Mental Health Hospitalizations in Canadian Children, Adolescents, and Young Adults Over the COVID-19 Pandemic
Authors: Roumeliotis Nadia , Carwana Matthew , Trudeau Ofélie , Charland Katia , Zinszer Kate , Benigeri Mike , Diop Mamadou , Papenburg Jesse , Ali Samina , Yaskina Maryna , Wahi Gita , Forgeot d’Arc Baudoin , Côté Sylvana , Sadarangani Manish , Basta Nicole E. , Fontela Patricia S. , Gantt Soren , Klassen Terry P. , Quach Caroline , Doan Quynh , Ahira Sarah , Allen Upton , Baerg Krista , Bale-Nick Megan , Banerjee Ananya , Barton Michelle , Beer Darcy , Berthelot Simon , Bettinger Julie , Bhatt Maala , Buba Melanie , Buchanan Francine , Bullard Jared , Burstein Brett , Burton Catherine , Chanchlani Rahul , Chassé Michaël , Choong Karen , Constantin Evelyn , Constantinescu Cora , Costello Carrie , Dewan Tammie , Di Genova Tanya , Drouin Olivier , Dryden-Palmer Karen , Du Pont- Thibodeau Geneviève , Dugas Marc-André , Dumont-Maurice Raven , Emeriaud Guillaume , Emsley Jason , Ferro Mark , Forbes Karen , Fortier Isabel , Foster Jennifer , Foulds Jessica , Freedman Stephen , Freire Gabrielle , Galanis Eleni , Gill Peter , Gravel Jocelyn , Gruenwoldt Emily , Guerra Gonzalo , Guttman Astrid , Hancock Betty Jean , Harrison Robyn , Holland Joanna , Joffe Ari , Kakkar Fatima , Kam April , Kellner James D. , Knisley Lisa , Lacaze-Masmonteil Thierry , Lalgudi Ganesan Saptharishi , Langlois Marc- André , Le Saux Nicole , Lee Laurie , Leifso Kirk , Li Patricia , Linares Andrea , Mahant Sanjay , Marc Isabelle , Mater Ahmed , McNally James , Meckler Garth , Morris Shaun , Mtaweh Haifa , Murthy Srin , Muttalib Fiona , Newhook Leigh- Anne , Nicoll Jessica , Orr-Gaucher Nathalie , Pagano Joseph , Pangilinan Anna , Pernica Jeffrey , Poonai Naveen , Portales-Casamar Elodie , Porter Robert , Purewal Rupeena , Robeson Paula , Robinson Joan , Salvadori Marina , Samuel Susan , Scott Shannon , Sehgal Anupam , Shah Archna , Sotindjo Tatiana , Southward Carla , Stoesz Taylor , Strang Robert , Suleman Shazeen , Szatmari Peter , Taheri Sepi , Tam Jennifer , Thibeault Roseline , Top Karina , Toulouse Krystel , Tse Sze-Man , Wadhwa Anupma , Wong Sam , Wright Bruce , Yeung Rae ,   POPCORN Investigators
Published: July 2024

Importance

The COVID-19 pandemic resulted in multiple socially restrictive public health measures and reported negative mental health impacts in youths. Few studies have evaluated incidence rates by sex, region, and social determinants across an entire population.

Objective

To estimate the incidence of hospitalizations for mental health conditions, stratified by sex, region, and social determinants, in children and adolescents (hereinafter referred to as youths) and young adults comparing the prepandemic and pandemic-prevalent periods.

Design, Setting, and Participants

This Canadian population-based repeated ecological cross-sectional study used health administrative data, extending from April 1, 2016, to March 31, 2023. All youths and young adults from 6 to 20 years of age in each of the Canadian provinces and territories were included. Data were provided by the Canadian Institute for Health Information for all provinces except Quebec; the Institut National d’Excellence en Santé et en Services Sociaux provided aggregate data for Quebec.

Exposures

The COVID-19–prevalent period, defined as April 1, 2020, to March 31, 2023.

Main Outcomes and Measures

The main outcome measures were the prepandemic and COVID-19–prevalent incidence rates of hospitalizations for anxiety, mood disorders, eating disorders, schizophrenia or psychosis, personality disorders, substance-related disorders, and self-harm. Secondary measures included hospitalization differences by sex, age group, and deprivation as well as emergency department visits for the same mental health conditions.

Results

Among Canadian youths and young adults during the study period, there were 218 101 hospitalizations for mental health conditions (ages 6 to 11 years: 5.8%, 12 to 17 years: 66.9%, and 18 to 20 years: 27.3%; 66.0% female). The rate of mental health hospitalizations decreased from 51.6 to 47.9 per 10 000 person-years between the prepandemic and COVID-19–prevalent years. However, the pandemic was associated with a rise in hospitalizations for anxiety (incidence rate ratio [IRR], 1.11; 95% CI, 1.08-1.14), personality disorders (IRR, 1.21; 95% CI, 1.16-1.25), suicide and self-harm (IRR, 1.10; 95% CI, 1.07-1.13), and eating disorders (IRR, 1.66; 95% CI, 1.60-1.73) in females and for eating disorders (IRR, 1.47; 95% CI, 1.31-1.67) in males. In both sexes, there was a decrease in hospitalizations for mood disorders (IRR, 0.84; 95% CI, 0.83-0.86), substance-related disorders (IRR, 0.83; 95% CI, 0.81-0.86), and other mental health disorders (IRR, 0.78; 95% CI, 0.76-0.79).

Conclusions and Relevance

This cross-sectional study of Canadian youths and young adults found a rise in anxiety, personality disorders, and suicidality in females and a rise in eating disorders in both sexes in the COVID-19–prevalent period. These results suggest that in future pandemics, policymakers should support youths and young adults who are particularly vulnerable to deterioration in mental health conditions during public health restrictions, including eating disorders, anxiety, and suicidality.