PC2008: Use of Virtual Data Warehouse to Study the Effect of COVID-19 Pandemic in Adolescent Anxiety and Depression in Primary Care Practice

Background: Adolescence is a multitude of physical and psychosocial changes during a defined period of growth and development. The advent of the Coronavirus disease, declared a pandemic by the World Health Organization on March 11, 2020, has negatively impacted all of human race especially the youth. There has been increased rates of adolescent anxiety and depression after the pandemic and is expected to worsen. We are interested to find objective data to demonstrate the impact of the pandemic to adolescent mental health by using the Virtual Data Warehouse (VDW). The VDW is a novel approach to gather secure data using electronic health records using appropriate levels of de-identification. Our goal was to analyze and compare the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) screening results as a consequence of the world-altering pandemic.

Methods: The VDW was utilized for the retrospective analysis of the PHQ-9 and GAD-7 questionnaires that completed 18 months pre-COVID and 18 months after the pandemic was declared. De-identified data was obtained from medical records of adolescents aged 13 to 17 years seen at the pediatric clinics in Western Michigan University Homer Stryker MD School of Medicine.

Results: Out of 1767 adolescents in the study,49.2% (n=869) were seen in clinic pre-pandemic and had completed the PHQ-9 and GAD-7 questionnaires. 50.8% (n=898) were after (post) COVID period. There were 413 males and 456 females in pre-COVID group compared to 431 males and 466 females in the latter group. A GEE model was created to assess whether PHQ-9 and GAD-7 score differs between pre and after Covid timeframes. With a corresponding p-value of 0.0163 there is sufficient evidence that PHQ-9 scores differ between pre and post Covid. The estimated odds e0.2597 = 1.2965, with corresponding confidence interval of (1.0490, 1.6025) showed the odds of having a severe PHQ-9 score is between 1.049 and 1.6025 times that for individuals post covid than for individuals in the pre covid timeframe (Table 1 and 2). With a corresponding p-value of 0.0442 there is sufficient evidence that GAD-7 scores differ between pre and after Covid. The estimated odds e0.3696 = 1.4471, with corresponding confidence interval of (1.0097, 2.0741) showed the odds of having a severe anxiety GAD-7 score is between 1.0097 and 2.0741 times that for individuals post covid than for individuals in the pre covid timeframe (Table 1 and 2).

Conclusion: Completion of this study shows that use of VDW could be effective, quick, and secure way to do studies of any nature and even more for sensitive topics like anxiety and depression with proper de-identification. We have also established a statistically significant increase of odds of having severe anxiety and depression in adolescents after covid pandemic than in the pre-covid timeframe.