The COVID-19 pandemic and associated lockdowns have negatively affected the mental health of young people in Canada and the United States, exacerbating depression, anxiety and eating disorders among certain groups, three new studies published Monday found. JAMA journal.
Pandemic leads to 65% increase in hospitalizations for eating disorders
One of two studies published today by the Pediatric Improving Outcomes through Coordinating Research Network (POPCORN) found reduced rates of hospitalization for mood disorders and substance use among boys and girls ages 6 to 20 years old before and during the COVID-19 pandemic.
However, hospitalizations for eating disorders increased in both men and women, while hospitalizations for anxiety disorders, personality disorders, suicide and self-harm increased significantly among women.
for studypublished in JAMA Network OpenThe researchers analyzed public health administrative data on all Canadians aged 6 to 20 years from April 2016 to March 2023.
Of 6.3 million Canadian youth, 218,101 were hospitalized for a mental illness (ages 6-11, 5.8%; ages 12-17, 66.9%; ages 18-20, 27.3%; women, 66.0%). Overall, hospitalizations for mental illness decreased from 51.6 to 47.9 per 10,000 person-years for both sexes from pre-pandemic to pandemic.
However, hospitalizations for anxiety disorders (11%), personality disorders (21%), suicide or self-harm (10%), and eating disorders increased for both women (66%) and men (47%). Hospitalizations for mood disorders (-16%), substance use (-17%), and other mental disorders (-22%) decreased for both men and women.
The proportion of hospitalizations due to mental illness in the 12-17 year old age group increased from 65.8% before the pandemic to 68.4% during the pandemic. During the same period, hospitalizations for participants aged 6-11 and 18-20 years decreased from 6.2% to 5.3% (from 28.0% to 26.3%).
These findings suggest it will be important that services aimed at women are maintained in future pandemics, particularly screening for eating disorders, anxiety, personality disorders and suicidality.
Before COVID-19, women made up 63.8% of mental hospital admissions, increasing to 69.0% during the pandemic. Before the pandemic, the proportion of hospital admissions for patients in the most materially deprived quintile (24.4%) was higher than the proportion of hospital admissions for patients in the least deprived quintile (16.9%). During the pandemic, this difference narrowed to 21.9% and 18.6%, respectively.
Living in a rural area was associated with increased rates of hospitalization for all psychiatric disorders except eating disorders.
During the study period, there were 881,765 emergency department (ED) visits for mental illness. Among ED visits during the pandemic, a higher proportion of women (65.8%) than before the pandemic (60.0%), as well as a higher proportion of participants aged 12-17 years (52.7% vs. 46.0%).
“Understanding how the pandemic has affected Canadian children, adolescents, and young adults is crucial for formulating public health policy, and these findings suggest that services targeted to women, particularly screening for eating disorders, anxiety disorders, personality disorders, and suicidality, will be important to maintain in preparation for future pandemics,” the authors wrote.
Tighter lockdowns are associated with hospitalizations
in JAMA PediatricsPOPCORN researchers say another study A study of 8,726 eating disorder hospitalizations among Canadian youth of the same age over the same period found that among girls aged 12 to 17, a 10% increase in the stringency of pandemic lockdowns was associated with a larger increase in eating disorder hospitalizations that varied by region.
The researchers used 12 indicators to measure the stringency of lockdowns, including office and school closures, cancellations of public events, travel restrictions and stay-at-home orders.
During the study period, there were 11,289 hospitalizations for eating disorders in Canada, of which 90.4% were girls, of whom 77% were aged between 12 and 17. A 10% increase in stricter lockdown measures led to larger increases in hospitalization rates in Quebec and Ontario (5%), the Prairie provinces (Alberta, Saskatchewan, Manitoba; 8%), and British Columbia (11%).
One year into the pandemic, excess hospitalizations have increased most in Quebec (117%), Ontario (144%), the Prairie Provinces (139%) and British Columbia (102%).
A total of 58.6% of hospitalizations before and during the pandemic were young people with no history of hospitalization for eating disorders.
