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Knier K, Weinman A, Mullan A, Cain M, Hevesi S, Bellamkonda VR. Association between school learning models and psychological and social health visits to the emergency room. J Am Coll Emerg Physicians Open 2024; 5:e13157. [PMID: 38634074 PMCID: PMC11021855 DOI: 10.1002/emp2.13157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 02/26/2024] [Accepted: 03/15/2024] [Indexed: 04/19/2024] Open
Abstract
Objectives We aimed to assess the impact of in-person and distance school learning models on children's visits to the emergency department (ED) for psychological or social ("psychosocial") complaints. Methods We analyzed presentations to one emergency department in a mid-sized Midwestern city. We used the public school system schedule to determine in-person and distance learning periods by the grade level. We calculated the incidence of visits to the emergency department during academic years 2018-2019, 2019-2020, and 2020-2021, with particular attention to the time after March 13, 2020, which was the pandemic period. We compared the incidence of visits during in-person versus distance learning school models. Results A total of 7181 visits occurred during the academic years studied, 17.1% due to psychosocial complaints. The incidence of psychosocial visits to the ED was lower during distance learning than during the pandemic in-person learning period (given per 1000 student years: 20.5 vs. 24.1, p = 0.14). This difference was statistically significant among middle schoolers (23.3 vs. 46.6, p < 0.001). While not statistically significant, the difference among high schoolers was pragmatically relevant (38.2 vs. 49.3, p = 0.086). Conclusions Distance learning was associated with a decrease in the incidence of psychosocial visits to the emergency department relative to in-person learning. Future investigation is required to verify results and better understand any causative relationships.
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Affiliation(s)
- Kit Knier
- Mayo Clinic Alix School of Medicine, Mayo Clinic College of Medicine and ScienceRochesterMinnesotaUSA
- Mayo Clinic Medical Scientist Training Program, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic College of Medicine and ScienceRochesterMinnesotaUSA
| | - Aliza Weinman
- Department of Emergency MedicineMayo Clinic College of Medicine and ScienceRochesterMinnesotaUSA
| | - Aidan Mullan
- Department of Biostatistics and InformaticsMayo ClinicRochesterMinnesotaUSA
| | - Meghan Cain
- Department of Emergency MedicineMayo Clinic College of Medicine and ScienceRochesterMinnesotaUSA
| | - Sara Hevesi
- Department of Emergency MedicineMayo Clinic College of Medicine and ScienceRochesterMinnesotaUSA
| | - Venkatesh R. Bellamkonda
- Department of Emergency MedicineMayo Clinic College of Medicine and ScienceRochesterMinnesotaUSA
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Hartnett Y, Alshurafa K, McAndrew J, Daly D, Alsaffar M, Cotter D, Cannon M, MacHale S, Murphy KC, Barry H. One year of psychiatric presentations to a hospital emergency department during COVID-19. Ir J Psychol Med 2023; 40:411-417. [PMID: 35285434 DOI: 10.1017/ipm.2022.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To examine the impact of the first full year of the COVID-19 pandemic and its associated restrictions on the volume and nature of psychiatric presentations to an emergency department (ED) in a large academic hospital. METHODS Anonymised clinical data on psychiatric presentations to the ED were collected for the 52-week period from the start of the COVID-19 pandemic and compared with corresponding 1 year periods in 2019 and 2018. RESULTS There was a significant increase in psychiatric presentations overall to the ED during the first year of the COVID-19 pandemic compared to previous years, in contrast to a reduction in total presentations for all other specialties. There was a marked increase in psychiatric presentations of those below 18 years, and in the 30-39 years and 40-49 years age groups, but a decrease in the 18-29 years group. There was a significant increase in anxiety disorder presentations but a decrease in alcohol related presentations. There was no significant change observed in the rates of presentations for self-harm or suicidal ideation. CONCLUSIONS Psychiatric presentations to the ED have increased during the first year of the COVID-19 pandemic in contrast to a decrease in presentations for other medical specialties, with this increase being driven by out-of-hours presentations. The fourfold increase in presentations of young people below the age of 18 years to the ED with mental health difficulties is an important finding and suggests a disproportionate burden of psychological strain placed on this group during the pandemic.
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Affiliation(s)
- Yvonne Hartnett
- Department of Psychiatry, Beaumont Hospital, Dublin 9, Ireland
| | | | - Joseph McAndrew
- Department of Psychiatry, Beaumont Hospital, Dublin 9, Ireland
| | - Darren Daly
- Department of Psychiatry, Beaumont Hospital, Dublin 9, Ireland
| | | | - David Cotter
- Department of Psychiatry, Beaumont Hospital, Dublin 9, Ireland
- Department of Psychiatry, Education and Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mary Cannon
- Department of Psychiatry, Beaumont Hospital, Dublin 9, Ireland
- Department of Psychiatry, Education and Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Siobhan MacHale
- Department of Psychiatry, Beaumont Hospital, Dublin 9, Ireland
- Department of Psychiatry, Education and Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kieran C Murphy
- Department of Psychiatry, Beaumont Hospital, Dublin 9, Ireland
- Department of Psychiatry, Education and Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Helen Barry
- Department of Psychiatry, Beaumont Hospital, Dublin 9, Ireland
- Department of Psychiatry, Education and Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
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Newton AS, Xie J, Wright B, Lategan C, Winston K, Freedman SB. Visits to Alberta Emergency Departments for Child Mental Health Concerns During the COVID-19 Pandemic: An Examination of Visit Trends in Relation to School Closures and Reopenings. Pediatr Emerg Care 2023; 39:542-547. [PMID: 37246141 PMCID: PMC10317191 DOI: 10.1097/pec.0000000000002979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE We examined emergency department (ED) mental health visit trends by children in relation to periods of school closure and reopening during the COVID-19 pandemic in Alberta, Canada. METHODS Mental health visits by school-aged children (5 to <18 years) were extracted from the Emergency Department Information System, a province-wide database, from March 11, 2020, to November 30, 2021 (pandemic period; n = 18,997) and March 1, 2019, to March 10, 2020 (1-year, prepandemic comparator period; n = 11,540). We calculated age-specific visit rates and compared rate differences between periods of school closure (March 15-June 30, 2020; November 30, 2020-January 10, 2021; April 22-June 30, 2021) and reopening (September 4-November 29, 2020; January 11-April 21, 2021; September 3-November 30, 2021) to matched prepandemic periods. We used a ratio of relative risk to examine the risk of a visit during closures versus reopenings. RESULTS The cohort included 11,540 prepandemic visits and 18,997 pandemic visits. Compared with prepandemic periods, ED visit rates increased across all ages during the first (+85.53%; 95% confidence interval [CI], 73.68% to 100.41%) and third (+19.92%; 95% CI, 13.28% to 26.95%) school closures, and decreased during the second closure (-15.37%; 95% CI, -22.22% to -7.92%). During school reopenings, visit rates decreased across all ages during the first reopening (-9.30%; 95% CI, -13.94% to -4.41%) and increased during the third reopening (+13.59%; 95% CI, 8.13% to 19.34%); rates did not change significantly during the second reopening (2.54%; 95% CI, -3.45% to 8.90%). The risk of a visit during school closure versus reopening was only higher for the first closure with 2.06 times the risk (95% CI, 1.88 to 2.25). CONCLUSIONS Emergency department mental health visit rates were highest during the first school closure of the COVID-19 pandemic, and the risk of a visit during this closure period was twice compared with when schools first reopened.
