COVID-19 Pandemic Increased Risk of Hospitalization for Mental Health Reasons

Alba Gutiérrez-Sacristán, PhD

Hospitalizations for psychiatric conditions, including anxiety, depression, and suicidality increased since the beginning of the COVID-19 for adolescent patients.

A team, led by Alba Gutiérrez-Sacristán, PhD, Department of Biomedical Informatics, Harvard Medical School, estimated the changes in the proportion of hospitalizations associated with mental health conditions among adolescent patients following the onset of the COVID-19 pandemic.

The Hypothesis

While the severity and overall increase is not well-characterized, the ongoing COVID-19 pandemic has been associated antidotally with an increase in mental health diagnoses among adolescents.

“Large-scale federated informatics approaches provide the ability to efficiently and securely query health care data sets to assess and monitor hospitalization patterns for mental health conditions among adolescents,” the authors wrote.

There have been several studies showing increases in depression, anxiety, and suicidality among adolescents since the start of the pandemic, attributed in part because of extensive disruptions related to social distancing measures, including reductions in routine educational and recreational activities, limited social interactions with peers, and exposure to economic and other stressors in the home.

The Cohort

In the retrospective, multisite cohort, the investigators examined adolescents aged 11-17 years who were hospitalized with at least 1 mental health condition diagnosis between February 2019 and April 2021. They used patient-level data from electronic health records of 8 children’s hospitals in the US and France.

The investigators sought main outcomes of the change in the monthly proportion of mental health condition-associated hospitalization between the prepandemic period of February 2019 and March 2020 and the pandemic period between April 2020 and April 2021 using interrupted time series analysis.

The final analysis included 9696 adolescents hospitalized with a mental health condition during the prepandemic period and 11,101 during the pandemic period. The mean age was 14.6 years in the prepandemic cohort and 14.7 years in the pandemic cohort.

Depression, Anxiety, and Suicidality

The investigators looked at the rates of different psychiatric conditions.

The majority of patients in the pandemic period were diagnosed with anxiety (n = 6066; 57.4%). Depression (n = 5065; 48%) and suicidality or self-injury (n = 4673; 44.2%) were also prominent during the pandemic period.

The investigators also found an increase in the proportions of monthly hospitalizations during the pandemic for a number of disorders, including anxiety (0.55%; 95% CI, 0.26%-0.84%), depression (0.50%; 95% CI, 0.19%-0.79%), and suicidality or self-injury (0.38%; 95% CI, 0.08%-0.68%).

The team estimated a 0.60% increase (95% CI, 0.31%-0.89%) overall in the monthly proportion of mental health–associated hospitalizations following onset of the pandemic compared with the prepandemic period.

“In this cohort study, onset of the COVID-19 pandemic was associated with increased hospitalizations with mental health diagnoses among adolescents,” the authors wrote. “These findings support the need for greater resources within children’s hospitals to care for adolescents with mental health conditions during the pandemic and beyond.”

The study, “Hospitalizations Associated With Mental Health Conditions Among Adolescents in the US and France During the COVID-19 Pandemic,” was published online in JAMA Network Open.