Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
McLean Hospital, Belmont, Massachusetts.
JAMA Psychiatry. 2023 Sep 1;80(9):924-932. doi: 10.1001/jamapsychiatry.2023.2195.
Understanding how children's utilization of acute mental health care changed during the COVID-19 pandemic is critical for directing resources.
To examine youth acute mental health care use (emergency department [ED], boarding, and subsequent inpatient care) during the second year of the COVID-19 pandemic.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional analysis of national, deidentified commercial health insurance claims of youth mental health ED and hospital care took place between March 2019 and February 2022. Among 4.1 million commercial insurance enrollees aged 5 to 17 years, 17 614 and 16 815 youth had at least 1 mental health ED visit in the baseline year (March 2019-February 2020) and pandemic year 2 (March 2021-February 2022), respectively.
The COVID-19 pandemic.
The relative change from baseline to pandemic year 2 was determined in (1) fraction of youth with 1 or more mental health ED visits; (2) percentage of mental health ED visits resulting in inpatient psychiatry admission; (3) mean length of inpatient psychiatric stay following ED visit; and (4) frequency of prolonged boarding (≥2 midnights) in the ED or a medical unit before admission to an inpatient psychiatric unit.
Of 4.1 million enrollees, 51% were males and 41% were aged 13 to 17 years (vs 5-12 years) with 88 665 mental health ED visits. Comparing baseline to pandemic year 2, there was a 6.7% increase in youth with any mental health ED visits (95% CI, 4.7%-8.8%). Among adolescent females, there was a larger increase (22.1%; 95% CI, 19.2%-24.9%). The fraction of ED visits that resulted in a psychiatric admission increased by 8.4% (95% CI, 5.5%-11.2%). Mean length of inpatient psychiatric stay increased 3.8% (95% CI, 1.8%-5.7%). The fraction of episodes with prolonged boarding increased 76.4% (95% CI, 71.0%-81.0%).
Into the second year of the pandemic, mental health ED visits increased notably among adolescent females, and there was an increase in prolonged boarding of youth awaiting inpatient psychiatric care. Interventions are needed to increase inpatient child psychiatry capacity and reduce strain on the acute mental health care system.
了解儿童在 COVID-19 大流行期间急性心理健康护理的利用情况如何变化对于指导资源分配至关重要。
在 COVID-19 大流行的第二年期间，检查青少年急性心理健康护理的使用情况（急诊部[ED]、住院和随后的住院治疗）。
设计、地点和参与者：这是一项针对全国性的、去识别的青少年心理健康 ED 和医院护理商业健康保险索赔的横断面分析，于 2019 年 3 月至 2022 年 2 月之间进行。在 5 至 17 岁的 410 万商业保险参保人中，分别有 17614 人和 16815 人在基线年（2019 年 3 月-2020 年 2 月）和大流行年 2（2021 年 3 月-2022 年 2 月）至少有 1 次心理健康 ED 就诊。
COVID-19 大流行。
从基线到大流行年 2 的相对变化如下：（1）有 1 次或多次心理健康 ED 就诊的青年比例；（2）心理健康 ED 就诊导致住院精神病学收治的百分比；（3）ED 就诊后住院精神病学治疗的平均住院时间；以及（4）在被收入住院精神病科单元之前，在 ED 或医疗单元中长时间（≥2 个午夜）留观的频率。
在 410 万参保人中，51%为男性，41%为 13 至 17 岁（5-12 岁），有 88665 次心理健康 ED 就诊。与基线相比，在大流行年 2 期间，有任何心理健康 ED 就诊的青少年增加了 6.7%（95%CI，4.7%-8.8%）。在青春期女性中，增幅更大（22.1%；95%CI，19.2%-24.9%）。导致精神病学收治的 ED 就诊比例增加了 8.4%（95%CI，5.5%-11.2%）。住院精神病学治疗的平均住院时间增加了 3.8%（95%CI，1.8%-5.7%）。需要延长留观的发作比例增加了 76.4%（95%CI，71.0%-81.0%）。
进入大流行的第二年，青春期女性的心理健康 ED 就诊显著增加，等待住院精神病治疗的青少年需要延长留观的情况增加。需要采取干预措施增加儿童精神病学的住院能力，并减轻急性心理健康护理系统的压力。