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Affiliation(s)
- Amanda S. Newton
- From the Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Jianling Xie
- Departments of Pediatrics and Emergency Medicine
| | - Bruce Wright
- From the Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Conné Lategan
- Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Kathleen Winston
- Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Alongi A, D'Aiuto F, Montomoli C, Borrelli P. Impact of the First Year of the COVID-19 Pandemic on Pediatric Emergency Department Attendance in a Tertiary Center in South Italy: An Interrupted Time-Series Analysis. Healthcare (Basel) 2023; 11:healthcare11111638. [PMID: 37297778 DOI: 10.3390/healthcare11111638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The evidence shows a reduction in pediatric emergency department (PED) flows during the early stages of the COVID-19 pandemic. Using interrupted time-series analysis, we evaluated the impact of different stages of the pandemic response on overall and cause-specific PED attendance at a tertiary hospital in south Italy. Our methods included evaluations of total visits, hospitalizations, accesses for critical illnesses and four etiological categories (transmissible and non-transmissible infectious diseases, trauma and mental-health) during March-December 2020, which were compared with analogous intervals from 2016 to 2019; the pandemic period was divided into three segments: the "first lockdown" (FL, 9 March-3 May), the "post-lockdown" (PL, 4 May-6 November) and the "second lockdown" (SL, 7 November-31 December). Our results showed that attendance dropped by a mean of 50.09% during the pandemic stages, while hospitalizations increased. Critical illnesses decreased during FL (incidence rate ratio -IRR- 0.37, 95% CI 0.13, 0.88) e SL (IRR 0.09, 95% CI 0.01, 0.74) and transmissible disease related visits reduced more markedly and persistently (FL: IRR 0.18, 95% CI 0.14, 0.24; PL: IRR 0.20, 95% CI 0.13, 0.31, SL: IRR 0.17, 95% CI 0.10, 0.29). Non-infectious diseases returned to pre-COVID-19 pandemic levels by PL. We concluded that that the results highlight the specific effect of the late 2020 containment measures on transmissible infectious diseases and their burden on pediatric emergency resources. This evidence can inform resource allocation and interventions to mitigate the impact of infectious diseases on pediatric populations and the health-care system.
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Affiliation(s)
- Alessandra Alongi
- Pediatric Emergency Unit, Di Cristina Hospital, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Civico Di Cristina e Benfratelli, 90127 Palermo, Italy
| | - Francesca D'Aiuto
- Pediatric Emergency Unit, Di Cristina Hospital, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Civico Di Cristina e Benfratelli, 90127 Palermo, Italy
| | - Cristina Montomoli
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Paola Borrelli
- Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, G. d'Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
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5
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Islam F, Milisen K, Gellens M, Enckels J, Kocot E, Sowada C, Sabbe M. Changes in the use and uptake of a national out-of-hours telephone triage service by younger and older patients seeking non-urgent unplanned care surrounding the COVID-19 pandemic in Flanders (Belgium). Acta Clin Belg 2023; 78:87-95. [PMID: 35505275 DOI: 10.1080/17843286.2022.2068296] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND This study seeks to examine if and how the COVID-19 pandemic has prompted changes in the use and uptake of a national out-of-hours (OOH) telephone triage service by younger and older patients seeking non-urgent unplanned care in Flanders (Belgium). METHODS A descriptive study was conducted using registry data obtained from the 1733 OOH telephone triage service in a Flemish region of Belgium. All calls received between 1 January 2019 and 31 December 2020 were analyzed. RESULTS A significant association was found between patient age and period of call (χ2 = 594.54, p < .001). Calls made to the 1733 OOH telephone triage service were significantly less likely to be dispatched to a higher level of urgency by operators compared to calls made before the COVID-19 period (OR = 0.80, 95% CI [0.74-0.85]). While calls concerning older adults were significantly more likely to be dispatched to a higher level of urgency by operators compared to younger adults (regardless of period of call) (65 to 74 yrs: OR = 5.75, 95% CI [4.86-6.80]; 75 to 84 yrs: OR = 15.21, 95% CI [13.18-17.56]; ≥ 85 yrs: OR = 28.77, 95% CI [25.01-33.09]), only 6.7% of all COVID-19 related calls involved older adults over 65 years of age. CONCLUSION Findings showed that there was a general decline in the number of calls dispatched to a higher level of urgency by operators during the COVID-19 period but that there were differences in the use and uptake of these services by younger and older age segments.
