Post-acute sequelae of COVID-19 infection.

To determine if people infected with SARS-CoV-2 were at higher risk of developing selected medical conditions post-recovery, data were extracted from the database of a large health maintenance organization (HMO) in Israel between March 2020 and May 2021. For each condition, a condition-naïve group prior to COVID-19 (PCR-positive) infection were compared to a condition-naïve, non-COVID-19 infected group, matched by gender, age, socioeconomic status, minority group status and number of months visited primary care physician (PCP) in previous year. Diagnosis and recuperation dates for each COVID-19 infected participant were applied to their matched comparison participant (1:1 ratio). Incidence of each condition was measured between date of recuperation and end of study period for each group and Cox regression models developed to determine hazard ratios by group status, controlling for demographic and health variables. Crude and adjusted incidence rates were higher for the COVID-19 infected group than those not infected with COVID-19 for treatment for depression/anxiety, sleep disturbance, diagnosis of deep venous thrombosis, lung disease and fibromyalgia. Differences in incidence were no longer observed between the two groups for treatment of sleep disturbance, and diagnosis of lung disease when those hospitalized during the acute-phase of illness (any reason) were excluded. No difference was found by COVID-19 infection status for post-acute incidence of diabetes, cerebrovascular accident, myocardial infarction, acute kidney disease, hypertension and ischemic heart disease. Patients post-COVID-19 infection should be evaluated for depression, anxiety, sleep disturbance, DVT, lung disease and fibromyalgia.

Mental health assessment of Israeli adolescents before and during the COVID-19 pandemic

ImportanceAdolescents mental health and well-being were severely compromised during the COVID-19 pandemic. Longitudinal follow-up studies, based on real-world data, assessing the changes in mental health of adolescents during the later phase of the COVID-19 pandemic are needed. ObjectiveTo quantify the effect of COVID-19 on the incidence of Israeli adolescents mental health outcomes from electronic health record (EHR) data. Design, Setting and ParticipantsRetrospective cohort study analyzing EHR data of Maccabi Healthcare Services members, the second largest Health Maintenance Organization in Israel. Eligible subjects were 12-17 years old, during 2017-2021 with no previous diagnosis or psychiatric drug dispensation of those analyzed in this study. This resulted in over 200,000 eligible participants each year. ExposureCOVID-19 pandemic and the measures taken to mitigate it. Main Outcomes and MeasuresIncidence rates of mental health diagnoses (depression; anxiety; obsessive-compulsive disorder; stress; eating disorders; ADHD), and psychiatric drugs dispensation (antidepressants; anxiolytics; antipsychotics; ADHD agents) were measured, and relative risks were computed between the years. Subgroup analyses were performed for age, gender, population sector and socioeconomic status. Interrupted time series (ITS) analysis evaluated changes in monthly incidence rates of psychiatric outcomes. ResultsDuring the COVID-19 period a 36% increase was observed in the incidence of depression (95%CI: 25-47), 31% in anxiety (95%CI: 23-39), 20% in stress (95%CI: 13-27), 50% in eating disorders (95%CI: 35-67), 25% in antidepressants (95%CI: 25-33) and 28% in antipsychotics dispensation (95%CI: 18-40). Decreased rate of 26% (95% CI: 0.80-0.88) was observed in ADHD diagnoses and 10% (95% CI: 0.86-0.93) in prescriptions of ADHD agents. The increase was mostly attributed to females in the general Israeli population; nevertheless, a 24% increase in anxiety was seen in males (95%CI: 13-37), 64% in Israeli Arabs (95%CI: 12-140) and 31% in ultra-orthodox (95%CI: 3-67). ITS analysis revealed a significantly higher growth in the incidence of psychiatric outcomes during the COVID-19 period, compared to previous years. Conclusions and RelevanceEHR data of adolescents shows increased incidence rates of mental health diagnoses and medications during the COVID-19 pandemic, specifically identified females as those with the highest mental health burden. Our study highlights that the deteriorating mental health of children should be considered by decision-makers when actions and policies are put in place entering the third year of the pandemic. Key PointsO_ST_ABSQuestionC_ST_ABSHas the COVID-19 pandemic and the strategies to contain it affected adolescents mental health? FindingsIn this retrospective cohort study of over 200,000 adolescents 12-17 years old, the incidence rates of several measured mental health diagnoses and psychiatric medications increased significantly during the COVID-19 pandemic compared to the period before. This increase was mostly attributed to females. MeaningThis real-world study highlights the deterioration of adolescents mental health during the COVID-19 pandemic and suggests that the mental health of this young population should be considered during management and health policy decision making.