Pediatric Behavioral Health Emergencies Before, During, and After the COVID-19 Pandemic

OBJECTIVES: To describe rates and characteristics of pediatric behavioral health (BH) emergency department (ED) visits and hospitalizations before, during, and after the COVID-19 pandemic. METHODS: We performed a repeated cross-sectional analysis of data from the California Department of Health Care Access and Information Emergency Discharge database, a database of visits to all California EDs. We included all patients aged 6 to 17 who presented to the ED between September 2018 and December 2022. We compared rates and disposition of BH ED visits during 3 time periods: prepandemic, pandemic, and postpandemic. We conducted logistic regression analysis to assess patient-level characteristics associated with BH visits, including race and ethnicity, socioeconomic status, and distance from the ED. RESULTS: We assessed 5,228,930 ED visits, of which 215,460 had a primary BH diagnosis. The pandemic was associated with a relative increase in rates of BH visits and admissions/transfers, compared with prepandemic. Postpandemic, rates of visits and admissions/transfers were similar to prepandemic, with notable exceptions among certain diagnoses and demographic groups. Across time periods, the most common BH visit diagnosis was suicide attempt/ideation, with suicide attempt/ideation remaining elevated postpandemic. Racial and ethnic minority groups had lower odds of BH visits but similar or higher rates of admission/transfer, compared with white patients. Postpandemic, children with public insurance and who live further from a hospital had higher severity of BH ED visits. CONCLUSIONS: Postpandemic, there appears to be an ongoing pediatric BH crisis and persistent disparities. There is a continued need for improved and equitable access to BH care.