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Affiliation(s)
- Farah Islam
- Department of Public Health and Primary Care, KU Leuven University, Leuven, Belgium.,Department of Health Economics and Social Security, Jagiellonian University, Kraków, Poland
| | - Koen Milisen
- Department of Public Health and Primary Care, KU Leuven University, Leuven, Belgium.,Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Marc Gellens
- Emergency Center 112-1733, Philipssite, Leuven, Belgium.,Department of Emergency Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Joël Enckels
- Emergency Center 112-1733, Philipssite, Leuven, Belgium
| | - Ewa Kocot
- Department of Health Economics and Social Security, Jagiellonian University, Kraków, Poland
| | - Christoph Sowada
- Department of Health Economics and Social Security, Jagiellonian University, Kraków, Poland
| | - Marc Sabbe
- Department of Public Health and Primary Care, KU Leuven University, Leuven, Belgium.,Department of Emergency Medicine, University Hospitals Leuven, Leuven, Belgium
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6
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[Inpatient care capacities in child and adolescent psychiatry-increase in emergency admissions during the COVID-19 pandemic?]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2023; 37:12-21. [PMID: 35817994 PMCID: PMC9273683 DOI: 10.1007/s40211-022-00423-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/19/2022] [Indexed: 12/03/2022]
Abstract
The COVID-19 pandemic and the accompanying containment measures have had a fundamental impact on the mental health of children and adolescents. In the present study, the emergency admissions of the first two Corona years (2020/21) at the Department for Child and Adolescent Psychiatry Hall i. T./Innsbruck were retrospectively analysed and compared with the two years before the COVID-19 pandemic (2018/19). There was no change in the total number of emergency admissions in 2020 compared to 2019 before Corona, but in 2021 emergency admissions increased by 40.1%. The pre-Corona (2018/19) gender ratio of 65.4% girls to 34.6% boys did not change in 2020. In 2021, the proportion of girls increased to 74.4%. In the COVID-19 pandemic, acute suicidality increased (+48.3%) while aggression decreased (-51.0%). Acute intoxications increased in the first Corona year and decreased again in 2021. The present study results show that the mental health needs of children and adolescents increased significantly in the course of the COVID-19 pandemic and that this was also reflected in child and adolescent psychiatry. The increased demands must now be met with appropriate care and prevention measures as well as sufficient child and adolescent psychiatric bed capacities in order to mitigate the longer-term psychosocial effects of the COVID-19 pandemic as best as possible.
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7
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Roland D, Gardiner A, Razzaq D, Rose K, Bressan S, Honeyford K, Buonsenso D, Da Dalt L, De T, Farrugia R, Parri N, Oostenbrink R, Maconochie IK, Bognar Z, Moll HA, Titomanlio L, Nijman RGG. Influence of epidemics and pandemics on paediatric ED use: a systematic review. Arch Dis Child 2023; 108:115-122. [PMID: 36162959 DOI: 10.1136/archdischild-2022-324108] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 09/05/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To assess the impact of epidemics and pandemics on the utilisation of paediatric emergency care services to provide health policy advice. SETTING Systematic review. DESIGN Searches were conducted of Medline, EMBASE, CINAHL, Scopus, Web of Science and the Cochrane Library for studies that reported on changes in paediatric emergency care utilisation during epidemics (as defined by the WHO). PATIENTS Children under 18 years. INTERVENTIONS National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies was used. MAIN OUTCOME MEASURES Changes in paediatric emergency care utilisation. RESULTS 131 articles were included within this review, 80% of which assessed the impact of COVID-19. Studies analysing COVID-19, SARS, Middle East respiratory syndrome (MERS) and Ebola found a reduction in paediatric emergency department (PED) visits, whereas studies reporting on H1N1, chikungunya virus and Escherichia coli outbreaks found an increase in PED visits. For COVID-19, there was a reduction of 63.86% (95% CI 60.40% to 67.31%) with a range of -16.5% to -89.4%. Synthesis of results suggests that the fear of the epidemic disease, from either contracting it or its potential adverse clinical outcomes, resulted in reductions and increases in PED utilisation, respectively. CONCLUSIONS The scale and direction of effect of PED use depend on both the epidemic disease, the public health measures enforced and how these influence decision-making. Policy makers must be aware how fear of virus among the general public may influence their response to public health advice. There is large inequity in reporting of epidemic impact on PED use which needs to be addressed. TRIAL REGISTRATION NUMBER CRD42021242808.
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Affiliation(s)
- Damian Roland
- SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Adam Gardiner
- School of Medicine, University of Leicester, Leicester, UK
| | - Darakhshan Razzaq
- Northampton General Hospital NHS Trust, Northampton, Northamptonshire, UK
| | - Katy Rose
- Department of Paediatric Emergency Medicine, St. Mary's Hospital - Imperial College NHS Healthcare Trust, London, UK
- Division of Emergency Medicine, University College London NHS Foundation Trust, London, UK
| | - Silvia Bressan
- Division of Pediatric Emergency Medicine, Università degli Studi di Padova, Padova, Italy
| | - Kate Honeyford
- Health Informatics Team, Division of Clinical Studies, Institute of Cancer Research, London, UK
| | - Danilo Buonsenso
- Department of Women, Child and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy
- Universita Cattolica del Sacro Cuore, Rome, Italy
| | - Liviana Da Dalt
- Division of Pediatric Emergency Medicine, Università degli Studi di Padova, Padova, Italy
| | - Tisham De
- Imperial College Medical School, Imperial College London, London, UK
| | - Ruth Farrugia
- Department of Child and Adolescent Health, Mater Dei Hospital, Msida, Malta
| | - Niccolo Parri
- Emergency Department & Trauma Center, Ospedale Paediatrico Meyer Firenze, Florence, Italy
| | - Rianne Oostenbrink
- Department of General Paediatrics, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Ian K Maconochie
- Department of Paediatric Emergency Medicine, St. Mary's Hospital - Imperial College NHS Healthcare Trust, London, UK
| | - Zsolt Bognar
- Department of Paediatric Emergency Medicine, Heim Pal National Paediatric Institute, Budapest, Hungary
| | - Henriette A Moll
- Department of General Paediatrics, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Luigi Titomanlio
- Pediatric Emergency Department, Hopital Universitaire Robert-Debre, Paris, France
| | - Ruud Gerard Gerard Nijman
- Department of Paediatric Emergency Medicine, St. Mary's Hospital - Imperial College NHS Healthcare Trust, London, UK
- Section of Paediatric Infectious Diseases, Imperial College London, London, UK
