Background: The coronavirus disease 2019 pandemic caused drastic disruptions in daily life, which might negatively impact mental health (MH). No nationwide data evaluating trends in pediatric MH diagnoses and psychotropic prescribing during the pandemic are currently available for the US.
Objectives: To compare prevalence and trends of pediatric MH conditions and psychotropic prescribing before and during the pandemic.
Methods: Using a US-nationwide commercial healthcare claims database, we assessed the monthly proportion of youth – stratified by age (6-12 vs. 13-18 years) and sex – with a MH diagnosis/psychotropic prescription fill between January 2018 and March 2022. We considered the most common MH conditions and medications in pediatric patients: anxiety, attention deficit/hyperactivity disorder (ADHD), depression, and eating disorders; anxiolytics, ADHD medications, antidepressants, and antipsychotics. Three phases were assessed: the pre-pandemic period (January 2018-March 2020), the early pandemic period when school closure was common (April-September 2020) and the recent pandemic period after schools started to re-open (October 2020-March 2022). Interrupted time series analyses were conducted to compare prevalence and trends of each condition/prescription in the pre-pandemic vs. the recent pandemic period.
Results: About 1.6 million youth contributed data to each calendar month, respectively. Among 13-18-year-old girls, there was an immediate significant prevalence increase of all four MH diagnoses in the recent pandemic period. Except for depression, the prevalence of MH diagnoses increased at a faster rate during than before the pandemic. Most strikingly, the prevalence of eating disorder diagnoses more than doubled during the pandemic. Among psychotropic medications, the most pronounced change between the pre-pandemic and recent pandemic period was observed for anxiolytic and antipsychotic prescribing rates, which showed slight upward trends in the pre-pandemic period but a ~50% increase between October 2020 and March 2022. Similar trends were not observed among 6-12-year-old girls or among boys.
Conclusions: Trends in MH diagnosis and psychotropic prescribing differed strongly by age and sex, with 13-18-year-old girls being by far the most vulnerable population. These findings highlight the urgency to identify the underlying causes of the increase in MH diagnoses and psychotropic medication prescriptions in teenage girls (e.g., social isolation, accelerated reliance on social media), so that targeted mitigation strategies can be developed to reverse the alarming trend which continues even several years into the pandemic.
