‘Sobering’ statistics reveal childhood mental health trauma

The COVID-19 pandemic has had a profound and lingering impact on children and adolescents’ mental health, a new nationwide assessment of paediatric hospital presentations suggests.
 
The study, published in Paediatrics, shows that during the initial COVID-19 restriction period hospitals recorded a spike in the number of youth mental health presentations that only declined slightly after restrictions eased and remain above pre-pandemic levels.
 
During the restriction period, the trend included an 82% increase in inpatient admissions for deliberate self-harm (DSH) behaviours and a 76% increase in emergency department (ED) visits related for eating disorders.
 
Chair of RACGP Specific Interests Child and Young Person’s Health, Dr James Best, described the findings as ‘disturbing’ and said they point to a significant health problem among paediatric and young patients.
 
‘The numbers are very sobering,’ he told newsGP.
 
‘They reflect the impact of the social dislocation and isolation that has happened through the pandemic … and what a profound effect this has had on the mental health of our children and young people.
 
‘Mental health issues have been referred to as the “second wave” of health problems [stemming] from the pandemic and that’s clearly being shown out there. I think this is particularly important in our paediatric population.’
 
The increases, which included a 15% jump in ED attendances related to overall mental health disorders, was higher among females and those living in the least socioeconomically disadvantaged areas, which the authors suggest indicates a widening gap between mental health-related presentations by sex and socioeconomic status.
 
Dr Karen Spielman, a GP with a special interest and expertise in mental health, young people and eating disorders, told newsGP she has ‘never been busier’, despite working in one of the most advantaged areas in the country.
 
‘I’ve been telling people I think the incidence of these concerns has doubled or tripled in the last few years. This study is very validating and I’m grateful to the researchers for their work,’ she said.
 
According to Dr Spielman, a multitude of complex reasons are likely fuelling the surge.
 
‘I think young people are our barometers,’ she said. ‘They sense increased pressures and stress at individual, family, community and global/political levels.
 
‘Eating disorders in particular are multi-factorial and it has really been a perfect storm.’
 
The research findings are based on monthly mental health-related inpatient admissions and ED attendance data from six large paediatric hospitals across Australia, taken from March 2020 to December 2021 and January to June 2022.
 
Overall, 130,801 mental health-related hospital admissions (54,907) and ED attendances (75,894) were analysed among children and adolescents aged 0–18 years.
 
Adolescents aged 12–18 accounted for 62.4% of inpatient admissions and 76.4% of ED attendances, while more females than males had hospital presentations (admissions 57.9% vs 42.0%; ED attendances 63.6% vs 35.4%).
 
Patients from the least disadvantaged areas accounted for one-third of hospital presentations, whereas those from the most disadvantaged areas accounted for one-fifth.
 

Dr James Best says GPs need to be aware that mental health concerns are an ‘increasing problem’ among young people.

Lead author Dr Jahid Khan said mental health issues are the ‘leading health concern’ for children and adolescents in Australia, with DSH behaviours and eating disorders particularly prevalent in the research.
 
According to the study there were an estimated 1100 additional ED attendances related to eating disorders, and approximately 1500 or more additional hospital admissions related to DSH behaviours during the COVID-19 restriction period.
 
Given the research shows mental health presentation numbers remain higher than pre-pandemic levels, Dr Best said GPs need to be aware that it is an ‘increasing problem’ among young people.
 
‘These things don’t resolve overnight,’ he said. ‘They may have had a family situation where there may have been unemployment and financial distress, or there may have been breakdown of friendships and social connections.
 
‘They also may have made a child or young person a bit traumatised by the whole experience and that can have ongoing mental health implications. So just because the social isolation and dislocation have reduced it doesn’t mean the effects of them have simply gone away.
 
‘Services in mental health are always very difficult to access, particularly in children and young people, and sometimes that falls back to the GP.
 
‘We certainly need to have our radar out; we need to try to recognise and deal with it as best we can.’
 
Dr Spielman agrees that GPs are ‘perfectly placed’ to screen for and detect mental health issues before they result in ED presentations, but lamented barriers that hamper their ability to provide this type of care.
 
‘We are a vital part of the team needed to address EDs and can recognise risk factors at individual, family and community level, and resource our patients and their families with education, connection to specialist colleagues and support organisations,’ she said. 
 
‘Many GPs I’ve spoken to are well aware of this and desperate to do more to help but are often hamstrung by systemic issues.’
 
She says more value needs to be placed on long-term relational care through increased Medicare rebates, particularly for longer appointments.
 
‘We need to support GPs to do what we are trained to do and passionately want to do – spend time with our patients rather than be consumed by red tape and anxiety due to not fit for purpose item numbers,’ Dr Spielman said.
 
‘We need to fund allied health practitioners located in general practices – nurses, social workers occupational therapists etcetera – to meet local individualised needs.
 
‘We need to support case conferences – for our allied health colleagues too – so we can provide community-based care to keep pressure off ED and inpatient services.
 
‘And we need seamless communication between in- and out-patient services to avoid our patients falling through gaps, and reduce relapse and re-admission rates.’
 
Meanwhile, the researchers say their findings show that the pandemic has compounded the existing stress on Australia’s mental health system, as the pressure did not ease alongside COVID-19 restrictions in 2022, which is a concern as Australia enters ‘COVID normal’.
 
‘This may lead to a mental health service crisis, such as health professionals’ burnout, and longer emergency room waiting times and outpatient waiting times,’ senior author Professor Raghu Lingam, a paediatrician and academic at UNSW Medicine & Health and the Black Dog Institute said.
 
‘This in turn may result in more children and adolescents having acute and worsened mental health conditions, due to potentially reduced access to timely and appropriate mental health services and delayed treatment.
 
‘Improving the mental health of children and adolescents in Australia should be a top priority given the long-term effects of poor mental health on social, academic, and developmental outcomes.’
 
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adolescents children eating disorders mental health paediatrics self-harm