— Mental health visits increased in 2020, especially among teen girls, Canadian study finds
Pediatric mental health visits to physicians increased during the first year of the COVID-19 pandemic in Ontario, Canada, according to a population-wide study.
Starting in July 2020, rates of visits to mental health services were consistently 6% to 15% above expected levels — based on prior years — and were sustained as of February 2021 (adjusted relative rate [aRR] 1.15, 95% CI 1.13-1.17), reported Natasha Ruth Saunders, MD, MSc, of the Hospital for Sick Children in Toronto, and colleagues.
The largest increase in physician-based mental health visits was recorded for adolescent girls (aRR 1.26, 95% CI 1.25-1.28), they noted in JAMA Pediatrics.
While visit rates declined rapidly to below expected levels in April 2020 (aRR 0.81, 95% CI 0.79-0.82), virtual care peaked that month, accounting for 90% of mental health care visits (5.3 visits per 1,000 population), dipping to 86.9% in May and 80.2% in June, and then leveling off to about 70% in the latter months of the year, with the largest decreases in children ages 3 to 6.
“The widespread shift to virtual mental health care has not been matched in other sectors, including pediatric primary care and ambulatory care more broadly, or in other jurisdictions,” the authors pointed out.
“The novel observation of large sex-based differences in pediatric mental health care utilization suggests pandemic-related changes disproportionately affected young female individuals and specific attention must be paid to ensure equity in and adequacy of supports for this sector of the population,” they wrote.
“Saunders and colleagues join the growing number of investigators confirming the substantial mental health outcomes associated with the COVID-19 pandemic in youth and a need to respond to the increasing demand for services,” wrote Tami Benton, MD, of the Children’s Hospital of Philadelphia, and colleagues in an accompanying editorial.
In April 2021, Benton spoke to a senate committee on the dire state of mental health during the pandemic, sharing the story of one of her own 5-year-old patients who could not receive adequate mental health care.
The American Academy of Pediatrics and other groups declared a national emergency in children’s mental health in October 2021, urging policymakers to improve access to services.
The study showed that from July 2020 onwards, visit rates for substance use disorders and psychotic disorders increased, though these made up only a small percent of all mental health visits, Saunders and team noted.
For mood and anxiety disorders, visit rates were also higher than expected. In July 2020, visit rates were 10% higher than in previous years (aRR 1.10, 95% CI 1.08-1.11) and followed a similar pattern with overall physician visits.
On the other hand, “visit rates for social problems and neurodevelopmental concerns followed a different pattern,” the authors wrote. Visit rates were lower than expected from March to June, as expected in July and August (and September for neurodevelopmental concerns), and increased to higher than expected in late fall.
In the emergency department (ED), visit rates sank in April 2020 before returning to expected levels by July. However, ED visit rates fell 12% to 20% again from September to the end of the study period in February 2021.
“Given the chronic and cumulative nature of distress on mental health and well-being, the impact of the pandemic on the mental health of children and adolescents is likely not yet fully realized,” Saunders and colleagues emphasized.
“The good news is that we do have effective treatments for pediatric mental health conditions. The challenge is ensuring that all children and adolescents who need them have access. This study adds support for virtual visits as one potential part of the solution,” Benton and colleagues wrote.
“We cannot wait to respond to the distress and escalating mental health and suicide crisis,” they added. “Prioritizing children’s and adolescents’ mental health demands a transformational societal and systems solution that protects their future.”
This population-based repeated cross-sectional study included 2.5 million children (48.7% female, mean age 10 years) in Ontario who were eligible for provincial health insurance, and used ICES (formerly the Institute for Clinical Evaluative Sciences) data from January 2017 to February 2020 to measure pre-COVID visits, and March 2020 to the end of February 2021 for post-COVID-onset visits. The primary outcome was the number of mental health outpatient visits to a pediatrician, family physician, or psychiatrist.
Prior to the pandemic, outpatient mental health care visits averaged 6.9 weekly visits per 1,000 population, and virtual care made up 0.1% of all visits.
Saunders and colleagues acknowledged that they could not measure unmet mental health care needs and non-physician care provided by social workers, psychologists, or therapists. They also noted that they could not distinguish between telephone and video virtual visits, which could impact the quality of care delivered.