Covid’s Impact on Mental Health

The Centers for Disease Control and Prevention (CDC) has had a bad year. Mixed messaging from the CDC has left millions of Americans confused when recommendations have fluctuated and statistics have conveyed false information.

Monica Gandhi and Jeanne Noble, writing in The Wall Street Journal, give us a good example. The CDC released a report recently warning that adolescent hospitalizations due to Covid-19 were on the rise. The media picked up the message and ran with it. But it wasn’t true. The CDC misrepresented the data and played down a more important finding that provides further evidence that pandemic-control measures are likely having a serious adverse impact on young people’s mental health.

In fact, adolescent hospitalizations for Covid-19 were back down to 0.6 per 100,000 by late May, before the CDC report was published, and well below the rate of 2.6 for the adult U.S. population. Covid-19 cases among children in 2021 have now fallen by 84% and hospitalizations are down by 69% since January, thanks largely to adult vaccinations.

But the real story about adolescents is this: 20% of teen hospitalizations in the study between January 1 and March 31, 2021 were for psychiatric emergencies, not Covid. The available data, though difficult to obtain due to pandemic-related closures, point to a crisis in adolescent mental health. We know that lockdowns and school closures have led to greater incidences of obesity and eating disorders, according to experts at the Stanford Children’s Health network.

The pandemic has reduced overall healthcare utilization rates for all types of elective healthcare, including cancer screening and mental health services. This exacerbated what the CDC has identified as a pre-existing mental health treatment gap for children in the U.S.

The closure of schools has made quantifying the pandemic’s impact on mental heath difficult. Referrals to child services were down in some places by as much as 50% in 2020, indicating major blind spots in awareness of child neglect. School systems were previously common sources of referrals for suspected child abuse and mental-health service agencies.

We do know data from Children’s Hospital of Oakland show a 66% increase in 10 to 17-year-olds screening positive for active or recent suicidal ideation in its emergency department between March and October 2020. The proportion of children seeking emergency mental-health services who required immediate hospitalization, including for eating disorders, rose 75% in 2020 compared to 2019. The Children’s Hospital of San Francisco emergency department reported 21% of adolescents treated in January 2021 expressed active or recent suicidal ideation, up from 14% in January 2020. These data reflect the highest proportion of suicidal adolescents ever recorded in this hospital.

Compare the rates of suicide between adults and young people. The California Department of Public Health shows 134 people under 18 died by suicide in 2020, up from 108 in 2019, a 24% increase. Adult suicide in California actually declined by 11% in the same period. Compare these statistics to the number of deaths by Covid. Of 62,000 Covid deaths since the start of the pandemic, only 23 have been in people under age 18 years. It would seem that the risk of suicide from the lockdowns of Covid represented a greater risk to adolescents than Covid itself.

Similar experiences occurred in other states. Colorado Children’s Hospital issued a press release declaring “a state of emergency” due to demands for pediatric mental-health services with mental-health emergency department visits up 90% in 2021 over 2019. Connecticut also reported a similar surge. The authors say it is likely that data on emergency department utilization and hospitalizations are catching only the tip of the iceberg.

It is not coincidental that California has the lowest rates of children returned to in-person learning of all 50 states. This should be a wake-up call for all Californians as they consider their vote in the recall election for their governor, Gavin Newsome. It should also be a warning to those public health officials who would call for more lockdowns in future pandemics.

 

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