Hospitalizations Associated With Mental Health Conditions Among Adolescents in the US and France During the COVID-19 Pandemic

Abstract

Importance: The COVID-19 pandemic has been associated with an increase in mental health diagnoses among adolescents, though the extent of the increase, particularly for severe cases requiring hospitalization, has not been well characterized. Large-scale federated informatics approaches provide the ability to efficiently and securely query health care data sets to assess and monitor hospitalization patterns for mental health conditions among adolescents.

Objective: To estimate changes in the proportion of hospitalizations associated with mental health conditions among adolescents following onset of the COVID-19 pandemic.

Design, setting, and participants: This retrospective, multisite cohort study of adolescents 11 to 17 years of age who were hospitalized with at least 1 mental health condition diagnosis between February 1, 2019, and April 30, 2021, used patient-level data from electronic health records of 8 children's hospitals in the US and France.

Main outcomes and measures: Change in the monthly proportion of mental health condition-associated hospitalizations between the prepandemic (February 1, 2019, to March 31, 2020) and pandemic (April 1, 2020, to April 30, 2021) periods using interrupted time series analysis.

Results: There were 9696 adolescents hospitalized with a mental health condition during the prepandemic period (5966 [61.5%] female) and 11 101 during the pandemic period (7603 [68.5%] female). The mean (SD) age in the prepandemic cohort was 14.6 (1.9) years and in the pandemic cohort, 14.7 (1.8) years. The most prevalent diagnoses during the pandemic were anxiety (6066 [57.4%]), depression (5065 [48.0%]), and suicidality or self-injury (4673 [44.2%]). There was an increase in the proportions of monthly hospitalizations during the pandemic for 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%). There was an estimated 0.60% increase (95% CI, 0.31%-0.89%) overall in the monthly proportion of mental health-associated hospitalizations following onset of the pandemic compared with the prepandemic period.

Conclusions and relevance: In this cohort study, onset of the COVID-19 pandemic was associated with increased hospitalizations with mental health diagnoses among adolescents. These findings support the need for greater resources within children's hospitals to care for adolescents with mental health conditions during the pandemic and beyond.

Figure 1.. Interrupted Time Series Analysis by Health Care Site

Dots represent the proportion of hospitalizations in a given month that included at least 1 mental health diagnosis. Results of the interrupted time series analyses are presented as monthly proportion differences between the prepandemic and pandemic periods. The 95% CIs were estimated using parametric bootstrapping (10 000 iterations). Solid lines represent the medians, the lower and upper dashed lines represent the 2.5th and 97.5th percentiles, respectively, and the shaded area represents the bootstrap iterations between the 2.5th and 97.5th percentiles.

Figure 2.. Meta-analysis of Interrupted Time Series Analysis by Health Care Site and Country

The proportion difference between the prepandemic and pandemic periods for each health care site or country was determined by interrupted time series analyses. The pooled effect was estimated using a random-effects meta-analysis. Squares represent mean proportion differences, with horizontal lines indicating 95% CIs. The size of the squares is proportional to the relative sample size of each health care site among all sites. Diamonds represent the pooled mean proportion differences among all health care sites, with outer points of the diamonds representing the 95% CIs of the pooled means. The vertical dashed lines represent projections of the pooled mean proportion differences.

Figure 3.. Interrupted Time Series Analysis for Selected Mental Health Conditions

Dots represent the proportion of hospitalizations in a given month that included at least 1 of the selected mental health diagnoses. Results of the interrupted time series analyses are presented as monthly proportion differences between the prepandemic and pandemic periods. The 95% CIs were estimated using parametric bootstrapping (10 000 iterations). Solid lines represent the medians, the lower and upper dashed lines represent the 2.5th and 97.5th percentiles, respectively, and the shaded area represents the bootstrap iterations between the 2.5th and 97.5th percentiles.

Figure 4.. Interrupted Time Series Analysis for Proportion of Hospitalizations Among Females

Dots represent the proportion of females among mental health–related hospitalizations across all sites in a given month. The result of the interrupted time series analysis is represented as the monthly proportion difference between the prepandemic and pandemic periods. The 95% CIs were estimated using parametric bootstrapping (10 000 iterations). Solid lines represent the medians, the lower and upper dashed lines represent the 2.5th and 97.5th percentiles, respectively, and the shaded area represents the bootstrap iterations between the 2.5th and 97.5th percentiles.