Pediatric Mental Health Stable in Early in the Pandemic

The mental health of children and adolescents was largely stable during the first year of the COVID-19 pandemic, but racial disparities in access to outpatient psychiatric care worsened, new research suggested.

The cross-sectional analysis of mental health impairment and outpatient mental health care use among children aged 6-17 years revealed a slight 0.3% decrease in the percentage of those severe mental health problems from 2019 to 2021. The percentage of those who used any outpatient mental health care showed little change.

However, racial disparities in outpatient mental health care intensified during this period, with an increased use of 3% in White youth vs a 4% decrease in Black youth.

“While the absence of an increase in child and adolescent mental health impairment from 2019 to 2021 suggests successful adaptation to pandemic-related psychosocial disruptions, broadening racial and ethnic differences in outpatient mental health care underscores the urgency of addressing structural factors that may drive this racial and ethnic disparity,” lead investigator Mark Olfson, MD, MPH, of the Department of Psychiatry, College of Physicians and Surgeons, New York City, and colleagues noted.

The study was published online on March 13 in JAMA Psychiatry.

While earlier studies reported an increase in depressive symptoms among children and adolescents, investigators noted there were little data on severe mental health impairment or changes in outpatient mental health care during the pandemic.

To address this knowledge gap, the researchers analyzed data from the nationally representative 2019 and 2021 Medical Expenditure Panel Surveys to measure changes in mental health impairment and outpatient mental health care in 8331 youth (mean age, 11.6 years; 3385 White; 4300 male).

The Columbia Impairment Scale — a parent-reported instrument — was used to measure mental health impairment. Researchers adjusted for age, sex, and impairment level.

The overall percentage of youngsters with severe mental health impairment decreased from 9.7% in 2019 to 9.4% in 2021 (adjusted difference, 0.3%; 95% CI, −1.9% to 1.2%).

There was also little difference over the study period in the overall percentage of youth who received outpatient care, which increased slightly from 11.9% in 2019 to 13% in 2021. Outpatient service use increased from 39% to 42% among youth with severe impairments.

However, when researchers analyzed the use of outpatient mental health care by race, they found a 4.3% decrease among Black youth (9.2% in 2019 to 4% in 2021) compared with a 3.3% increase in use among White youth (15.1% in 2019 to 18.4% in 2021; P for interaction = .002).

“The absence of an increase in child and adolescent severe mental health impairment from 2019 to 2021 should not lull healthcare policymakers into complacency regarding the need to increase public funding for outpatient child and adolescent mental health services,” the authors wrote, adding that more than half of US youth with severe mental health impairment did not receive any outpatient mental health care in either year.

“It is also important to place these findings in a longer-term context of increasing youth mental health challenges over the last decade.”

No source of study funding is listed. The authors reported no relevant financial relationships.

Batya Swift Yasgur, MA, LSW, is a freelance writer with a counseling practice in Teaneck, New Jersey. She is a regular contributor to numerous medical publications, including Medscape and WebMD, and is the author of several consumer-oriented health books as well as Behind the Burqa: Our Lives in Afghanistan and How We Escaped to Freedom (the memoir of two brave Afghan sisters who told her their story).