As the coronavirus pandemic dragged through its second year, an increasing number of American families were so desperate to get help for depressed or suicidal children that they brought them to emergency rooms.
A large-scale analysis of private insurance claims shows that this surge in acute mental health crises was 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 emergency compared with a prepandemic baseline, with rises in patients with suicidal behavior and eating disorders, according to the study of 4.1 million patients published on Wednesday in JAMA Psychiatry.
During the same period, March 2021 to March 2022, 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 an emergency room visit related to mental health increased 7 percent over a prepandemic baseline. The study was based on privately insured Americans, and does not capture what was happening in Medicaid or uninsured households.
Though the study did not seek to explain the large gap between teen boys and girls, authors pointed to disruption of 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, an author of the study and a 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 emergencies, a trend that preceded the pandemic.
Research published in 2022 by the Centers for Disease Control and Prevention found teens were heavily affected by parents’ job loss and food insecurity, with more than half of adolescents reporting emotional abuse by a parent and more than one in 10 reporting physical abuse. Two-thirds of students said they had difficulty completing schoolwork.
Data from Britain found that these difficulties were most pronounced for older girls from poorer households, with the gap narrowing in wealthier households.
The gap may also reflect attitudes toward mental health care, with teen girls more likely to share their distress with one another, said Christine M. Crawford, a child and adolescent psychiatrist at Boston Medical Center.
Girls’ peers “may be suggesting to them, Perhaps you should talk to your parents about what’s going on, or perhaps you should go and get some help,” Dr. Crawford said. Social media platforms became an important factor during the pandemic, she said, when teens were “making 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, because 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.
Prolonged waiting, known as boarding, ratchets up stress levels for youth in crisis, and their parents “frequently likened 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 study’s authors, described that increase as “dramatic, very dramatic” and particularly worrisome, since emergency rooms provide little care for acute mental health crises.
She said staffing shortages were most likely a central factor in the sharp rise in boarding. She said financial incentives — particularly reimbursement rates for mental health care — should be adjusted to make more care available for adolescents.
“Certainly having the surgeon general come out and say this is the defining public health crisis of our time draws attention,” she said. “But policy change takes time, and we have to move faster.”
