Seasonality of Pediatric Mental Health Emergency Department Visits, School, and COVID-19.

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The aim of this study was to explore how the academic calendar, and by extension school-year stressors, contributes to the seasonality of pediatric mental health emergency department (ED) visits.


The authors reviewed all pediatric mental health ED visits at a large urban medical center from 2014 to 2019. Patients who were younger than 18 years at time of presentation, were Durham residents, and had a primary payer of Medicaid were included in the sample population, and the dates of ED visits of the sample population were compared against dates of academic semesters and summer/winter breaks of a relevant school calendar. Of patients with multiple ED visits, only the first ED presentation was included, and descriptive statistics and a rate ratio were used to describe the study group and identify the rate of ED visits during semesters compared with breaks.


Among the sample population from 2014 to 2019, there were 1004 first pediatric mental health ED visits. Of these ED visits, the average number of visits per week during summer/winter breaks was 2.2, and the average number of visits per week during academic semester dates was 3.4. The rate of ED visits was significantly greater during academic semesters compared with breaks (Rate Ratio, 1.6; 95% confidence interval, 1.4-2.0; P < 0.001).


Children may be at greater risk of behavioral health crises or having increased mental needs when school is in session. As many children's mental health has worsened during the COVID-19 (coronavirus disease 2019) pandemic, these findings highlight the need for increased mental health services in the school setting as children return to in-person learning. In addition, it may benefit health systems to plan behavioral health staffing around academic calendars.






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Copeland, John Nathan, Michael Babyak, Adrienne Banny Inscoe and Gary R Maslow (2022). Seasonality of Pediatric Mental Health Emergency Department Visits, School, and COVID-19. Pediatric emergency care, Publish Ahead of Print. 10.1097/pec.0000000000002671 Retrieved from

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J. Nathan Copeland

Assistant Professor of Psychiatry and Behavioral Sciences

Michael Alan Babyak

Professor Emeritus in Psychiatry and Behavioral Sciences

Since coming to Duke as an intern in 1994 I have collaborated as a biostatistician and co-investigator at Duke on numerous observational and experimental studies involving behavior, psychosocial factors, health, and disease. The substantive topics have ranged across questions concerning exercise and depression, hypertension, weight loss, the genetics of stress and heart disease, sickle cell disease, to name a few. I am particularly interested in the issue of improving reproducibility and transparency in data analysis.


Gary Ross Maslow

Professor of Psychiatry and Behavioral Sciences

Adaptation to chronic illness, transition to adulthood for youth with chronic illness, positive youth development, quality of life.

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