Characteristics of adolescents with mental health emergencies requiring inpatient psychiatric hospitalization
DOI:
https://doi.org/10.18203/2349-3291.ijcp20261523Keywords:
Adolescent mental health crisis, COVID-19 pandemic, Mental health disorders, Pediatric psychiatric hospitalizationAbstract
Background: Pediatric psychiatric crisis was pushed to the forefront during the COVID-19-pandemic. Emergency departments (ED) and inpatient pediatric hospitals saw much higher volumes of mental health complaints, with many patients staying in these places until definitive care was available. The study objective was to evaluate pediatric psychiatric emergency visits and hospital admissions before and during the pandemic and identify the high-risk features of the patients requiring inpatient psychiatric hospitalization.
Methods: Retrospective chart review of ED and inpatient visits conducted from 3/1/2010-2/29/2022 of adolescents aged 13-18-years with a range of psychiatric diagnoses. Part I included data collection prior to the first case of COVID-19 in Michigan (3/1/2010-3/9/2020), and part II included data collection after the first case (3/10/2020-2/28/2022). Charts of patients needing inpatient psychiatric admissions during the pandemic were reviewed for factors affecting mental health.
Results: Retrospective chart review of ED and inpatient visits conducted from 3/1/2010-2/29/2022 of adolescents aged 13-18-years with a range of psychiatric diagnoses. Part I included data collection prior to the first case of COVID-19 in Michigan (3/1/2010-3/9/2020), and part II included data collection after the first case (3/10/2020-2/28/2022). Charts of patients needing inpatient psychiatric admissions during the pandemic were reviewed for factors affecting mental health.
Conclusions: Decreased prescribed medication use and inconsistent therapy appointments were seen in adolescents requiring inpatient psychiatric hospitalization. Identifying the gaps in care presents an opportunity for reducing the need for inpatient psychiatric care.
References
American Psychological Association (May 2022). Children’s mental health Why is children’s mental health important? Available from: https://www.apa.org/topics/children/mental-health. Accessed on 21 February 2026.
Cassidy-Bushrow AE, Baseer M, Kippen K, Levin AM, Li J, Loveless I, et al. Social distancing during the COVID-19 pandemic: quantifying the practice in Michigan- a “hotspot state” early in the pandemic - using a volunteer-based online survey. BMC Public Health. 2021;21(1):245.
Turning Point of Tampa. What is Driving the Increase in Adolescent Mental Health Issues? 2021. Available from: https://www.tpoftampa.com/ increase-in-adolescent-mental-health-issues/. Accessed on 21 February 2026.
Whitney K. Children’s mental health is in crisis. University of Michigan. 2022. Available from: https://www.michiganmedicine.org/medicine-michigan/childrens-mental-health-crisis. Accessed on 21 February 2026.
Leeb RT, Bitsko RH, Radhakrishnan L, Martinez P, Njai R, Holland KM. Mental health-related emergency department visits among children aged <18 years during the COVID-19 pandemic- United States, January 1-October 17, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:1675-80.
Cama S, Malowney M, Smith AJ, Spottswood M, Cheng E, Ostrowsky L, et al. Availability of outpatient mental health care by pediatricians and child psychiatrists in five US cities. Int J Health Serv. 2017;47(4):621-35.
Shivaram D. Pediatricians say the mental health crisis among kids has become a national emergency. NPR. 2021. Available from: https://www.npr.org/2021/10/20/1047624943/pediatricians-call-mental-health-crisis-among-kids-a-national-emergency. Accessed on 21 February 2026.
Racine N, McArthur BA, Cooke JE, Eirich R, Zhu J, Madigan S. Global prevalence of depressive and anxiety symptoms in children and adolescents during COVID-19: a meta-analysis. JAMA Pediatr. 2021;175(11):1142-50.
Wolff JC, Maron M, Chou T, Hood E, Sodano S, Cheek S, et al. Experiences of Child and Adolescent Psychiatric Patients Boarding in the Emergency Department from Staff Perspectives: Patient Journey Mapping. Adm Policy Ment Health. 2023;50(3):417-26.
Chun TH, Mace SE, Katz ER. American Academy of Pediatrics; Committee on pediatric emergency medicine and American college of emergency physicians; Pediatric emergency medicine committee. Evaluation and management of children and adolescents with acute mental health or behavioral problems. Part I: common clinical challenges of patients with mental health and/or behavioral emergencies. Pediatrics. 2016;138(3):e20161570.
Kalb LG, Stapp EK, Ballard ED, Holingue C, Keefer A, Riley A. Trends in psychiatric emergency department visits among youth and young adults in the US. Pediatrics. 2019;143(4):e20182192.
Hua LL, Lee J, Rahmandar MH, Sigel EJ. Committee on adolescence, council on injury, violence and poison prevention. Suicide and suicide risk in adolescents. Pediatrics. 2024;153(1):e2023064800.
Foy JM, Green CM, Earls MF. Committee on psychosocial aspects of child and family health, mental health leadership work group. Mental health competencies for pediatric practice. Pediatrics. 2019;144 (5):e20192757.
