The COVID-19 pandemic: what was its impact on child mental health prevalence in the US?

By Neha MathurMay 25 2023Reviewed by Lily Ramsey, LLM

In a recent article published in JAMA Network Open, researchers performed a cross-sectional study to assess whether the coronavirus disease 2019 (COVID-19) pandemic increased the incidence of any mental health (MH) conditions among youth and pediatric patients aged six to 18 years in the United States of America (USA).

Study: Prevalence of Mental Health Diagnoses in Commercially Insured Children and Adolescents in the US Before and During the COVID-19 Pandemic. Image Credit: Ground Picture/Shutterstock.com

Background

The pandemic due to COVID-19 had a major impact on the mental health of children, adolescents, and youth in the US.

The lack of access to care services, social isolation, the increased financial burden on families due to loss of jobs, and even increased social media usage highly disrupted their lives.

US health organizations focused on monitoring the mental health of youth in the US considered it a state of emergency because the COVID-19 pandemic seemingly exacerbated MH conditions among US youth.

Yet, there is a lack of studies that have evaluated trends in MH diagnoses in children during the COVID-19 pandemic.

About the study

In the present study, researchers assessed the prevalence of MH diagnoses in US children and youth before and during the COVID-19 pandemic. Specifically, they assessed three time periods of the COVID-19 pandemic, as follows:

i) the pre-pandemic period starting January 2018 and ending March 2020;

ii) the early pandemic period starting April 2020 and ending September 2020, corresponding to the time of school closure in the US; and

iii) the recent pandemic period ending in March 2022 and beginning in October 2020 when schools reopened in the US.

For study data, the team first used de-identified data from a commercial healthcare claims database, from where the team extracted the monthly proportion of children/youths with MH diagnoses between January 2018 and March 2022, stratified by age and gender.

They assessed the prevalence of four MH conditions, attention-deficit/hyperactivity disorder (ADHD), anxiety disorders, depression, and eating disorders.

The researchers performed interrupted time series analyses to compare the pattern/trend of prevalence of each MH condition diagnosed in the pre-pandemic vis-a-vis the recent pandemic time. They did not include the early pandemic period, i.e., a state of flux in their interrupted time series analyses to give sufficient time for the pandemic to manifest.

The team analyzed all data using SAS statistical software v.9.4 between October 2022 and March 2023 and computed two-sided 95% confidence intervals (CIs) post-analysis.

This study received approval from the institutional review board (IRB) of Brigham and Women’s Hospital in Boston, Massachusetts, and strictly adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

Results and conclusion

Nearly 1.7 million commercially insured US youths contributed study data to each calendar month throughout the study duration. Of these, on average, 440,722 and 461,331 were six- to 12-year-old female and male children, respectively, whereas 410,373 and 426,358 were female and male adolescents aged 13 to 18 years, respectively.

Among adolescents, 13- to 18-year-old females showed an instant surge in the prevalence of all four diagnosed MH conditions in the recent pandemic time. The prevalence of all MH diagnoses (except depression) in this group increased rapidly during the pandemic.

Intriguingly, the prevalence of eating disorders doubled in two pandemic years between 2020 and 2022 among 13- to 18-year-old female adolescents, from 1,065 to 13,99 between March 2020 and October 2020, and further to 2,058 adolescents by March 2022.

Among 13- to 18-year-old male adolescents, the incidence of eating disorders was markedly lower, but trends were comparable compared to females in the same age category.

The authors noted no changes in the prevalence of other MH diagnoses in pre-pandemic vs. during the pandemic among male adolescents aged 13 to 18.

Except for ADHD, the prevalence of all MH conditions was lower in six- to 12-year-olds than in their adolescent counterparts. Between six- to 12-year-old female children and female adolescents, prevalence changes for other MH diagnoses were comparable but much less pronounced.

Among 13- to 18-year-olds, the authors noted no prevalence changes before vs. during the pandemic for other MH diagnoses.

The study data was limited to commercially insured youths and did not cover publicly insured or uninsured children. It introduced heterogeneity in the sampled population. Likewise, recorded MH diagnoses did not represent the actual MH status of the US youth.

Nonetheless, the observed trends in MH diagnosis varied by age and gender during the COVID-19 pandemic. Youth, especially female adolescents, emerged as the most susceptible population who showed substantial surges in the incidence of MH diagnoses, especially eating disorders, during the COVID-19 pandemic.