We previously reported in May 2021 that pediatric outpatient, emergency department (ED), and hospitalization encounters were more likely to be for mental health conditions than any other diagnosis.1 In another study, we noted that female adolescents were more likely than males to have an outpatient mental health visit, particularly for eating disorders from early 2020 through February 2021.2 As adolescents have returned to in-person schooling and other activities as pandemic-era policies to stay at home have been retired, we evaluated whether these initial trends in increased mental health care have remained. We studied 45,706,313 outpatient, 33,927,152 emergency, and 7,921,464 hospital encounters for patients ages 18 and younger from January 2015 to May 2023 to determine the rate of mental health encounters in various care settings over time.
We found that outpatient encounters for pediatric mental health have decreased from their peak of 4.3% of encounters in April 2020 to 3.4% of encounters in May 2023. The May 2023 rate is about 11% higher than the pre-pandemic rate of 3.1% of encounters in December 2019. Of note, there was a steep drop in all outpatient encounters in April 2020, which may have contributed to the observed increase in the proportion of mental-health-related outpatient encounters.
However, these rates vary quite a bit by sex and age. While outpatient mental health encounter rates for pediatric males are at or below their pre-pandemic levels, rates for pediatric females have increased from their pre-pandemic levels. This finding also holds true when we narrow to the subset of mental health diagnoses related to eating disorders.
Like outpatient encounters for mental health, ED encounters for pediatric mental health have also decreased from their pandemic high, decreasing from a high of 6.7% of pediatric ED encounters in November 2020 to 4.1% in May 2023. The May 2023 rate is similar to pre-pandemic rates, which were around 3.5-4% in late 2019.
As with the outpatient mental health encounters, adolescent females had the highest rates of mental health ED encounters.
Pediatric hospitalizations for mental health did not have the same pandemic increase in rate as outpatient and ED encounters, although hospitalizations did rise slightly to 6.6% in November 2020 and remained elevated until July 2021 when they started to decrease. However, pediatric mental health admissions appear to be on the rise again in 2023, increasing from 5.0% in November 2022 to 5.9% in May 2023. As with the other types of encounters, adolescent females continue to have the highest rate of mental health admissions compared to males and younger age groups.
While rates of pediatric mental health encounters overall have decreased, the increases in mental health encounters for adolescent females continue to outpace any other pediatric demographic. However, as adolescent males are less likely to seek mental health care,3 our observed rates in this study may undercount the true prevalence of mental health needs in the male population.
