The number of teenage girls visiting emergency rooms for eating disorders, self-cutting and suicide attempts soared in the second year of the COVID-19 pandemic, a study has found.
Six researchers published the study Wednesday in JAMA Psychiatry. They examined the anonymous private insurance records of 4.1 million youths ages 5 to 17 admitted to hospital emergency departments from March 2019 to February 2022.
Mental health visits increased by 6.7% from 4.7% of youths treated in an emergency room during the year before the pandemic (March 2019-February 2020) to 8.8% of them in the second year (March 2021-February 2022) after public health restrictions started in March 2020, they found.
“This finding was driven largely by a striking spike in mental health ED use among adolescent girls with suicidal thoughts or behaviors and self-injury,” co-author Haiden A. Huskamp, a health economist at Harvard Medical School, told The Washington Times.
Among teen girls, mental health visits soared by 22.1% from 19.2% of those aged 13 to 17 before the pandemic to 24.9% in its second year, the sharpest increase of any group. By comparison, the share of teen boys treated in the ER for emotional issues dropped by 9% from 13.2% of visitors in the same age group before the pandemic to 5.1% of them in year two.
“This contrast is consistent with prior literature showing adolescent females have been more negatively impacted by the pandemic than males,” the researchers wrote. “Multiple factors likely contribute to females’ increase in mental distress, including higher pandemic-related stress, more pandemic-related disruptions to school, and emotional abuse in the home.”
The study found that suicidal ideation, suicide attempts, or self-injury increased by 43.6%, from 39.4% of all girls visiting the ER before the pandemic to 47.5% in the second year. Eating disorder visits increased by 120.4% over the same period.
Emergency departments also treated bipolar, schizophrenia or related disorders; anxiety disorder; adjustment or trauma disorder; conduct or impulse control disorder; attention-deficit or hyperactivity disorder; and autism spectrum disorder.
Study limitations included the fact that the private insurance records covered primarily White and affluent counties across the nation, the researchers noted.
The study also found that children in extreme mental distress waited longer to move from hospital emergency wards to inpatient psychiatric care as a surge in demand overwhelmed mental health providers.
The fraction of visits that resulted in a psychiatric admission rose by 8.4% and the mean length of inpatient psychiatric stays increased by 3.8% over the same period, the study found.
The fraction of episodes where children and teens stayed at least two nights in the hospital before moving to inpatient psychiatric care jumped by 76.4%.
“COVID put further stress on our already stressed mental health system,” said Ms. Huskamp.
The research adds to a pile of emerging reports that show children and teens experienced surges in anxiety, depression and other mental illnesses during COVID lockdowns of schools and public social activities.
U.S. Surgeon General Vivek Murthy has described the spike in youth mental health care needs as the “defining public health crisis of our time.”
According to some mental health providers not involved in the study, the findings confirm what they’ve seen in their hospitals and offices over the past three years.
“The kids are very, very sick, and they’re not getting better as quickly as they used to,” said Dr. John V. Campo, director of child and adolescent psychiatry at Johns Hopkins Children’s Center. “I can’t tell you why; I don’t know why.”
The nation’s emergency rooms were not equipped to deal with emotional breakdowns and are now overwhelmed by the surge in children on suicide watch, he added.
“Kids like predictability, and our lives have been less structured in recent years,” Dr. Campo told The Times. “Some kids are spending more time on social media, and it’s not helping.”
More teenage girls have been texting and chatting on the national 988 Suicide and Crisis Lifeline over the past year, added Timothy Jansen, CEO of Community Crisis Services, a 988 call center in Hyattsville, Maryland.
He said that while lifeline contacts from youths “increased steadily” during the pandemic, boys didn’t end up in the ER as often as girls because they were likelier to use guns in suicide attempts.
“We’re seeing more girls, more suicide, and their mental health isn’t rebounding as quickly as people had hoped,” Mr. Jansen said. “The isolation, the loneliness and the impaired relationships from not seeing each other during lockdowns have continued.”
The JAMA Psychiatry study urges public officials to address shortages and burnout among mental health providers who work with youth.
“Brief therapeutic interventions in the ED, possibly via telemedicine, may even reduce the need for admission,” the researchers wrote. “Long-term, increased reimbursement rates for mental health care could help incentivize hospitals to prioritize psychiatric inpatient care.”
Future mental health outreach should focus on boys in addition to girls, said social psychologist Brett Pelham, a professor at Montgomery College in Maryland who was not involved in the study.
“From a very young age, girls are more likely than boys to acknowledge and seek help for their distress, both physical and psychological,” Mr. Pelham told The Times. “It’s possible that COVID had an equally strong or stronger psychological impact on boys, but that boys were less likely to acknowledge or seek help for their suffering.”
For more information, visit The Washington Times COVID-19 resource page.
• Sean Salai can be reached at ssalai@washingtontimes.com.