Solmi M, Estradé A, Thompson T, Agorastos A, Radua J, Cortese S, et al. Physical and mental health impact of COVID-19 on children, adolescents, and their families: The Collaborative Outcomes study on Health and Functioning during Infection Times-Children and Adolescents (COH-FIT-C&A). J Affect Disord. 2022;299:367-76.
Mojtabai R, Olfson M. National Trends in Mental Health Care for US Adolescents. JAMA Psychiatr. 2020;77(7):703-714.
Banks J, Xu XW. The mental health effects of the first two months of lockdown during the COVID-19 pandemic in the UK. Fisc Stud. 2020;41:685-708.
Kauhanen L, Wan Mohd Yunus WM, Lempinen L, Peltonen K, Gyllenberg D, Mishina K, et al. A systematic review of the mental health changes of children and young people before and during the COVID-19 pandemic. Eur Child Adolesc Psychiatr. 2023;32(6):995-1013.
Bignardi G, Dalmaijer ES, Anwyl-Irvine AL, Smith TA, Siugzdaite R, Uh S, et al. Longitudinal increases in childhood depression symptoms during the COVID-19 lockdown. Arch Dis Childhood 2020;106(8):791-7.
Ravens-Sieberer U, Kaman A, Erhart M, Devine J, Schlack R, Otto C. Impact of the COVID-19 pandemic on quality of life and mental health in children and adolescents in Germany. Eur Child Adolesc Psychiatr. 2021;31:879-89.
Wang CY, Zhao H, Zhang HR. Chinese college students have higher anxiety in new semester of online learning during COVID-19: a machine learning approach. Front Psychol 2020;11:587413.
Chen X, Qi H, Liu R, Feng Y, Li W, Xiang M, et al Depression, anxiety and associated factors among Chinese adolescents during the COVID-19 outbreak: a comparison of two cross-sectional studies. Translat Psychiatr. 2021;11:148.
Magson NR, Freeman JYA, Rapee RM, Richardson CE, Oar EL, Fardouly J. Risk and protective factors for prospective changes in adolescent mental health during the COVID-19 pandemic. J Youth Adolesc. 2021;50:44-57
Thorisdottir IE, Asgeirsdottir BB, Kristjansson AL, Valdimarsdottir HB, Jonsdottir Tolgyes EM, Sigfusson J, et al. Depressive symptoms, mental wellbeing, and substance use among adolescents before and during the COVID-19 pandemic in Iceland: a longitudinal, population-based study. Lancet Psychiatr. 2021;8(8):663-72.
Miranda-Mendizabal A, Castellví P, Parés-Badell O, Alayo I, Almenara J, Alonso I, et al. Gender differences in suicidal behavior in adolescents and young adults: systematic review and meta-analysis of longitudinal studies. Int J Public Health. 2019;64(2):265.
Hoffmann JA, Alegría M, Alvarez K, Anosike A, Shah PP, Simon KM, et al. Disparities in Pediatric Mental and Behavioral Health Conditions. Pediatrics. 2022;150(4):e2022058227.
Joyce VW, King CD, Nash CC, Lebois LAM, Ressler KJ, Buonopane RJ. Predicting psychiatric rehospitalization in adolescents. Adm Policy Ment Health. 2019;46(6):807-20.
Edgcomb JB, Sorter M, Lorberg B, Zima BT. Psychiatric readmission of children and adolescents: a systematic review and meta-analysis. Psychiatr Serv. 2020;71(3):269-79.
Madden A, Vajda J, Llamocca EN, Campo JV, Gorham TJ, Lin S, et al. Factors associated with psychiatric readmission of children and adolescents in the US: a systematic review of the literature. Gen Hosp Psychiatr. 2020;65:33-42.
Chang H, Yao Z, Zhang Y, Chen J, Shi P. The relationship between abuse and neglect and adolescent suicidality: a moderated mediation model. Front Psychol. 2022;13:1019878.
Kumar P, Srivastava S, Mishra PS, Sinha D. Suicidal ideation among adolescents-the role of sexual abuse, depression, and impulsive behavior. Front Psychiatr. 2021;12:726039.
Campbell K, Peebles R. Eating disorders in children and adolescents: state of the art review. Pediatrics. 2014;134(3):582-92.
Tordoff DM, Wanta JW, Collin A, Stepney C, Inwards-Breland DJ, Ahrens K. Mental health outcomes in transgender and nonbinary youths receiving gender-affirming care. JAMA Netw Open. 2022;5(2):e220978.
Waller CR, Leal AS, Silvers JA. Disparities in depression and anxiety that impact self-identified sexual minority people affect a broader group of same-gender attracted young adults. J Adolesc Health. 2023;73(4):739-45.
Argyriou A, Goldsmith KA, Rimes KA. Mediators of the disparities in depression between sexual minority and heterosexual individuals: a systematic review. Arch Sex Behav. 2021;50:925-59.
Thapar A, Collishaw S, Pine DS, Thapar AK. Depression in adolescence. Lancet. 2012;379:1056-67.
Goodman A, Joyce R, Smith JP. The long shadow cast by childhood physical and mental problems on adult life. Proc Natl Acad Sci. 2011;108:6032-7.
Gaynes BN, Brown C, Lux LJ, Ashok M, Coker-Schwimmer E, Hoffman V, Sheitman B, Viswanathan M. Management strategies to reduce psychiatric readmissions. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD. 2019.