Vol. 152 No. 0708 (2022)
The mental distress of our youth in the context of the COVID-19 pandemic: A retrospective cohort study of child and adolescent psychiatric emergency contacts before and during the COVID-19 pandemic in the Canton of Zurich from 2019 to 2021
- Gregor Berger
- Isabelle Häberling
- Alana Lustenberger
- Fabian Probst
- Maurizia Franscini
- Dagmar Pauli
- Susanne Walitza
BACKGROUND: Epidemiological evidence from population-based surveys suggest that the psychological well-being of adolescents has been severely affected by the COVID-19 pandemic itself, as well as by the safety measures implemented. The rationale of the study was to investigate the influence of the pandemic on psychiatric emergency service use, psychiatric admissions rates, emotional well-being, suicidality and self-harm behaviour in help-seeking children and adolescents.
METHODS: Retrospective cohort study of electronic patient records before and during the COVID-19 pandemic from the emergency out-patient facility of the department of child and adolescent psychiatry and psychotherapy of the Psychiatric University Hospital Zürich. The frequency of all emergency service contacts from 1 January 2019 to 31 June 2021 were described and the frequency of records compared in half-year intervals. Emotional well-being, behavioural problems, suicidality and self-harm were estimated based on the mental state examination notes of electronic patient records from the 1 March to the 30 April for the years 2019, 2020 and 2021.
RESULTS: After an initial decline in emergency contacts at the beginning of the first lockdown, the use of the centralised emergency service increased during the subsequent months and has since stabilised at a significantly higher level than before the pandemic. Comparison of emergency contacts in the first half of 2019 with the first half of 2021 shows that the number of emergency phone contacts nearly doubled, emergency outpatient assessments increased by 40%, emergency bridging interventions increased by 230%, and inpatient admissions of minors to adult psychiatric inpatient units more than doubled because of lack of service capacity in child and adolescent psychiatry. The proportion of adolescents who reported suicidal ideation increased significantly by 15%, from 69% to 84%, and the proportion of adolescents who reported self-harm behaviour increased by 17%, from 31% to 48%.
CONCLUSION: We found a significant increase in psychiatric service use, as well as in reported serious mental health symptoms such as suicidality and self-harm behaviour in help-seeking children and adolescents in the course of the pandemic. The child and adolescent psychiatric healthcare system is overburdened and down-referral of adolescents in need of ongoing therapy is becoming increasingly difficult. We recommend prioritising preventive and therapeutic measures to support the mental health of our children and adolescents alongside the somatic management of the COVID-19 pandemic.
- Mohler-Kuo M, Dzemaili S, Foster S, Werlen L, Walitza S. Stress and Mental Health among Children/Adolescents, Their Parents, and Young Adults during the First COVID-19 Lockdown in Switzerland. Int J Environ Res Public Health. 2021 Apr;18(9):4668. https://doi.org/10.3390/ijerph18094668
- Aknin L, De Neve J-E, Dunn E, Fancourt D, Goldberg E, Helliwell J, et al. A review and response to the early mental health and neurological consequences of the COVID-19 pandemic. 2021.
- McGinty EE, Presskreischer R, Anderson KE, Han H, Barry CL. Psychological Distress and COVID-19-Related Stressors Reported in a Longitudinal Cohort of US Adults in April and July 2020. JAMA2020 Dec 22;324(24):2555-7.
- Ettman CK, Abdalla SM, Cohen GH, Sampson L, Vivier PM, Galea S. Prevalence of Depression Symptoms in US Adults Before and During the COVID-19 Pandemic. JAMA Netw Open. 2020 Sep;3(9):e2019686. https://doi.org/10.1001/jamanetworkopen.2020.19686
- Ebrahimi OV, Hoffart A, Johnson SU. Physical Distancing and Mental Health During the COVID-19 Pandemic: Factors Associated With Psychological Symptoms and Adherence to Pandemic Mitigation Strategies. Clin Psychol Sci. 2021 May;9(3):489–506. https://doi.org/10.1177/2167702621994545
- Ravens-Sieberer U, Kaman A, Otto C, Erhart M, Devine J, Schlack R. Impact of the COVID-19 Pandemic on Quality of Life and Mental Health in Children and Adolescents. Available at SSRN 37215082020.
