School Reopenings Linked to Surge in Pediatric Psychiatric Crises

Credit: Adobe Stock/Mariya Surmacheva

School openings after the COVID-19 outbreak were associated with increases in the incidence of acute psychiatric emergencies in children and adolescents, according to a study published in JAMA Open Network. These results indicate that school can be a significant source of stress for kids, which can a have considerably negative impact their mental health.

Although research has shown academic pressure can increase stress levels among children, data evaluating this connection has been limited and inconclusive. School disruptions caused by the COVID-19 pandemic offer an interesting opportunity to assess the potential associations the impact of school has on mental health emergencies.

“Investigating possible factors in youth psychiatric emergencies is timely given the steep increase in their number and severity and the trend of increasing suicide rates in youth over the past decade,” wrote lead investigator Chiara Davico, MD, associated with the Department of Public Health and Pediatric Sciences at the University of Turin/Regina Margherita Children’s Hospital in Turin, Italy.

The cross-sectional study included 13,014 cases of pediatric emergency department visits across 9 urban Italian hospitals to determine how the varying degrees of school interruption were linked to changes in emergency department psychiatric visits prior to and after the COVID-19 outbreak. In Italy, the strictest lockdowns began in the spring of 2020 and in-person school was reopened in September 2021. The study evaluated cases between January 1, 2018, and December 31, 2021. Information on demographic characteristics and the type of psychopathologic factors were also collected and assessed.

The primary outcomes were the total number of pediatric emergency department visits, psychiatric emergency department visits and the psychiatric emergency visits categorized by specific reasons, such as suicide ideation, suicide attempt, eating disorders and psychomotor agitation, which were compiled on a weekly basis.

The total number of psychiatric emergency department visits accounted for 1.3% of all pediatric emergency department stays. The mean age of patients was 13.8 years and most (63.2%) were female.

The number of pediatric emergency visits were significantly reduced in 2020 and 2021 compared with 2018 and 2019. However, psychiatric visits steadily increased from .9% in 2018, 1.0% in 2019, 1.4% in 2020 and 2.0% in 2021. The mean age at presentation was significantly lower in 2018 (13.47 years) compared with 2020 (13.75 years) and 2021 (13.94 years).

The main reasons for psychiatric visits were psychomotor agitation (33.1%), anxiety (16.1%), eating disorders (10.4%), suicidal ideation (8.8%) and suicide attempts (8.6%). Among the acute psychiatric emergencies reported, eating disorders, suicidal ideation and suicide attempts were shown to rise over time, with increases of 294.8%, 297.8% and 249.1%, respectively.

The reopening of schools—but not necessarily lockdown restriction—increased the psychiatric visits. This was particularly observed among female patients and for suicide ideation and suicide attempt. However, the severity of lockdown restrictions were linked to an increase in mental health emergencies among female patients and was more prevalent in older adolescents (≥ 14 years) compared with younger children. Regarding other factors, socioeconomic status was linked to increased visits among male patients, but not females.

“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,” investigators concluded. “Future research should address differences in psychological well-being of students by school system as well as the association between school calendar and psychiatric emergency department visits.”