A United States National Assessment of Pediatric Emergency and Inpatient Encounters Before, During, and Following the COVID-19 Pandemic: Mental and Behavioral Health Diagnoses.

Objective: To demonstrate changes in health care encounters and identify risk factors associated with mental and behavioral health among the pediatric population before, during, and after the COVID-19 pandemic. Method: Using data from Epic Cosmos, an interrupted time series analysis was conducted to examine changes in health care encounters associated with mental and behavioral health between 2017 and 2023 among a national sample of youth (6-17 years old). Logistic regression analyses predicted encounters attributed to mental and behavioral health using sociodemographic variables, and their interactions with the COVID-19 era were followed by post hoc analyses to highlight differences in these visits before, during, and after the pandemic. Results: More than 20 million health care encounters were examined among the pediatric population from 2017 through 2023. Among those records, more than 2 million encounters, approximately 10.3% of the encounters, were attributed to mental or behavioral health diagnoses. During the COVID-19 era, the proportion of encounters increased significantly for every mental and behavioral diagnosis. The most common diagnoses linked with these health care encounters were depression (n = 713,744), anxiety and obsessive-compulsive disorder (n = 682,458), and hyperkinetic disorders and attention-deficit/hyperactivity disorder (n = 607,676). Health care encounters attributed to mental health were more common in older ( Conclusion: In addition to elevated proportion of health care encounters associated with mental health during the pandemic, higher odds of such encounters were consistently demonstrated among White and non-Hispanic youth, suggesting disparities in care based on race and ethnicity. These disparities were relatively consistent, though some inconsistencies were observed based on specific race or ethnicity group and disorder class. Diversity & Inclusion Statement: We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list.