The researchers say this increase in hospitalizations likely has multiple causes, including increased social isolation, loss of routine and extracurricular activities, an increase in eating disorders and increased compensatory exercise.
The importance of young people’s social connections (including support networks and parent education) needs to be promoted to ensure that children facing school closures and other restrictions do not become socially isolated as much as possible.
“Given that the majority of people with eating disorders are treated on an outpatient basis, the lack of outpatient services during the pandemic may have led to a progression of illness that, if left untreated or unrecognized, is more likely to result in hospitalization compared to other psychiatric disorders, given the immediate medical health risks,” the researchers wrote.
In future pandemics, pediatric health care providers should find ways to stay connected with patients for ongoing clinical assessment and psychosocial support, either during hospital visits or through telehealth, the researchers said.
“Healthcare providers should also screen young people for emerging eating disorders, regardless of weight, sex, or socioeconomic status,” the authors write. “They should promote the importance of young people’s social connections (including support networks and parent education) to minimize social isolation as much as possible for children during school closures and other restrictions.”
Low-income young people fare better amid COVID-19 stress
last weekend, JAMA Network Open, researcher Researchers at Children’s Hospital Los Angeles hypothesized that mental health related to COVID-19 lockdowns would be worse among US youth living in low-income households, but actually found that kids from more affluent families reported higher rates of depression and anxiety.
The research team used the Child Behavior Checklist (CBCL), Family Environment Scale (FES) and Income Needs Ratio (INR) to assess the mental health of 10,399 children aged 10-12 years who participated in the Youth Brain Cognitive Development Study, conducted over a 10-year period in multiple locations, before and during the pandemic.
The pre-pandemic group underwent 2 years of follow-up before the COVID-19 lockdown (before March 2020) and the pandemic group underwent 2 years of follow-up after that date.The final sample consisted of 10,171 young people with 1 year of follow-up data (pre-pandemic, 7,343 young people; pandemic, 2,828) and 10,399 with 2 years of follow-up data (pre-pandemic, 7,493; pandemic, 2,906).
52.3% of participants were male, 66.0% were White, 20.3% were Hispanic, 14.5% were Black, 12.2% were mixed race, 44.2% reported that the caregiver’s education level was less than a 4-year college degree, and 26.2% had an INR less than 100% (poverty) or between 100% and 200% (near poverty).
No significant differences were found over time in the mean total problems on the CBCL between pre-pandemic and pandemic group participants, and a one-unit increase in INR was associated with a decrease in the mean percent change in total problems.
Our research group previously published data showing that socioeconomically disadvantaged households may be taking more actions to reduce psychological distress related to the COVID-19 pandemic.
For youth whose INR differed by one unit between the pre-pandemic and pandemic cohorts at one- to two-year follow-up, the expected difference in overall problems was 0.79, holding gender, age, caregiver education, and study interval constant, the researchers said, suggesting that youth with lower INRs in the pandemic group tended to have fewer overall problems than youth in the pre-pandemic group who were followed up before COVID-19.
For each one-unit difference in INR, the expected differences between the pandemic and pre-pandemic groups at 1- to 2-year follow-up were 0.19 for anxiety or depression, 0.17 for aggression, 0.09 for inattention, 0.08 for social problems, 0.06 for rule breaking, 0.12 for cognitive problems, 0.27 for internalizing problems, and 0.23 for externalizing difficulties.
The researchers noted that previous findings suggest that children from lower-income families may be better adapted to the stresses of the pandemic. “Indeed, our research group previously published data suggesting that children from socioeconomically disadvantaged families may be engaging in more behaviors to mitigate psychological distress associated with the COVID-19 pandemic,” they said.
“These results suggest that socioeconomic status may be important when considering young people’s mental health outcomes due to COVID-19 lockdowns, which may be important for targeted treatment approaches,” the researchers concluded.
But the researchers cautioned that the study doesn’t tell us anything about what might be causing the differences between the pre- and post-pandemic groups.
