New and continuing physician-based outpatient mental health care among children and adolescents during the COVID-19 pandemic in Ontario, Canada: a population-based study

Alene Toulany; Simone Vigod; Paul Kurdyak; Therese A Stukel; Rachel Strauss; Longdi Fu; Astrid Guttmann; Jun Guan; Eyal Cohen; Maria Chiu; Charlotte Moore Hepburn; Kimberly Moran; William Gardner; Mario Cappelli; Purnima Sundar; Natasha Saunders

doi:10.3389/fpsyt.2023.1063203

New and continuing physician-based outpatient mental health care among children and adolescents during the COVID-19 pandemic in Ontario, Canada: a population-based study

Front Psychiatry. 2023 Nov 6:14:1063203. doi: 10.3389/fpsyt.2023.1063203. eCollection 2023.

Authors

Alene Toulany^{1

2

3

4

5

6}, Simone Vigod^{3

5

7

8}, Paul Kurdyak^{3

5

7

9}, Therese A Stukel^{3

5}, Rachel Strauss³, Longdi Fu³, Astrid Guttmann^{1

2

3

4

5

6}, Jun Guan³, Eyal Cohen^{1

2

3

4

5

6}, Maria Chiu^{3

5}, Charlotte Moore Hepburn^{1

2

6}, Kimberly Moran¹⁰, William Gardner^{11

12}, Mario Cappelli¹³, Purnima Sundar¹³, Natasha Saunders^{1

2

3

4

5

6}

Affiliations

¹ The Hospital for Sick Children, Toronto, ON, Canada.
² Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
³ ICES, Toronto, ON, Canada.
⁴ Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada.
⁵ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
⁶ Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, ON, Canada.
⁷ Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
⁸ Women's College Hospital, Women's College Research Institute, Toronto, ON, Canada.
⁹ Centre for Addiction and Mental Health, Toronto, ON, Canada.
¹⁰ Children's Mental Health Ontario, Toronto, ON, Canada.
¹¹ Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.
¹² School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
¹³ Knowledge Institute on Child and Youth Mental Health and Addictions, Ottawa, ON, Canada.

Abstract

Objective: To assess physician-based mental health care utilization during the COVID-19 pandemic among children and adolescents new to care and those already engaged with mental health services, and to evaluate differences by sociodemographic factors.

Study design: We performed a population-based repeated cross-sectional study using linked health and administrative databases in Ontario, Canada among all children and adolescents 3-17 years. We examined outpatient visit rates per 1,000 population for mental health concerns for those new to care (no physician-based mental healthcare for ≥1 year) and those with continuing care needs (any physician-based mental healthcare <1 year) following onset of the pandemic.

Results: Among ~2.5 million children and adolescents (48.7% female, mean age 10.1 ± 4.3 years), expected monthly mental health outpatient visits were 1.5/1,000 for those new to mental health care and 5.4/1,000 for those already engaged in care. Following onset of the pandemic, visit rates for both groups were above expected [adjusted rate ratio (aRR) 1.22, 95% CI 1.17, 1.27; aRR 1.10, 95% CI 1.07, 1.12] for new and continuing care, respectively. The greatest increase above expected was among females (new: aRR 1.33, 95% CI 1.25, 1.42; continuing: aRR 1.22 95% CI 1.17, 1.26) and adolescents ages 13-17 years (new: aRR 1.31, 95% CI 1.27, 1.34; continuing: aRR 1.15 95% CI 1.13, 1.17). Mood and anxiety concerns were prominent among those new to care.

Conclusion: In the 18 months following onset of the pandemic, outpatient mental health care utilization increased for those with new and continuing care needs, especially among females and adolescents.

Keywords: adolescents; children; continuity of care; coronavirus; mental health; psychiatry.

Grants and funding

This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH). This study was also supported by the MOH Grant 710 and the Canadian Institutes of Health Research Grant MS1-173069, both awarded to NS and AT. AG is funded by a Canada Research Chair. The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOH is intended or should be inferred. Parts or the whole of this material are based on data and/or information compiled and provided by Immigration, Refugees and Citizenship Canada (IRCC) current to May 2017. However, the analyses, conclusions, opinions, and statements expressed in the material are the authors’ and not necessarily the IRCC. Geographical data are adapted from Statistics Canada, Postal Code Conversation File +2011 (Version 6D) and 2016 (Version 7B). This does not constitute endorsement by Statistics Canada of this project.