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Ludwig-Walz H, Dannheim I, Pfadenhauer LM, Fegert JM, Bujard M. Increase of depression among children and adolescents after the onset of the COVID-19 pandemic in Europe: a systematic review and meta-analysis. Child Adolesc Psychiatry Ment Health 2022; 16:109. [PMID: 36587221 PMCID: PMC9805372 DOI: 10.1186/s13034-022-00546-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/13/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Research points to a high depression burden among youth during the COVID-19 pandemic; however, a lack of systematic evidence exists. We determine the change in depression symptoms among children and adolescents during COVID-19 compared to pre-pandemic baselines. By using country differences in pandemic-related restrictions and school closures in Europe as quasi-experimental design, we evaluate policy impacts on depression. METHODS In this systematic review and meta-analysis, following the PRISMA statement, we searched six databases (MEDLINE, EMBASE, PsycINFO, Cochrane Central, Web of Science, WHO COVID-19) using a peer-reviewed search string up until March 18, 2022 with citation tracking and grey literature searches. No limitations regarding language and effect measures existed. We included studies that compared (1) general depression symptoms or (2) clinically relevant depression rates in children and adolescents (≤ 19 years) before and during the COVID-19 pandemic in Europe. The validated Oxford Stringency Index was used as indicator for pandemic-related restrictions. Screening for eligibility, extracting data from published reports and from unpublished data requested directly from study authors, assessing the study risk of bias and grading certainty of evidence using the GRADE approach, were all done in duplicate. Data were pooled in a random-effects model. PROSPERO CRD42022303714. RESULTS Of 7,422 nonduplicate records, 22 studies with data from 868,634 participants pre-pandemic and 807,480 during pandemic, met full inclusion criteria. For the comparison of depression symptoms before and during the COVID-19 pandemic, moderate certainty of evidence was observed for general depression symptoms (standardized mean difference, 0.21 [95%CI, 0.12-0.30]; I2 = 94%) and low certainty of evidence for clinically relevant depression rates (odds ratio, 1.36 [95%CI, 1.05-1.76]; I2 = 95%) for total population. Increase in general depression symptoms was higher for male adolescents, whereas increase in clinically relevant depression rates was higher for females. Effect estimates were significantly higher when pandemic-related restrictions were more stringent or school closure occurred. CONCLUSION An increase in depression symptoms occurred in a pre-pandemic vs. during-pandemic comparison within the COVID-19 pandemic, whereby pandemic-related restrictions (such as school closures) resulted in a considerable effect increase. Ensuring adequate supply of mental health recovery services and long-term monitoring is of high public health relevance.
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Affiliation(s)
| | - Indra Dannheim
- grid.430588.2Regional Innovative Centre of Health and Quality of Live Fulda (RIGL), Fulda University of Applied Sciences, Fulda, Germany ,grid.430588.2Department of Nutritional, Food and Consumer Sciences, Fulda University of Applied Sciences, Fulda, Germany
| | - Lisa M. Pfadenhauer
- grid.5252.00000 0004 1936 973XInstitute for Medical Information Processing, Biometry and Epidemiology-IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany ,Pettenkofer School of Public Health, Munich, Germany
| | - Jörg M. Fegert
- Department for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center, Competence Domain Mental Health Prevention, Ulm, Germany
| | - Martin Bujard
- grid.506146.00000 0000 9445 5866Federal Institute for Population Research (BiB), Wiesbaden, Germany ,grid.7700.00000 0001 2190 4373 Institute for Medical Psychology, Medical Faculty, University Heidelberg, Heidelberg, Germany
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9
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Erez G, Yakubovich S, Sadeh H, Shoval G, Schoen G, Meiri G, Hertz-Palmor N, Butler T, Barzilai Y, Mosheva M, Gothelf D, Bloch Y. Pediatric psychiatric emergency rooms during COVID-19: a multi-center study. BMC Psychiatry 2022; 22:828. [PMID: 36575441 PMCID: PMC9793352 DOI: 10.1186/s12888-022-04371-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/05/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The COVID-19 (SARS-CoV-2) pandemic has been a major stressor for the mental health and well-being of children and adolescents. Surveys and reports from hotlines indicate a significant rise in mental health problems. As the psychiatric emergency room (ER) is a first-line free-of-charge facility for psychiatric emergencies, we expected to see a significant increase in visits, specifically of new patients suffering from anxiety, depression, or stress-related disorders. METHODS Data from two psychiatric hospital ERs and one general hospital were included. All visits of children and adolescents from the computerized files between March and December of 2019 were analyzed anonymously and compared to the same months in 2020, using multilevel linear modeling. RESULTS There was a significant decline in the total number of visits (p = .017), specifically among those diagnosed as suffering from stress-related, anxiety, and mood disorder groups (p = .017), and an incline in the proportion of visits of severe mental disorders (p = .029). DISCUSSION The limited use of child and adolescent psychiatric emergency facilities during the pandemic highlights the importance of tele-psychiatry as part of emergency services. It also suggests the importance of the timeline of the emergence of clinically relevant new psychiatric diagnoses related to the pandemic. Future studies are needed to establish the long-term effects of the pandemic and the expeditious use of tele-psychiatry.
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Affiliation(s)
- Galit Erez
- grid.415607.10000 0004 0631 0384Shalvata Mental Health Center and Tel Aviv University, Hod Hasharon, Israel
| | - Sol Yakubovich
- grid.415607.10000 0004 0631 0384Shalvata Mental Health Center, Hod Hasharon, Israel
| | - Hadar Sadeh
- grid.7489.20000 0004 1937 0511Soroka Medical Center and Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Gal Shoval
- grid.415340.70000 0004 0403 0450Geha Mental Health Center and Tel Aviv University, Petah Tikva, Israel
| | - Gila Schoen
- grid.415340.70000 0004 0403 0450Geha Mental Health Center and Tel Aviv University, Petah Tikva, Israel
| | - Gal Meiri
- grid.7489.20000 0004 1937 0511Soroka Medical Center and Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Nimrod Hertz-Palmor
- grid.413795.d0000 0001 2107 2845Sheba Medical Center and Tel Aviv University, Ramat Gan, Israel
| | - Tali Butler
- grid.415739.d0000 0004 0631 7092Ziv Medical Center (Safed) and Bar-Ilan University, Safed, Israel
| | - Yael Barzilai
- grid.415607.10000 0004 0631 0384Shalvata Mental Health Center, Hod Hasharon, Israel
| | - Mariela Mosheva
- grid.413795.d0000 0001 2107 2845Sheba Medical Center and Tel Aviv University, Ramat Gan, Israel
| | - Doron Gothelf
- grid.413795.d0000 0001 2107 2845Sheba Medical Center and Tel Aviv University, Ramat Gan, Israel
| | - Yuval Bloch
- Shalvata Mental Health Center and Tel Aviv University, Hod Hasharon, Israel.
