Data-driven assessment of adolescents’ mental health during the COVID-19 pandemic
Authors: Bilu Yonatan , Flaks-Manov Natalie , Bivas-Benita Maytal , Akiva Pinchas , Kalkstein Nir , Yehezkelli Yoav , Mizrahi-Reuveni Miri , Ekka-Zohar Anat , Ben David Shirley Shapiro , Lerner Uri , Bodenheimer Gilad , Greenfeld Shira 
Published: January 2022

Importance

Adolescents’ mental health and well-being were severely compromised during the COVID-19 pandemic. Longitudinal follow-up studies, based on real-world data, assessing the changes in mental health of adolescents during the later phase of the COVID-19 pandemic are needed.

Objective

To quantify the effect of COVID-19 on the incidence of Israeli adolescents’ mental health outcomes from electronic health record (EHR) data.

Design, Setting and Participants

Retrospective cohort study analyzing EHR data of Maccabi Healthcare Services members, the second largest Health Maintenance Organization in Israel. Eligible subjects were 12-17 years old, during 2017-2021 with no previous diagnosis or psychiatric drug dispensation of those analyzed in this study. This resulted in over 200,000 eligible participants each year.

Exposure

COVID-19 pandemic and the measures taken to mitigate it.

Main Outcomes and Measures

Incidence rates of mental health diagnoses (depression; anxiety; obsessive-compulsive disorder; stress; eating disorders; ADHD), and psychiatric drugs dispensation (antidepressants; anxiolytics; antipsychotics; ADHD agents) were measured, and relative risks were computed between the years. Subgroup analyses were performed for age, gender, population sector and socioeconomic status. Interrupted time series (ITS) analysis evaluated changes in monthly incidence rates of psychiatric outcomes.

Results

During the COVID-19 period a 36% increase was observed in the incidence of depression (95%CI: 25-47), 31% in anxiety (95%CI: 23-39), 20% in stress (95%CI: 13-27), 50% in eating disorders (95%CI: 35-67), 25% in antidepressants (95%CI: 25-33) and 28% in antipsychotics dispensation (95%CI: 18-40). Decreased rate of 26% (95% CI: 0.80-0.88) was observed in ADHD diagnoses and 10% (95% CI: 0.86-0.93) in prescriptions of ADHD agents. The increase was mostly attributed to females in the general Israeli population; nevertheless, a 24% increase in anxiety was seen in males (95%CI: 13-37), 64% in Israeli Arabs (95%CI: 12-140) and 31% in ultra-orthodox (95%CI: 3-67). ITS analysis revealed a significantly higher growth in the incidence of psychiatric outcomes during the COVID-19 period, compared to previous years.

Conclusions and Relevance

EHR data of adolescents shows increased incidence rates of mental health diagnoses and medications during the COVID-19 pandemic, specifically identified females as those with the highest mental health burden. Our study highlights that the deteriorating mental health of children should be considered by decision-makers when actions and policies are put in place entering the third year of the pandemic.

Key Points

Question

Has the COVID-19 pandemic and the strategies to contain it affected adolescents’ mental health?

Findings

In this retrospective cohort study of over 200,000 adolescents 12–17 years old, the incidence rates of several measured mental health diagnoses and psychiatric medications increased significantly during the COVID-19 pandemic compared to the period before. This increase was mostly attributed to females.

Meaning

This real-world study highlights the deterioration of adolescents’ mental health during the COVID-19 pandemic and suggests that the mental health of this young population should be considered during management and health policy decision making.