In a recent article published in JAMA Network Open, researchers conducted a retrospective, multisite cohort study amongst 11 to 17-year-old adolescents in america of America (USA) and France. They assessed the month-on-month change within the variety of mental health condition–related hospitalizations between pre- and post-pandemic times.

Study: Hospitalizations Associated With Mental Health Conditions Amongst Adolescents within the US and France Throughout the COVID-19 Pandemic. Image Credit: Ahmet Misirligul/Shutterstock

Background

The COVID-19 pandemic caused global disruption resulting in 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 greater than males. Yet, studies didn’t adequately characterize the extent of this unlucky surge in severe mental health issues amongst adolescents, particularly for severe cases requiring hospitalization.

Public health programs must goal the psychiatric healthcare needs of those adolescents and make changes to the healthcare infrastructure and resources required to supply top-notch mental healthcare facilities in the longer term.

In regards to the study

In the current 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 evaluation (ITS) to estimate the variations in mental health condition–related hospitalizations amongst adolescents between February 1, 2019, to March 31, 2020, and April 1, 2020, to April 30, 2021.

The ITS evaluation proportional difference, if positive, indicated a rise in the common month-on-month change in hospitalization proportion between pre-pandemic times and through the pandemic. The team used linear regression models to estimate the monthly variations in adolescent hospitalization (average) proportions between pre- and post-pandemic periods.

Moreover, they performed mental condition-specific analyses, wherein they only included adolescents with a particular mental condition and again assessed the change in monthly proportions of hospitalizations. They, as an illustration, assessed three mental conditions most prevalent within the study participants and examined eating disorders.

Moreover, the team compared the hospitalization characteristics between the 2 study periods. Specifically, they determined the variety 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 1 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 guard patient confidentiality but eventually shared it for added aggregate analyses, stratified by sex. Also, they ensured that this data adhered to a standard 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 have been 9696 and 11,101 adolescents with no less than one mental health condition–related hospitalization within the reference pre-pandemic and examined pandemic periods, respectively, with a mean age of 14.6 and 14.7 years, at hospitalization.

The common 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 each study periods, the three mental health conditions most predominant within the study participants were depression, anxiety, and suicidality.

Throughout the pandemic, hospitalization amongst adolescents with anxiety disorders peaked from 52.4% within the pre-pandemic period to 57.4%. The proportion of hospitalizations amongst adolescents diagnosed with suicidality also increased between each periods, from 42.3% to 44.2%. Nevertheless, the month-on-month change in hospitalizations amongst adolescents with depression was minimal and peaked from 46.9% to simply about 48.0%.

Moreover, the researchers noted a time-based increase in mental health–related hospitalization proportions in 4 US and one France health care sites, with an inter-period proportional difference of 0.60% per thirty days.

Conclusions

In 2020, suicide represented the third top reason for death amongst children and adolescents aged 10 to 24. The social isolation related to the COVID-19 pandemic may need exacerbated the situation. Thus, quantifying the changes in mental health burden could inform future public health policies globally. Nevertheless, within the short term, first, it will improve the detection/screening of mental health disorders and their related conditions. Second, it will increase access to good mental health care services, including through telemedicine and school-based awareness programs, even after the COVID-19 pandemic ends.