Pandemic-Intensified Mental Health Issues in Youth Across the US

Mental Health Issues in Youth Across the US

United States: The mental health of the younger population of the United States and its nearby nations has been distorted during or after the post-COVID-19 pandemic, according to a recently conducted study. Unhealthy mental health has been responsible for increasing conditions like anxiety, depression, and some eating disorders linked to mental issues.

The study was published in JAMA Journals, according to reports by CIDRAP News.

Rise in Eating Disorder Hospitalizations Amidst the Pandemic

A study from the Pediatric Outcome Improvement through Coordination of Research Networks (POPCORN), unveiled today, indicates a decline in hospitalization rates for mood disorders and substance use among males and females aged 6 to 20 years from before the pandemic. Conversely, admissions for eating disorders surged for both sexes, with substantial increases in anxiety, personality disorders, suicidal ideation, and self-harm among females.

While conducting the research, the authors surveyed around 6.3 million – aged between six and 20 years – from April 2016 to March 2023. Out of the total Canadian youth, as many as 218,101 sought hospital admissions for mental illnesses.

However, hospitalizations escalated for anxiety (11%), personality disorders (21%), suicide or self-harm (10%), and eating disorders in females (66%) and males (47%). For both sexes, hospitalizations for mood disorders (-16%), substance use (-17%), and other mental disorders (-22%) saw a decline.

Reportedly, the increased hospitalization due to mental illness was seen among the population aged between 12 to 17 years. The rate of hospitalization has increased from 68.4 percent to 65.8 percent during the pandemic and before the pandemic, respectively. However, the rate decreased among people aged between six to 11 and 18 to 20 years.

Living in rural areas was associated with a higher rate of mental disorder hospitalizations for all conditions except eating disorders.

There were 881,765 emergency department (ED) visits for mental health conditions during the study period. Females represented a larger proportion of ED visits during the pandemic (65.8%) compared to before (60.0%), alongside participants aged 12 to 17 years (52.7% vs. 46.0%).

“Understanding the impact of the pandemic on children, adolescents, and young adults in Canada is critical for shaping public health policy. These findings suggest that maintaining services geared towards females, especially screening for eating disorders, anxiety, personality disorders, and suicidality, will be vital in future pandemics,” the authors noted.

Link Between Lockdown Stringency and Hospitalizations

Another study in JAMA Pediatrics by POPCORN researchers investigated 8,726 hospitalizations for eating disorders among Canadian youths of the same age over the same period. It found that among girls aged 12 to 17, a 10% increase in lockdown stringency correlated with significant rises in hospitalizations for eating disorders, varying by region.

Lockdown stringency was measured using 12 indicators, including office and school closures, public event cancellations, travel restrictions, and stay-at-home orders.

During the study period, Canada witnessed 11,289 eating disorder hospitalizations, with 90.4% among girls, 77% of whom were aged 12 to 17. A 10% increase in lockdown stringency corresponded to a notable rise in hospitalization rates in Quebec and Ontario (5%), the Prairie provinces (8%), and British Columbia (11%).

Excess hospitalizations peaked at the one-year mark of the pandemic, with significant increases in Quebec (117%), Ontario (144%), the Prairies (139%), and British Columbia (102%).

Visual Representation. Credit | Getty images

Before and during the pandemic, 58.6% of hospitalizations were for youths without a prior history of eating disorder hospitalizations.

The surge in such hospitalizations likely stemmed from various factors, including increased social isolation, disrupted routines and extracurricular activities, more disordered eating, and heightened compensatory physical exercise, the researchers stated.

“Given that most patients with eating disorders are treated as outpatients, the lack of outpatient services during the pandemic may have led to disease progression, resulting in a higher likelihood of hospital admission compared to other mental health disorders due to the immediate medical health risk,” they wrote.

For future pandemics, pediatric healthcare providers should establish ways to stay connected with patients for ongoing clinical assessment and psychosocial support, either through hospital visits or telehealth.

“Healthcare practitioners should also screen youths for new eating disorders regardless of weight, gender, or socioeconomic status,” the authors wrote. “Promoting social connectedness for youths, including support networks and parental education, is crucial to ensure that children experiencing restrictions, such as school closures, are minimally socially isolated.”

Impact of COVID Stress on Low-Income Youth

In JAMA Network Open, researchers from Children’s Hospital Los Angeles found that children from wealthier families reported higher levels of depression and anxiety during COVID-19 lockdowns, contrary to the hypothesis that lower-income youths would fare worse.

Using the Child Behavior Checklist (CBCL), the Family Environmental Scale (FES), and the income-to-needs ratio (INR), the study assessed mental health before and during the pandemic among 10,399 children aged 10 to 12 years participating in the multisite, 10-year Adolescent Brain Cognitive Development Study.

There were no significant differences in the average number of total problems on the CBCL between the pre-pandemic and pandemic groups over time. An increase of one unit in the INR corresponded to a reduction in the average rate of change in total problems.

The study suggested that families with more socioeconomic disadvantage may have taken more actions to alleviate emotional distress related to the pandemic.

Visual Representation of Mental Health Issues in Youth. Credit | Getty images

For youths differing by one unit in INR between the prepandemic and pandemic cohorts from one- to two-year follow-up, the expected difference in total problems was 0.79, with sex, age, caregiver education, and interstudy interval held constant, indicating lower total problems among youths with lower INR in the pandemic group than those in the prepandemic group.

For every one-unit difference in INR, the expected differences between the pandemic and prepandemic groups from one- to two-year follow-up were 0.19 for anxiety or depression, 0.17 for aggression, 0.09 for inattention, 0.08 for social problems, 0.06 for rule-breaking, 0.12 for cognitive issues, 0.27 for internalization problems, and 0.23 for externalization issues.

The researchers noted that previous findings suggested children in lower-income families may have better adapted to pandemic stressors. “Indeed, our research group previously published data demonstrating that families with more socioeconomic disadvantage may have taken more action to alleviate emotional distress related to the COVID-19 pandemic,” they said.

“These results imply that socioeconomic status may play a role in youth mental health outcomes during the COVID-19 lockdown, which could be crucial for targeted treatment approaches,” they concluded.

However, the study did not provide insight into what drove the differences between the pandemic and pre-pandemic groups.

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