P3.J187: COVID-19 Effect on the Frequency and Characteristics of Children’s Mental Health Presentation to a Safety Net Hospital

Background: 19 months after the onset of the COVID-19 pandemic, a national emergency in child and adolescent mental health was declared in the United States due to soaring mental health complaints among youth. A report by Healthy Children in December 2021 stated that since the start of the COVID-19 pandemic, hospitals have seen more mental health emergencies among kids. This study aims to address the effect of COVID-19 on child and adolescent admission rates, length of stay (LOS), and placement of Baker acts at our hospital, as well as an equity analysis.

Methods: This study was conducted at our large academic institution in Florida. It was approved by our hospital’s Institutional Review Board as a retrospective data collection for children age ≥ 8 years old admitted to the pediatric emergency department or our pediatric unit (hospital) in the period between March 2018 to March 2022 (pandemic start date 03/13/2020). These patients had one or more of the following diagnoses: suicidal ideation, suicide attempt, and behavioral problems such as aggressiveness and violence. Patients with a positive drug screen, patients with severe developmental delay who are non-verbal, and patients with schizophrenia were excluded from the study. We collected age, gender, race, LOS, and Baker Act presence. Mann-Whitney U, Kruskal-Wallis and Fisher’s exact were used as appropriate. We then aggregated the data monthly and performed a Poisson regression with a pre-/post-pandemic indicator variable to determine the effect of the pandemic on the number of patients presenting monthly. All analyses were two-sided with p-value < 0.05 considered significant.

Results: 505 total encounters were collected during the requested period, of which 124 were before COVID-19 and 381 were after (Figure 1). We found no difference in the LOS (median 0.4 days) pre- and post-pandemic (p = 0.562), or across race (p = 0.312). The placement of Baker acts did not differ between the 2 epochs (p = 0.132). There was no difference in gender between the two periods, 67.7% female before COVID-19 and 63.3% female after COVID-19 (p = 0.541). The racial distribution did not change between the epochs (p = 0.948). Median age in the 2 epochs was 15 years and did not change (p =0.680). However, there were younger patients presenting post-pandemic, with the lowest age of 8 years compared to 11 years pre-pandemic (Figure 2). Poisson regression showed that on average post-pandemic months had 2.64 (95% confidence interval, 2.24-3.13) times the number of admissions as pre-pandemic, p < 0.001.

Conclusion: The absolute numbers of mental health presentations tripled after the pandemic, with no change found in the LOS in our hospital before and after the pandemic. This study did not detect any signals of inequity or disparity.