Back-to-School Stress? Children’s Mental Health ER Visits Rise During the School Year

Mental and behavioral health conditions, including substance use, are a public health concern for American schoolchildren. A new school year can be exciting but also stressful. To time prevention well, a large team led by Lakshmi Radhakrishnan of CDC, with state and local health departments and school partners, looked at seasonal patterns in emergency department (ED) visits.

The data

Visits by children aged 5 to 17 from 1,919 facilities in 46 states, from January 2018 to June 2023, came from CDC's National Syndromic Surveillance Program. Of 27 condition categories, eight had enough data for reliable estimates in every age group. Each school semester — fall (September–December) and spring (January–June) — was compared with the summer just before it (June–September).

What they found

For ages 10–14 and 15–17, visits for eight conditions rose each year in the school semesters — up to twice as high as in summer:

The share of all ED visits for depressive disorders, for example, was up to 1.95 times the summer share among 10- to 14-year-olds and 1.60 times among 15- to 17-year-olds; for suicidal ideation or self-harm, up to 2.00 and 1.74 times.

Visits dipped briefly each year over the winter holiday break, then returned to previous levels. Among children 5 to 9, visits rose for five conditions, though low numbers make those results less certain.

In spring 2020, the share of visits for these conditions rose but the number fell — likely because of the COVID-19 emergency declared in March 2020.

Why school may matter

• School stressors: starting a new year or school, academic pressure and testing, bullying and peer victimization.
• Social anxiety that worsens into a crisis.
• More mental health screening at the start of the year, prompting referrals.
• Staff noticing problems through classroom behavior, attendance or grades, or students disclosing them.

What can help

• Social and emotional learning programs that give students and teachers tools to cope.
• Pediatric mental health care access programs, suicide prevention gatekeeper training, trauma and grief interventions, crisis response services, peer-led help-seeking programs, comprehensive health education, and access to mobile crisis services and community alternatives.
• Protective factors: physical activity, nutrition, sleep, social, community or faith support, and inclusive schools and communities.
• Preparing for the fall surge in back-to-school planning, and messaging tailored to parents, students, providers and educators at the times of year it's needed.

The authors stress that government, education and community groups need to work together, rather than leaving it all to schools. CDC resources include its guide to preventing adverse childhood experiences, the Whole School, Whole Community, Whole Child model and its Suicide Prevention Resource for Action.

Limitations

The data are a convenience sample, not nationally representative; visits aren't people, since one child may make several; condition categories overlap; results for ages 5–9 are uncertain; and differing school calendars may blur — and understate — the pattern. Many mental health visits happen outside EDs.

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 Radhakrishnan L, Carey K, Pell D, et al., "Seasonal Trends in Emergency Department Visits for Mental and Behavioral Health Conditions Among Children and Adolescents Aged 5–17 Years — United States, January 2018–June 2023," MMWR, Centers for Disease Control and Prevention; a work of the United States government in the public domain.