When Tanner Bommersbach, M.D., and a team of Mayo Clinic researchers analyzed national records of pediatric emergency department visits, they provided essential data to describe the growing national crisis in pediatric mental health.

Their study found that from 2011 to 2020, youth visits to emergency departments for mental health reasons doubled, while the proportion of visits for suicide-related symptoms increased fivefold.

The team's findings were recently published in the Journal of the American Medical Association.  

Dr. Bommersbach, a child and adolescent psychiatry fellow, hopes the study's results will be useful in national conversations about youth mental health.

Taking on a serious problem

Dr. Bommersbach has had a longstanding interest in children's mental health. During high school and college, he worked in a North Dakota group home for children with developmental disabilities where he observed their interactions with their psychiatrists. The experience prompted him to pursue a career as a physician. He attended Mayo Clinic Alix School of Medicine where he found a mentor in psychiatrist J. Michael Bostwick, M.D. Working with Dr. Bostwick during medical school, Dr. Bommersbach became interested in research and took part in studies investigating how people with suicidal symptoms interact with the healthcare system.

After pursuing a master's in public health to learn more about research methodology and completing his residency, Dr. Bommersbach returned to Mayo for fellowship training, where he has continued to conduct research on suicide prevention and epidemiology in pediatric mental health. He was recently first author on another study about rising rates of suicidal behaviors and unmet treatment needs among U.S. adults who experience a major depressive episode.

Rising rates of illness

Dr. Bommersbach says the study of pediatric emergency room visits expanded upon other studies that have shown rising rates of youth mental health concerns — but the magnitude of the rise in pediatric mental health visits, especially those that were suicide-related, took him by surprise.

The study used data from 2011 to 2020 from the National Hospital Ambulatory Medical Care Survey, an annual cross-sectional national probability sample survey of emergency departments. The research team examined mental health-related visits for patients aged 6 to 24 years. Data showed a significant rise in visits across all age groups, sexes, races and ethnicities. But the greatest increase was for patients aged 10 to 14 years.

Even though data were not yet available from 2021 or 2022, the findings did include some data from early in the COVID-19 pandemic.

"Over the last few decades, we've seen an increase in youth mental health issues. COVID likely accelerated and exacerbated these concerns," says Alastair McKean, M.D., a co-author of the JAMA study.

Prompting change

The findings of the study do not identify why children's mental health visits increased so dramatically, but the authors point to several potential contributing factors, including increased awareness of mental health concerns among youth, improved and increased referrals from doctors, greater willingness among young people to seek help and reduced access to other mental health services in the community.

Of particular concern is the increase in suicide-related symptoms in young people, which increased in all age groups, across sex, race and ethnicity, insurance type and geographic region. The authors point out that suicide-related visits among adolescents accounted for 6.6% of all ED visits in 2019-2020.

The numbers are a call to action, they say.

"The first part of prompting change is having real data, and this study shows that this is a growing national crisis," says Dr. McKean.

"One area that needs to be addressed in a national conversation is increasing access to non-hospital services that can treat mental health issues. Emergency departments frequently act as safety nets for individuals with unmet health needs, especially for uninsured and undocumented children," says Dr. Bommersbach. "My goal is to continue research that will illuminate these national gaps so that we can move toward a national commitment to mental healthcare and expanded community-based services for young people."

— Alexi Gonzalez

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