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10
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Nenna R, Zeric H, Petrarca L, Mancino E, Midulla F. Weighing policymaking: A narrative review of school closures as COVID-19 pandemic-mitigation strategies. Pediatr Pulmonol 2022; 57:1982-1989. [PMID: 34894111 DOI: 10.1002/ppul.25787] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 11/30/2021] [Accepted: 12/07/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION In the era of data-driven decision-making, unacceptable haziness, and inconsistency surrounds the yearlong scientific and public debate on the school closure policy in the coronavirus disease-2019 (COVID-19) pandemic mitigation efforts. AIM The present literature review stems out of the need for a clear scaffold collecting in one place all current evidence, as well as helping to organize incoming future evidence, concerning both the role of schools in driving the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) community spread and the cost-effectiveness of school closure in containing such spread. METHODS References for this review were initially identified through searches of PubMed, Scopus, and Cochrane Library for articles published from March 2020 to March 2021 by the use of key terms "Schools," "COVID-19," "pandemic," "clusters," "outbreak," and "seroprevalence," selecting all articles from 2020 to 2021 with full-text availability. A further search was undertaken by screening citations of articles found in the original search and through Google Scholar and ResearchGate. RESULTS Overall, evidence shows that opening schools and keeping them open in the context of the SARS-CoV-2 pandemic is possible, although behaviorally challenging and unfeasible if educational facilities or testing services are inadequate. Contrary to other respiratory viruses, children are not chief targets of SARS-CoV-2 infection, transmission, and disease. It also appears that the second wave of the SARS-CoV-2 virus spread in the WHO European region has been unrelated to school re-opening. CONCLUSIONS A fact-based understanding of what is currently known on such a consequential policy is required to provide a basis of evidence for advocacy of either school closure or school opening at times of high-intensity community transmission of SARS-CoV-2.
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Affiliation(s)
- Raffaella Nenna
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Hana Zeric
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Laura Petrarca
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Enrica Mancino
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Fabio Midulla
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
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Dror C, Hertz-Palmor N, Yadan-Barzilai Y, Saker T, Kritchmann-Lupo M, Bloch Y. Increase in Referrals of Children and Adolescents to the Psychiatric Emergency Room Is Evident Only in the Second Year of the COVID-19 Pandemic-Evaluating 9156 Visits from 2010 through 2021 in a Single Psychiatric Emergency Room. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19158924. [PMID: 35897293 PMCID: PMC9332552 DOI: 10.3390/ijerph19158924] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/16/2022] [Accepted: 07/21/2022] [Indexed: 02/01/2023]
Abstract
Introduction: The COVID-19 pandemic affected the wellbeing of children and adolescents. The psychiatric emergency room (ER) is the hub of psychiatric emergencies and reflects clinically significant mental problems. Previous studies compared 2019 and 2020 and observed a decline in ER referrals. The current study focused on the continuous trend of referrals from 2010 to the end of 2021. Method: In our observational retrospective study, we procured data from 9156 child and adolescent referrals to our psychiatric ER. The comparison was made based on similar months of each year. Results: There was a significant positive trend in monthly referrals between 2010 and 2021, representing a similar increase in referrals per month in comparison to that month in the preceding year (unstandardized β = 4.21, 95% CI = 3.44 to 4.98, p < 0.0001). Between March 2020 and February 2021 (monthly visits = 72.5 + 16.6 [median = 79.5], annual referrals = 870), we observed no additive effect beyond this general trend after controlling for population growth. Conversely, between March and December 2021 (monthly referrals = 106.1 + 31.8 [median = 105.5], overall referrals = 1061) we observed a significant additive effect beyond the projected incline, as predicted by previous years (β = 21.61, 95% CI = 12.12 to 31.06, p < 0.0001). Conclusions: The first year of the COVID-19 pandemic was no different from the continuous decade long rise of referrals to the children and adolescents’ psychiatric ER. Conversely, the second year showed an additional incline beyond the general trend. The complexity in this rising need demands the awareness of clinicians and policy makers alike.
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Affiliation(s)
- Chen Dror
- Shalvata Mental Health Center, Hod Hasharon 45100, Israel; (Y.Y.-B.); (T.S.); (M.K.-L.); (Y.B.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Correspondence: (C.D.); (N.H.-P.)
| | - Nimrod Hertz-Palmor
- The Child and Adolescent Psychiatry Division, Sheba Medical Center, Edmund and Lily Safra’s Children Hospital, Ramat Gan 52621, Israel
- School of Psychological Sciences, Tel Aviv University, Tel Aviv 69978, Israel
- Correspondence: (C.D.); (N.H.-P.)
| | - Yael Yadan-Barzilai
- Shalvata Mental Health Center, Hod Hasharon 45100, Israel; (Y.Y.-B.); (T.S.); (M.K.-L.); (Y.B.)