- Santomauro DF, Mantilla Herrera AM, Shadid J, Zheng P, Ashbaugh C, Pigott DM, et al. Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. The Lancet2021 2021/11/06/;398(10312):1700-12.
- Fancourt D, Steptoe A, Bu F. Trajectories of anxiety and depressive symptoms during enforced isolation due to COVID-19 in England: a longitudinal observational study. Lancet Psychiatry. 2021 Feb;8(2):141–9. https://doi.org/10.1016/S2215-0366(20)30482-X
- Stocker D, Jäggi J, Liechti L, Schläpfer D, Németh P, Künzi K. Der Einfluss der COVID-19-Pandemie auf die psychische Gesund-heit der Schweizer Bevölkerung und die psychiatrisch-psychotherapeutische Versorgung in der Schweiz (Kurzfassung erster Teil)2020 Contract No.: 20.013447 / 225.2-11/1.
- Werling AM, Walitza S, Drechsler R. Impact of the COVID-19 lockdown on screen media use in patients referred for ADHD to child and adolescent psychiatry: an introduction to problematic use of the internet in ADHD and results of a survey. J Neural Transm (Vienna). 2021 Jul;128(7):1033–43. https://doi.org/10.1007/s00702-021-02332-0
- Werling AM, Walitza S, Grünblatt E, Drechsler R. Media use before, during and after COVID-19 lockdown according to parents in a clinically referred sample in child and adolescent psychiatry: results of an online survey in Switzerland. Compr Psychiatry. 2021 Aug;109:152260. https://doi.org/10.1016/j.comppsych.2021.152260
- Schmidt SJ, Barblan LP, Lory I, Landolt MA. Age-related effects of the COVID-19 pandemic on mental health of children and adolescents. Eur J Psychotraumatol. 2021 Apr;12(1):1901407. https://doi.org/10.1080/20008198.2021.1901407
- de Quervain D, Coynel D, Aerni A, Amini E, Bentz D, Freytag V, et al. Swiss Corona Stress Study: survey in high school students, March 2021. 2021.
- de Quervain D, Aerni A, Amini E, Bentz D, Coynel D, Gerhards C, et al. The Swiss corona stress study. 2020.
- Viner R, Russell S, Saulle R, Croker H, Stansfeld C, Packer J, et al. Impacts of school closures on physical and mental health of children and young people: a systematic review. medRxiv 2021:2021.02.10.21251526. https://doi.org/10.1101/2021.02.10.21251526
- Lee PH, Marek J, Nálevka P. Sleep pattern in the US and 16 European countries during the COVID-19 outbreak using crowdsourced smartphone data. Eur J Public Health. 2021 Feb;31(1):23–30. https://doi.org/10.1093/eurpub/ckaa208
- Lim MT, Ramamurthy MB, Aishworiya R, Rajgor DD, Tran AP, Hiriyur P, et al. School closure during the coronavirus disease 2019 (COVID-19) pandemic - Impact on children’s sleep. Sleep Med. 2021 Feb;78:108–14. https://doi.org/10.1016/j.sleep.2020.12.025
- Albrecht JN, Werner H, Rieger N, Widmer N, Janisch D, Huber R, et al. Pandemic High School Closures - Is There a Silver Lining? Effects of homeschooling on adolescents’ sleep and health. in submission2021.
