Youth Mental Health Hospitalization Rates Rose in 2020

Mental health hospitalization rates rose for Canadian children and youth between ages 5 and 24 years in 2020, despite a slight decrease in the overall number of hospital visits, according to new data.

Hospitalizations for eating disorders increased significantly, rising nearly 60% for girls between ages 10 and 17 years.

"One of the key questions throughout the pandemic has focused on the unintended consequences of the pandemic itself, as well as public health measures," Tracy Johnson, MBA, director of health system analytics at the Canadian Institute for Health Information, told Medscape Medical News.

"Hospitalizations and emergency department visits decreased during the first year of the pandemic because of closures and fears about coming in for care," she said. "But the need for mental health care maintained. This kind of jump we're seeing signals that something is happening."

The findings were published online May 5 by the Canadian Institute for Health Information.

Sex and Socioeconomic Differences

Johnson and colleagues analyzed data from the National Ambulatory Care Reporting System and the Discharge Abstract Database to identify children and youth between ages 5 and 24 years who visited emergency departments or had inpatient stays for mental disorders. They also analyzed mental health drug use with data from the National Prescription Drug Utilization Information System.

The research team found that hospitalizations for mental health disorders declined slightly from 2019 to 2020, dropping from 39,801 to 36,708. Hospitalizations for all other conditions also dropped during that time, from 146,845 to 122,996.

But the proportion of hospitalizations for mental health disorders increased from 21% to 23%. Nearly 1 in 4 hospitalizations for patients aged 5 to 24 years were for mental health conditions in 2020.

Girls accounted for about 58% of hospitalizations for mental health disorders in 2020; boys accounted for 42%. Girls between ages 15 and 17 years were twice as likely to be hospitalized as boys of the same age.

For patients aged 10 to 17 years, eating disorders were particularly burdensome, compared with the previous 4 years. For girls, the rate of hospitalizations for eating disorders was 1.6 times higher in 2020 than it was in 2019.

The use of psychotropic drugs for mood and anxiety disorders also increased, continuing a steady upward trend from the previous 5 years. About 7372 medications were dispensed for patients aged 5 to 24 years per 100,000 population in 2020, compared with 7109 in 2019 and 6714 in 2018. In 2020, the rate of mood and anxiety medication use was more than two times higher for females than for males.

Among children and youth living in less affluent neighborhoods, rates of emergency department visits and hospitalizations for mental health were higher overall. More than one fourth of those hospitalized for all mental health conditions lived in the least affluent neighborhoods.

However, the trend was reversed for hospital care for eating disorders. Among those living in more affluent neighborhoods, hospitalization rates for eating disorders were higher. About one third of patients hospitalized for eating disorders lived in the most affluent neighborhoods.

Early Interventions Needed

Surveys have indicated that mental health declined among Canadians during the pandemic, owing to high levels of anxiety and loneliness, as well as changes to the care they were able to obtain, the study authors write.

In 2020, the proportion of youth reporting excellent or good mental health decreased by 20%. In addition, the Kids Help Phone reported double the number of interactions (through phone calls, texts, and the use of self-directed help resources), compared with 2019.

The pandemic appears to have affected certain mental disorders disproportionately, the authors note. For example, an increase in eating disorders may have stemmed from constraints on physical activities, a lack of social supports, and increased exposure to media and social media.

"The health experts have told us they're seeing more kids, and they're having to admit sicker kids than before," Johnson said. "We know that the earlier the treatment, the higher the chance of helping a child to make a full recovery, particularly with eating disorders."

In the future, health systems will need to prioritize early interventions and prevention methods, she said. Provincial governments are considering new ministries of mental health and substance use, which could improve access to care, as well as virtual visits offered during the pandemic.

"Virtual care is being touted as one of the ongoing ways to alleviate some of the care problems we have," she said. "At the same time, there are a number of questions, including which programs were transferred to virtual care and whether the outcomes were as good, if we're going to use virtual care moving forward."

"Striking and Concerning"

Commenting on the study for Medscape Medical News, Leanna Isserlin, MD, an assistant professor of child and adolescent psychiatry at the University of Ottawa, Ontario, said, "The increase in hospitalizations for youth due to an eating disorder during the pandemic is striking and concerning."

Isserlin, who wasn't involved with this report, is also the psychiatric director for the child and adolescent eating disorders program at the Children's Hospital of Eastern Ontario.

"It is also a significant underrepresentation of the true increase because research shows that eating disorders aren't just a disease of the affluent," she said. "Many young people from marginalized communities and less affluent neighborhoods have difficulty accessing treatment for eating disorders and would not be reflected in these data."

The study was supported by the Canadian Institute for Health Information. Johnson and Isserlin have disclosed no relevant financial relationships.

Canadian Institute for Health Information. Published online May 5, 2022. Text

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