Impact of the COVID-19 Pandemic on Child and Adolescent Psychiatric Emergencies

Chiara Davico, MD^a,‡,* ; Daniele Marcotulli, MD, PhD^a,‡ ; Caterina Lux, MD^a ; Dario Calderoni, MD^b ; Luca Cammisa, MD^b ; Claudia Bondone, MD^c ; Martina Rosa-Brusin, MD^a ; Ilaria Secci, MD^a ; Marzia Porro, MD^a ; Roberta Campanile, MD^d ; Chiara Bosia, MD^a ; Federica Di Santo, MD^b ; Arianna Terrinoni, MD^b ; Federica Ricci, MD^a ; Federico Amianto, MD, PhD^e ; Antonio Urbino, MD^c ; Mauro Ferrara, MD^b ; Benedetto Vitiello, MD^a

J Clin Psychiatry 2021;82(3):20m13467

ABSTRACT

Objective: By forcing closure of schools, curtailing outpatient services, and imposing strict social distancing, the COVID-19 pandemic has abruptly affected the daily life of millions worldwide, with still unclear consequences for mental health. This study aimed to evaluate if and how child and adolescent psychiatric visits to hospital emergency departments (EDs) changed during the pandemic lockdown, which started in Italy on February 24, 2020.

Methods: We examined all ED visits by patients under 18 years of age in the 7 weeks prior to February 24, 2020, and in the subsequent 8 weeks of COVID-19 lockdown at two urban university hospitals, in Turin and Rome, Italy. ED visits during the corresponding periods of 2019 served as a comparison using Poisson regression modeling. The clinician’s decision to hospitalize or discharge home the patient after the ED visit was examined as an index of clinical severity.

Results: During the COVID-19 lockdown, there was a 72.0% decrease in the number of all pediatric ED visits (3,395) compared with the corresponding period in 2019 (12,128), with a 46.2% decrease in psychiatric visits (50 vs 93). The mean age of psychiatric patients was higher in the COVID-19 period (15.7 vs 14.1 years). No significant changes were found in hospitalization rate or in the prevalence distribution of the primary reason for the psychiatric ED visit (suicidality, anxiety/mood disorders, agitation).

Conclusions: In the first 8 weeks of the COVID-19–induced social lockdown, the number of child and adolescent psychiatric ED visits significantly decreased, with an increase in patient age. This decrease does not appear to be explained by severity-driven self-selection and might be due to a reduction in psychiatric emergencies or to the implementation of alternative ways of managing acute psychopathology.

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