Impact of the COVID-19 pandemic on mental healthcare consultations among children and adolescents in Norway: a nationwide registry study

Abstract

BACKGROUND: There have been widespread concerns about the impact of the COVID-19 pandemic and its associated restrictions on children's and adolescents' mental health. While some studies have found increasing rates of mental health problems during the pandemic, other evidence suggest that mental symptoms and disorders were increasing before the pandemic. This study compared trends in mental healthcare use during the first 15 months of the pandemic with similar pre-pandemic trends. METHODS: Consultations related to mental symptoms and disorders were identified through national registries from primary and specialist healthcare services, including hospitalizations, covering the entire population of children 6-18 years in Norway (N=908 272). The monthly likelihood of having a consultation or hospitalization related to overall mental health problems, and specific diagnoses for depression, anxiety, ADHD and sleep problems were plotted from January 2020 to May 2021 and compared to trends over the same period between 2017-2019 using event study and difference-in-difference designs. FINDINGS: We found reductions in consultations for mental health symptoms and disorders in primary and specialist healthcare during the first weeks of lockdown in 2020. This decline was temporary, and volumes of consultations quickly returned to pre-pandemic levels. However, during fall 2020, consultation volumes related to mental health in primary care increased. This increase persisted into the winter of 2021 but levelled off by the last month of the sample period. The increase in consultation volumes was about 50 % compared to the pre-pandemic period. We did not find increases in consultations in specialist healthcare, except for hospitalizations. CONCLUSION: We found an increase in primary care consultation volumes related to mental health among children that depart from the previously established increases over recent years. We did not see similar increases in consultations in the specialist healthcare. It is unknown whether increases in primary care consultations represent milder cases, which primarily do not need specialist treatment, or if the stability in specialist healthcare consultations reflects capacity problems or timelags in referrals.

Eating Disorder Diagnoses in Children and Adolescents in Norway Before vs During the COVID-19 Pandemic

“…Changes were compared by difference-in-difference models. 6 We calculated monthly percentages of individuals with eating disorders using event study models to estimate relative changes. Analyses were done by sex and age group (6-12 and 13-16 years) using Stata, version 16.0.…”

“…We assessed changes in the percentage of individuals with recorded eating disorders since onset of the pandemic in March 2020 in the pandemic cohort and after March 2018 in the prepandemic cohort. Changes were compared by difference-in-difference models . We calculated monthly percentages of individuals with eating disorders using event study models to estimate relative changes.…”

Changes in Adolescent Mental and Somatic Health Complaints Throughout the COVID-19 Pandemic: A Three-Wave Prospective Longitudinal Study

“…In the present study, increased loneliness during the first year of the pandemic was strongly related to elevated symptoms of both mental and somatic complaints. The cross-sectional and longitudinal association between loneliness and mental health problems in adolescents is well established in the literature [ 23 ] and the relationship between loneliness and mental health problems is most likely bidirectional [ 24 ]. However, in line with a recent meta-analysis of 80 studies on loneliness in adolescents, we discovered that loneliness was associated with subsequent anxiety and depression [ 23 ].…”

“…However, like most other countries, the capacity of these resources was also challenged during the pandemic. During 2021 primary healthcare consultations increased by 38.5% for adolescents aged 13–15 years in Norway, compared to the year before [ 24 ]. The increase was highest for anxiety and depression, with a 52% increase in 2021 [ 24 ].…”

“…During 2021 primary healthcare consultations increased by 38.5% for adolescents aged 13–15 years in Norway, compared to the year before [ 24 ]. The increase was highest for anxiety and depression, with a 52% increase in 2021 [ 24 ]. Although it is not clear how the social and cultural context impacts the health status of the youth population during such a health-related crisis, knowledge about these contextual factors is pivotal in the findings and comparing these to research from other parts of the world.…”