Mental Health Care Utilization and Prescription Rates Among Children, Adolescents, and Young Adults in France

Abstract

Importance: Amid escalating mental health challenges among young individuals, intensified by the COVID-19 pandemic, analyzing postpandemic trends is critical.

Objective: To examine mental health care utilization and prescription rates for children, adolescents, and young adults before and after the COVID-19 pandemic.

Design, setting, and participants: This population-based time trend study used an interrupted time series analysis to examine mental health care and prescription patterns among the French population 25 years and younger. Aggregated data from the French national health insurance database from January 2016 to June 2023. Data were analyzed from September 2023 to February 2024.

Main outcomes and measures: The number of individuals with at least 1 outpatient psychiatric consultation, those admitted for full-time psychiatric hospitalization, those with a suicide attempt, and those receiving psychotropic medication was computed. Data were stratified by age groups and sex. Quasi-Poisson regression modeled deseasonalized data, estimating the relative risk (RR) and 95% CI for differences in slopes before and after the pandemic.

Results: This study included approximately 20 million individuals 25 years and younger (20 829 566 individuals in 2016 and 20 697 169 individuals in 2022). In 2016, the population consisted of 10 208 277 of 20 829 566 female participants (49.0%) and 6 091 959 (29.2%) aged 18 to 25 years. Proportions were similar in 2022. Significant increases in mental health care utilization were observed postpandemic compared with the prepandemic period, especially among females and young people aged 13 years and older. Outpatient psychiatric consultations increased among women (RR, 1.13; 95% CI, 1.07-1.20), individuals aged 13 to 17 years (RR, 1.15; 95% CI, 1.06-1.23), and individuals aged 18 to 25 years (RR, 1.08; 95% CI, 1.03-1.14). Hospitalizations for suicide attempt increased among women (RR, 1.14; 95% CI, 1.02-1.27) and individuals aged 18 to 25 years (RR, 1.07; 95% CI, 1.03-1.12). Regarding psychotropic medications, almost all classes, except hypnotics, increased in prescriptions between 2016 and 2022 for females, with a particularly marked rise in the postpandemic period. For men, only increases in the prescriptions of antidepressants (RR, 1.03; 95% CI, 1.01-1.06), methylphenidate (RR, 1.09; 95% CI, 1.06-1.12), and medications prescribed for alcohol use disorders (RR, 1.08; 95% CI, 1.04-1.13) were observed, and these increases were less pronounced than for women (antidepressant: RR, 1.13, 95% CI, 1.09-1.16; methylphenidate: RR, 1.15; 95% CI, 1.13-1.18; alcohol use dependence: RR, 1.12; 95% CI, 1.08-1.16). Medications reserved for severe mental health situations, such as lithium or clozapine, were prescribed more frequently starting at the age of 6 years.

Conclusions and relevance: In this study, an interrupted time-series analysis found a marked deterioration in the mental health of young women in France in the after the COVID-19 pandemic, accentuating a trend of deterioration that was already observed in the prepandemic period.

Figure 1.. Interrupted Time Series Analysis of Changes in Mental Health Care Utilization Before and After the Beginning of the COVID-19 Pandemic With Annual Relative Risk (RR)

^aP < .001. ^bP < .05. The reported RR are annual and can be interpreted as follows, using full-time psychiatric hospitalization as an example: before March 2020, the annual rate of these hospitalizations increased significantly by 1% (RR = 1.01). After March 2020, this rate increased annually by 10% (RR = 1.10). Consequently, the annual trend was considered to have significantly accelerated by 8% (RR for the difference in slopes = 1.08) after March 2020 compared with before. The dotted lines are Quasi-Poisson estimates with shading indicating 95% CIs. Dots are actual observations. Orange line indicates the annual trend. The rates are expressed per 1000 inhabitants.

Figure 2.. Interrupted Time Series Analysis of Changes in Prescriptions of Antidepressants, Anxiolytics, Hypnotics, and Mood Stabilizers Before and After the Beginning of the COVID-19 Pandemic With Annual Relative Risk (RR)

^aP < .001. ^bP < .05. The reported RR are annual and can be interpreted as follows, using antidepressants prescriptions as an example: before March 2020, the annual rate of these prescriptions increased significantly by 9% (RR = 1.09). After March 2020, this rate increased annually by 20% (RR = 1.20). Consequently, the annual trend was considered to have significantly accelerated by 10% (RR for the difference in slopes = 1.10) after March 2020 compared with before. The dotted lines are quasi Poisson estimates with shading indicated 95% CIs. Dots are actual observations. Orange line indicates the annual trend. The rates are expressed per 1000 inhabitants.

Figure 3.. Interrupted Time Series Analysis of Changes in Prescriptions of Antipsychotics, Methylphenidate, and Medications for Alcohol Dependence Before and After the Beginning of the COVID-19 Pandemic With Annual Relative Risk (RR)

^aP < .001. ^bP < .05. The reported RR are annual and can be interpreted as follows, using antipsychotics prescriptions as an example: before March 2020, the annual rate of these prescriptions increased significantly by 6% (RR = 1.06). After March 2020, this rate increased annually by 10% (RR = 1.10). Consequently, the annual trend was considered to have significantly accelerated by 3% (RR for the difference in slopes = 1.03) after March 2020 compared with before. The dotted lines are quasi-Poisson estimates with shading indicating 95% CI. Dots are actual observations. Orange line indicates the annual trend. The rates are expressed per 1000 inhabitants.