In a recent study published in JAMA Network Open, researchers evaluated the incidence of mental health conditions in young people before and during Canada’s coronavirus disease 2019 (COVID-19) pandemic.

Study: Mental Health Hospitalizations in Canadian Children, Adolescents, and Young Adults Over the COVID-19 Pandemic. Image Credit: Ground Picture/Shutterstock.com

Background

A growing body of evidence suggests that the health impact of COVID-19 on youth and children extends beyond the direct illness. Youth and children had less severe acute illness than adults; however, their health has been considerably affected by public health measures to curb hospitalizations and mortality.

Mental health service use by youth and children has been significantly impacted due to the COVID-19 pandemic, albeit inconsistencies remain in how this is defined and estimated.

Besides, comprehensive analyses of the consequences of the pandemic on mental health in youth, including pre-COVID-19 periods, are limited.

About the study

In the present study, researchers evaluated the differences in the incidence of hospitalizations for mental health conditions in children, adolescents, and young adults over pre-COVID-19 and pandemic periods in Canada.

They used health administrative data collected between April 2016 and March 2023. The study population included people aged 6–20 across all provinces and territories.

The team assessed the change in hospitalization rates for mental health conditions between pre-pandemic (April 2016 to March 2020) and COVID-19 (April 2020 to March 2023) periods. The primary outcome was hospitalization for a mental health condition. The secondary outcome was an ED visit for a mental health condition.

The International Classification of Diseases, Tenth Revision (ICD-10) diagnostic codes were used to identify mental health conditions, such as anxiety, eating disorders, personality disorders, substance use, mood disorders, psychosis, schizophrenia, other behavioral or mental disorders, and self-harm and suicide. Outcomes were stratified by age, sex, deprivation, and region.

Chi-squared tests compared hospitalizations between periods. Annual crude incidence was estimated by mental health condition, stratified by sex, region, and deprivation. The incidence rate of mental health visits was compared between the two periods using a Poisson exact test. Incidence rate ratios and 95% confidence intervals were computed.

Findings

Overall, 218,101 hospitalizations were reported for mental health conditions during the study period. Most hospitalizations occurred among females (66%) and in the 12–17 age group (66.9%). The relative proportions of hospitalizations surged from 65.8% in the pre-pandemic period to 68.4% during COVID-19 in individuals aged 12–17.

By contrast, hospitalizations decreased for the 6–11 and 18–20 age groups over the same period. Females accounted for up to 64% of hospitalizations during the pre-pandemic period, which increased to 69% during COVID-19-prevalent years. The proportion of hospitalizations in pediatric care centers was higher (25%) during the pandemic than before (21.4%).

In the pre-pandemic period, a larger proportion of hospitalizations occurred in the most deprived quintile (24.4%) than in the least deprived quintile (16.9%).

However, this difference in hospitalizations reduced during COVID-19 as hospitalizations in the least deprived quintile surged. Overall, the hospitalization rate for mental health conditions dropped by 7.2% between the pre-pandemic and COVID-19 periods.

Regional patterns were similar between the two periods, with a decrease in substance use, mood, and other disorders and an increase in eating disorders across all regions.

Regional increases in mood disorders, self-harm and suicide, and anxiety emerged in 2022, which returned to pre-pandemic levels in 2023. Further, females had a significant increase in hospitalizations for eating and personality disorders, anxiety, and self-harm and suicide in the COVID-19 period.

By contrast, males had an increase in hospitalizations for eating disorders. Overall, 881,765 ED visits were made for mental health conditions during the study period.

Consistently, females and individuals aged 12–17 had a higher proportion of ED visits during the COVID-19 period than in the pre-pandemic period. ED visits increased for eating disorders during the pandemic, while those for psychosis, substance use disorders, and mood disorders declined.

Conclusions

Together, the findings highlight increases in hospitalizations for eating disorders, self-harm and suicide, personality disorders, and anxiety during the COVID-19 period relative to pre-pandemic years. This trend largely manifested from changes in females, especially those aged 12–17.

Notably, hospitalizations and ED visits for substance use, mood, and other disorders declined for both sexes during the pandemic.