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