Trends in Pediatric Emergency and Inpatient Healthcare Use for Mental and Behavioral Health Among North Carolinians During the Early COVID-19 Pandemic

Abstract

Background: Widespread school closures and health care avoidance during the COVID-19 pandemic led to disruptions in access to pediatric mental health care.

Methods: We conducted a retrospective study of emergency and inpatient administrative claims from privately insured children aged 6-20 years in North Carolina between January 2019 and December 2020. We compared rates of emergency department (ED) visits (per 100 000 person-days) and risks of hospitalizations (per 100 000 persons) with diagnosis codes in each category (mental/behavioral health; suicidal ideation, suicide attempt, and intentional self-harm [SI/SA/ISH]; and social issues) across 3 time periods (pre-pandemic, lockdown, and reopening). We calculated the proportion and 95% confidence intervals (CI) of total ED visits and total hospitalizations attributable to mental/behavioral health and SI/SA/ISH across the 3 time periods.

Results: Rates of all categories of ED visits decreased from pre-pandemic to the lockdown period; from pre-pandemic to the reopening period, mental/behavioral health visits decreased but rates of SI/SA/ISH visits were unchanged. The proportion of ED visits attributable to mental/behavioral health increased from 3.5% (95% CI 3.2%-3.7%) pre-pandemic to 4.0% (95% CI 3.7%-4.3%) during reopening, and the proportion of SI/SA/ISH diagnoses increased from 1.6% (95% CI 1.4%-1.8%) pre-pandemic to 2.4% (95% CI 2.1%-2.7%) during the reopening period. Emergency care use for social issues and hospital admissions for mental/behavioral health and SI/SA/ISH diagnoses were unchanged across the study periods.

Conclusions: In the early pandemic, pediatric mental health care and acute suicidal crises accounted for increased proportions of emergency care. During pandemic recovery, understanding the populations most impacted and increasing access to preventative mental health care is critical.

Keywords: COVID-19 pandemic; healthcare utilization; pediatric mental health.

Figure 1.

Proportion of emergency department visits with claims for diagnoses of interest. The solid vertical line corresponds to March 2020, the beginning of the COVID-19 pandemic. Dots represent the proportion of all ED encounters among eligible enrollees that contained discharge diagnoses in the following categories: (1) mental and behavioral health, (2) suicidal ideation/suicide attempt/intentional self-harm, and (3) social issues. ICD-10 CM diagnoses included in each of these categories are in Supplementary Table 1. Trend lines represent proportion of ED visits across each study period (pre-pandemic, lockdown, and reopening), estimated by a quasibinomial regression.

Figure 2.

Proportion of hospital admissions with claims for diagnoses of interest. The solid vertical line corresponds to March 2020, the beginning of the COVID-19 pandemic. Dots represent the monthly proportion of all inpatient hospitalizations among eligible enrollees that contained discharge diagnoses in the following categories: (1) mental and behavioral health, and (2) suicidal ideation/suicide attempt/intentional self-harm. ICD-10 CM diagnoses included in each of these categories are in Supplementary Table 1. Trend lines represent proportion of admissions across each study period (pre-pandemic, lockdown, and reopening), estimated by a quasibinomial regression.