Association between COVID-19 restrictions and emergency department presentations for paediatric mental health in Victoria, Australia
Harriet Hiscock A B C * , Wanyu Chu A B , Gerard O’Reilly D E , Gary L Freed F , Mary White A B G , Margie Danchin H I and Simon Craig J KA Health Services Research Unit, The Royal Children’s Hospital, 50 Flemington Road, Parkville, Melbourne, Vic., 3052, Australia.
B Health Services, Murdoch Children’s Research Institute, Melbourne, Vic., Australia.
C Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.
D School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia.
E Emergency and Trauma Centre, The Alfred, Melbourne, Vic., Australia.
F Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA.
G Department of Endocrinology & Diabetes, The Royal Children’s Hospital, Melbourne, Vic., Australia.
H Vaccine Uptake Group, Murdoch Children’s Research Institute, Melbourne, Vic., Australia.
I Department of General Medicine, The Royal Children’s Hospital, Melbourne, Vic., Australia.
J Department of Paediatrics, School of Clinical Sciences, Monash University, Clayton, Vic., Australia.
K Paediatric Emergency Department, Monash Medical Centre, Emergency Service, Monash Health, Clayton, Vic., Australia.
Australian Health Review 46(5) 529-536 https://doi.org/10.1071/AH22015
Submitted: 8 December 2021 Accepted: 15 June 2022 Published: 5 July 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA. This is an open access article distributed under the Creative Commons Attribution 4.0 International License (CC BY).
Abstract
Objective To determine the association between coronavirus disease 2019 (COVID-19) restrictions and paediatric mental health emergency department presentations.
Methods Secondary analysis of Victorian Emergency Minimum Dataset data from 38 Victorian public hospital emergency departments. Paediatric patients (birth to <18 years) attending emergency departments with an International Classification of Disease-Australian Modification (ICD-10-AM) diagnosis of a mental health problem between 1 January 2018 and 31 October 2020 were included. We compared pre-COVID-19 (1 January 2018–27 March 2020) to the COVID-19 period (28 March–26 October 2020) to examine the number of mental health presentations by patient age, socioeconomic status, location, and emergency department triage category. A Poisson regression prediction model was built for each diagnosis group to predict the presentation number in the COVID-19 period, assuming the pandemic and associated restrictions had not happened.
Results There were 15 898 presentations (589 presentations/month on average) in the pre-COVID-19 period and 4747 presentations (678 presentations/month on average) in the COVID-19 period. Compared with predicted presentations, there was an increase in observed presentations for eating disorders throughout lockdown (on average, an increase of 36 presentations/month) and for anxiety (11/month) and self-harm (18/month). There were no meaningful changes for mood disorders or developmental and behavioural problems, and presentations for substance abuse mostly fell.
Conclusions Pandemic restrictions were associated with increased emergency department presentations for eating disorders and, to a lesser extent, anxiety and self-harm. Given the ongoing pandemic, clinicians and policy makers must work together to find timely, accessible solutions to better manage these conditions.
Keywords: anxiety, COVID-19, eating disorders, emergency services, healthcare, health services research, mental health, paediatric, self-harm.
References
[1] Johnson SE, Lawrence D, Hafekost J, et al. Service use by Australian children for emotional and behavioural problems: Findings from the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Aust N Z J Psychiatry 2016; 50 887–98.| Service use by Australian children for emotional and behavioural problems: Findings from the second Australian Child and Adolescent Survey of Mental Health and Wellbeing.Crossref | GoogleScholarGoogle Scholar | 26769979PubMed |
[2] Australian Institute of Health and Welfare. Impacts of COVID-19 on Medicare Benefits Scheme and Pharmaceutical Benefits Scheme service use. Canberra: AIHW; 2020. Available at https://www.aihw.gov.au/reports/health-care-quality-performance/covid-impacts-on-mbs-and-pbs/contents/impact-on-mbs-service-use#GP [accessed August 2021]
[3] Leeb RT, Bitsko RH, Radhakrishnan L, et al. Mental health–related emergency department visits among children aged <18 years during the COVID-19 pandemic—United States, January 1–October 17, 2020. Morb Mortal Wkly Rep 2020; 69 1675–80.
| Mental health–related emergency department visits among children aged <18 years during the COVID-19 pandemic—United States, January 1–October 17, 2020.Crossref | GoogleScholarGoogle Scholar |
[4] Hill RM, Rufino K, Kurian S, et al. Suicide ideation and attempts in a paediatric emergency department before and during COVID-19. Pediatrics 2021; 147 e2020029280
| Suicide ideation and attempts in a paediatric emergency department before and during COVID-19.Crossref | GoogleScholarGoogle Scholar | 33328339PubMed |
[5] Dann L, Fitzsimons J, Gorman KM, et al. Disappearing act: COVID-19 and paediatric emergency department attendances. Arch Dis Child 2020; 105 810–1.
| Disappearing act: COVID-19 and paediatric emergency department attendances.Crossref | GoogleScholarGoogle Scholar | 32518141PubMed |
[6] Cheek JA, Craig SS, West A, et al. Emergency department utilisation by vulnerable paediatric populations during COVID-19 pandemic. Emerg Med Australas 2020; 32 870–1.
| Emergency department utilisation by vulnerable paediatric populations during COVID-19 pandemic.Crossref | GoogleScholarGoogle Scholar | 32705775PubMed |
[7] Department of Health and Human Services (Victoria). Victorian Emergency Minimum Dataset (VEMD) manual 2020-21, 25th edn. Melbourne: DHHS; 2020. Available at https://www2.health.vic.gov.au/about/publications/policiesandguidelines/vemd-manual-2020-21-sec-1-6 [accessed August 2021]
[8] National Centre for Classification in Health. The International Statistical Classification of Diseases and Related Health Problems. 10th revision, Australian modification (ICD-10-AM), 7th edn. Sydney: NCCH, University of Sydney; 2010.