| | - Talia Saker
- Shalvata Mental Health Center, Hod Hasharon 45100, Israel; (Y.Y.-B.); (T.S.); (M.K.-L.); (Y.B.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Maya Kritchmann-Lupo
- Shalvata Mental Health Center, Hod Hasharon 45100, Israel; (Y.Y.-B.); (T.S.); (M.K.-L.); (Y.B.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Yuval Bloch
- Shalvata Mental Health Center, Hod Hasharon 45100, Israel; (Y.Y.-B.); (T.S.); (M.K.-L.); (Y.B.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
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12
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Liang T, Chamdawala HS, Tay ET, Chao J, Waseem M, Lee H, Mortel D, Agoritsas K, Teo HO, Meltzer JA. Pediatric emergency care in New York City during the COVID-19 pandemic shutdown and reopening periods. Am J Emerg Med 2022; 56:137-144. [PMID: 35397354 PMCID: PMC8966116 DOI: 10.1016/j.ajem.2022.03.049] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 12/20/2022] Open
Abstract
Objective New York City (NYC) is home to the largest public healthcare system in the United States and was an early epicenter of coronavirus disease 2019 (COVID-19) infections. This system serves as the safety net for underserved and marginalized communities disproportionately affected by the pandemic. Prior studies reported substantial declines in pediatric emergency department (ED) volume during the initial pandemic surge, but few describe the ongoing impact of COVID-19 throughout the year. We evaluated the characteristics of pediatric ED visits to NYC public hospitals during the pandemic lockdown and reopening periods of 2020 compared to the prior year. Methods Retrospective cross-sectional analysis of pediatric ED visits from 11 NYC public hospitals from January 2019–December 2020. Visit demographics, throughput times, and diagnosis information during the early (3/7/20–6/7/20) and late (6/8/20–12/31/20) pandemic periods coinciding with the New York State of emergency declaration (3/7/20) and the first reopening date (6/7/20) were compared to similar time periods in 2019. Findings were correlated with key pandemic shutdown and reopening events. Results There was a 47% decrease in ED volume in 2020 compared to 2019 (125,649 versus 238,024 visits). After reopening orders began in June 2020, volumes increased but peaked at <60% of 2019 volumes. Admission rates, triage acuity, and risk of presenting with a serious medical illness were significantly higher in 2020 versus 2019 (P < 0.001). Time-to-provider times decreased however provider-to-disposition times increased during the pandemic (P < 0.001). Infectious and asthma diagnoses declined >70% during the pandemic in contrast to the year prior. After reopening periods began, penetrating traumatic injuries significantly increased compared to 2019 [+34%, Relative Risk: 3.2 (2.6, 3.8)]. Conclusions NYC public hospitals experienced a sharp decrease in pediatric volume but an increase in patient acuity during both the initial pandemic surge and through the reopening periods. As COVID-19 variants emerge, the threat of the current pandemic expanding remains. Understanding its influence on pediatric ED utilization can optimize resource allocation and ensure equitable care for future surge events.
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Affiliation(s)
- Tian Liang
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, New York University Langone Health, 550 1st Ave, New York, NY 10016, United States of America; New York City Health + Hospitals, Bellevue, 462 1st Ave, New York, NY 10016, United States of America.
| | - Haamid S Chamdawala
- Department of Pediatrics, Division of Emergency Medicine, New York City Health + Hospitals, Jacobi, 1400 Pelham Pkwy S, Bronx, NY 10461, United States of America; Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461, United States of America
| | - Ee Tein Tay
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, New York University Langone Health, 550 1st Ave, New York, NY 10016, United States of America; New York City Health + Hospitals, Bellevue, 462 1st Ave, New York, NY 10016, United States of America
| | - Jennifer Chao
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, New York City Health + Hospitals, Kings County, 451 Clarkson Ave, Brooklyn, NY 11203, United States of America; State University of New York Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203, United States of America
| | - Muhammad Waseem
- Department of Emergency Medicine, New York City Health + Hospitals, Lincoln, 234 E 149th St, Bronx, NY 10451, United States of America; Weill Cornell Medicine, 1300 York Ave, New York, NY 10065, United States of America
| | - Horton Lee
- Department of Pediatrics, New York City Health + Hospitals, Elmhurst, 79-01 Broadway, Queens, NY 11373, United States of America; Division of Emergency Medicine and Paediatrics, Hospital for Sick Children, 555 University Ave, Toronto, ON, United States of America
| | - David Mortel
- Department of Emergency Medicine, New York City Health + Hospitals, Harlem, 506 Lenox Ave, New York, NY 10037, United States of America; Columbia University College of Physicians & Surgeons, 630 W 168th St, New York, NY 10032, United States of America
| | - Konstantinos Agoritsas
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, New York City Health + Hospitals, Kings County, 451 Clarkson Ave, Brooklyn, NY 11203, United States of America; State University of New York Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203, United States of America
| | - Hugo O Teo
- New York City Health + Hospitals, 125 Worth St, New York, NY 10013, United States of America
| | - James A Meltzer
- Department of Pediatrics, Division of Emergency Medicine, New York City Health + Hospitals, Jacobi, 1400 Pelham Pkwy S, Bronx, NY 10461, United States of America; Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461, United States of America
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13
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Allgaier K, Schneider PS, Buck S, Reusch PA, Hagmann D, Barth GM, Renner TJ. [Child and Adolescent Psychiatric Emergencies During the Second Wave of the SARS-CoV2-19 Pandemic: Findings from the Tübingen University Hospital]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2022; 50:275-285. [PMID: 35225657 DOI: 10.1024/1422-4917/a000858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Child and Adolescent Psychiatric Emergencies During the Second Wave of the SARS-CoV2-19 Pandemic: Findings from the Tübingen University Hospital Abstract. Objective: Child and adolescent psychiatric emergencies during the SARS-CoV2-19 pandemic are part of a controversial discussion. This study investigates the volume of such emergencies, the age of the patients, and the diagnoses of eating disorders and obsessive-compulsive disorders (OCD) that occurred at the Child and Adolescent Psychiatric Center (CAP) Tübingen during the second wave of the pandemic compared to the year before. Methods: We evaluated data on all emergencies at CAP Tübingen (telephone calls, outpatients, patient admissions) from 10/2019-01/2020 (first time period) and 10/2020-01/2021 (second wave). Results: The volume of emergencies during the second wave (319 presentations) was 29.7 % higher than during the first time period, and the number of patients (172 presentations) increased by 10.3 %. Compared to the first time period, the number of inpatients was 27.9 % higher, and the emergency admissions increased by 27.8 %. Patients in the second wave were somewhat older, with an average age of 14.8 years (first period: 14.2 years). Eating disorders were more frequent during the second wave, whereas OCD were more frequent in the first time period. Conclusions: Almost 30 % more emergencies were recorded in the second wave of the pandemic, with especially eating disorders increasing. Systematic emergency records should be documented at all German CAPs to enable demand-oriented planning.
