Trends in Pediatric Mental Health-Related Emergency Department Visits During the School Year and School Breaks.
Lora Henderson Smith, Genevieve R Lyons, Hector A Hernandez Laines and 3 others
PMID 42576345WHAT IT FOUND
School breaks did not coincide with more suicidal ideation visits, but visits during breaks were more often admitted or transferred.
Youth mental health ED visits rose after August 2020.
Key findings
01In 2536 unique patients with 3358 encounters, suicidal ideation was the most common diagnosis code, appearing in 28% of all ICD-10 diagnosis codes.
02Mental health-related ED visit frequency was flat or slightly decreasing before August 2020, then increased after August 2020, with an estimated slope of 0.31 per month and p = 0.0053.
03School break timing was not associated with visits coded for suicidal ideation, but school break visits had about 30% increased odds of inpatient psychiatric admission or transfer compared with school-year visits, and visits coded for suicidal ideation had about three times the odds of admission compared with visits without that code.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study used one academic medical center, so the trends may not match other regions. The data came from electronic health records designed for billing, so diagnoses may be nonspecific, inaccurate, or incomplete. Emergency department visits are for evaluation and stabilization, not definitive mental health diagnosis. School break was inferred from months, not individual school calendars or summer school attendance. Some patients aged 18 may have finished high school. The study cannot show cause, only associations between timing, demographics, and admission. Race and sex categories were limited, and nonbinary or other gender categories could not be analyzed.
Declared interests
The authors declared no conflicts of interest. Funding included the University of Virginia iTHRIV Scholars Program, supported by the National Center for Advancing Translational Sciences of the National Institutes of Health and the University of Virginia, and the National Foundation of Emergency Medicine Scholar/Mentor Program.
The easy way to misread this
Do not conclude that school breaks caused more severe mental health problems or that in-person school protects youth mental health. The study is observational and only links visit timing to admission likelihood. The authors say this interpretation should be made cautiously.