Mental health after the COVID-19 pandemic among Finnish youth: a repeated, cross-sectional, population-based study

Transitions in mental health care utilisation at GHU Paris between 2019 and 2024: A post-pandemic perspective

OBJECTIVE

This study aimed to analyse the long-term evolution of mental health services use following the COVID-19 pandemic.

DESIGN

This was a retrospective study, conducted from 2019 to 2024, using the Groupe Hospitalier Universitaire Paris Psychiatry and Neurosciences (GHU Paris) databases.

METHODS

We considered the number of patients consulting at GHU Paris clinics, number of patients presenting at the emergency department (ED), and number of hospital admissions per week, by sex and age group. We performed a piecewise linear regression, using a threshold approach to identify time patterns between 2019 and 2024: pre-pandemic period (T1), short-term (T2) and long-term post-pandemic period (T3). Temporal changes in mental healthcare service use were then analysed.

RESULTS

No significant overall changes were observed in the number of outpatients after the COVID-19 pandemic, except for a slight increase among patients aged 15-24 years. The number of hospital admissions remained lower in 2024 compared with 2019, with a decreasing trend in T3 for all subgroups. In contrast, the number of ED visits increased over time, with higher use of emergency services by women and young people in 2024 compared with 2019. The overall long-term trend (T3) continued to show an increasing pattern. Additionally, a reduction in schizophrenia presentations was observed, while there was an overall increase in patients with substance use or neurotic disorders.

CONCLUSIONS

Our results described transitions in mental health service use at GHU Paris between 2019 and 2024, highlighting reduced hospital admissions, increased psychiatric emergencies, and changes in the reasons for seeking care.

Change in psychological distress and associated factors among Hong Kong young adults in post-COVID-19 era: a latent transition analysis

PURPOSE

The COVID-19 pandemic has brought negative impacts on young adults' mental health. The present study aimed to examine the transition of psychological distress classes in young adults after the pandemic and the associated factors.

METHODS

A total of 577 young adults (mean age = 25.9 years, SD = 4.4) in Hong Kong participated in a longitudinal online survey on mental health in 2022 and 2023. The participants completed the 10-item Chinese Health Questionnaire and self-constructed items on COVID-19 distress, financial distress, and social distress. Latent class analysis was used to classify the participants into latent classes of psychological distress. Latent transition analysis was conducted with measurement invariance to examine the transition amongst the latent classes from 2022 to 2023 and the associations with changes in the stressors.

RESULTS

The data supported three latent classes of psychological distress. A third of the participants belonged to the High-distress class with elevated symptoms and its prevalence decreased from 34.3% to 27.8% over one year. 40.9% and 10.0% of the Moderate-distress and High-distress classes transitioned to the Low-distress class after the pandemic, respectively. Financial distress (OR = 3.14, 95% CI = 1.17-8.41) and social distress (OR = 3.25, 95% CI = 1.70-6.21) was significantly linked to higher odds of transitioning from the Low-distress to High-distress class. Increased social distress was associated with decreased odds (OR = 0.57, 95% CI = 0.39-0.84) of improvement from the High-distress to Moderate-distress class.

CONCLUSION

The findings suggest an overall reduction in psychological distress among young adults after the pandemic. Increases in financial and social distresses after COVID-19 showed significant effects on worsening psychological distress.

Are we out of the woods yet? Youth-developed recommendations on recovery from the COVID-19 pandemic: A national Delphi study

OBJECTIVES

To generate concrete, youth-derived recommendations to support Canada's post-pandemic recovery from COVID-19 to support youth mental health and substance use (MHSU), economic, and educational recovery.

METHODS

Using a virtual, modified Delphi, participants rated recommendation items over three rounds, with the option to create their own recommendation items. A priori consensus was defined as ≥ 70% of the entire group, or subgroups of youth (e.g., age, race/ethnicity, gender and sexual identities), rating items at a 6 or 7 (on a 7-point Likert scale). Items were dropped in subsequent rounds if they did not achieve consensus. Qualitative responses were analyzed using content analysis for Round 1.

