The impact of COVID‐19 on psychiatric clinical encounters among low‐income racially‐diverse children

Abstract

BackgroundThere is a lack of longitudinal data to examine the impact of COVID‐19 on all types of clinical encounters among United States, underrepresented BIPOC (Black, Indigenous, and people of color), children. This study aims to examine the changes in all the outpatient clinical encounters during the pandemic compared to the baseline, with particular attention to psychiatric encounters and diagnoses.MethodThis study analyzed 3‐year (January 2019 to December 2021) longitudinal clinical encounter data from 3,394 children in the Boston Birth Cohort, a US urban, predominantly low‐income, Black and Hispanic children. Outcomes of interest were completed outpatient clinical encounters and their modalities (telemedicine vs. in person), including psychiatric care and diagnoses, primary care, emergency department (ED), and developmental and behavioral pediatrics (DBP).ResultsThe study children's mean (SD) age is 13.9 (4.0) years. Compared to 2019, psychiatric encounters increased by 38% in 2020, most notably for diagnoses of adjustment disorders, depression, and post‐traumatic stress disorders (PTSD). In contrast, primary care encounters decreased by 33%, ED encounters decreased by 55%, and DBP care decreased by 16% in 2020. Telemedicine was utilized the most for psychiatric and DBP encounters and the least for primary care encounters in 2020. A remarkable change in 2021 was the return of primary care encounters to the 2019 level, but psychiatric encounters fluctuated with spikes in COVID‐19 case numbers.ConclusionsAmong this sample of US BIPOC children, compared to the 2019 baseline, psychiatric encounters increased by 38% during 2020, most notably for the new diagnoses of adjustment disorder, depression, and PTSD. The 2021 data showed a full recovery of primary care encounters to the baseline level but psychiatric encounters remained sensitive to the pandemic spikes. The long‐term impact of the pandemic on children's mental health warrants further investigation.

Prospective Cohort Study of Emergency Department Visit Frequency and Diagnoses Before and During COVID-19 Pandemic in Urban, Low-Income, US- and Foreign-Born Mothers in Boston, MA

“…A study by Rusk et al on pediatric utilization within a similar population also showed an increase in outpatient visits for mental health despite an overall decrease in other kinds of outpatient healthcare encounters. 9 While emerging studies highlight the impact of COVID-19 on mental health, 2,10 less is known regarding the mental health implications of COVID-19 as it relates to ED presentations, particularly among people of color, immigrants, and those of lower socioeconomic status who were disproportionately affected by the COVID-19 pandemic. 11,12 Black and Hispanic populations are more likely to be infected with and die from COVID-19 infection.…”