Patterns of new psychiatric diagnoses among children and adolescents during the COVID-19 pandemic

A new study published in PLoS Medicine aimed to determine the number of adolescents and children with primary or secondary diagnoses across the pandemic. The observed data were then compared to the predictions of the pre-pandemic data of January 2017.

Background

Coronavirus disease 2019 (COVID-19) pandemic restrictions and stressors could be associated with increased psychiatric problems among adolescents and children. Studies reported elevated anxiety and depression symptoms among children and adolescents, as well as a reduction in the use of psychiatric services during the early stages of the pandemic.

However, many issues remain unclear. First, only a few studies covered the first year of the pandemic and showed mixed results for different outcomes. Second, the pandemic and its associated restrictions impacted different age groups and geographical areas differently.

Furthermore, only a few studies reported how different diagnostic groups used services. The number of patients, visits, and referrals using services helps to understand their demand but does not indicate the number of children and adolescents using it for the first time. Finally, the data on the new diagnoses in psychiatric services during the pandemic was limited.

About the study

The study involved children and adolescents aged between 0 and 17 years who lived in Finland between January 2017 and September 2021. The periods of interest were before the COVID-19 pandemic (January 2017 to February 2020), the initial three months of the pandemic (March to May 2020), and the next 16 months of the pandemic (June 2020 to September 2021).

Strict restrictions were in place in Finland from March to May 2020, resulting in the closure of schools and other educational institutions. The restrictive measures were gradually reduced in May 2020. However, school restrictions were re-implemented in many areas of Finland between December 2020 and April 2021 due to increased infection rates.

Data were obtained from Statistics Finland to identify the annual population stratified by sociodemographic characteristics. New monthly diagnoses were identified using The Care Register for Health Care. The main outcome involved new monthly diagnoses of primary secondary neurodevelopmental and psychiatric disorders carried out through specialist services between January 2017 and September 2021. Secondary outcomes included the use of services for any new diagnosis between 0 to 12 versus 13 to 17 years and were stratified by sex.

Study findings

The results indicated that the at-risk population of children and adolescents ranged from 1,037,378 to 1,035,517 from 2017 to 2020. The age of the majority of participants was between 0 and 12 years. 16,637 to 16,592 participants were reported to use services and psychiatric diagnoses for any disorder from 2017 to 2020. The incidence of diagnoses was observed to be low during g the pre-pandemic period of January 2017 to February 2020 and was lowest during the Finnish school holiday months of December and July.

The observed incidence decreased from the predicted incidence from March to May 2020. The observed incidence was reported to be a fifth higher than predicted from June 2020 to September 2021. The observed rates were also reported to be higher than predicted between December 2020 and September 2021. The observed incidence was reported to be lower than predicted among males and those aged between 13 and 17 years from March to May 2020. From June 2020 to September 2021, significant differences in observed and predicted differences were reported in females and those between 13 and 17 years.

The observed diagnoses were reported to be lower than the predicted for depression, substance use, and anxiety disorders from March to May 2020. After that, an increase in the observed diagnoses was reported for anxiety disorders, depression, eating disorders, and neurodevelopmental disorders. The increase in depression, anxiety, and eating disorders peaked in September 2020, while neurodevelopmental disorders peaked in December 2020. Females reported increased observed rates for only depression and anxiety as compared to males, while all other patterns were observed to be similar between them.

Therefore, the current study indicated an increase in new primary and secondary diagnoses of psychiatric or neurodevelopmental disorders when the restrictions for the COVID-19 pandemic were eased gradually. This can occur due to changes in referrals, help-seeking, psychiatric problems, and delayed access to services. Further research is required to develop action plans to deal with future pandemics as well as unexpected crises.

Limitations

The study has certain limitations. First, the study was unable to identify psychiatric symptoms among children and adolescents who did not seek help. Second, the study could not determine the cause of pandemic associated changed diagnoses. Furthermore, quantitative data on changes in waiting time, staff capacity, and policy changes across the service system was unavailable.

Additionally, if a patient’s first psychiatric diagnosis is initially incorrect and later corrected could not be determined. Fifth, the results could not be generalized to other countries. Finally, the study did not consider immigration, emigration, and prior diagnoses.