention efforts, are needed to support adolescents' mental and behavioral health.

FIGURE

Mean weekly number (A) and percentage (B) of emergency department visits^, for mental health conditions overall, all suicide-related behaviors, and all drug overdoses among persons aged 12–17 years — National Syndromic Surveillance Program, United States, January 2019–February 2023 Abbreviations: ED = emergency department; ICD-9-CM = International Classification of Diseases, Ninth Edition, Clinical Modification; ICD-10-CM = International Classification of Diseases, Tenth Edition, Clinical Modification; MHC = mental health condition; NSSP = National Syndromic Surveillance Program; SNOMED = Systematized Nomenclature of Medicine. * NSSP receives anonymized medical record information from approximately 75% of nonfederal EDs nationwide. NSSP collects free-text reason-for-visit (chief complaint), discharge diagnosis, and patient demographic details. Diagnosis information is collected using ICD-9-CM, ICD-10-CM, and SNOMED codes. ^† To reduce artifactual impact from changes in reporting patterns, analyses were restricted to facilities with a coefficient of variation for ED visits ≤40 and average weekly informative discharge diagnosis ≥75% complete throughout the study period. ^§ The overall MHC classification identifies any mental health-related ED visits, including those for the nine MHCs included in this analysis (anxiety, attention-deficit/hyperactivity disorders, bipolar disorders, depression, disruptive behavioral and impulse-control disorders, eating disorders, obsessive-compulsive disorders, tic disorders, and trauma and stressor-related disorders), schizophrenia spectrum disorders, additional low-prevalence MHCs (e.g., delusional disorders and reactive attachment), and general mental health terms and codes. ^¶ The suicide-related behaviors classification identifies ED visits related to suicidal ideation, self-harm, and suspected suicide attempts. ** The drug overdose classification identifies acute drug poisonings from any type of drug. ^†† The time series displays data from epidemiologic week 1 for 2019 (December 30, 2018) through epidemiologic week 5 for 2023 (February 4, 2023).