Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2024 Aug 1;7(8):e2425829.
doi: 10.1001/jamanetworkopen.2024.25829.

COVID-19 Pandemic School Disruptions and Acute Mental Health in Children and Adolescents

Chiara Davico  1 , Daniele Marcotulli  1 , Giuseppe Abbracciavento  2 , Thomas Anfosso  3 , Massimo Apicella  4 , Roberto Averna  4 , Marzia Bazzoni  5 , Dario Calderoni  6 , Luca Cammisa  6 , Alessandra Carta  7 , Sara Carucci  5   8 , Giorgio Cozzi  2 , Federica Di Santo  6 , Elisa Fazzi  3 , Caterina Lux  1 , Chiara Narducci  5   8 , Lino Nobili  9   10 , Ilaria Onida  7 , Tiziana Pisano  11 , Umberto Raucci  4 , Idanna Sforzi  12 , Laura Siri  10 , Stefano Sotgiu  7 , Simone Tavano  11 , Arianna Terrinoni  6 , Sara Uccella  9   10 , Stefano Vicari  4   13 , Caterina Zanus  2 , Benedetto Vitiello  1 ; Italian Covid-Child and Adolescent Psychiatric Emergencies Study Group
Collaborators, Affiliations
Observational Study

COVID-19 Pandemic School Disruptions and Acute Mental Health in Children and Adolescents

Chiara Davico et al. JAMA Netw Open. .

Abstract

Importance: There are suggestions that school pressure may be stressful and a factor in child and adolescent mental health disturbances, but data about this association are scarce and inconclusive.

Objective: To assess whether varying degrees of school interruption were associated with changes in emergency department (ED) psychiatric visits of children and adolescents before and after the COVID-19 outbreak.

Design, setting, and participants: A cross-sectional observational study was conducted at 9 urban university hospitals in Italy. All ED visits from January 1, 2018, to December 31, 2021, for psychiatric reasons of patients younger than 18 years were examined for demographic characteristics and type of psychopathologic factors. Data analysis was conducted from July 1 to August 31, 2023.

Exposure: The disruption in the usual succession of school and holiday periods brought on by the COVID-19 pandemic at different times and with various degrees of intensity.

Main outcomes and measures: Total number of pediatric ED visits, psychiatric ED visits, and psychiatric ED visits categorized by specific reasons (eg, psychomotor agitation, suicide ideation [SI] or suicide attempt [SA], and eating disorders) on a weekly basis.

Results: A total of 13 014 psychiatric ED visits (1.3% of all pediatric ED visits) were recorded (63.2% females; mean [SD] age, 13.8 [3.8] years). The number of ED psychiatric visits increased over time (incidence rate ratio [IRR], 1.19; 95% CI, 1.16-1.22 for each year). Significant increases in ED visits were observed for eating disorders (294.8%), SI (297.8%), and SA (249.1%). School opening, but not social lockdown restriction, was associated with an increase in the number of ED psychiatric visits (IRR, 1.29; 95% CI, 1.23-1.34), which was evident for females and for SI with SA. Socioeconomic status was associated with an increase in psychiatric visits for males (IRR, 1.12; 95% CI, 1.04-1.20) but not females (IRR, 1.04; 95% CI, 0.98-1.10).

Conclusions and relevance: In this study, school opening was associated with an increased incidence of acute psychiatric emergencies among children and adolescents, suggesting that school can be a substantial source of stress with acute mental health implications.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Davico reported consultant fees from Lundbeck and personal fees from Roche outside the submitted work. Dr Marcotulli reported receiving consultant fees from Ethos Ltd outside the submitted work. Dr Carucci reported participation in a clinical trial sponsored by Janssen-Cilag outside the submitted work. Dr Vitiello reported receiving grants from the Italian Ministry of University and Research and Italian Autism Foundation, and personal fees from Menarini, Angelini, Medice, and Alkermes outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Monthly Psychiatric Visits, Years 2018-2021
Monthly trends of psychiatric visits per year.
See this image and copyright information in PMC

References

    1. Lancet Child Adolescent Health . Time to take academic pressure seriously. Lancet Child Adolesc Health. 2023;7:671. doi: 10.1016/S2352-4642(23)00231-6 - DOI - PubMed
    1. Goldstein AB, Silverman MAC, Phillips S, Lichenstein R. Mental health visits in a pediatric emergency department and their relationship to the school calendar. Pediatr Emerg Care. 2005;21(10):653-657. doi: 10.1097/01.pec.0000181420.56729.4f - DOI - PubMed
    1. Copeland JN, Babyak M, Inscoe AB, Maslow GR. Seasonality of pediatric mental health emergency department visits, school, and COVID-19. Pediatr Emerg Care. 2022;38(12):e1673-e1677. doi: 10.1097/PEC.0000000000002671 - DOI - PMC - PubMed
    1. Lueck C, Kearl L, Lam CN, Claudius I. Do emergency pediatric psychiatric visits for danger to self or others correspond to times of school attendance? Am J Emerg Med. 2015;33(5):682-684. doi: 10.1016/j.ajem.2015.02.055 - DOI - PubMed
    1. Hansen B, Sabia JJ, Schaller J. In-person schooling and youth suicide: evidence from school calendars and pandemic school closures. J Hum Resour. 2024;59:S227-S255. doi: 10.3368/jhr.1222-12710R2 - DOI

Publication types