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Affiliation(s)
- Katharina Allgaier
- Abteilung für Psychiatrie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universitätsklinik für Psychiatrie und Psychotherapie, Zentrum für Psychische Gesundheit, Tübingen.,LEAD Graduate School and Research Network, Universität Tübingen
| | - Priska S Schneider
- Abteilung für Psychiatrie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universitätsklinik für Psychiatrie und Psychotherapie, Zentrum für Psychische Gesundheit, Tübingen
| | - Simone Buck
- Abteilung für Psychiatrie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universitätsklinik für Psychiatrie und Psychotherapie, Zentrum für Psychische Gesundheit, Tübingen
| | - Pauline A Reusch
- Abteilung für Psychiatrie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universitätsklinik für Psychiatrie und Psychotherapie, Zentrum für Psychische Gesundheit, Tübingen
| | - Daniela Hagmann
- Abteilung für Psychiatrie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universitätsklinik für Psychiatrie und Psychotherapie, Zentrum für Psychische Gesundheit, Tübingen
| | - Gottfried M Barth
- Abteilung für Psychiatrie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universitätsklinik für Psychiatrie und Psychotherapie, Zentrum für Psychische Gesundheit, Tübingen
| | - Tobias J Renner
- Abteilung für Psychiatrie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universitätsklinik für Psychiatrie und Psychotherapie, Zentrum für Psychische Gesundheit, Tübingen.,LEAD Graduate School and Research Network, Universität Tübingen
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14
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Stewart SL, Vasudeva AS, Van Dyke JN, Poss JW. Following the Epidemic Waves: Child and Youth Mental Health Assessments in Ontario Through Multiple Pandemic Waves. Front Psychiatry 2021; 12:730915. [PMID: 34867522 PMCID: PMC8635704 DOI: 10.3389/fpsyt.2021.730915] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/18/2021] [Indexed: 02/01/2023] Open
Abstract
Emerging studies across the globe are reporting the impact of COVID-19 and its related virus containment measures, such as school closures and social distancing, on the mental health presentations and service utilization of children and youth during the early stages of lockdowns in their respective countries. However, there remains a need for studies which examine the impact of COVID-19 on children and youth's mental health needs and service utilization across multiple waves of the pandemic. The present study used data from 35,162 interRAI Child and Youth Mental Health (ChYMH) assessments across 53 participating mental health agencies in Ontario, Canada, to assess the mental health presentations and referral trends of children and youth across the first two waves of the COVID-19 pandemic in the province. Wave 1 consisted of data from March to June 2020, with Wave 2 consisting of data from September 2020 to January 2021. Data from each wave were compared to each other and to the equivalent period one year prior. While assessment volumes declined during both pandemic waves, during the second wave, child and youth assessments in low-income neighborhoods declined more than those within high-income neighborhoods. There were changes in family stressors noted in both waves. Notably, the proportion of children exposed to domestic violence and recent parental stressors increased in both waves of the pandemic, whereas there were decreases noted in the proportion of parents expressing feelings of distress, anger, or depression and reporting recent family involvement with child protection services. When comparing the two waves, while depressive symptoms and recent self-injurious attempts were more prevalent in the second wave of the pandemic when compared to the first, a decrease was noted in the prevalence of disruptive/aggressive behaviors and risk of injury to others from Wave 1 to Wave 2. These findings highlight the multifaceted impact of multiple pandemic waves on children and youth's mental health needs and underscore the need for future research into factors impacting children and youth's access to mental health agencies during this time.
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Affiliation(s)
| | | | | | - Jeffrey W. Poss
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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15
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Carison A, Babl FE, O'Donnell SM. Increased paediatric emergency mental health and suicidality presentations during COVID-19 stay at home restrictions. Emerg Med Australas 2021; 34:85-91. [PMID: 34708565 PMCID: PMC8652435 DOI: 10.1111/1742-6723.13901] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 11/30/2022]
Abstract
Objective Anecdotal reports indicate an increase in mental health presentations and acuity to EDs during the COVID‐19 pandemic and associated stay at home restrictions. Paediatric and adolescent data to confirm this are unavailable in the Australian setting. Methods Retrospective electronic medical record review of all ED patients with mental health discharge codes at a large tertiary children's hospital in Australia during the period of stay at home restrictions from 1 April to 30 September 2020 compared with the same dates in 2019. Results We found a 40% decrease in ED presentations (18 935–11 235) with a concurrent 47% increase in mental health presentations (809–1190) to ED during the study periods between 2019 and 2020. This resulted in an increase of 100 mental health admissions from ED. Diagnoses with greatest percentage increases were eating disorders, social issues and suicidality. We found suicidality presentation numbers were highest in June to September 2020 compared with 2019. Patients with a diagnosis of suicidality had a higher rate of re‐presentation in 2020 (1.83 presentations per patient) compared to 2019 (1.38 presentations per patient). Conclusions Despite an overall decrease in ED presentations, the absolute increase in mental health presentations for children and adolescents during the stay at home restriction period was pronounced. It is unclear how sustained this change and the impact on mental health resource use will be post‐pandemic.
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Affiliation(s)
- Anna Carison
- Emergency Department, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Franz E Babl
- Emergency Department, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Paediatrics and Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Sinead M O'Donnell
- Emergency Department, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
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16
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Adolescent and young adult stress and coping during COVID-19: the utility of a pediatric emergency department screener. Int J Emerg Med 2021; 14:41. [PMID: 34315406 PMCID: PMC8314256 DOI: 10.1186/s12245-021-00359-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/06/2021] [Indexed: 11/28/2022] Open
Abstract
Background COVID-19 altered lives, especially adolescents and young adults who lost their emotional and social support systems and may be suffering. Objective In response to the coronavirus pandemic, a questionnaire was created and administered to Pediatric Emergency Department (PED) patients in order to identify psychosocial stress and coping abilities. Methods A 12-question (yes/no) quality improvement (QI) paper-based questionnaire was administered by PED providers to assess psychosocial stress and coping among patients 12 years and greater who presented to the PED at a tertiary Children’s Hospital, March-September 2020. Questions were asked/recorded to determine rates of distress and provide social work intervention, if needed. Analysis-Chi-squared, Fisher’s exact, and Mann-Whitney U tests. Results Among 1261 PED patients who participated in the study, the mean age was 15.4 years (SD = 2.4), (58% female, 41.5% male, 0.6% missing data). We identified 611 patients (48.5%) who admitted to feeling scared about contracting the disease, 876 patients (69.5%) who were concerned about the health of their families, and 229 patients (18.2%) who screened positive for food insecurity. In addition, 596 patients (47.3%) felt anxiety, 333 patients (26.4%) felt depressed, and 13 patients (1%) admitted to having suicidal ideation because of COVID-19. The majority of patients, 1165 (92.4%), felt supported during the pandemic. Social work was consulted for 235 (18.6%) of patients participating. Conclusions While patients typically present to PEDs for a somatic complaint, screening their psychosocial and emotional states may reveal underlying mental health concerns that require intervention and at times, assistance from social workers.
