Seasonality and school day-based trends in mental-health-related pediatric emergency department visits during COVID-19 in British Columbia.

Objectives: The association between mental health related pediatric emergency department (ED) visits and school attendance during the COVID-19 pandemic remains unclear. We aimed to determine the change in rate of mental health-related pediatric ED visits related to type of school day (i.e., school closure days, school days, winter/summer break days) during the pandemic. We also aimed to compare the number of presentations per week during pandemic school periods to expected values based on pre-pandemic trends.

Methods: We included all pediatric ED visits by children aged 2-17 years between January 1st, 2014, and December 31st, 2022, at a single quaternary pediatric center. We calculated the rate (number of mental health pediatric ED visits by 100,000 children) in British Columbia per day on each type of school day, as well as the rate of visits per week during each school period of the pandemic in comparison to the expected values.

Results: There was a 36% decrease in presentation rates on non-school days relative to school days in both pre-pandemic and pandemic periods. During the two periods of school closure due to pandemic protocols, mental health visits were substantially lower compared to school days during the pandemic. There were fewer mental health pediatric ED visits for three of the four pandemic school years when compared to pre-pandemic trends.

Conclusions: Mental health-related pediatric ED visits were consistently higher on school days than non-school days, including COVID-19 school closure days. In comparison to expected rates based on pre-pandemic trends, mental health-related pediatric ED visits decreased in three of the four school years during the pandemic. Our findings suggest an increased need for mental health support in the ED on school days. They also suggest that EDs should be prepared for mental health demands alongside surges and pandemics.