RESULTS

A total of 40 youths participated in Round 1, with good retention (97.5%) in subsequent rounds. Youths achieved consensus on eight recommendations to support post-pandemic recovery. Youths endorsed post-pandemic strategies that prioritize the implementation of effective, accessible, and low-cost MHSU services in schools, workplaces, and communities; the integration of MHSU education into school lessons; increased awareness about MHSU services in schools and workplaces; and the prioritization of health and well-being in schools and workplaces.

CONCLUSION

Findings indicate the need for stronger partnerships between schools, community-based MHSU services, and hospitals, and job opportunities that pay a living wage.

Depressive symptoms and suicidal ideation among university students before and after the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic and lockdown have had negative effects on students' mental health. However, little information is available regarding the frequencies of depressive symptoms and suicidal ideation during the post-pandemic period. We aimed to determine the effect of the COVID-19 pandemic on depressive symptoms and suicidal ideation among French university students.

METHODS

In this comparative study, 4463 students were recruited during the pre-COVID-19 pandemic period (2013-2020) and 1768 students, during the post-COVID-19 pandemic period (2022-2023). Standardized frequencies of depressive symptoms and suicidal ideation were compared between the two time periods. Changes in the level of depressive symptoms and suicidal ideation between the pre- and post-pandemic periods, were then analyzed using interrupted time series analysis.

RESULTS

Compared to participants from the pre-pandemic sample, participants from the post-pandemic sample had higher standardized rates of depressive symptoms (40.6 % vs 25.6 %) and suicidal ideation (29.3 % vs 21.1 %). Segmented logistic regression showed an about 50 % increased risk of depressive symptoms (aOR, 1.47; 95 % CI, 1.01-2.13) and a 100 % increased risk of suicidal ideation (aOR, 2.00; 95 % CI, 1.33-3.00) in the post-pandemic period. Before the pandemic, there was no significant time-trend for depressive symptoms (aOR, 1.002; 95 % CI, 0.999-1.006) and suicidal thoughts (0.999-1.006; aOR, 0.999; 95 % CI, 0.995-1.002).

LIMITATIONS

Potential biases related to self-selection of participants in the study and information bias. History of depression and suicide attempt were self-reported.

CONCLUSIONS

These findings reveal an alarming deterioration of students' mental health in the post-pandemic period compared to the pre-pandemic era.

Measuring disordered eating in adolescent boys: a systematic literature review

PURPOSE

The aim of this study was to map which instruments are currently being used to measure disordered eating in adolescent boys as part of a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis.

METHOD

Utilizing the PRISMA review protocol, 174 journal articles were reviewed.

RESULTS

Sixty-seven articles used versions of the Eating Attitudes Test to measure adolescent boys' disordered eating, 32 used versions of the Eating Disorder Examination-Questionnaire, 30 used versions of the Eating Disorder Inventory, 25 used SCOFF, and 10 used the Drive for Muscularity Scale. A plethora of other instruments for measuring disordered eating were utilized as well.

CONCLUSION

Studying adolescent boys' disordered eating by using instruments primarily developed and validated for girls may provide unreliable estimates of the numbers of boys who suffer from disordered eating, which would preclude early intervention. One strength of the reviewed studies was that several used multiple measurements to validate their results. One of the weaknesses was the lack of distinguishing genders among certain groups, such as athletes or patients. Among the opportunities identified was the possibility of expanding on research on the association between puberty and disordered eating, with sports and parents potentially acting as buffers against the onset of disordered eating. A clear threat to research on disordered eating among adolescent boys was the (in)accuracy of the measurements.

Trends in Adolescent Depression Screening Outcomes Over the COVID-19 Pandemic at a Large, Integrated Health Care System in Southern California

PURPOSE

Little is known about changes in depression screening outcomes among adolescents in primary healthcare across the COVID-19 pandemic. We describe trends in depression screening outcomes within a large integrated health care system in Southern California.

METHODS

Retrospective electronic health record data from preventative healthcare visits of 11-12-year-olds and 13-17-year-olds screened for depression from March 1, 2017, to August 31, 2022, were extracted in 6-month blocks. The percentages of screens meeting "threshold depression" were reported overall, and by sex, race or ethnicity, and median household income quintiles. We used Poisson regression to estimate rate ratios of threshold depression in 3 winter blocks (September to February) comparing lockdown (2020), reopening (2021) to a pre-COVID (2019) period, and reopening relative to lockdown. Disparities in trends by sex, race, or ethnicity and household income were tested using interaction terms.

