Colorado youth mental health emergencies peak in April, hospital says

DENVER — People treating mental health problems at Children’s Hospital Colorado don’t have to look at the calendar or the weather to know that April has arrived.

Kids and teens who previously felt fine are seeking outpatient help, existing outpatients need more support and the number of young people showing up in mental health crisis is growing.

Typically, emergency department visits for mental health reasons are about 20% higher in April at than the annual average, though last year, that gap narrowed to 12%, said Dr. Lauren Eckhart, director of patient care services for the hospital’s Pediatric Mental Health Institute.

“This is something that we talk about a lot every time April rolls around,” she said.

Rates of depression and anxiety among youths peaked during the pandemic, following gradual increases over the previous decade. Since then, fewer students are reporting distress, but the most recent Healthy Kids Colorado Survey found about 1 in 4 high school students still said they felt sad enough that they stopped doing normal activities.

Not all parts of the country seem to have the same pattern, although the data point to school breaks as relative lulls. Nationwide, mental health emergencies among youths peak a few weeks after school begins in the fall, and then again in the spring, with dips around Thanksgiving and Christmas, said Dr. Jennifer Hoffman, an attending physician at Lurie Children’s Hospital of Chicago.

The pattern could reflect that schools are one of the major places that identify students’ mental health concerns, as well as the accumulation of academic and social stressors, she said.

Most Colorado schools end classes in May, meaning that, in April, time is running short for students who are trying to raise their grades, and even those who are doing well face a crunch of tests and project deadlines, Eckhart said.

In addition, subsets of students are dealing with standardized testing, transitions to new schools or high-stakes social events such as prom, she said.

“All our kids are coming in with more stress,” she said.

That rings true to Ayush Vispute, a junior at Rampart High School in Colorado Springs. His friends and classmates are dealing with Advanced Placement course exams and the SAT or ACT. And although most teachers and parents want to help, he hasn’t seen specific programs to counter the stress.

One of the most helpful things is studying as a group, even when that isn’t the most efficient way to review the material, he said.

“Working in solidarity can be the best way to work through stressful times,” he said.

Outpatient providers also see a seasonal effect.

Calls to Wellpower’s access center seeking help for children and teens increased 25% from February to March this year, and appear on track to rise again in April, said Dr. Casey Wolf, the Denver mental health center’s medical director and a child and adolescent psychiatrist. Existing patients also struggle as the end of the school year nears, she said.

“This time of year, I just come to work knowing that nobody is doing well,” she said.

Young people who are already dealing with some level of anxiety or depression need more support when their academic or social stress increases, Wolf said. On top of that, many struggle to adjust to Daylight Saving Time and sleep less, which interferes with their ability to manage their moods and focus in class, she said.

“They’re going to bed even later, but school starts at the same time,” she said. “When people don’t get enough sleep, they don’t think as well.”

In addition to bringing end-of-school stress, something about spring itself seems to trigger distress for a subset of people, said Dr. Ruth Gerson, director of child and adolescent psychiatry at New York University, Brooklyn.

Scientists aren’t certain why that is, with theories including an increase in allergens, different viruses circulating and increased temperature and daylight hours, she said.

“We think that some people are more vulnerable to whatever these triggers are,” she said.

In adults, suicide rates tend to increase in spring and summer, although the data from UCHealth’s screening offered to all patients suggest the number of people at potentially high risk doesn’t change nearly as much from season to season, said Robert Albrecht, behavioral health supervisor for the emergency department team at University of Colorado Hospital.

Longer days can increase symptoms for people with bipolar disorder or schizophrenia, and for some people with severe depression, the change of seasons can give them just enough energy to make or carry out a suicide plan, he said.

“It’s a little counterintuitive,” he said.

In addition, people may expect to feel better when winter is over and have a hard time coping when they don’t, Albrecht said. And, of course, warmer weather tends to bring an increase in social events, which add stress for some people, he said.

Working with a mental health provider can help people identify their seasonal and situational triggers and come up with a plan to manage them, Albrecht said. That could include medication, therapy and lifestyle changes such as planning exercise and regular social interactions, he said.

One of the biggest things parents can do to protect their children is to prioritize sleep, including by limiting screen time, Gerson said. They can also help young people prepare for stressful events like finals, college applications and social events by asking them to anticipate how they’ll feel if they succeed or fail, and helping brainstorm ways to respond if something doesn’t go their way, she said.

If they have a plan developed before their emotions are running high, they’ll be better able to understand that disappointment or the feeling of being trapped will pass – and will know their parents believe in their resilience, Gerson said.

“They’ll have thought about what can I do, who can I talk to,” she said.

And, of course, parents need to be willing to ask uncomfortable questions if they see their child is really struggling, Gerson said. Kids are already aware of suicide, and asking them about it won’t give them the idea, she said.

“We’ll let them know that we’re not scared of the hardest thoughts and feelings they’re having” by discussing them directly, she said.

Ideally, parents and youths will start working together as early as January to plan for how they’ll manage increasing stress in the spring, Wolf said. Schools also may be able to help if parents explain their child’s needs and what kind of support could help, she said.

Although spring may be a particularly stressful time that lands someone in a crisis center or emergency room, most people in that situation need ongoing support to manage their underlying mental health concerns, Wolf said.

“When the acute crisis might pass … there’s still the depression or the anxiety, or what I most often see is a combination of both,” she said.