In a recent article published in JAMA Network Open, researchers conducted a retrospective, multisite cohort study among 11 to 17-year-old adolescents in the United States of America (USA) and France. They assessed the month-on-month change in the number of mental health condition–related hospitalizations between pre- and post-pandemic times.
Background
The COVID-19 pandemic caused global disruption leading to a surge in mental health–related hospitalizations. Studies documented the occurrence of depression, anxiety, and suicidality in adolescents with the onset of the pandemic, which exposed them to economic stressors at home and limited their social interactions. Females were affected more than males. Yet, studies did not adequately characterize the extent of this unfortunate surge in severe mental health issues among adolescents, particularly for severe cases requiring hospitalization.
Public health programs must target the psychiatric healthcare needs of these adolescents and make changes to the healthcare infrastructure and resources required to provide top-notch mental healthcare facilities in the future.
About the study
In the present study, researchers retrieved patient-level data from electronic health records (EHRs) of eight children’s hospitals in France and the USA. They used interrupted time series analysis (ITS) to estimate the variations in mental health condition–related hospitalizations among adolescents between February 1, 2019, to March 31, 2020, and April 1, 2020, to April 30, 2021.
The ITS analysis proportional difference, if positive, indicated an increase in the average month-on-month change in hospitalization proportion between pre-pandemic times and during the pandemic. The team used linear regression models to estimate the monthly variations in adolescent hospitalization (average) proportions between pre- and post-pandemic periods.
Additionally, they performed mental condition-specific analyses, wherein they only included adolescents with a specific mental condition and again assessed the change in monthly proportions of hospitalizations. They, for instance, assessed three mental conditions most prevalent in the study participants and examined eating disorders.
Furthermore, the team compared the hospitalization characteristics between the two study periods. Specifically, they determined the number of unique patients hospitalized in each period and compared patient and hospital characteristics. Finally, the team used meta-analysis to estimate aggregate proportion variations in hospitalizations across hospitals and countries. They considered the hospital and country-based effects random, as they explained how the pandemic variedly affected different populations.
The study population comprised adolescents with a minimum of one mental condition diagnosis between February 1, 2019, and April 30, 2021. The team used a federated approach, stored data, and analyzed it locally at each site to protect patient confidentiality but eventually shared it for additional aggregate analyses, stratified by sex. Also, they ensured that this data adhered to a common data standard shared across the Consortium for Clinical Characterization of COVID-19 (4CE) consortium.
The team defined mental health conditions based on 16 diagnostic codes of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) relevant to adolescents.
Study findings
Five and three US and French pediatric hospitals, respectively, contributed data for the study analyses. There were 9696 and 11,101 adolescents with at least one mental health condition–related hospitalization in the reference pre-pandemic and examined pandemic periods, respectively, with an average age of 14.6 and 14.7 years, at hospitalization.
The average hospitalization duration was seven days, and more females than males were hospitalized during pre-pandemic and pandemic periods, 5966 females vs. 3730 males and 7603 females vs. 3498 males. During both study periods, the three mental health conditions most predominant in the study participants were depression, anxiety, and suicidality.
During the pandemic, hospitalization among adolescents with anxiety disorders peaked from 52.4% in the pre-pandemic period to 57.4%. The proportion of hospitalizations among adolescents diagnosed with suicidality also increased between both periods, from 42.3% to 44.2%. However, the month-on-month change in hospitalizations among adolescents with depression was minimal and peaked from 46.9% to just about 48.0%.
Furthermore, the researchers noted a time-based increase in mental health–related hospitalization proportions in four US and one France health care sites, with an inter-period proportional difference of 0.60% per month.
Conclusions
In 2020, suicide represented the third top reason for death among children and adolescents aged 10 to 24. The social isolation related to the COVID-19 pandemic might have exacerbated the situation. Thus, quantifying the changes in mental health burden could inform future public health policies globally. However, in the short term, first, it would improve the detection/screening of mental health disorders and their related conditions. Second, it would increase access to good mental health care services, including through telemedicine and school-based awareness programs, even after the COVID-19 pandemic ends.
