Mental Health Hospitalizations Among Adolescents in the US, France Rose During the Pandemic

A study published this week found the COVID-19 pandemic was linked with an increase in hospitalizations in young adults with mental health conditions.

While it is already known that the pandemic had a deleterious effect on mental health, the extent of the problem, particularly in regard to severe conditions requiring hospitalization, including anxiety, depression, and self-harm or suicidality, has not been known.

The retrospective cohort study, published in JAMA Network Open, aimed to estimate the change in adolescent hospitalizations.

Patients were included if they were between the age of 11-17 years and had a hospitalization of at least 1 mental health condition between February 1, 2019, and April 30, 2021. These patients came from 8 different pediatric hospitals in the United States (5) and France (3), participating in the Consortium of Clinical Characterization of COVID-19 (4CE). The consortium is focused on clinical investigations of COVID-19 using electronic health record data.

The study compared 9696 adolescents who had been hospitalized with at least 1 mental health condition pre-pandemic period (February 1, 2019, to March 30, 2020) with 11,101 adolescents during the pandemic period (April 1, 2020, to April 30, 2021).

The mean (SD) age in the pre-pandemic group was 14.6 years, and 14.7 in the pandemic group.

Results showed an overall increase of 0.60% (95% CI, 0.31%-0.89%) in hospitalizations per month during the pandemic period compared with pre-pandemic hospitalizations.

In addition to the overall increase in hospitalizations, the study found that most affected patients were female in both the pre-pandemic (61.5%) and pandemic (68.5%) periods.

The most prevalent mental health conditions during the pandemic were 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 authors acknowledged certain limitations to their findings. First, they were unable to determine the primary cause of hospitalizations, and instead used all hospitalizations with at least 1 mental health condition to examine changes over time. Second, because the authors extracted data prespecified for 4CE, there was limited ability to test other characteristics of patients outside of the 4CE network data.

It is also important to note that prior to the pandemic, there already existed a high burden of adolescent hospitalizations related to anxiety, depression, and suicidality or self-injury. More than 40% of adolescents who were hospitalized pre-pandemic were diagnosed with 1 of the 3 mental health conditions.

The authors attribute social isolation and other disruptions of the COVID-19 pandemic as possible exacerbations to this increased trend in adolescent hospitalizations.

Despite these limitations, the increased trends of mental health-related hospitalizations suggest a need for ongoing support and prioritization of resources within the pediatric health care setting.

“Quantifying the change in mental health burden provides data to guide future policies and public health programs globally to improve access to high-quality mental health care in the outpatient and inpatient settings, even after the COVID-19 pandemic,” concluded the authors.

Reference

Gutiérrez-Sacristán A, Serret-Larmande A, Hutch MR, et al. Hospitalizations associated with mental health conditions among adolescents in the US and France during the COVID-19 pandemic. JAMA Network Open. 2022;5(12). doi:10.1001/jamanetworkopen.2022.46548