Researchers addressed the association of COVID-19 pandemic-related school disruptions with children’s incidence of acute psychiatric emergencies.
Analyzing psychiatric emergency department (ED) visits among an adolescent population, school openings were significantly associated with an increase in acute psychiatric emergencies, while COVID-19 lockdown restrictions were not. Their findings show an overall need to better understand children’s school-related stress, rather than pandemic-related mental health implications.
“The COVID-19 pandemic disrupted school for millions of students worldwide at different times and with variable intensity. This unique situation can offer an opportunity to study the association between school and psychiatric emergencies. The initial wave of the pandemic in the spring of 2020 was accompanied by a marked overall decrease in all pediatric ED visits but a less pronounced decrease for psychiatric visits,” wrote authors of a study published in JAMA Network Open.1
Indeed, expanding the scope of COVID-19-related mental illness outside of just children, a KFF/CNN survey showed that 90% of US adults believe the country was facing a mental health crisis in 2023.2 With millions of Americans losing their jobs and forced to stay inside, US adults were faced with unprecedented stressors stemming from the COVID-19 pandemic. However, children faced similar types of restrictions but with different implications.
“In Italy, the strictest COVID-19 preventive restrictions (social lockdown with limitation of in-person schooling) started in the spring of 2020 and were in force for most of that year, with gradual attenuation, based on the fluctuating incidence of the infection, in 2021. School was online in many areas, at least during some weeks, until the summer of 2021. In-person school reopened in September 2021,” continued the authors.1
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From early pandemic-related lockdowns in 2020 to children returning to in-person schooling in September 2021, many adolescents’ obligations to attend school across the world were significantly disrupted. In this study, researchers aimed for a better understanding of COVID-19’s effect on adolescents’ ED psychiatric visits.
They analyzed all ED visits at 9 urban hospitals in Italy from January 1, 2018, to December 31, 2021. Researchers included a total of 13,014 ED visits (63.2% women; mean age, 13.8 years) in the study and separated individuals’ visits by category: pediatric ED visits, psychiatric ED visits, and psychiatric ED visits categorized by specific reasons; including psychomotor agitation, suicide ideation or attempt, and eating disorders.
Next, after recording ED visits and separating each into specific categories, researchers found “the disruption in the usual succession of school and holiday periods brought on by the COVID-19 pandemic at different times and with various degrees of intensity.”
From the beginning of 2018 through 2021, adolescent ED psychiatric visits increased over time, with significant increases associated with the opening of schools around the observed locales of Italy. Furthermore, an increase in ED visits were significantly more evident among the female population, finding that suicide attempts and ideations were the main causes of this population’s ED visits. For the male population, however, socioeconomic status was associated with an increase in ED psychiatric visits.
Throughout the study period, researchers found an overall increase in ED psychiatric visits for eating disorders, suicide ideations, and suicide attempts, with each condition increasing by over 249%.
While the first COVID-19-related state of emergency in Italy was announced on January 31, 2020, some variation of lockdowns persisted in the country throughout the study period, until the state of emergency was lifted in 2022, after the study period ended.3 “Another limitation is the time frame of only 4 years, which prevents assessing the trend in psychiatric ED visits antecedent to the pandemic,” wrote the authors.1 While researchers identified the short study window as a limitation to their results, the differences between school openings and closures and their effects on ED psychiatric visits were significant enough to suggest further studies on the social and stressful aspects of schooling and how they affect adolescent mental health.
More importantly, the researchers’ suggestion for future studies is not reliant on the disruptions of school attendance caused by the pandemic. Rather, they suggest future studies focus on the direct effect school openings and closures have on children’s mental health unrelated to COVID-19 restrictions.
“The results support the view that school may be a significant source of stress for youth and point to the need to investigate possible contributing factors, such as perceived academic pressure, individual vulnerabilities, parental expectations, and social stress from peer interaction, as potential mediators of school-associated mental health disturbances in youth. Future research should address differences in psychological well-being of students by school system as well as the association between school calendar and psychiatric ED visits,” they concluded.1
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