A Longitudinal Cohort Study of Youth Mental Health and Substance use Before and During the COVID-19 Pandemic in Ontario, Canada: An Exploratory Analysis

Abstract

Background Youth mental health appears to have been negatively impacted by the COVID-19 pandemic. The impact on substance use is less clear, as is the impact on subgroups of youth, including those with pre-existing mental health or substance use challenges. Objective This hypothesis-generating study examines the longitudinal evolution of youth mental health and substance use from before the COVID-19 pandemic to over one year into the pandemic among youth with pre-existing mental health or substance use challenges. Method A total of 168 youth aged 14–24 participated. Participants provided sociodemographic data, as well as internalizing disorder, externalizing disorder, and substance use data prior to the pandemic’s onset, then every two months between April 2020–2021. Linear mixed models and Generalized Estimating Equations were used to analyze the effect of time on mental health and substance use. Exploratory analyses were conducted to examine interactions with sociodemographic and clinical characteristics. Results There was no change in internalizing or externalizing disorder scores from prior to the pandemic to any point throughout the first year of the pandemic. Substance use scores during the pandemic declined compared to pre-pandemic scores. Exploratory analyses suggest that students appear to have experienced more mental health repercussions than non-students; other sociodemographic and clinical characteristics did not appear to be associated with mental health or substance use trajectories. Conclusions While mental health remained stable and substance use declined from before the COVID-19 pandemic to during the pandemic among youth with pre-existing mental health challenges, some youth experienced greater challenges than others. Longitudinal monitoring among various population subgroups is crucial to identifying higher risk populations. This information is needed to provide empirical evidence to inform future research directions.

The COVID‐19 impact and characterization on substance use‐related emergency department visits for adolescents and young adults in Canada: Practical implications

“…Substance use‐related ED visits among adolescents and young adults have decreased by 1.5 times during the pandemic compared to the prepandemic level in Ontario, Canada. This finding aligns with existing literature reporting a reduced volume of substance use‐related ED visits during the COVID‐19 pandemic 11,12,28,33,39–42 . This overall reduction in 2020 may reflect an increased threshold for seeking hospital care due to anxiety surrounding COVID‐19 exposure and the enactment of healthcare policies that prioritized urgent visits and delayed/ceased elective care.…”

“…This finding aligns with existing literature reporting a reduced volume of substance userelated ED visits during the COVID-19 pandemic. 11,12,28,33,[39][40][41][42] This overall reduction in 2020 may reflect an increased threshold for seeking hospital care due to anxiety surrounding COVID-19 exposure and the enactment of healthcare policies that prioritized urgent visits and delayed/ceased elective care. It is worth noting that as the public safety measures lifted, 2,3 the rate of presentations slowly increased in 2021, in line with other studies reporting a similar trend of volume recovery.…”

“…[34][35][36][37][38] With a backlog of substance use patients, waves of substance use-related ED visits may be expected. 33 Thus far, the trend in terms of the volume of substance-related ED visits during the pandemic has been frequently reported, mostly suggesting a decline, 11,28,33,[39][40][41][42] with an exception that reports an increase of ED visits for alcohol intoxication when measured a few weeks before and after the lockdown in Italy. 43 However, as COVID-19 continues to evolve, updating the trend of substance use-related ED visits is essential to reach a global consensus.…”

The Relationship Between a History of High-risk and Destructive Behaviors and COVID-19 Infection: Preliminary Study

“…In the context of COVID-19, the GAIN-SS survey has been used to investigate behavioral differences between students and nonstudents [ 28 ]. Findings demonstrated that MH issues were stable but substance use declined in youths during the pandemic.…”

Differing impact of the COVID-19 pandemic on youth mental health: combined population and clinical study

“…As for addiction, a decline in substance use has been reported, especially among adolescents initially at higher risk for substance use disorder. 21 , 22 It is clear from these limitations that longitudinal trajectory research with comprehensive mental health assessments, spanning the pre-pandemic period and across multiple lockdown and release phases, is needed to understand the long-term impact of the COVID-19 pandemic on youth mental health. 13 Research comparing data from the general population and from patient groups is also needed.…”