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Mental Illness Surges Alongside COVID-19 Waves

October 23, 2023

Editor’s Note: Dr. Eli Cahan (he/him/his) is the editor of the Section on Pediatric Trainees (SOPT) Feature in Pediatrics and an investigative journalist. He is also a resident physician in pediatrics at The Boston Combined Residency Program at Boston Children's Hospital and Boston Medical Center. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics

During my residency, when I was cross-covering in the emergency room, I met Luna (name changed for privacy). Luna was a charming 11-year-old. She loved chicken fingers and anime—in particular, Sanrio, the universe that Hello Kitty comes from—she explained to me, with dual parts enthusiasm and impatience. The huff, the pomp, the circumstance, the earnestness—in those ways, Luna was as typical a pre-teen as they come. But Luna, like many, also suffers from a common problem among American pre-teens (and other ages) in 2023— she has severe mental illness.

Her disease, like that of many other American youth, may have pre-dated the COVID-19 pandemic, but was exacerbated during it. As life inverted, she took control of what she could. On her left forearm, there was evidence of cutting - thin horizontal scars sit on top of thin horizontal scars. She’d tried to take her own life with the only medicine that hadn’t already been locked up—albuterol—earlier that day.

Since the COVID-19 pandemic, youth mental illness has hit epidemic levels. Data from the Centers for Disease Control and Prevention (CDC) demonstrated that suicidal behaviors increased in youth across demographic groups between 2019 and 2021. Additionally, a June CDC data briefing found that, as of 2021, 1 in 7 youth were actively receiving mental health treatment. In October 2021, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children's Hospital Association declared a national emergency in youth mental health.

While studies have noted the association between surging youth mental illness and the post-March 2020 world, few have systematically investigated the impact of the COVID-19 pandemic itself. In an article being early released this week in Pediatrics, Dr. Deborah Levine and colleagues at Weill Cornell Medicine and Columbia University used national emergency department data to link rates of youth mental illness to the timing of 5 COVID-19 surges (through June 2022) in New York City (10.1542/peds.2022-060553).

The authors found that emergency visits attributable to mental health—in all 5 waves—outpaced pre-pandemic norms. Eating disorders, anxiety disorders, and substance use disorders were particularly overrepresented. Females, adolescents, those who identified as Asian and children from higher socioeconomic areas were also disproportionately affected. (The authors attribute the last finding to structural barriers in healthcare access faced by those from resource-poor neighborhoods during the COVID-19 pandemic.)

While the authors do not speculate in depth about the root causes of such patterns, they note that these trends have persisted well past the early days of the COVID-19 pandemic, noting that the findings were “not significantly associated with city-level COVID-19 case prevalence or state-level societal restrictions.”

“Our findings demonstrate the lasting impact of the COVID-19 pandemic on youth mental health and their continued vulnerability despite our resumption of normal activity,” the authors write. “The sustained high rates,” they add, “may reflected continued insufficient resources and sociocultural barriers to mental healthcare services for youth.”

Given the ongoing crisis and pediatricians’ critical role in caring for these children, I’d recommend those interested in better understanding the COVID-19 pandemic’s impact on children read this article.

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