Increase in Psychiatric Care Needs of Rural Children Post covid-19

Background: Due to the COVID-19 pandemic children were deprived of in-person attendance at school and experienced social isolation. The impact of these social-distancing measures on pediatric mental health is only now being unraveled. We conducted a descriptive review of psychiatric diagnoses at a pediatric outpatient practice in a Southern Illinois rural community. We compared the trends of pediatric psychiatric diagnosis before and following the COVID pandemic.

Methods: Pediatric Group LLC has multiple office locations in Rural Southern Illinois catering to about 10,000 pediatric patients staffed by pediatric providers and a clinical psychologist. The pediatric population has remained stable during the period. The care providers and practices have remained unchanged over the past four years. We did a retrospective review of electronic health records from January 2019 through June 2021. Using ICD-10 diagnostic codes, we analyzed the top 100 diagnoses made at the pediatric practice. Diagnoses were broadly classified into psychiatric and non-psychiatric categories. Psychiatric illnesses included anxiety, attention deficit hypersensitivity disorder (ADHD), conduct disorders, mood disorders, sleep disorders, and other psychiatric illnesses such as post-traumatic stress disorder (PTSD). Descriptive comparisons were made between pre-COVID (2019) and post-COVID (2021) periods.

Results: Compared to a baseline of 5044 encounters in 2019 (pre-COVID), attendance was 9% lower (4680) in 2020. Attendance dropped by 14% (2206) in the first half of 2020, increasing by 11% (2474) to reach pre-COVID levels in the second half of 2020. The attendances continued to increase in the first half of 2021, reaching 43% higher (3614) numbers compared to pre-COVID levels. Compared to 2019 and 2020, an increase in all psychiatric diagnoses was seen in our offices in the year 2021. Further analysis of the year 2021 showed significant increases in Anxiety and Depressive disorders, Oppositional Defiant Disorder (ODD), Disruptive Mood Dysregulation disorder (DMDD), and Major Depressive disorders (MDD) that almost doubled the statistics from the pre-COVID period. Sleep disorders and Post Traumatic Distress Disorder (PTSD) visits increased by far more than 150 percent. (Table 1)

Conclusion: A steady increase in pediatric psychiatric illness has been noted in the second half of 2020 and first half of 2021 following COVID pandemic. We observed an increase by over two times with almost all the psychiatric disorders in 2021. The overall increase in the incidence of various pediatric psychiatric illnesses is concerning. We believe that the absence of in-school attendance may have played a significant role.