CDC report finds COVID-19 stress taking a toll on children’s health
Published reports suggest that the COVID-19 pandemic has had a negative effect on children’s mental health, according to a report from the Centers for Disease Control and Prevention (CDC).
Emergency departments (EDs) are often the first point of care for children experiencing mental health emergencies, particularly when other services are inaccessible or unavailable). During March 29–April 25, 2020, when widespread shelter-in-place orders were in effect, ED visits for persons of all ages declined 42 percent compared with the same period in 2019; during this time, ED visits for injury and non-COVID-19–related diagnoses decreased, while ED visits for psychosocial factors increased.
To assess changes in mental health–related ED visits among U.S. children aged <18 years, data from CDC’s National Syndromic Surveillance Program (NSSP) from Jan. 1 through Oct. 17, 2020, were compared with those collected during the same period in 2019. During weeks 1–11 (Jan. 1–March 15, 2020), the average reported number of children’s mental health–related ED visits overall was higher in 2020 than in 2019, whereas the proportion of children’s mental health–related visits was similar.
Beginning in week 12 (March 16) the number of mental health–related ED visits among children decreased 43 percent concurrent with the widespread implementation of COVID-19 mitigation measures; simultaneously, the proportion of mental health–related ED visits increased sharply beginning in mid-March 2020 (week 12) and continued into October (week 42) with increases of 24 percent among children aged 5–11 years and 31percent among adolescents aged 12–17 years, compared with the same period in 2019.
The increased proportion of children’s mental health–related ED visits during March–October 2020 might be artefactually inflated as a consequence of the substantial decrease in overall ED visits during the same period and variation in the number of EDs reporting to NSSP. However, these findings provide initial insight into children’s mental health in the context of the COVID-19 pandemic and highlight the importance of continued monitoring of children’s mental health throughout the pandemic, ensuring access to care during public health crises, and improving healthy coping strategies and resiliency among children and families.
CDC analyzed NSSP ED visit data, which include a subset of hospitals in 47 states representing approximately 73 percent of U.S. ED visits. Mental health–related ED visits among children aged <18 years was a composite variable derived from the mental health syndrome query of the NSSP data for conditions likely to result in ED visits during and after disaster events (e.g., stress, anxiety, acute posttraumatic stress disorder, and panic).
During 2019 and 2020, the proportion of mental health–related ED visits was higher among females aged <18 years than it was among males. Similar patterns of increasing proportions of mental health–related ED visits were observed in 2020 for males and females, with increases beginning mid-March and continuing through October.
Substantial declines in the overall reported numbers of children’s mental health–related ED visits occurred in 2020 during mid-March to early May, coincident with the widespread implementation of community mitigation measures enacted to prevent COVID-19 transmission (e.g., school closures and restrictions to nonemergent care) and decreases in overall ED visits for the same period. A previous report found the mean weekly number of ED visits for children aged <14 years declined approximately 70percent during March 29–April 25, 2020, relative to the corresponding period in 2019. Further, the mean number of weekly ED visits for persons of all ages decreased significantly for asthma (–10 percent), otitis media (–65 percent), and sprain- and strain-related injuries (–39 percent), and mean weekly ED visits for psychosocial factors increased 69 percent.
This report demonstrates that, whereas the overall number of children’s mental health–related ED visits decreased, the proportion of all ED visits for children’s mental health–related concerns increased, reaching levels substantially higher beginning in late-March to October 2020 than those during the same period during 2019. Describing both the number and the proportion of mental health–related ED visits provides crucial context for these findings and suggests that children’s mental health warranted sufficient concern to visit EDs during a time when nonemergent ED visits were discouraged.
Many children receive mental health services through clinical and community agencies, including schools. The increase in the proportion of ED visits for children’s mental health concerns might reflect increased pandemic-related stress and unintended consequences of mitigation measures, which reduced or modified access to children’s mental health services, and could result in increased reliance on ED services for both routine and crisis treatment. However, the magnitude of the increase should be interpreted carefully because it might also reflect the large decrease in the number and proportion of other types of ED visits (e.g., asthma, otitis media, and musculoskeletal injuries) and variation in the number of EDs reporting to NSSP.
Children’s mental health during public health emergencies can have both short- and long-term consequences to their overall health and well-being. Ensuring availability of and access to developmentally appropriate mental health services for children outside the in-person ED setting will be important as communities adjust mitigation strategies. Implementation of technology-based, remote mental health services and prevention activities to enhance healthy coping and resilience in children might effectively support their well-being throughout response and recovery periods. CDC supports efforts to promote the emotional well-being of children and families and provides developmentally appropriate resources for families to reduce stressors that might contribute to children’s mental health–related ED visits.
