Adolescent Total and Mental Health–Related Emergency Department Visits During the COVID-19 Pandemic

IMPORTANCE: Previous research has assessed changes in pediatric and adolescent health care utilization during the COVID-19 pandemic; however, less is known regarding how the pandemic affected adolescents’ use of emergency care, specifically for mental health (MH). OBJECTIVE: To determine how adolescents (ages 12-17 years), compared with other age groups, sought help in emergency departments (EDs) in general and for MH conditions during the COVID-19 pandemic. DESIGN AND SETTING: In this cross-sectional study, National Syndromic Surveillance Program data and the Centers for Disease Control and Prevention Mental Health, version 1, query were used to track patterns in weekly adolescent ED visits by region across the 10 US Department of Health and Human Services regions from January 2019 through December 2021. Data analysis was performed in April and May 2023. MAIN OUTCOMES AND MEASURES: Total ED visits, MH-related ED visits, and the proportion of total ED visits that were MH related by week-region. RESULTS: Both weekly regional ED visits and MH-related ED visits dropped after the onset of the pandemic. Because total ED visits dropped more than MH-related ED visits, the proportion of MH-related ED visits increased for the adolescent group. Total ED visits only returned to prepandemic weekly levels (2019: mean [range], 7358 [715-25 908] visits) in the middle of 2021 (overall in 2021: mean [range], 6210 [623-25 777] visits). Mental health–related visits also dropped in 2020 but rebounded to prepandemic weekly levels (2019: mean [range], 634 [56-1703] visits) by the end of 2020 (mean [range], 533 [39-1800] visits). CONCLUSIONS AND RELEVANCE: This cross-sectional study suggests that families’ perceptions of the need for emergent MH care were reduced during the pandemic by less than their perception of the need for emergency care overall. Emergency departments should be equipped to provide critical care specifically for adolescents facing MH emergencies.