Comparison of new psychiatric diagnoses among Finnish children and adolescents before and during the COVID-19 pandemic: A nationwide register-based study

BackgroundCoronavirus Disease 2019 (COVID-19) restrictions decreased the use of specialist psychiatric services for children and adolescents in spring 2020. However, little is known about the pattern once restrictions eased. We compared new psychiatric diagnoses by specialist services during pandemic and pre-pandemic periods. Methods and findingsThis national register study focused on all Finnish residents aged 0 to 17 years from January 2017 to September 2021 (approximately 1 million a year). The outcomes were new monthly diagnoses for psychiatric or neurodevelopmental disorders in specialist services. These were analyzed by sex, age, home location, and diagnostic groups. The numbers of new diagnoses from March 2020 were compared to predictive models based on previous years. The predicted and observed levels in March to May 2020 showed no significant differences, but the overall difference was 18.5% (95% confidence interval 12.0 to 25.9) higher than predicted in June 2020 to September 2021, with 3,821 more patients diagnosed than anticipated. During this period, the largest increases were among females (33.4%, 23.4 to 45.2), adolescents (34.4%, 25.0 to 45.3), and those living in areas with the highest COVID-19 morbidity (29.9%, 21.2 to 39.8). The largest increases by diagnostic groups were found for eating disorders (27.4%, 8.0 to 55.3), depression and anxiety (21.0%, 12.1 to 51.9), and neurodevelopmental disorders (9.6%, 3.0 to 17.0), but psychotic and bipolar disorders and conduct and oppositional disorders showed no significant differences and self-harm (-28.6, -41.5 to -8.2) and substance use disorders (-15.5, -26.4 to -0.7) decreased in this period. The main limitation is that data from specialist services do not allow to draw conclusions about those not seeking help. ConclusionsFollowing the first pandemic phase, new psychiatric diagnoses in children and adolescents increased by nearly a fifth in Finnish specialist services. Possible explanations to our findings include changes in help-seeking, referrals and psychiatric problems, and delayed service access. Author summary Why was this study done? Healthcare emergencies and conflicts pose real threats to the availability of psychiatric services for children and adolescents.Previous studies compared limited pandemic and pre-pandemic periods or they did not cover the whole spectrum of psychiatric or neurodevelopmental disorders.This study was done to provide a comprehensive overview of the patterns of new diagnoses among children and adolescents during the pandemic. What did the researchers do and find? This study compared the predicted and observed new diagnoses from March 2020 to September 2021 based on pre-pandemic data and analyzed data from 2017 to 2021 among approximately 1 million children and adolescents per year.No significant changes in diagnoses were seen during the first phase of the pandemic, from March to May 2020, but new diagnoses increased by 18.5% from June 2020 to September 2021.Particularly high increases were observed in females, adolescents, and those living in areas with the highest Coronavirus Disease 2019 (COVID-19) rates. The highest increases in diagnoses related to eating disorders, depression and anxiety disorders, and neurodevelopmental disorders. What do these findings mean? The rapid increases in primary and secondary diagnoses by specialist services after the first 3 months of the pandemic raises concerns about gaps in services, accessibility, and continuity after the pandemic.Changes in supply and demand can pose serious challenges for psychiatric services, as they adapt to provide efficient services for children and adolescents.These data emphasize the importance of preparing for sudden changes in service use due to healthcare emergencies or crises, including the ongoing pandemic and the current conflict in Europe.

Automated summary

Restrictions during the COVID-19 pandemic led to a decrease in the use of specialist psychiatric services for children and adolescents, but little is known about the pattern after the restrictions eased. This study compared new psychiatric diagnoses during the pandemic and pre-pandemic periods and found that there was an increase in diagnoses by nearly a fifth after the first phase of the pandemic. The increases were highest among females, adolescents, and those living in areas with high COVID-19 morbidity, and the most significant increases were seen in eating disorders, depression and anxiety disorders, and neurodevelopmental disorders.