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Pediatric Mental Health Crisis Soars Despite Pandemic in NYC


Pediatric mental health emergency department (MH-ED) visits exceeded the expected rates adjusted for seasonality during each of the first five COVID-19 waves in New York City (NYC).


  • This cross-sectional study analyzed data from the INSIGHT Clinical Research Network database, which encompasses electronic health records from five major medical centers in the NYC metropolitan area.

  • All MH-ED visits of patients aged 5-17 years from January 1, 2016, to June 12, 2022, covering five COVID-19 waves were included.

  • Seasonally adjusted time series and interrupted time series models were used to estimate changes in MH-ED visit rates.

  • Sociodemographic characteristics and the impact of COVID-19 prevalence and societal restrictions on MH-ED visit rates were analyzed.


  • MH-ED visits were consistently higher during each COVID-19 wave compared to the expected prepandemic patterns, with the greatest increase in visit rates during wave 2.

  • Different mental health diagnoses displayed varying patterns of excess MH-ED visits over the five waves, with eating disorders leading to increased visits in all waves and anxiety disorders in all but wave 3.

  • Across all waves, female, adolescent, and Asian patients experienced the highest increases in MH-ED visit rates beyond the predicted baseline levels.

  • No significant associations were observed between MH-ED visit rates and COVID-19 prevalence (cases/10,000 NYC residents) or societal restrictions, measured using the state-level Stringency Index.


“The continued insufficiency of mental health resources (access to outpatient and school-based services, inpatient resources) and sociocultural barriers (services proximal to patients in need, insurance coverage, cultural acceptance to mental health issues) to mental health services contributed to the rise in MH-ED visit rates,” the lead author Deborah Levine, MD, associate professor of clinical emergency medicine and pediatrics at Weill Cornell Medicine, told Medscape Medical News.

“This mental health crisis was present prior to the pandemic and continues despite the attenuation of COVID-19. We need to alleviate the burden on EDs by increasing school-based services, the availability of counsellors and therapists for all insurance coverages, and inpatient beds and ED-based treatments while patients board in the ED,” she added.


The study, conducted by Levine and colleagues, was published online on October 20 in the Pediatrics.


  • The study is based on secondary data with potential misclassification and missing data.

  • Pre-COVID-19 trends were used as the baseline, which may have introduced bias due to residual autocorrelation.

  • The findings are specific to the NYC area and may not represent broader populations.


The study received financial support from RTW Foundation. The authors declared no conflicts of interest.

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  • Posted on November 17, 2023