RESULTS

Of 735,333 visits with complete screening (183,550 for 11-12-year-olds and 551,783 for 13-17-year-olds), 4.6%, 6.5%, and 7.4% of 11-12-year-olds had "threshold depression" during winter blocks of pre-COVID, lockdown and reopening, respectively. The corresponding rates were 5.8%, 8.5%, and 9.8% for 13-17-year-olds. The rates were higher during lockdown and reopening relative to pre-COVID and higher during reopening relative to lockdown for both age groups (all p-values <.001). Trends differed by sex in both age groups (p-values <.001) and by race or ethnicity (p = .001) in the 13-17-year age group.

DISCUSSION

Californian adolescents demonstrated an increase in threshold depression since COVID lockdown starting March 2020 with further increase observed during reopening in September 2021. Future studies are needed to determine the long-term trends.

A multicenter retrospective study of antidepressant use in outpatient clinics in China pre- and post-COVID

BACKGROUND

Analyzing antidepressant prescribing in real-world settings can provide clinicians and health policymakers valuable information.

AIM

This epidemiological study examined the status and trends in antidepressant prescribing among the Chinese population from July 1, 2017, to June 30, 2022.

METHOD

A retrospective study was conducted in three hospitals. Data were collected 2.5 years before and 2.5 years after the onset of the COVID-19 pandemic. We analyzed the number of patients diagnosed with depression and their corresponding antidepressant prescriptions. Using the chi-square test, stratified analyses were performed to explore the characteristics of these prescriptions in different ages and sexes.

RESULTS

The study included 124,355 patients and 400,840 antidepressant prescriptions. We observed fluctuating upward trends in the number of patients and antidepressant prescriptions. Post-COVID-19, the number of patients increased by 37.1% compared to the pre-pandemic period, and the number of antidepressant prescriptions rose by 88.3%. The three most frequently prescribed antidepressants for adolescents were sertraline, citalopram, and escitalopram. Among adults, citalopram, escitalopram, and sertraline were most common, while in older adults, citalopram, escitalopram, and mirtazapine were predominant. Male patients used mirtazapine, venlafaxine, paroxetine, bupropion, fluvoxamine, vortioxetine, and clomipramine more frequently compared to female patients, who were more likely to be prescribed citalopram, flupentixol/melitracen, agomelatine, and fluoxetine. Antidepressant monotherapy represented 76.6% of prescriptions, with the most common combination being antidepressants and anxiolytics.

CONCLUSION

Over the past 5 years, both the number of patients and antidepressant prescriptions have shown upward trends, and the COVID-19 pandemic has impacted prescribing. Understanding the changes in antidepressant prescriptions can identify adherence to national guidelines.

Psychotic-like experiences in a nationally representative study of general population adolescents

BACKGROUND

Subclinical psychotic-like experiences (PLEs) are common among general population adolescents but have been found to correlate with various problems in well-being. Due to limited sample sizes these effects have not been well differentiated by sex and age.

METHODS

Using a nationally representative survey of almost 160,000 adolescents, we studied endorsement and correlates of PLEs by sex among middle adolescence pupils (ages 14-16) and late adolescence students (ages 16-20). PLEs were investigated with three questionnaire items: auditory and visual hallucinatory experiences and suspicious thought content, using a frequency response scale.

RESULTS

Weekly PLEs were reported by 14 % of the adolescents, more often in females (17 %) than males (11 %) and in the younger age group (17 %) compared to the older adolescents (10 %). A latent PLE factor represented the three assessed PLEs with good fit. Factor scores were highest for the younger females and lowest for the older males. The PLE factor correlated with two latent factors of other well-being, namely living environment ("adversity", loading most heavily on parental mental abuse; r = 0.63), and concurrent mental health ("distress", loading most heavily on depressive symptoms; r = 0.50). Adversity was associated especially strongly with PLEs in 14-16-year-old males.

CONCLUSIONS

This cross-sectional study reaching the whole 14-20 age group in schools in Finland offers data on the meaning and relevance of PLEs as general markers of vulnerability. Many adolescents experience PLEs recurrently and these experiences are associated with a wide variety of burden in the adolescent's everyday life.