Discussion
Each year from 2018 to 2023, the number and proportion of weekly emergency room visits for eight mental and behavioral health conditions showed seasonal increases during the fall and spring school semesters compared to the summer period; the timing of the increase varied depending on the specific conditions. Trends suggest that students may need additional mental health support during the return to school in the fall and throughout the school year.
Visitation patterns during the spring 2020 school semester showed a relative increase in incidence (visit rate > 1) and lower average weekly visit counts (percentage change < 0) compared to the summer 2019 period These results indicate that the relative proportion of visits was higher while the average weekly number of visits was lower and was likely influenced by the declaration of a public health emergency for the COVID-19 pandemic in March 2020 (1,3).
These findings raise concerns about the challenges American children and adolescents face in school settings (4). Several factors could contribute to these increases. Children and adolescents may face unique school-related stressors**, including transitioning to a new school year or attending a new school, pressure on academic performance and testing, and as school bullying and peer victimization. Social anxiety can lead to worsening mental health, leading to a visit to the emergency room (5–7). Mental health screenings and assessments by schools and providers typically increase at the start of the school year, prompting referrals for care (8). Mental and behavioral health issues may be recognized by school staff when they manifest as classroom behavior problems (e.g., classroom disruptions, poor attendance and academic performance) or when students disclose problems mental health.
Engaging children and adolescents in social and emotional learning (SEL) programs can support their emotional well-being. School-based SEL programs†† provide students and teachers with tools to cope with stressors. Other strategies that have been shown to be effective in promoting and maintaining the emotional well-being of children and adolescents include pediatric mental health care access programs; suicide prevention gatekeeper training; trauma and bereavement interventions; crisis intervention and response services; peer-led approaches to encourage students to seek help; A comprehensive, evidence-based health education curriculum that includes courses on mental health disorders, self-care, substance use prevention, and sexual health education, providing access to local and national mobile emergency services and expanding community service alternatives (2,9,ten).
Multi-sector collaboration and coordination, including government, education and community organizations, is needed to promote and prioritize child and adolescent mental health and to avoid placing responsibility for improvement on institutions alone. of teaching.§§ Evidence-based strategies (e.g., CDC’s Preventing Adverse Childhood Experiences (ACEs): Leveraging the Best Available Evidence Resource)¶¶ provide options for a comprehensive, systemic approach to supporting children and families. State and local government agencies and school partners can collaborate to address children’s behavioral health. CDC approaches, including the Whole School, Whole Community, Whole Child*** model, What Works in Schools program,††† Suicide Prevention Resource for Action,§§§ and the ACE training module may be useful for schools seeking to support or enhance protective factors and respond using trauma-informed methods (7,9). Government agencies can collaborate to establish tailored and culturally appropriate messages.¶¶¶,****,†††† for diverse audiences (e.g., parents and guardians, students, community leaders, health care providers, and education professionals), including social media campaigns about the mental health needs of students during certain periods of the ‘year.§§§§
Boundaries
The findings of this report are subject to at least five limitations. First, the NSSP ED visit data is a convenience sample and is not nationally representative. Second, emergency room visits represent single events, not individual people, and may reflect multiple visits for the same person. Third, the refined categories of the HCUP clinical classification software are not mutually exclusive; Codes may appear in multiple categories. Fourth, findings for children aged 5–9 years should be interpreted with caution, particularly data on suicidal ideation or self-harm, due to low visit volume and uncertainty about intentionality. Finally, because school start and end dates vary within and between regions, some emergency department visits may be misclassified, resulting in an underestimate of the magnitude of the increase in emergency department visits for mental and behavioral health issues; many of these visits may occur outside of emergency departments and the reasons for changes in emergency department visit patterns cannot be determined from these data.
Public health implications
Systemic changes that prioritize protective factors (e.g., physical activity, nutrition, sleep, social, community, or faith-based support, and inclusive school and community environments) and promotion of well-being could improve the mental health of children and adolescents well before a trip. to an emergency service is necessary. These changes include addressing the seasonal timing of increases in child and adolescent mental and behavioral health problems; efforts to integrate preparation for mental health issues into curriculum planning, particularly during the back-to-school period; prevention of conditions that increase the risk of mental disorders; early identification of mental health disorders; and targeted interventions. Parents and guardians, educators, health care providers, and others who regularly interact with children and adolescents can learn more about the signs and symptoms of mental distress.¶¶¶¶ and monitor children and adolescents for possible increases in mental distress in the weeks before and during the school year.
