Mental health-related presentations to Australian hospital emergency departments by children and young people, before and after the onset of the COVID-19 pandemic: a systematic review and meta-analysis

Abstract Introduction COVID-19 pandemic-related ‘lockdowns’ (i.e., measures to restrict movements) used to reduce the spread of the COVID-19 virus may have impacted how children and young people (CYP) utilised mental health services. The aim of this review was to synthesise research on COVID-19-related changes in mental health-related emergency department (ED) presentations by CYP in Australia, with reference to lockdown stringency. Methods and analysis We searched five databases for observational studies published after 31/12/2019 examining ED mental health-related presentations by CYP (aged 0–24 years) before and after onset of COVID-19 lockdowns. Studies were stratified by location and the relative restriction stringency, obtained via the Oxford COVID-19 Government Response Tracker. Region level variation was described, with pooled effects calculated using random effects models. Results Thirteen studies were included; five from New South Wales, four from Victoria (where lockdowns were most stringent), three from Queensland, and one including multiple Australian states. Outcome definitions and exposure periods were heterogeneous. Pooled estimates showed a moderate-to-large increase in monthly rates of eating disorder presentations, slight-to-moderate increases in overall mental health-related presentations and self-harm and suicide-related presentations, and inconclusive evidence for changes in substance-related and addictive disorder and behavioural/neurodevelopmental disorder-related presentations. Heterogeneity of pooled effects was extremely high (I 2 = 84.8–99.5%), and the overall certainty of evidence was very low for all outcomes. Findings differed by jurisdiction, but there was insufficient evidence to identify an association between lockdown stringency and ED presentations. Conclusions CYP ED presentations for eating disorders appear to have increased over the pandemic period, though certainty of evidence was very low. Findings for overall mental health-related presentations and other disorder groups were mixed, with presentations appearing to be lower in Queensland than other states. Future research should prioritise high quality interrupted-time-series analyses of linked and standardised administrative data to better examine the association between specific pandemic policy measures and CYP mental health-related ED utilisation, whilst controlling for potential confounders. Systematic review registration This review has been registered with PROSPERO (CRD42022342496).