A comparative analysis of pediatric mental health-related emergency department utilization in Montreal, Canada before and during the COVID-19 pandemic

BackgroundReports on longitudinal trends in mental health-related (MHR) emergency department (ED) utilization spanning the pre- and post-pandemic periods are lacking, along with evidence comparing healthcare services utilization by sociodemographic subgroups. The aim of this study was to evaluate COVID-19-associated changes in MHR ED utilization among youth overall and by age, sex, and socioeconomic status (SES). MethodsThis retrospective cross-sectional study analyzed MHR ED utilization before and during the COVID-19 pandemic at a large urban pediatric tertiary care hospital in Montreal, Canada. All ED visits for children (5-11 years) and adolescents (12-17 years) between April 1, 2016 and November 30, 2021 were included. The main outcome was the monthly count of MHR ED visits. Pre-pandemic and pandemic periods were compared using an interrupted time series design. The effect of seasonality (in months), age (in years), sex (male or female), and SES (low, average, high) were compared using a generalized additive model. ResultsThere were a total of 437,147 ED visits (204,215 unique patients) during the five-year study period of which 9,748 (5.8%) were MHR visits (7,686 unique patients). We observed an increase of 69% (95% CI, +53% to +85%; p = .001) in the mean monthly count of MHR ED visits during the pandemic period, which remained significant after adjusting for seasonality (44% increase, 95% CI, +38% to +51%; p = .001). The chance of presenting for a MHR ED visit increased non-linearly with age. There were increased odds of presenting for a MHR ED visit among girls between the pre-pandemic and pandemic periods (OR 1.42, 95% CI 1.29-1.56). No difference by SES group during and before the COVID-19 pandemic was found (OR 1.01, 95% CI 0.89-1.15 [low]; OR 1.09, 95% CI 0.96-1.25 [high]). ConclusionsOur study shows important increases in MHR ED utilization among youth, and especially among girls, during the first 20 months of the COVID-19 pandemic, highlighting the need for sustained, targeted and scalable mental health resources to support youth mental health during the current and future crises.

Associations of childhood sociability and responsibility with cannabis use trajectories during adolescence: results from a prospective population-based birth cohort study.

This study aims to identify distinct trajectories of cannabis use during adolescence and examine whether Sociability (ability to relate to others) and Responsibility (ability to integrate a community setting) during childhood are associated with these trajectories, accounting for individual and familial confounders. Population-based cohort study (1998-2019): 1511 children from the Quebec Longitudinal Study of Child Development were followed between ages 5 months and 19 years. We identified developmental trajectories of adolescent cannabis use (assessed biyearly between ages 12 and 19 years) using a group-based trajectory model. We performed multinomial regression analyses to estimate the association between childhood Sociability and Responsibility assessed yearly between ages 6 and 12 years, and cannabis use trajectories. At 19 years, 62.8% (807/1286) of adolescents had used cannabis at least once in their lifetime, 44.2% had used at least once in the past 12 months (504/1140), and 6.8% were reporting daily use (77/1140). We identified three cannabis use trajectories: nonusers (n = 577, 38.2%), late users (n = 690, 45.7%; mean age of initiation: 16.2 ± 1.6), and early users (n = 244, 16.2%; mean age of initiation: 14.1 ± 1.3). Compared with Nonusers, children with low Sociability had a lower risk for late (OR, 0.43; 95 CI 0.27; 0.68) and early (OR, 0.22; 95 CI 0.12; 0.41) cannabis use. Children with low Responsibility were at higher risk of being Early users (OR, 2.23; 95 CI 1.13; 4.37) but not Late users (OR, 1.20; 95 CI 0.71; 2.03). Understanding the multiple dimensions of social skills and their association with cannabis use trajectories may help improve the effectiveness of evidence-based prevention strategies.

Depression and Anxiety Symptoms in Young Adults Before and During the Covid-19 Pandemic: Evidence from a Canadian Population-Based Cohort

ObjectivesConcerns have been raised that the COVID-19 pandemic could increase risk for adverse mental health outcomes, especially in young adults, a vulnerable age group. We investigated changes in depression and anxiety symptoms (overall and severe) from before to during the pandemic, as well as whether these changes are linked to COVID-19 related stressors and pre-existing vulnerabilities in young adults followed in the context of a population-based cohort. MethodParticipants (n=1039) from the Quebec Longitudinal Study of Child Development reported on their depression and anxiety symptoms and completed a COVID-19 questionnaire during the first wave of the COVID-19 pandemic in the summer of 2020 (age 22 years). Assessments at age 20 (2018) were used to estimate pre-pandemic depression and anxiety symptom severity. ResultsWhile overall levels of depression and anxiety symptoms did not change, there was an increase in rates of severe depression (but not severe anxiety) from before (6.1%) to during (8.2%) the pandemic. Depressive and anxiety symptoms increased from before to during the COVID-19 pandemic among young adults with the lowest levels of symptoms before the pandemic, while they decreased among those with the highest levels of pre-existing symptoms. Youth who were living alone experienced an increase in depressive symptoms. Other COVID-19 related variables (e.g., loss of education/occupation, frequent news-seeking) and pre-existing vulnerabilities (e.g., low SES, low social support) were not associated with changes in depression or anxiety symptoms. ConclusionDepression and anxiety symptoms in young adults from Quebec in Summer 2020 were comparable to symptoms reported in 2018. Most COVID-19 related stressors and pre-existing vulnerabilities were not associated with changes in symptoms. However, the increased rate of severe depression and the increase in depression and anxiety symptoms among young adults with the least mental health symptoms before the COVID-19 pandemic are concerning.