[9] Australian College for Emergency Medicine. Guidelines on the Implementation of the Australasian Triage Scale in Emergency Departments, 4th edn. Melbourne: ACEM; 2016. Available at https://acem.org.au/getmedia/51dc74f7-9ff0-42ce-872a-0437f3db640a/G24_04_Guidelines_on_Implementation_of_ATS_Jul-16.aspx [accessed August 2021].
[10] Australian Bureau of Statistics. Socio-Economic Indexes for Areas. Canberra: ABS; 2018. Available at https://www.abs.gov.au/websitedbs/censushome.nsf/home/seifa [accessed August 2021]
[11] Australian Bureau of Statistics. The Australian Standard Geographical Classification (ASGC) Remoteness Structure. Canberra: ABS; 2016. Available at https://www.abs.gov.au/websitedbs/D3310114.nsf/home/remoteness+structure [accessed August 2021]
[12] Wright A. Chronology of Victorian border closures due to COVID-19. Melbourne: Parliament of Victoria; 2021.
[13] Say DF, Carison A, Hill A, et al. Mental health presentations to the paediatric emergency department: A retrospective study. J Paediatr Child Health 2021; 57 684–95.
| Mental health presentations to the paediatric emergency department: A retrospective study.Crossref | GoogleScholarGoogle Scholar | 33404176PubMed |
[14] Racine N, McArthur BA, Cooke JE. Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19: A Meta-analysis. JAMA Pediatr 2021; 175 1142–50.
| Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19: A Meta-analysis.Crossref | GoogleScholarGoogle Scholar | 34369987PubMed |
[15] Todd IMF, Miller JE, Rowe SL, et al. Changes in infection-related hospitalizations in children following pandemic restrictions: an interrupted time-series analysis of total population data. Int J Epidemiol 2021; 50 1435–43.
| Changes in infection-related hospitalizations in children following pandemic restrictions: an interrupted time-series analysis of total population data.Crossref | GoogleScholarGoogle Scholar | 34056664PubMed |
[16] Batchelor S, Stoyanov S, Pirkis J, Kõlves K. Use of Kids Helpline by Children and Young People in Australia during the COVID-19 Pandemic. J Adolesc Health 2021; 68 1067–74.
| Use of Kids Helpline by Children and Young People in Australia during the COVID-19 Pandemic.Crossref | GoogleScholarGoogle Scholar | 33858763PubMed |
[17] Sockalingam S, Arena A, Serhal E, et al. Building provincial mental health capacity in primary care: an evaluation of a project ECHO mental health program. Acad Psychiatry 2018; 42 451–7.
| Building provincial mental health capacity in primary care: an evaluation of a project ECHO mental health program.Crossref | GoogleScholarGoogle Scholar | 28593537PubMed |
[18] Olson JR, Benjamin PH, Azman AA, et al. Systematic review and meta-analysis: Effectiveness of wraparound care coordination for children and adolescents. J Am Acad Child Adolesc Psychiatry 2021; 60 1353–66.
| Systematic review and meta-analysis: Effectiveness of wraparound care coordination for children and adolescents.Crossref | GoogleScholarGoogle Scholar | 33785404PubMed |
[19] Spillane IM, Krieser D, Dalton S, et al. Limitations to diagnostic coding accuracy in emergency departments: implications for research and audits of care. Emerg Med Australas 2010; 22 91–2.
| Limitations to diagnostic coding accuracy in emergency departments: implications for research and audits of care.Crossref | GoogleScholarGoogle Scholar | 20152010PubMed |
[20] Woods HC, Scott H. #Sleepyteens: Social media use in adolescence is associated with poor sleep quality, anxiety, depression and low self-esteem. J Adolesc 2016; 51 41–9.
| #Sleepyteens: Social media use in adolescence is associated with poor sleep quality, anxiety, depression and low self-esteem.Crossref | GoogleScholarGoogle Scholar | 27294324PubMed |
[21] Masten AS, Motti-Stefanidi F. Multisystem Resilience for Children and Youth in Disaster: Reflections in the Context of COVID-19. Advers Resil Sci 2020; 1 95–106.
| Multisystem Resilience for Children and Youth in Disaster: Reflections in the Context of COVID-19.Crossref | GoogleScholarGoogle Scholar | 32838305PubMed |
[22] Adegboye D, Williams F, Collishaw S, et al. Understanding why the COVID‐19 pandemic‐related lockdown increases mental health difficulties in vulnerable young children. JCPP Adv 2021; 1 e12005
| Understanding why the COVID‐19 pandemic‐related lockdown increases mental health difficulties in vulnerable young children.Crossref | GoogleScholarGoogle Scholar | 34485985PubMed |
[23] Ferrara P, Franceschini G, Corsello G, et al. Children witnessing domestic and family violence: a widespread occurrence during the Coronavirus Disease 2019 (COVID-19) pandemic. J Pediatr 2021; 235 305–6.e2.
| Children witnessing domestic and family violence: a widespread occurrence during the Coronavirus Disease 2019 (COVID-19) pandemic.Crossref | GoogleScholarGoogle Scholar | 33964263PubMed |
