# Paediatric Emergency Department Mental Health and Behavioural Presentations in Australia Before and After the Onset of the COVID‐19 Pandemic: Retrospective Observational Study

## TL;DR

This study compares mental health and behavioral emergency department visits by children and adolescents in Australia before and during the early years of the COVID-19 pandemic.

## Contribution

The study provides new insights into how the pandemic affected the characteristics of mental health presentations in pediatric emergency care.

## Key findings

- Adolescents and girls were more likely to present during the pandemic period.
- Patients during the pandemic had longer waiting times and ED stays, and were more likely to be admitted.
- There was an increase in cases involving self-harm, eating disorders, and psychosocial stressors during the pandemic.

## Abstract

Although child and adolescent mental health and behavioural presentations to hospital emergency departments (EDs) increased during the first 2 years of the COVID‐19 pandemic (2020 and 2021), little is known about the characteristics of these presentations. We aimed to compare demographic, clinical and psychosocial profiles of paediatric presentations to Australian EDs before and after the onset of the pandemic.

We conducted a retrospective observational study of 100 randomly sampled presentations by children (6–11‐year‐olds) and adolescents (12–17‐year‐olds) to 10 Australian EDs between 1 January and 31 December 2019 (pre‐COVID‐19) and 1 January and 31 December 2021 (COVID‐19). Using a multilevel factor model, we compared the pre‐COVID‐19 and COVID‐19 cohorts regarding demographic characteristics, diagnoses, precipitants, time‐to‐treatment, length of stay, and discharge disposition.

The COVID‐19 period was characterised by increased presentations by adolescents and girls. Compared to the pre‐COVID‐19 cohort, the COVID‐19 cohort experienced increased median waiting times (48 and 72 min, respectively), median length of ED stay (4.7 and 5.4 h), and likelihood of admissions to the ED short stay unit (9.5% and 12.9%). Patients in the COVID‐19 cohort were more likely to present with self‐harm and suicidal thoughts/behaviours, eating disorders, neurodevelopmental and neurocognitive disorders, and psychosocial stressors, and less likely to have diagnoses of disruptive behaviour, impulse control, and conduct disorders.

Young people presenting to the ED in 2021 for mental health reasons were more likely to wait longer, stay longer, have a diagnosis of intentional self‐harm and/or a neurodevelopmental disorder, and report psychosocial stressors.