COVID-19 Pandemic Responsible for Increased Need for Pediatric Behavioral Health Services

Yael Dvir, MD

A recent investigation into metal health resources for children and young adults during the COVID-19 pandemic suggested an increasing need for pediatric behavioral health services and outpatient treatment.

Though the data did not suggest a causative relationship between the pandemic and pediatric mental illness, they did show the number of youths presenting to pediatric primary care clinicians with mental health concerns increased during the COVID-19 pandemic compared to prior years—as did the rate of complexity in their presentations.

In recent studies, pandemic-related social isolation, school closures, and anxiety about the future had been associated with mental health burden among young people.

Investigators led by Yael Dvir, MD, of the Division of Child and Adolescent Psychiatry at the University of Massachusetts Chan Medical School, felt the findings into mental health effects of the COVID-19 pandemic has not captured the substantial number of youths who do not visit the hospital.

As such, they examined data from the Massachusetts Child Psychiatry Access Program (MCPAP).

The Methods

The MCPAP was established in 2004 to aid PCCs in providing psychiatric treatment through consultation and referral services. For their cross-sectional study, Dvir and colleagues collected data on unique patient telephone and in-person encounters during fiscal years (FYs) from 2019 to 2021.

The UMass Chan Medical School institutional review board indicated that oversight and informed consent was not required because the study team had not accessed private identifiable information.

The number of monthly encounters in 2021 was then compared with those In 2019 and 2020 using a Mann-Whitney U test. By using available data, the team conducted χ2 tests to compare the counts of encounters before the COVID-19 pandemic (March and April in 2018 and 2019) and during the pandemic (March and April in 2021) by sex, type of insurance, and patient age.

Dvir and colleagues noted that these months were chosen for consistency relative to the timing of the pandemic and to minimize seasonal differences.

From there, the mean number of monthly encounters by mental health diagnosis was compared between periods before and during the pandemic using descriptive data such as means and percentage change, and a P < .05 using a 2-tailed test was considered statistically significant.

The Findings

Investigators recruited a total of 2515 unique patients with encounters at the MCPAP before the COVID-19 pandemic as well as 1700 patients with encounters during the pandemic.

During the pandemic, investigators observed that patients were more likely to be female compared with before the pandemic (904 [54%] vs 1102 [44%]; odds ratio [OR], 1.47; 95% CI, 1.30-1.67. Patients were also less likely to be 12 years or older (657 [39%] vs 1283 [51%]; OR, 0.60; 95% CI, 0.53-0.68).

Though no difference in the percentage of patients with private insurance during and before the pandemic was found (898 [58%] vs 1252 [55%]; OR, 1.10; 95% CI, 0.97-1.26), and increase was seen regarding the number of patient encounters per month increased for each mental health diagnosis from before to during the anxiety.

Regarding anxiety, the number of patient encounters increased from 211 to 301, and depression saw an increase from 166 to 238. Similar increases were observed in patients on the autism spectrum disorder (31 to 82), attention-deficit/hyperactivity disorder (172 to 175) and other (264 to 307).

The greatest percentage increase, however, was for encounters for autism spectrum disorder (165%), followed by anxiety (43%), depression (43%), other (16%), and attention-deficit/hyperactivity disorder (2%).

Dvir and investigators added the data suggested an increased need for pediatric behavioral health services and treatment on an outpatient basis.

“We hypothesize that decreased availability of in-home applied behavioral analysis and in-person special education was associated with disruption and stress for youths and families who depend on them,” the team wrote.

The study, "Comparison of Use of the Massachusetts Child Psychiatry Access Program and Patient Characteristics Before vs During the COVID-19 Pandemic," was published online in JAMA Open Network.