Pediatric mental health tops patient safety threat list

The Emergency Care Research Institute (ECRI), an independent non-profit organization whose goals are to improve the safety, quality, and cost-effectiveness of care across all health care settings worldwide, recently released its annual list of patient safety concerns. ECRI deemed children experiencing anxiety and depression as the most pressing patient safety concern for 2023.

According to the report, anxiety and depression among children aged 3 to 17 years, increased 29% and 27% respectively, in 2020 compared to 2016.

According to the report, extreme anxiety and depression have led to increased visits to the emergency department (ED) for suspected suicide attempts in adolescents and young adults aged 12 to 25 years. Adolescent suicide attempts decreased during spring 2020; however, the mean weekly number of ED visits for suspected suicide attempts was 22% higher in summer 2020 and 39% higher during winter 2021 among those aged 12 to 17 years.

“ECRI is spot on with their objectives with the mental health crisis that is occurring in pediatrics,” said Tina Tan, MD, FAAP, FIDSA, FPIDS, editor-in-chief of Contemporary Pediatrics®.

Age, gender, sexuality, race, or socioeconomic status can be factors impacting boys and girls experiencing depression, anxiety and other mental health issues resulting from the pandemic.

“For poor and minority children, poverty and discrimination is what is most contributing to the rise in [pediatric] depression and anxiety,” said Michael S. Jellinek, MD, professor of psychiatry and pediatrics, Harvard Medical School. “For all others, I think we are putting more pressure on children to perform academically and in their activities at younger ages.”

In October 2021, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry (AACAP), and the Children’s Hospital Association declared child and adolescent mental health a national state of emergency.

Diagnosing and recognizing major depression during formative years can be critical in avoiding continuation to adulthood. Only half of children aged 5 to 21 years with major depression are diagnosed. Of those that are diagnosed, only 40% receive any mental health treatment.

Anxiety and depression is more likely to be diagnosed in girls, while ADHD is more likely to be diagnosed in boys, according to the report. The reasoning is difficult to pinpoint with the current level of research made available, says Jellinek.

“Many are claiming [the reason for the increase in anxiety and depression among children] is the internet and social media,” said Jellinek. “Very easy to blame, but hard to know for sure. Internet has also helped in many areas and the issues raised by social media have been present before. We need more research, especially directed to adolescent girls, who seem to be the ones having the most difficulty with anxiety and depression.”

In March of 2022, Peter S. Jensen, MD, founder and board chair of the REACH Institute, told Contemporary Pediatrics diagnosing pediatric mental health problems can be difficult due to a “drastic shortage of child and adolescent psychiatrists and child psychologists.” Further, PCCs, who Jensen deemed as “first responders” to manage most common and treatable pediatric mental health problems, received little pediatric mental health training during residencies.

“There are not enough [resources],” said Jellinek. “I would ask the pediatrician for help, but longer term we need better support so that more people choose social services, psychology and psychiatry as careers.”

PCC training programs, increased resources, more research and the ability to diagnose pediatric mental health issues in children, adolescents and youth can be crucial in deterring the pediatric mental health crisis, which is the biggest threat to patient safety concerns, according to ECRI.

Reference

ECRI. Pediatric mental health crisis is top patient safety threat. March 13, 2023. Accessed March 15, 2023. https://www.ecri.org/top-10-patient-safety-concerns-2023-special-report