Teen ER Visits for Mental Health and Overdoses Eased in 2022, Except Among Girls

The crisis in adolescent mental health began before COVID-19 and worsened during it, with more poor mental health, suicide-related behavior and drug overdose deaths reported in 2020–2021. CDC's look at emergency department (ED) visits by 12- to 17-year-olds through early 2023 found some signs of improvement by fall 2022 — but not for girls, whose visits stayed at or above already high pre-pandemic levels, and not for opioid overdoses.

How it was measured

CDC analyzed visits from January 2019 through early February 2023 at EDs reporting consistently to the National Syndromic Surveillance Program, which covers about 75% of U.S. EDs. Visits followed the school calendar, so CDC compared the spring, summer and fall of 2022 with the same periods in 2021 (recent change) and 2019 (the pre-pandemic baseline). A change of 10% or more counted as a real increase or decrease.

Fall 2022 compared with fall 2021

Visits fell for adolescents overall and for girls; for boys, overall mental health and suicide-related visits were stable, though visits for anxiety (−10%), depression (−12%) and suspected suicide attempts (−13%) fell.

Fall 2022 compared with fall 2019

Overall mental health visits were below the 2019 baseline and suicide-related visits about the same, but drug overdose visits were higher — and for girls, suicide-related, suicide-attempt and overdose visits were all above pre-pandemic levels. Visits for eating disorders were up 55% from fall 2019, for both sexes, and tic disorders rose 56% among girls. Earlier in 2022 the gaps were larger: in spring 2022, girls' visits for suspected suicide attempts were 43% above spring 2019.

Reading the trends

• Why some improvement? Many adolescents were back in pre-pandemic school and community life, which may have eased isolation, and family stress and other adverse childhood experiences may have declined. Communication campaigns, the 988 suicide crisis line and more accessible care such as telehealth may have helped families find support before a crisis or outside the ED.
• Opioid overdoses are rare among adolescents, so even large percentage increases are small in absolute numbers — about 40 visits a week in fall 2022. But any adolescent overdose is concerning, especially with potent counterfeit pills containing illicitly made fentanyl reaching teens through social media.
• Still a crisis. Poor adolescent mental health remains a major public health problem, especially among girls.

What can help

Early identification and trauma-informed interventions, with broader evidence-based prevention; CDC resources to help states, communities and schools choose strategies against suicide, overdose and adverse childhood experiences; and support for adolescents and their families. Clinicians treating adolescents for opioid overdose might screen for opioid use disorder and offer timely FDA-approved medications, and screen adolescents for depression and anxiety.

Limits

The data are not nationally representative and reporting quality varies; the 10% threshold can miss changes in common visits and exaggerate them in rare ones; trends can't show causes; the data couldn't separate primary from secondary diagnoses; and ED visits capture only part of adolescents' mental health problems.

If you or someone you know is thinking about suicide, call or text 988 to reach the 988 Suicide & Crisis Lifeline in the United States.

Sources

Based on Kayla N. Anderson, Dylan Johns, Kristin M. Holland, et al., "Emergency Department Visits Involving Mental Health Conditions, Suicide-Related Behaviors, and Drug Overdoses Among Adolescents — United States, January 2019–February 2023," Morbidity and Mortality Weekly Report, volume 72, Centers for Disease Control and Prevention; a work of the United States government in the public domain.