BACKGROUND: Little is known about changes in child well-being and family quality of life (QoL) among children seeking emergency department care because of mental health concerns over the course of the pandemic. METHODS: Prospective cohort study of children <
18 who visited two paediatric EDs in Alberta, Canada, for an acute mental health concern. Early and late pandemic time periods were defined as 15 March 2020-14 March 2021 and 1 July 2021-30 June 2022, respectively. The Stirling Children's Well-being and Warwick-Edinburgh Mental Well-being scales quantified well-being
the Family Quality of Life Scale assessed family QoL. These scales were completed as soon as possible following the ED visit. Linear regression models assessed the association between pandemic period and the change in well-being and family QoL. RESULTS: One thousand four hundred four children were enrolled during the study time periods (50.4% early, 49.6% late). Seventy-two percent (1009/1404) of participants were White, 53.8% (744/1404) were female, and the median age was 13 (IQR, 11-15) years. Well-being remained unchanged between time periods, whereas family QoL was lower in the late pandemic time period than in the early period (mean difference: -2.16, 95% CI: -3.79, -0.53
p = 0.01). Among children <
13 years, previous mental health care and requiring inpatient admission were negatively associated with well-being. Having an autism diagnosis and a comprehensive ED mental health evaluation were negatively associated with well-being in older children. CONCLUSIONS: Reduced family QoL may signal stressors experienced by caregivers and the lingering consequences of the pandemic. Resources that address well-being and support the family unit are needed to improve the mental health of children.