The COVID-19 Pandemic and Mental Health-Related School-Nurse Visits in U.S. Schools

Tina M. Banzon, Division of Allergy and Immunology, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. Electronic address: Tina.Banzon@childrens.harvard.edu.
William J. Sheehan, Division of Allergy and Immunology, Children's National Hospital, Washington, DC; George Washington University School of Medicine and Health Sciences, Washington, DC. Electronic address: wsheehan@childrensnational.org.
Carter R. Petty, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts. Electronic address: Carter.Petty@childrens.harvard.edu.
Marissa Hauptman, Division of Allergy and Immunology, Boston Children's Hospital, Boston, Massachusetts; Pediatric Environmental Health Center, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts. Electronic address: Marissa.Hauptman@childrens.harvard.edu.
Shelby Flanagan, Division of Allergy and Immunology, Boston Children's Hospital, Boston, Massachusetts; Pediatric Environmental Health Center, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts. Electronic address: Shelby.Flanagan@childrens.harvard.edu.
Darin Bell, Harvard Medical School, Boston, Massachusetts. Electronic address: darin_bell@alumni.brown.edu.
Brett Shamosh, SchoolCare, Ramsey, New Jersey. Electronic address: brett@schoolcare.com.
Lisa M. Bartnikas, Division of Allergy and Immunology, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. Electronic address: Lisa.Bartnikas@childrens.harvard.edu.
Wanda Phipatanakul, Division of Allergy and Immunology, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. Electronic address: Wanda.Phipatanakul@childrens.harvard.edu.

Document Type

Journal Article

Publication Date

9-10-2022

Journal

Academic pediatrics

DOI

10.1016/j.acap.2022.09.002

Keywords

COVID-19; mental health; pediatrics; school-nurse; schools

Abstract

OBJECTIVES: No studies have examined school-nurse visits related to mental health (MH) during the COVID-19 pandemic. We examined changes in the rate of MH-related school-nurse visits before and during the COVID-19 pandemic. METHODS: We analyzed school-nurse visit data (n=3,445,240) for subjects Grade K-12 in U.S. public schools using electronic health record software (SchoolCare, Ramsey, NJ). Data between January 1-December 31 in 2019 (pre-COVID-19 pandemic) vs. January 1-December 31 in 2020 (during COVID-19 pandemic) were compared. For each year, total visits to a school-nurse were calculated for general MH, anxiety, and self-harm. The exposure was number of school-nurse visits in each time period (2019 vs. 2020). The main outcome was change in the rate of general MH, anxiety, and self-harm visits in 2019 vs. 2020. RESULTS: There were 2,302,239 total school-nurse visits in 2019 vs. 1,143,001 in 2020. During the COVID-19 pandemic, the rate of visits for general MH increased by 30% (4.7 to 6.1 per 10,000 visits, 95%CI [18%,43%]; p<0.001), and visits for anxiety increased by 25% (24.8 to 31 per 10,000 visits, 95%CI [20%,30%]; p<0.001). There was no significant difference in self-harm visits across all ages during the COVID-19 pandemic. CONCLUSIONS: Our study found a significant increase in the rate of school-nurse visits for MH and anxiety during the COVID-19 pandemic, suggesting the pediatric population is at-risk for increased negative MH-effects associated with the pandemic and highlights a critical role of school-nurses in identifying youth with potential MH-needs.

Department

Pediatrics

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