43 - Pediatric Mental Health Emergencies Across Three Waves of the COVID-19 Pandemic in New York City

Poster Number: 43
Publication Number: 43.103

Deborah A. Levine, Weill Cornell Medical College - New York, NY, Port Washington, NY, United States; P. Stephen Oh, New York Presbyterian, Weill Cornell Medicine, New York, NY, United States; Katherine Nash, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Will Simmons, Weill Cornell Medicine, New York, NY, United States; Zachary M. Grinspan, Weill Cornell Medicine, New York, NY, United States; Erika Abramson, Weill Cornell Medicine, New York, NY, United States; Shari Platt, Weill Cornell Medicine, New York, NY, United States; Cori Green, Weill Cornell Medicine, Brooklyn, NY, United States

Background: The mental health of children has been adversely affected by the COVID-19 pandemic. In New York City (NYC), an epicenter of the pandemic, three distinct waves in cases each posed unique and growing psychosocial challenges for children. 

Objective: We aimed to describe trends in patient volume, sociodemographics, clinical diagnoses, and disposition of mental health emergencies (MHEs) in children in NYC during each wave of the COVID-19 pandemic.

Design/Methods: We conducted a cross-sectional analysis of pediatric emergency department (PED) visits using electronic health record (EHR) data from the INSIGHT Clinical Research Network, a large multicenter database comprised from five major institutions in NYC. We examined four study periods (dates determined by NYC Department of Health data trends and study investigator consensus): pre-pandemic (2017-2019), wave 1 (3/1-7/31/20), wave 2 (8/1-6/30/21),wave 3 (7/1-9/20/21). We described changes in the number of MHEs per 100,000 PED visits, sociodemographic characteristics (including social deprivation index (SDI), race, and ethnicity), clinical diagnoses, and disposition during the pandemic waves compared to pre-pandemic.  We used descriptive statistics and unadjusted, two-tailed, two-sample tests for equality of proportions.

Results: We included 12,611 patients with MHEs. The proportion of MHEs in children presenting to the PED has been increasing since 2017, with a large rise during the COVID-19 pandemic, especially during the 2nd wave (Figure 1). The proportion of female, White, and adolescent patients increased throughout the pandemic. Median SDI was lower compared to pre-pandemic. The proportions of MHEs with anxiety and substance abuse diagnoses were highest in the 1st wave. The proportions of MHEs with depression, eating disorders, and suicide/self-injury diagnoses were highest in the 2nd wave. The proportion of MHEs with autism spectrum disorders was highest during the 3rd wave (Table 1). A greater proportion of pediatric MHEs resulted in hospitalization during the pandemic compared to pre-pandemic (2.9% vs 1.4%; difference 1.5%; 95% CI: 0.9%-2.2%). Descriptively, a higher proportion of Black and Hispanic children returned to the PED within 30 days during the pandemic compared to pre-pandemic (Table 2).Conclusion(s): The proportion of MHEs in children presenting to the PED in NYC rose throughout the COVID-19 pandemic, and was highest during the 2nd wave. Increased admissions may signify higher MHE acuity. Sociodemographic differences in PED visits may represent inequitable access to mental healthcare.
Figure 1. Mental Health-Related PED Visits
Table 1. Patient Characteristics and Primary Mental Health Diagnosis by COVID Wave