In a recent study published in JAMA Network Open, researchers investigate the association between coronavirus disease 2019 (COVID-19) pandemic-related school disruptions and youth mental health emergencies in Italy.

Study: COVID-19 Pandemic School Disruptions and Acute Mental Health in Children and Adolescents. Image Credit: shisu_ka / Shutterstock.com

How did the pandemic affect psychiatric care?

Previous research suggests that school days are associated with increased visits to psychiatric emergency departments (ED), especially for self-harm and aggression. When schools were closed during the COVID-19 pandemic, a significant reduction in pediatric ED visits was observed; however, visits for psychiatric emergencies did not decline to the same degree.

Understanding the relationship between the transition back to in-person schooling and mental health is crucial, considering the rising rates of youth mental health crises and suicide in recent years.

About the study

The current study’s researchers analyzed changes in the number and types of visits to psychiatric EDs in Italy as schools reopened after prolonged closures during the COVID-19 pandemic. Other factors, such as social restrictions and the socioeconomic status, age, and sex of the patients, were also considered in this analysis.

The current cross-sectional and observational study involved the analysis of hospital records of ED visits by adolescents and children between zero and 17 years of age from the beginning of 2018 to the end of 2021 across nine Italian university hospitals, which served a cumulative population of approximately seven million people.

Researchers collected and examined anonymized data without recruiting participants, thus ensuring that ethical standards were met with approval from a hospital ethics committee. Trained clinicians supervised by experienced psychiatrists reviewed the medical records to identify the psychiatric reasons behind each visit. This ultimately led to a reliability score of 0.90 for the physician assessments.

To analyze the data, school openings were categorized as closure, in-person, and online schooling. The intensity of lockdown measures was recorded each week, whereas patients’ socioeconomic status was determined by calculating deprivation indices for their neighborhoods.

Generalized mixed models were used to evaluate the relationship between psychiatric visits, school opening, and lockdown severity while accounting for differences across the hospitals included in the study.

Study findings

During the study period, 1,017,885 visits to EDs were reported, 1.3% of which were psychiatric visits. The average age of these patients was 13.8 years, and 63.2% of psychiatric visits were reported by female patients.

The number of psychiatric visits rose significantly over the study period. In 2018, 2,655 psychiatric visits were reported, which accounted for 0.9% of all ED visits. By 2021, 4,660 psychiatric visits were reported, which accounted for 2% of all ED visits. The rates of eating disorders, suicidal ideation (SI), and suicide attempts (SA) also significantly increased by 294.8%, 297.8%, and 249.1%, respectively.

School reopening was associated with a 29% increase in psychiatric visits, with each year reporting a 19% increase in these visits. Lockdown severity negatively impacted the number of ED visits.

The main reasons for psychiatric visits to EDs included psychomotor agitation, anxiety, and eating disorders, which accounted for 33%, 16%, and 10.4% of these visits, respectively. These findings indicate that school openings mainly affected females, with a significant increase in visits related to suicidal behavior.

Conclusions

The reopening of schools after COVID-19 restrictions were lifted led to a significant increase in acute psychiatric emergencies, particularly among females. These findings emphasize the need to better understand how academic and social pressures at school contribute to mental health issues.

Key strengths of the study include its large sample size from nine major hospitals, which provides a comprehensive view of pediatric ED visits during the COVID-19 pandemic. However, notable limitations of the current study include the lack of epidemiological sampling, which may affect the generalizability of the results. The four-year study period also restricts insights into long-term trends before the pandemic.

Future studies are needed to identify the specific factors that lead to mental health disturbances in students, such as academic pressure and social dynamics. Differences in mental health outcomes based on sex and socioeconomic status, as well as the effects of various school systems, also necessitate additional research. Understanding these factors will improve mental health support for children and adolescents in educational settings.