Mental Health Attendances to the Emergency Department by Children and Young People -a Comparison between Pre-Pandemic and Pandemic Years

ABSTRACT

Aims The COVID-19 pandemic has had an unprecedented impact on the lives of children and young people (CYP);with illness-related anxiety, social/physical distancing, mandatory quarantines, travel restrictions, school closures, isolation and family disruptions having a negative impact on mental wellbeing. While several reports have highlighted high rates of mental health problems and suicidal ideation, few studies have focused on self-harm related hospital attendances by CYP during the pandemic or provided reliable trend analyses in comparison with pre-pandemic data. Our objective was to compare pre-pandemic (2019) and pandemic (2020 and 2021) attendances to the emergency department by CYP, for mental health issues including overdose, self-harm, suicidal ideation/attempt. Methods * Single-centre observation study of CYP of age 8 years to 18 years, attending the emergency department (ED) for overdose, self-harm and suicidal ideation/attempt, from 01/ 01/2019 to 31/12/2021 (36 months). * Eligible patients were identified using discharge diagnostic coding and mental health services database review using search terms including 'overdose', 'deliberate self-harm', 'self-harm', 'self-injury', 'self-injured', 'hurt themselves', 'suicide', 'suicidal', 'suicidal ideation. Results * 1226 patients fulfilled the inclusion criteria. * Number of CYP attending ED in 2019, 2020 and 2021 were 374, 418 and 434 respectively. * Compared to 2019, in 2021 there is a 16% overall increase in the number of CYP attending ED for mental health issues (figure 1). Of note, 2021's analysis shows that the rate of ED attendance was greater in the first 6 months when compared to the latter 6 months. * The greatest increase from 2019 is seen in CYP attending with suicidal intent and overdose (figure 2). * We will be carrying out further data analysis on our inner-city population evaluating the disparities across age, gender and socio-economic status as well as the care journey of reattenders. In addition, data collection will continue in 2022 to evaluate if this trend continues or stabilises post-removal of pandemic restrictions Conclusion * Continuing incremental trend of ED attendances in 2021 despite the easing of pandemic restrictions in July 2021 and vaccine roll-out for 12-16-year-olds in September 2021 suggest a cumulative impact on mental health from the long course of the pandemic. As noted in figure 2, over 60% of the patients seen in 2021 were in the first half of the year, suggesting that continuing lockdowns may have had an impact in attendance. Further, UK youth surveys report that many CYP found the 2021 lockdown harder than the 2020 lockdowns, possibly due to the prolongation of uncertainty over the future.1 * The short and long-term mental health implications of the pandemic should be seen against the background of worsening mental health morbidity in CYP in the UK over the preceding few years, especially as our data shows a large increase in presentations with suicidal ideation/attempt. This calls for a systematic response to widen access to mental health services in the future. (Figure Presented).