During the COVID-19 pandemic, there was a spike in the number of Australian children and adolescents presenting to hospital with mental health issues, according to a new study from UNSW Sydney researchers. The number of emergency department (ED) visits and inpatient admissions declined slightly after COVID-19 restrictions eased, but remained higher than pre-pandemic levels.

The research, published in Paediatrics, is one of the first studies to evaluate the impact of the COVID-19 pandemic on mental health-related hospital presentations in children and adolescents Australia-wide. These findings expand upon the researchers’ previous study, which analysed similar data for this age group in Sydney between January 2020 and February 2021.

“Mental health issues are the leading health concern for children and adolescents in Australia,” said lead author Dr Jahid Khan from UNSW Medicine & Health.

“The study highlights the increasing numbers of children and adolescents presenting to hospitals in mental health crisis during and since the COVID-19 pandemic.”

Increasing mental health hospitalisations

The researchers analysed patient records, for children and adolescents, from six large public paediatric hospitals across New South Wales, Victoria, Western Australia, South Australia and Queensland. They obtained data from over 130,000 ED visits and inpatient admissions, during the COVID-19 restrictions from March 2020 to December 2021, and when restrictions eased from January to June 2022.

During the initial COVID-19 restriction period, there was a 15 per cent increase in ED visits for all mental health conditions. There was also an 8.9 per cent increase for inpatient admissions, but this was not statistically significant.

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The trend was more dramatic for certain scenarios. For example, there was an 82 per cent increase in inpatient admissions for deliberate self-harm (DSH) behaviours, and a 76 per cent increase in ED visits related for eating disorders.

“These two conditions resulted in an estimated 1100 additional ED attendances related to eating disorders, and an estimated 1500 or more additional hospital admissions related to DSH behaviours during the COVID-19 restriction period,” said co-author Dr Nan Hu from UNSW Medicine & Health.  

During January to June 2022, there was a slight decrease in mental health hospital presentations for children and adolescents. However, the numbers remained higher than pre-pandemic levels.

Pandemic effects on mental health

Many aspects of the COVID-19 pandemic and associated restrictions have the potential to affect young people’s mental health. These include uncertainty about the future, illness, social isolation, financial stress, and disruption to education and life routines.

In the meantime, the pandemic affected the way mental healthcare was delivered. There were disruptions to community-based mental health services, for example due to restrictions and staff absences. Also, some people experienced technological and emotional barriers to telehealth services. This may have led to increased use of hospital services for mental health concerns.   

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“The number of mental health-related hospital presentations remained high after the COVID-19 pandemic restrictions were eased. This may be a result of continued pandemic-related stresses and delaying seeking mental health care,” Dr Khan said.   

Implications for our health system

These findings show that the pandemic has compounded the existing stress on Australia’s mental health system. The pressure didn’t ease along with COVID-19 restrictions in 2022, which is a concern as Australia enters ‘COVID normal’.

“This may lead to mental health service crisis, such as health professionals’ burnout, and longer emergency room waiting times and outpatient waiting times,” said senior author Professor Raghu Lingam, who is an academic at UNSW Medicine & Health and the Black Dog Institute, and a paediatrician in the Sydney Children’s Hospital Network.

“This in turn may result in more children and adolescents having acute and worsened mental health conditions, due to potentially reduced access to timely and appropriate mental health services and delayed treatment.”

According to the researchers, additional resources and supports are needed to increase the capacity of the paediatric mental health system. Investment is needed in early interventions that improve children’s mental health, preventing them from needing to use hospital services. Monitoring of hospital presentations related to mental health will also be important into the future.

“Improving the mental health of children and adolescents in Australia should be a top priority given the long-term effects of poor mental health on social, academic, and developmental outcomes,” Prof. Lingam said.