713 - Increase in Mental Health Diagnoses among Children with Medical Complexity during the COVID-19 Pandemic

Poster Number: 713
Publication Number: 713.328

Valerie S. Harder, Robert Larner, M.D., College of Medicine at the University of Vermont, Burlington, VT, United States; Caitlin Early, Robert Larner, M.D., College of Medicine at the University of Vermont, Burlington, VT, United States; Susan E.. Richardson, University of Vermont, Burlington, VT, United States; Matthew Colby. Hollander, Robert Larner, M.D., College of Medicine at the University of Vermont, Burlington, VT, United States; Alyssa Consigli, Department of Pediatrics, The Larner College of Medicine at the University of Vermont, Burlington, VT, United States; Keith J.. Robinson, UVM Children's Hospital / Vermont Child Health Improvement Program, Burlington, VT, United States

Background: Youth mental health problems escalated during the COVID-19 pandemic and continue to be an urgent public health issue (U.S. Surgeon General). Children managing physical chronic illness are more likely to have co-occurring mental health problems, yet little is known about the impact of the pandemic on the mental health of children with medical complexity.

Objective: The objective of this study was to compare the prevalence of common mental health diagnoses before and during the COVID-19 pandemic within the context of the child’s medical complexity.

Design/Methods: Using a retrospective cohort design, the study population included 3,688 children 6-17 years old in Vermont’s all-payer claims database who received outpatient specialty care in both 2020 and 2019 for physical illness at a single rural academic children’s hospital. We compared the prevalence of common mental health diagnoses (mood and anxiety) within this cohort before (April-December 2019) and during the pandemic (April-December 2020) using Chi-Squared tests and associated p-values< .05. We stratified models to investigate the role of medical complexity using the Pediatric Medical Complexity Algorithm categorization (complex chronic, non-complex chronic, non-chronic).

Results: Overall, mood diagnoses were higher in 2020 (14%) than 2019 (11%; p< .0001). Similarly, anxiety diagnoses were higher in 2020 (27%) than 2019 (21%; p< .0001). Among 1,239 children with complex chronic disease, anxiety diagnoses were 4% higher (p=.001) in 2020 compared to 2019. Among 1,464 children with non-complex chronic disease, both mood and anxiety diagnoses were 4% (p=.003) and 7% (p< .0001) higher, respectively, by 2020. Among 985 non-chronic children, the prevalence of mood or anxiety diagnoses were low (< 6%), yet there was a 3% increase (p< .0001) in anxiety diagnoses by 2020.

Conclusion(s): During the first year of the pandemic, children receiving specialty care for physical illness exhibited significantly higher prevalence of common mental health diagnoses than before the pandemic. The higher and increasing prevalence among children with chronic illness suggests a need for greater attention and specialty clinic resources to support the mental well-being of children with medical complexity. Future studies will examine additional mental disorders of concern and follow children with medical complexity throughout the continuing pandemic into 2021 and 2022.