Although pediatric anxiety and depression had been on the rise for years, today it is well documented that the COVID-19 pandemic exacerbated the mental health crisis among children and teens in a profound way. But as a pediatric resident at the start of the pandemic, Deanna Hano, M.D., MSc, now a pediatric hospitalist at NewYork-Presbyterian and Weill Cornell Medicine, only had anecdotal evidence to go off of. She noticed more mental health concerns presenting in her pediatric patients than before the pandemic, which led her to wonder if her observations were true.
Dr. Hano worked with fellow residents as well as Cori Green, M.D., MSc, a pediatrician at NewYork-Presbyterian and Weill Cornell Medicine and vice chair of behavioral health in the Department of Pediatrics at Weill Cornell Medicine, to conduct a retrospective cohort study investigating the differences in the prevalence of positive depression screens before and during the COVID-19 pandemic within primary care settings in New York City. The results of the study were recently published in Maternal and Child Health Journal.
Below, Dr. Hano and Dr. Green discuss the impact of COVID-19 on the pediatric mental health crisis, the findings of their study, and how their research can impact screening and care for children with depression and anxiety.
There was a crisis before the pandemic hit, but it became hard to ignore. Kids were isolated from their friends during a time of their lives when they are meant to be social and connected, and it impacted their mental health greatly.
— Dr. Cori Green
What did you observe about children’s mental health during the pandemic?
Dr. Green: During the pandemic, Dr. Hano and I were both noticing such an increased rate of mental health problems among adolescents, mainly depression. There was a crisis before the pandemic hit, but it became hard to ignore. Kids were isolated from their friends during a time of their lives when they are meant to be social and connected, and it impacted their mental health greatly.
Dr. Hano: This led us to examine pre-pandemic and intra-pandemic prevalence of depression and other mental health comorbidities in our adolescent population. We looked at patients aged 12-21 who had been seen at two New York City primary care clinics for well-child visits and who had completed depression screens before and during the pandemic. We reviewed 1,621 patient charts and of those, 232 patients had screens completed during both time periods. So we began to dig in to see who had changes in their depression screen results from both periods and what the characteristics were of those patients.
What were the results of the study?
Dr. Hano: The results were interesting: 9.9% of patients screened positive for depressive symptoms before the pandemic and 16.4% screened positive during the pandemic. Of those:
- 11.2% with negative depression screens before the pandemic had positive screens during the pandemic.
- 5.2% had positive screens during both time periods.
- 4.7% had positive screens before the pandemic but negative during the pandemic.
There were also significant differences in diagnosed mental health conditions between the two periods:
- Prevalence of depression was higher during the pandemic (15.5%) compared to pre-pandemic (9.1%).
- Prevalence of anxiety was higher during the pandemic (9.9%) than pre-pandemic (7.3%).
- More patients indicated having suicidal ideations during the pandemic (4.3%) than pre-pandemic (1.7%).
Another area of difference was in substance use between the two periods:
- Nearly 1% of patients endorsed alcohol use pre-pandemic while 4.3% did so during the pandemic.
- 2.6% of patients endorsed drug use pre-pandemic compared to 4.7% during the pandemic.
This confirmed what we were seeing anecdotally – that the pandemic was having a profound impact on the mental health of our adolescents.
Dr. Green: We then dug a little bit deeper to see what was going on with each cohort. If you had persistently positive screens, who were you? If you had negative screens and then positive, was there something about you that led to that change? And what we found was that children with comorbid mental health problems were the ones going from negative screens to positive ones, or who remained positive. I think there were a lot of kids who had symptoms prior to the pandemic but not disorders, and then the stressors of the pandemic hit, and they developed a diagnosis that might not have shown up on a screen prior to the pandemic.
What our study illustrated was that not only was there an increased prevalence of mental health conditions among youth, but that the need for resources for this population is significant. We need to put them into place now so that when a future traumatic event happens, we’re already prepared to help our patients.
— Dr. Deanna Hano
Another cause was access. If you were in care before the pandemic, your care might have lapsed because you weren’t doing in-person visits. Not all mental health centers had the ability to do telehealth, which definitely impacted patients.
What do you hope will be the larger takeaway from the research?
Dr. Hano: What our study illustrated was that not only was there an increased prevalence of mental health conditions among youth, but that the need for resources for this population is significant. We need to put them into place now so that when a future traumatic event happens, we’re already prepared to help our patients.
Dr. Green: There are 9,000 child and adolescent psychiatrists in the whole country. If one in five kids have a mental health problem, there simply aren’t enough professionals available to help them. So, our findings add data to what we already know, that we need more clinicians and resources to meet the increasing mental health needs of our youth.
As someone who teaches pediatricians how to screen, I’m hoping the results also encourage pediatricians to not only screen but to take the next step and help children get a diagnosis, because you need that to guide treatment for the child and help the family understand what’s going on.