- Canady VA. CDC data finds sharp rise in suicide attempts among teen girls amid COVID‐19. Ment Health Wkly. 2021;31(24):1–3. https://doi.org/10.1002/mhw.32836
- Flament J, Scius N, Zdanowicz N, Regnier M, De Cannière L, Thonon H. Influence of post-COVID-19 deconfinement on psychiatric visits to the emergency department. Am J Emerg Med. 2021 Oct;48:238–42. https://doi.org/10.1016/j.ajem.2021.05.014
- Ougrin D, Wong BH, Vaezinejad M, Plener PL, Mehdi T, Romaniuk L, et al. Pandemic-related emergency psychiatric presentations for self-harm of children and adolescents in 10 countries (PREP-kids): a retrospective international cohort study. Eur Child Adolesc Psychiatry. 2021 Mar. https://doi.org/10.1007/s00787-021-01741-6
- Duong MT, Bruns EJ, Lee K, Cox S, Coifman J, Mayworm A, et al. Rates of mental health service utilization by children and adolescents in schools and other common service settings: A systematic review and meta-analysis. Adm Policy Ment Health. 2021 May;48(3):420–39. https://doi.org/10.1007/s10488-020-01080-9
- Stocker D, Stettler P, Jäggi J, Bischof S, Guggenbühl T, Abrassart A, et al. Versorgungssituation psychisch erkrankter Personen in der Schweiz. Büro für arbeits-und sozialpolitische Studien BASS2016.
- von Wyl A, Howard EC, Bohleber L, Haemmerle P, editors. Psychische Gesundheit und Krankheit von Kindern und Jugendlichen in der Schweiz: Versorgung und Epidemiologie. Eine systematische Zusammenstellung empirischer Berichte von 2006 bis 2016; 2017.
- Tørmoen AJ, Myhre M, Walby FA, Grøholt B, Rossow I. Change in prevalence of self-harm from 2002 to 2018 among Norwegian adolescents. Eur J Public Health. 2020 Aug;30(4):688–92. https://doi.org/10.1093/eurpub/ckaa042
- Berger G, Pauli D, Blaser M, Häberling I, Kaess M, Walitza S. Jugendsuizidalität stabil hoch. Psychiatr Neurol (Basel). 2021;(2):1–3.
- Döpfner M, Lehmkuhl G, Berner W, Flechtner H, Schwitzgebel P, von Aster M, et al. [Documentation of psychopathologic findings: a procedure for the evaluation of psychological disorders in children and adolescents]. Z Kinder Jugendpsychiatr. 1993 Jun;21(2):90–100.
- Stieglitz RD, Fähndrich E, Helmchen H. [Application of the AMDP system in diagnosis and prediction]. Acta Psychiatr Belg. 1987 Mar-Apr;87(2):117–40.
- Wathelet M, Duhem S, Vaiva G, Baubet T, Habran E, Veerapa E, et al. Factors associated with mental health disorders among university students in France confined during the COVID-19 pandemic. JAMA network open2020;3(10):e2025591-e.
- McGorry P, Trethowan J, Rickwood D. Creating headspace for integrated youth mental health care. World psychiatry : official journal of the World Psychiatric Association2019;18(2):140.
- Malboeuf-Hurtubise C, Taylor G, Lefrançois D, Essopos I, Lacourse E. The impact of a mindfulness-based intervention on happiness: a reflection on the relevance of integrating a positive psychology framework within mindfulness research in youth. International Journal of Applied Positive Psychology. 2018;2(1):23–37. https://doi.org/10.1007/s41042-017-0010-2
- Moltrecht B, Deighton J, Patalay P, Edbrooke-Childs J. Effectiveness of current psychological interventions to improve emotion regulation in youth: a meta-analysis. Eur Child Adolesc Psychiatry. 2020;•••:1–20.
- Aknin LB, Dunn EW, Proulx J, Lok I, Norton MI. Does spending money on others promote happiness?: A registered replication report. J Pers Soc Psychol. 2020 Aug;119(2):e15–26. https://doi.org/10.1037/pspa0000191
- Malouff JM, Schutte NS. Can psychological interventions increase optimism? A meta-analysis. J Posit Psychol. 2017;12(6):594–604. https://doi.org/10.1080/17439760.2016.1221122
- Heekerens JB, Eid M. Inducing positive affect and positive future expectations using the best-possible-self intervention: A systematic review and meta-analysis. J Posit Psychol. 2021;16(3):322–47. https://doi.org/10.1080/17439760.2020.1716052