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John A, Eyles E, Webb RT, Okolie C, Schmidt L, Arensman E, Hawton K, O'Connor RC, Kapur N, Moran P, O'Neill S, McGuiness LA, Olorisade BK, Dekel D, Macleod-Hall C, Cheng HY, Higgins JP, Gunnell D. The impact of the COVID-19 pandemic on self-harm and suicidal behaviour: a living systematic review. F1000Res 2020; 9:1097. [PMID: 33604025 PMCID: PMC7871358 DOI: 10.12688/f1000research.25522.1] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2020] [Indexed: 12/22/2022] Open
Abstract
Background: The COVID-19 pandemic has caused morbidity and mortality, as well as, widespread disruption to people's lives and livelihoods around the world. Given the health and economic threats posed by the pandemic to the global community, there are concerns that rates of suicide and suicidal behaviour may rise during and in its aftermath. Our living systematic review (LSR) focuses on suicide prevention in relation to COVID-19, with this iteration synthesising relevant evidence up to June 7 th 2020. Method: Automated daily searches feed into a web-based database with screening and data extraction functionalities. Eligibility criteria include incidence/prevalence of suicidal behaviour, exposure-outcome relationships and effects of interventions in relation to the COVID-19 pandemic. Outcomes of interest are suicide, self-harm or attempted suicide and suicidal thoughts. No restrictions are placed on language or study type, except for single-person case reports. Results: Searches identified 2070 articles, 29 (28 studies) met our inclusion criteria, of which 14 articles were research letters or pre-prints awaiting peer review. All articles reported observational data: 12 cross-sectional; eight case series; five modelling; and three service utilisation studies. No studies reported on changes in rates of suicidal behaviour. Case series were largely drawn from news reporting in low/middle income countries and factors associated with suicide included fear of infection, social isolation and economic concerns. Conclusions: A marked improvement in the quality of design, methods, and reporting in future studies is needed. There is thus far no clear evidence of an increase in suicide, self-harm, suicidal behaviour, or suicidal thoughts associated with the pandemic. However, suicide data are challenging to collect in real time and economic effects are evolving. Our LSR will provide a regular synthesis of the most up-to-date research evidence to guide public health and clinical policy to mitigate the impact of COVID-19 on suicide. PROSPERO registration: CRD42020183326 01/05/2020.
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Affiliation(s)
- Ann John
- Population Psychiatry, Suicide and Informatics, Swansea University, Swansea, UK
- Public Health Wales NHS Trust, Swansea, UK
| | - Emily Eyles
- National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Roger T. Webb
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
| | - Chukwudi Okolie
- Population Psychiatry, Suicide and Informatics, Swansea University, Swansea, UK
- Public Health Wales NHS Trust, Swansea, UK
| | - Lena Schmidt
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ella Arensman
- School of Public Health and National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Keith Hawton
- University Department of Psychiatry, Centre for Suicide Research, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Rory C. O'Connor
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Nav Kapur
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Paul Moran
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | | | - Luke A. McGuiness
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Dana Dekel
- Population Psychiatry, Suicide and Informatics, Swansea University, Swansea, UK
| | | | - Hung-Yuan Cheng
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Julian P.T. Higgins
- National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
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18
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John A, Eyles E, Webb RT, Okolie C, Schmidt L, Arensman E, Hawton K, O'Connor RC, Kapur N, Moran P, O'Neill S, McGuiness LA, Olorisade BK, Dekel D, Macleod-Hall C, Cheng HY, Higgins JP, Gunnell D. The impact of the COVID-19 pandemic on self-harm and suicidal behaviour: update of living systematic review. F1000Res 2020; 9:1097. [PMID: 33604025 PMCID: PMC7871358 DOI: 10.12688/f1000research.25522.2] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 12/19/2022] Open
Abstract
Background: The COVID-19 pandemic has caused considerable morbidity, mortality and disruption to people's lives around the world. There are concerns that rates of suicide and suicidal behaviour may rise during and in its aftermath. Our living systematic review synthesises findings from emerging literature on incidence and prevalence of suicidal behaviour as well as suicide prevention efforts in relation to COVID-19, with this iteration synthesising relevant evidence up to 19 th October 2020. Method: Automated daily searches feed into a web-based database with screening and data extraction functionalities. Eligibility criteria include incidence/prevalence of suicidal behaviour, exposure-outcome relationships and effects of interventions in relation to the COVID-19 pandemic. Outcomes of interest are suicide, self-harm or attempted suicide and suicidal thoughts. No restrictions are placed on language or study type, except for single-person case reports. We exclude one-off cross-sectional studies without either pre-pandemic measures or comparisons of COVID-19 positive vs. unaffected individuals. Results: Searches identified 6,226 articles. Seventy-eight articles met our inclusion criteria. We identified a further 64 relevant cross-sectional studies that did not meet our revised inclusion criteria. Thirty-four articles were not peer-reviewed (e.g. research letters, pre-prints). All articles were based on observational studies. There was no consistent evidence of a rise in suicide but many studies noted adverse economic effects were evolving. There was evidence of a rise in community distress, fall in hospital presentation for suicidal behaviour and early evidence of an increased frequency of suicidal thoughts in those who had become infected with COVID-19. Conclusions: Research evidence of the impact of COVID-19 on suicidal behaviour is accumulating rapidly. This living review provides a regular synthesis of the most up-to-date research evidence to guide public health and clinical policy to mitigate the impact of COVID-19 on suicide risk as the longer term impacts of the pandemic on suicide risk are researched.
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Affiliation(s)
- Ann John
- Population Psychiatry, Suicide and Informatics, Swansea University, Swansea, UK
- Public Health Wales NHS Trust, Swansea, UK
| | - Emily Eyles
- National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Roger T. Webb
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
| | - Chukwudi Okolie
- Population Psychiatry, Suicide and Informatics, Swansea University, Swansea, UK
- Public Health Wales NHS Trust, Swansea, UK
| | - Lena Schmidt
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ella Arensman
- School of Public Health and National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Keith Hawton
- University Department of Psychiatry, Centre for Suicide Research, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Rory C. O'Connor
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Nav Kapur
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Paul Moran
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | | | - Luke A. McGuiness
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Dana Dekel
- Population Psychiatry, Suicide and Informatics, Swansea University, Swansea, UK
| | | | - Hung-Yuan Cheng
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Julian P.T. Higgins
- National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
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