COVID-19 and Adolescent Outpatient Mental Health Service Utilization: an interrupted time series analysis

Abstract

The COVID-19 pandemic created challenges accessing mental health (MH) services when adolescent well-being declined. Still, little is known on how the COVID-19 pandemic affected outpatient MH service utilization for adolescents. Retrospective data was collected from electronic medical records of adolescents aged 12 to 17 years at Kaiser Permanente Mid-Atlantic States, an integrated healthcare system from January 2019 to December 2021. MH diagnoses included anxiety, mood disorder/depression, anxiety and mood disorder/depression, attention deficit/hyperactivity disorder, or psychosis. We used interrupted time series analysis to compare MH visits and psychopharmaceutical prescribing before and after the COVID-19 onset. Analyses were stratified by demographics and visit modality. The study population of 8,121 adolescents with MH visits resulted in a total 61,971 (28.1%) of the 220,271 outpatient visits associated with a MH diagnosis. During 15,771 (7.2%) adolescent outpatient visits psychotropic medications were prescribed. The increasing rate of MH visits prior to COVID-19 was unaffected by COVID-19 onset; however, in-person visits declined by 230.5 visits per week (p < 0.001) from 274.5 visits per week coupled with a rise in virtual modalities. Rates of MH visits during the COVID-19 pandemic differed by sex, mental health diagnosis, and racial/ethnic identity. Psychopharmaceutical prescribing during MH visits declined beyond expected values by a mean of 32.8 visits per week (p < 0.001) at the start of the COVID-19 pandemic. A sustained switch to virtual visits highlight a new paradigm in care modalities for adolescents. Psychopharmaceutical prescribing declined requiring further qualitative assessments to improve the quality of access for adolescent MH.