As the coronavirus pandemic drags into its second year, a growing number of American families are so desperate to get help for depressed or suicidal children that they’ve brought them to emergency rooms.
A large-scale analysis of private insurance claims shows that this increase in acute mental health crises has been driven largely by a single group – girls aged 13 to 17.
During the second year of the pandemic, there was a 22 percent increase in teenage girls who visited emergency rooms with a mental health crisis compared to a pre-pandemic baseline, with increases in patients with suicidal behavior and eating disorders, according to a study of 4.1 million. patients published Wednesday in JAMA Psychiatry.
During the same year, the records showed a 9 percent drop in teenage boys who made emergency room visits for mental health problems.
Overall, the proportion of young people who made a mental health emergency room visit increased 7 percent over a pre-pandemic baseline. The study was based on privately insured Americans, and does not capture what happened in Medicaid or uninsured households.
Although the study did not seek to explain the large gap between adolescent boys and girls, authors pointed to disruption from school, separation from peers and conflict at home as stressors that may have hit girls particularly hard.
“I was especially concerned that it was driven by suicidal thoughts, suicidal behavior and self-harm,” said Lindsay Overhage, study author and doctoral candidate at Harvard Medical School’s Department of Health Care Policy.
No single explanation has emerged for the gender gap in hospitalizations for mental health crises, a trend that predates the pandemic.
Research published in 2022 by the Centers for Disease Control and Prevention found that teenagers were strongly affected by parental job loss and food insecurity, with more than half of teenagers reporting emotional abuse from a parent and more than one in 10 reporting physical abuse. Two-thirds of students said they had difficulty completing schoolwork.
Data from the UK found that these difficulties were most pronounced for older girls from poorer householdswith the gap narrowing in wealthier households.
The gap may also reflect attitudes toward mental health care, with teenage girls more likely to share their distress with each other, said Christine M. Crawford, a child and adolescent psychiatrist at Boston Medical Center.
Girls’ peers “may suggest to them, Maybe you should talk to your parents about what’s going on, or maybe you should go get help,” Dr. Crawford said. Social media platforms have become an important factor during the pandemic, she said, as teenagers “made searches on TikTok about mental health and mental health systems.”
Emergency room visits — never a good way to provide acute mental health care — were especially problematic during the pandemic, as patients often had long waits before inpatient psychiatric beds became available, the JAMA study of insurance claims found.
The second year of the pandemic brought a 76 percent increase in the number of young people who spent two or more nights in an emergency room before admission, the study found.
A long wait, known as boarding, raises stress levels for youth in crisis, and their parents “often compared the environment to incarceration,” the study said.
Haiden Huskamp, an economist at Harvard Medical School’s Department of Health Care Policy and one of the authors of the study, described that increase as “dramatic, very dramatic” and particularly worrisome, because emergency rooms provide little care for acute mental health crises.
She said staff shortages were most likely a central factor in the sharp rise in boardings. She said financial incentives – particularly reimbursement rates for mental health – should be adjusted to provide more care for teenagers.
“Certainly for the surgeon general to come out and say this is the defining public health crisis of our time is telling,” she said. “But political change takes time, and we need to move faster.”