Officials predicted negative consequences for youth – and now we have the data.

In the weeks and months following the beginning of the coronavirus pandemic here in the U.S., professionals who work with children and adolescents warned that young people might experience a wide range of negative consequences as a result of the various mitigation strategies prescribed by our public health officials.

Virtual school, social distancing, shelter-in-place orders, and restrictions on non-essential travel would have complicated consequences for everyone, they told us. But our children and teens would be at increased risk of mental health, developmental, and social issues that could impact their lives for years to come.

Whereas many adults develop coping mechanisms throughout their lives to efficiently and productively process stress and trauma, most youths have yet to develop a robust set of coping strategies – and those who have are in the early stages of developing them. Add to that the fact that adolescence is the time when the symptoms of many mental health disorders first appear, and mental health professionals – especially those with expertise in child and adolescent development – told us to prepare for what might be a legitimate mental health crisis.

When we first heard those predictions, they seemed logical, but also on the alarmist side. Our kids need in-person school for a variety of reasons. We can all agree on that. However, last March, no one knew how long the mitigation strategies would last. No one knew if the expert predictions would play out as predicted. And among those who thought the experts were right overall, no one knew the details of exactly how the problems would play out.

Now, almost a year later, the data are coming in.

While we’re not ready to jump up and shout “Crisis!” – we are concerned we may be heading in that direction.

CDC Report on Emergency Room Visits

The Centers for Disease Control (CDC) collect a vast amount of data every day on disease, injury, and mortality from hospitals around the country. They publish the data in its initial form in reports called MMWRs – the Morbidity and Mortality Weekly Report. Clearly, they’ve been preoccupied with the pandemic itself for the past year, but their work on MMWRs for non-coronavirus related issues continued unabated.

We’d like to take a moment to be cheerleaders for the rank and file CDC scientists who go to work every day to help us – and the world – understand the health issues that affect us all every day. The CDC is a national treasure and we’re all the better for its presence in our lives.

Now – back to the topic.

Last November, the CDC published an MMWR with details on mental health-related emergency room visits for children and adolescents during the pandemic. They analyzed the mountains of data collected from hospitals between January 1^st, 2020, and October 17^th, 2020 – and their conclusions show that expert predictions about youth mental health were well-founded.

We’re not necessarily in a full-blown youth mental health crisis, but we do need to respond proactively to the available data, or that’s where we may find ourselves in the near future.

Let’s take a look at that data.

Increases in Key Metrics

We’ll start by comparing the first eleven weeks of 2019 with the first eleven weeks of 2020:

• The average number of mental health-related (MH) Emergency Department (ED) visits was 25% higher between January 1^st, 2020, and March 14^th, 2020 than for the same period during 2019.
• The proportion of MH visits during this period in 2020 was about the same as the corresponding period in 2019.

What this means is that overall, more children and teens sought help for mental health problems than ever before – but as a percentage of overall pediatric ER visits, the increase in mental health visits was not statistically significant.

Now let’s look at what happened between March 14^th and October 17^th.

Heres’ that data:

• The total number of MH/ED visits for children and teens decreased from mid-March 2020 through early April. This matches the first weeks of national shelter-in-place orders.
• The proportion of MH/ED visits for children and teens increased 50% compared to the same period in 2019.

What this means is that although the total number of ED visits decreased – as is expected, given the pandemic – the relative share of those visits for MH reasons increased significantly – but 50 percent, as you can see.

Now let’s look at what happened, big picture, between March and October 2020, as compared to the same period in 2019.

Heres’ that data:

• March – October 2019, Average MH/ED Visits per 100,000:
  • Kids 0-4: 75
  • Kids 5-11: 782
  • Teens 12-17: 3,098
• March – October 2020, Average MH/ED Visits per 100,000:
  • Kids 0-4: 81
  • Kids 5-11: 972
  • Teens 12-17: 4,051

Hidden in the data is an increase of 66 percent in MH/ED visits for all kids for the week of April 12-18, 2020, as compared to the same week in 2019.

Let’s talk about all these numbers now.

What the Data Tell Us

This data shows that from 2019-2020, MH/ED visits for March-October for kids age 0-4 increased 8 percent, MH/ED visits for kids age 5-11 increased 25 percent, and MH/ED visits for teens age 12-17 increased 31 percent. The data for that one week in April reveal the short-term response to our national shelter-in-place orders: mental health visits for kids increased dramatically, which – as we read these numbers – many kids had a tough time, at the beginning.

Another trend the raw numbers do not show is that between March and October 2020, the number of MH/ED visits for kids and teens gradually increased and leveled off at a number 50 percent higher than during 2019.

We know that’s a lot of data to throw at you, but we have a point that’s unrelated to your math skills and facility with statistical interpretation:

The pandemic is having a negative effect on our children’s mental health – and it’s more pronounced among teens age 12-17 than among the other age groups.

That’s what the data tell us.

What We Can Do

The first thing we can do is understand that the expert warnings of a year ago are beginning to be confirmed by trustworthy data. Additional reports on the prevalence of suicide, binge-drinking, and rates of depression are cause for concern, bordering on alarm.

With that said – clearly for everyone in the back – we need to reiterate the fact that we can meet and overcome these challenges. Mental health professionals know how to help people process toxic stress. They know how to help people who experience significant trauma process and move past that trauma. They know how to help people with alcohol or substance use disorders achieve sobriety and maintain long-term recovery. And they know how to help people with mental health disorders, such as depression, manage their symptoms and live life on their own terms.

We know they can do these things because that’s what we do. We’re experts at helping teens handle these exact issues. The CDC recommends that all parents, teachers, therapists, and public health officials increase their vigilance and monitor our children and teens more closely than ever. And if they see any signs or symptoms of mental health or substance use disorders in our children and teens, they recommend professional support and treatment.

One more thing we know: the CDC recommends support and treatment, because support and treatment works – the sooner, the better.