Age-specific determinants of psychiatric outcomes after the first COVID-19 wave: baseline findings from a Canadian online cohort study

Abstract

Background Canadians endured unprecedented mental health (MH) and support access challenges during the first COVID-19 wave. Identifying groups of individuals who remain at risk beyond the acute pandemic phase is key to guiding systemic intervention efforts and policy. We hypothesized that determinants of three complementary, clinically actionable psychiatric outcomes would differ across Canadian age groups. Methods The Personal Impacts of COVID-19 Survey (PICS) was iteratively developed with stakeholder feedback, incorporating validated, age-appropriate measures. Baseline, cross-sectional online data collected between November 2020-July 2021 was used in analyses. Age group-specific determinants were sought for three key baseline MH outcomes: (1) current probable depression, generalized anxiety disorder, obsessive–compulsive disorder and/or suicide attempt during COVID-19, (2) increased severity of any lifetime psychiatric diagnosis, and (3) inadequate MH support access during COVID-19. Multivariable logistic regression models were constructed for children, youth (self- and parent-report), young adults (19–29 years) and adults over 29 years, using survey type as a covariate. Statistical significance was defined by 95% confidence interval excluding an odds ratio of one. Results Data from 3140 baseline surveys were analyzed. Late adolescence and early adulthood were identified as life phases with the worst MH outcomes. Poverty, limited education, home maker/caregiver roles, female and non-binary gender, LGBTQ2S + status and special educational, psychiatric and medical conditions were differentially identified as determinants across age groups. Interpretation Negative psychiatric impacts of COVID-19 on Canadians that include poor access to MH support clearly persisted beyond the first wave, widening pre-existing inequity gaps. This should guide policy makers and clinicians in current and future prioritization efforts.

Adolescent Mental Health during the COVID-19 Pandemic: The Interplay of Age, Gender, and Mental Health Outcomes in Two Consecutive Cross-Sectional Surveys in Northern Italy

“…Age has emerged as a significant predictor of mental health outcomes, particularly depressive symptoms and low HRQoL. Similar findings have been previously reported [ 68 ]. Late adolescence is characterized by substantial changes and challenges such as increased responsibility, educational, or occupational transitions, and the development of complex social and emotional relationships.…”

The Parallel Pandemic: A Systematic Review on the Effects of the COVID-19 Pandemic on OCD among Children and Adolescents

“…Age was also found to impact OCD outcomes among children and adolescents in four studies; some of the findings were contradictory, however. Three of the four studies found a significant correlation between OCD symptoms worsening among older adolescents when compared to their younger counterparts [32,37,50]. On the contrary, study [34] reported higher levels of worsening OCD symptoms among younger participants, as well as in those with earlier age of onset compared to their older counterparts.…”

“…Regarding gender distributions, there were no gender-specific studies. However, the sample in most studies (95%) were predominantly female [31][32][33][34]38,40,[45][46][47][48]50]. Study [39] did not disclose the gender distribution of their study sample.…”

“…As shown in Table S1, the relationships between the COVID-19 pandemic and OCD among children and adolescents were mixed. That notwithstanding, an overwhelming majority of the included studies (n = 17; 77%) reported that the COVID-19 pandemic had an adverse impact on OCD among children and adolescents [4,5,7,[32][33][34]36,[38][39][40][41][42]45,46,[48][49][50]. A few studies (n = 3, 17%) found mixed relationships [31,37,47], and two (n = 2, 9%) found no influence of the pandemic on OCD among children and adolescents [30,51].…”

“…In this theme, comorbidities or prior diagnosis were the most common factors influencing OCD in 10 studies (Table S2). Overall, children and adolescents who were diagnosed with other conditions, including prior COVID-19 infection [42], pre-COVID psychiatric diagnosis of OCD [32,38,39], presentation of aggressive and sexual symptoms [34], and pre-COVID psychiatric diagnosis of comorbid mental health and autism spectrum disorder/developmental delay [5,37,42,50] experienced higher rates of obsessions and worsening of OCD symptoms during the pandemic. In study [49], a three-point longitudinal study, participants that were previously identified as at risk for OCD in any of the earlier two time points were associated with risk of OCD in the third time point during the pandemic.…”