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Child and adolescent mental health worsened during the pandemic

Health and Benefits|Wellbeing
COVID 19 Coronavirus

By Jeff Levin-Scherz, MD | May 11, 2022

COVID-19 continues to exact a heavy toll on individual wellbeing, especially among youth.

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About the series

Dr. Jeff Levin-Scherz provides regular updates on the latest COVID-19 developments with a focus on the implications for employers and guidance on how they can tackle pandemic-related challenges to keep their workplaces safe. Explore the series.

The COVID-19 pandemic caused large disruptions in the lives of children and adolescents, substantially worsening their mental health. As schools closed their doors, students tried to adapt to remote learning style overnight. Many couldn’t socialize and lost access to reliable nutrition through school breakfast and lunch programs, and to scheduled physical activity like gym classes and team sports.

A nationally representative survey of over 7,500 adolescents in 2021 showed more than a third of high school students reported poor mental health. The details are unsettling:

  • 44% reported persistent feelings of sadness/hopelessness.
  • 20% seriously considered attempting suicide.
  • More than half reported they experienced emotional abuse in their homes.
  • More than one in 10 reported that they experienced physical abuse.
  • More than a quarter of adolescents reported a parent or other adult in the home lost a job.
Pre-pandemic statistics for mental health in children found 3.4% of ages 3 to 5 with of behavior disorders (with the depression and anxiety percentages around or below 1%).
1.7% of children ages 6 to 11 experienced depression, 6.6% anxiety and 9.1% experienced behavior disorders. And in adolescence (ages 12 to 17) 6% experienced depression, 10.5% anxiety and 7.5% behavior disorders.
Pre-pandemic prevalence of depression, anxiety and behavior disorders by age

Source: The Journal of Pediatrics, 2019

Unfortunately, getting mental health care for children and adolescents isn’t easy. Forty-three states have a severe shortage of youth mental/behavioral health professionals, and 148 million people live in designated Mental Health Professional Shortage Areas. Eight in 10 children with depression receive treatment, while only six in 10 children with anxiety and half of children with behavior disorders obtain treatment.

Implications for employers:

  • Difficulty finding mental health care and resources for children and families is a major problem for employees, and can cause stress, distraction and presenteeism. It can also be a major cause of dissatisfaction with health benefit coverage.
  • Employers can continue to deploy mental health solutions and family resources that incorporate virtual care, which is especially effective at addressing geographic shortages.
  • Employers can query employee assistance programs, medical carriers, mental health solutions and navigation providers about their efforts to increase access to mental health care for children and adolescents and their families.
  • Employers can help train managers to recognize and refer employees with mental health needs.

Telehealth hits a bump with controlled substances

Telehealth increased dramatically during the pandemic, and I’m heartened to see that virtual visits have allowed increased access to mental health care and continuity for treatment of chronic diseases like diabetes, even when patients were unable to be seen in person.

But some pharmacies and pharmacy benefit managers have recently restricted dispensing Schedule 2 medications prescribed by providers of digital health companies. Schedule 2 medications are drugs with the high potential for abuse, like narcotics and amphetamines, and were generally not prescribed through telemedicine prior to the pandemic. There are concerns that providers of some start-ups might be performing incomplete evaluations, and that these prescriptions could lead to an increase in drug abuse — much as “pill mills” promoted the opioid crisis. This is a special issue with stimulants like Adderall and Vyvanse used for attention-deficit/hyperactivity disorder. This could leave some members scrambling to refill prescriptions that should not be stopped abruptly. The shortage of mental health providers means that virtual care is necessary to meet real member needs. But companies need to monitor their providers carefully.

The podcast Tradeoffs recently highlighted studies that demonstrate the need to carefully monitor telemedicine. For instance, previous research has shown that telemedicine providers who prescribe antibiotics for respiratory infections get higher ratings and have shorter visit times, allowing for more productivity. Companies should evaluate telemedicine providers carefully while expecting them to train and monitor their providers to maintain appropriate, evidence-based prescription practices.

COVID-19 transmission increases but deaths are at the lowest level since the beginning of the pandemic

COVID-19 cases continue to increase in the U.S. with reported cases up about 50% over the last two weeks (to over 60,000 per day). Most new cases are diagnosed with home tests at this point, so this substantially undercounts new cases. Hospitalizations have also increased by about 20% to 17,500.

Reported COVID-19 deaths in the U.S. are at the lowest level since the beginning of the pandemic. Still, we are inching toward one million deaths attributed to COVID-19 in the U.S., and we expect decreased life expectancy due to the pandemic to continue into next year. In 2021, COVID-19 was the third-leading cause of death.

Wastewater continues to show an increase in viral concentration in all regions of the country except for the West where there is a small decline. This indicates that we will likely continue to see cases rise over the coming weeks.

Wastewater copies of virus per ml are as follows: Northeast: 500 and rising; Midwest: around 350 and rising; South: above 300 and rising; West: below 250 and declining.
U.S. wastewater surveillance of COVID-19 (copies of virus per ml)

Source: Biobot, May 4, 2022

Recent COVID-19 news

  • Omicron subvariants 2.12.1 (first identified in New York; currently 36.5% of virus sampled in the U.S.) and BA.4 and BA.5 (both first identified in South Africa; not yet prevalent in the U.S. to date) appear to be better able to overcome immunity, including from past Omicron infection. None of these appear at this point to cause more serious disease, and those who have immunity from vaccination or previous infection continue to be less likely to become severely ill.
  • The Kaiser Family Foundation vaccine monitor survey found that most workers feel safe at their workplace — although lower-wage and Black employees feel less safe. Ironically, those who were unvaccinated perceived themselves to be safer in the workplace than those who were vaccinated, demonstrating that perceptions of risk and actual risk are not the same. The survey showed that only one in five parents of children under the age of five would immediately get their children vaccinated when the FDA is expected to authorize a vaccine next month.
Just over half of total employees surveyed perceived their workplace to be safe. Those with higher incomes (60%) and the unvaccinated (71%) felt the safest at work.
Employee perception of safety at work

Source: Kaiser Family Foundation, May 4, 2022

Author

Population Health Leader, Health and Benefits, North America

Jeff is a practicing physician and has led WTW’s clinical response to COVID-19. He has served in leadership roles in provider organizations and a health plan, and is an Assistant Professor at Harvard Chan School of Public Health.


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