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Among teen girls, weekly emergency department (ED) visits for tic disorders tripled during the pandemic and visits for eating disorders doubled, according to a new study.
“Eating disorders can be triggered by pandemic-related risk factors (e.g., lack of structure in daily routine, emotional distress, and change in food availability) or exacerbated by reduced access to mental health care during the pandemic,” authors wrote in a new Morbidity and Mortality Weekly Report. Pandemic stress also can contribute to tic disorders, they added.
Researchers looked at data from EDs during 2020, 2021 and January 2022 and compared them to the same months in 2019. They found that among girls ages 12-17 years, ED visits for eating and tic disorders increased in 2020. Both of those were elevated again in 2021 in addition to depression and obsessive-compulsive disorder (OCD). In January 2022, visits for anxiety, trauma/stressor-related disorders, eating disorders, tic disorders and OCD all were elevated for teen girls compared to 2019.
Authors said prolonged time at home during the pandemic could cause more stress for some, especially if their parent has increased mental health and substance use challenges or financial hardship. Teens also have experienced the loss of parents and disruptions to school, routines and socialization.
“Early identification and expanded evidence-based prevention and intervention strategies are critical to improving children’s and adolescents’ mental health, especially among adolescent females who might have increased need,” authors wrote.
Late last year, the AAP, American Academy of Child and Adolescent Psychiatry and Children’s Hospital Association declared a national emergency in children’s mental health, and the U.S. surgeon general issued an advisory calling for action to protect the mental health of youths. These declarations came on the heels of data showing mental health ED visits making up a larger proportion of pediatric ED visits and an increase in suicide attempts among teen girls.
In the latest CDC study, visits to the ED for mental health conditions continue to make up a larger proportion of pediatric ED visits than they did before the pandemic even though absolute numbers of mental health ED visits decreased in 2020 and were relatively stable in 2021 and early 2022.
The number of weekly visits for mental health conditions among male and female children and among male adolescents mostly decreased during the pandemic. Authors said males may have different needs for help or may not be as willing to seek help.
In a second study that looked more broadly at ED visits for children during the pandemic, researchers noted older children and adolescents had increases in visits for self-harm, firearm injuries and drug poisonings.
“Comprehensive prevention strategies including strengthening supports to reduce family stress; enhancing access to services and resources; safe storage of firearms and other lethal means; and limiting accessibility to drugs such as cannabis, to reduce use among children and adolescents, can help address these factors,” they wrote.
Overall, pediatric ED visits were down 51% in 2020, 22% in 2021 and 23% in January 2022 compared to 2019.
Authors said families may have been avoiding EDs during the pandemic. They also said there were large decreases in visits for respiratory illnesses other than COVID-19, which may have been due to mitigation measures like masks and physical distancing.
Unsurprisingly, ED visits for COVID-19 and infectious disease screening spiked during the pandemic and were especially high for children under 5 years in January 2022 as the omicron variant surged.
There were increases in visits for some chronic conditions, which authors said, “might indicate a delay of care and routine well child visits; reduced screening; or postponed procedures to reallocate resources during the pandemic.” They encouraged families to seek necessary care for these conditions.
- AAP mental health initiatives
- AAP interim guidance on children’s emotional and behavioral health during the pandemic
- Information for parents from HealthyChildren.org on mental health during the pandemic
- COVID-19 parental resources toolkit on mental health from the CDC
- S. surgeon general advisory “Protecting Youth Mental Health”
- Information from the American Medical Association on integrating behavioral health care into a clinical practice