Emergency room visits for teenage girls are increasing during the pandemic
As the coronavirus pandemic dragged on for the second year, growing numbers of American families were so desperate for help for depressed or suicidal children that they rushed them to the emergency room.
A large-scale analysis of private insurance claims shows that this increase in acute mental health crises was largely caused by a single group – girls aged 13-17.
In the second year of the pandemic, compared to pre-pandemic baseline, there was a 22 percent increase in teenage girls visiting the emergency room for a mental health emergency, with increases in the number of patients with suicidal behavior and eating disorders, the 4-year study found .1 million patients published Wednesday in JAMA Psychiatry.
During the same period, March 2021 to March 2022, records showed a 9 percent decrease in teens presenting to the emergency room for mental health issues.
Overall, the proportion of young people who attended an emergency department for their mental health increased 7 percent from pre-pandemic baseline levels. The study was based on privately insured Americans and does not capture what was happening in Medicaid or uninsured households.
Although the study did not set out to explain the large gap between teenage boys and girls, the authors did point out that disruptions at school, separation from their peers, and conflicts at home are stressors that girls may hit particularly hard had.
“I was particularly concerned that suicidal thoughts, behavior, and self-harm were behind it,” said Lindsay Overhage, study author and graduate student in Harvard Medical School’s Department of Health Care Policy.
There is no single explanation for the gender gap in hospitalizations for mental health emergencies, a trend that predates the pandemic.
Research released in 2022 by the Centers for Disease Control and Prevention found that teens are severely affected by parental job loss and food insecurity, with more than half of teens suffering from emotional abuse by a parent and more than one in ten from physical abuse abuse reported. Two-thirds of students said they had trouble completing schoolwork.
Data from the UK found that these difficulties were most pronounced among older girls from poorer households, with the gap narrowing in wealthier households.
The gap may also reflect attitudes toward mental health care, as teenage girls are more likely to share their distress with one another, said Christine M. Crawford, a child and adolescent psychiatrist at Boston Medical Center.
The girls’ peers “may suggest to them, ‘Maybe you should talk to your parents about what’s going on, or maybe you should go and get help,'” said Dr. Crawford. Social media platforms have become a major factor during the pandemic, she said, as teens “searched TikTok for mental health and mental health systems.”
The JAMA study of insurance claims found that emergency department visits — never a good way to provide acute mental health care — have been particularly problematic during the pandemic, with patients often having to wait a long time for inpatient psychiatric beds to become available.
The study found that in the second year of the pandemic, the number of young people who spent two or more nights in an emergency room before admission increased by 76 percent.
Long waits, also known as boarding, increase young people’s stress levels in crisis situations, and their parents “often compared the environment to being incarcerated,” the study says.
Haiden Huskamp, an economist in Harvard Medical School’s Department of Health Care Policy and one of the study’s authors, described this increase as “dramatic, very dramatic” and of particular concern given the lack of care in acute mental health emergencies in emergency departments.
She said staff shortages are most likely a key factor in the sharp rise in boarding school numbers. She said financial incentives — particularly mental health care reimbursement rates — should be adjusted to make more care available to youth.
“It certainly draws attention when the surgeon general comes out and says this is the defining public health crisis of our time,” she said. “But political changes take time and we need to move faster.”