新冠疫情早期儿童与心理健康相关的急诊科就诊情况
Mental Health-Related Emergency Department Visits Among Children During The Early COVID-19 Pandemic.
作者信息
Edgcomb Juliet Beni, Benson Nicole M, Tseng Chi-Hong, Thiruvalluru Rohith, Pathak Jyotishman, Bussing Regina, Harle Christopher A, Zima Bonnie T
机构信息
UCLA-Semel Institute for Neuroscience and Human Behavior Department of Psychiatry and Biobehavioral Sciences University of California at Los Angeles Los Angeles California USA.
McLean Hospital Harvard Medical School Belmont Massachusetts USA.
出版信息
Psychiatr Res Clin Pract. 2022 Feb 23;4(1):4-11. doi: 10.1176/appi.prcp.20210036. eCollection 2022 Spring.
OBJECTIVE
To measure univariate and covariate-adjusted trends in children's mental health-related emergency department (MH-ED) use across geographically diverse areas of the U.S. during the first wave of the Coronavirus-2019 (COVID-19) pandemic.
METHOD
This is a retrospective, cross-sectional cohort study using electronic health records from four academic health systems, comparing percent volume change and adjusted risk of child MH-ED visits among children aged 3-17 years, matched on 36-week (3/18/19-11/25/19 vs. 3/16/20-11/22/20) and 12-week seasonal time intervals. Adjusted incidence rate ratios (IRR) were calculated using multivariate Poisson regression.
RESULTS
Visits declined during spring-fall 2020 ( = 3892 vs. = 5228, -25.5%) and during spring ( = 1051 vs. = 1839, -42.8%), summer ( = 1430 vs. = 1469, -2.6%), and fall ( = 1411 vs. = 1920, -26.5%), compared with 2019. There were greater declines among males (28.2% vs. females -22.9%), children 6-12-year (-28.6% vs. -25.9% for 3-5 years and -22.9% for 13-17 years), and Black children (-34.8% vs. -17.7% to -24.9%). Visits also declined for developmental disorders (-17.0%) and childhood-onset disorders (e.g., attention deficit and hyperactivity disorders; -18.0%). During summer-fall 2020, suicide-related visits rose (summer +29.8%, fall +20.4%), but were not significantly elevated from 2019 when controlling for demographic shifts. In contrast, MH-ED use during spring-fall 2020 was significantly reduced for intellectual disabilities (IRR 0.62 [95% CI 0.47-0.86]), developmental disorders (IRR 0.71 [0.54-0.92]), and childhood-onset disorders (IRR 0.74 [0.56-0.97]).
CONCLUSIONS
The early pandemic brought overall declines in child MH-ED use alongside co-occurring demographic and diagnostic shifts. Children vulnerable to missed detection during instructional disruptions experienced disproportionate declines, suggesting need for future longitudinal research in this population.
目的
在2019年冠状病毒病（COVID-19）大流行的第一波期间，测量美国不同地理区域儿童心理健康相关急诊科（MH-ED）就诊情况的单变量和协变量调整趋势。
方法
这是一项回顾性横断面队列研究，使用来自四个学术医疗系统的电子健康记录，比较3至17岁儿童中MH-ED就诊量的百分比变化和调整后的风险，这些儿童在36周（2019年 / 3 / 18至2019年 / 11 / 25与2020年 / 3 / 16至2020年 / 11 / 22）和12周的季节性时间间隔上进行匹配。使用多变量泊松回归计算调整后的发病率比（IRR）。
结果
与2019年相比，2020年春夏季就诊量下降（分别为3892例对5228例，下降25.5%），春季（1051例对1839例，下降42.8%）、夏季（1430例对1469例，下降2.6%）和秋季（1411例对1920例，下降26.5%）。男性下降幅度更大（28.2%，女性为 -22.9%），6至12岁儿童（下降28.6%，3至5岁儿童为 -25.9%，13至17岁儿童为 -22.9%），以及黑人儿童（下降34.8%，其他种族为 -17.7%至 -24.9%）。发育障碍（下降17.0%）和儿童期起病的疾病（如注意力缺陷多动障碍；下降18.0%）的就诊量也有所下降。在2020年夏秋季，与自杀相关的就诊量上升（夏季上升29.8%，秋季上升20.4%），但在控制人口结构变化后，与2019年相比无显著升高。相比之下，2020年春夏季，智力残疾（IRR 0.62 [95% CI 0.47 - 0.86]）、发育障碍（IRR 0.71 [0.54 - 0.92]）和儿童期起病的疾病（IRR 儿童期起病的疾病（IRR 0.74 [0.56 - 0.97]）的MH-ED就诊量显著减少。
结论
疫情早期导致儿童MH-ED就诊量总体下降，同时出现了人口结构和诊断方面的变化。在教学中断期间易被漏诊的儿童下降幅度不成比例，这表明需要对该人群进行未来的纵向研究。
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