Changes in psychiatric diagnoses and psychotropic medication use among children and adolescents before, during, and after the COVID-19 pandemic: a population-based cross-sectional study

Abstract

The COVID-19 pandemic has resulted in significant disruptions to the daily routines of children, potentially altering trends in psychiatric diagnoses and medication utilization. This study investigates longitudinal changes in psychiatric diagnoses and the usage of psychotropic medications, thereby offering valuable insights into the developmental patterns of vulnerability among children and adolescents in the aftermath of the COVID-19 pandemic. This population-based, cross-sectional study utilized electronic medical records from Clalit Health Services (2016–2023). For each calendar year, data from approximately one million children and adolescents aged 5–18 years were analyzed. The study compared quarterly dispensing rates of antidepressants, antipsychotics, and psychostimulants, as well as the quarterly incidence of major psychiatric diagnoses, across pre-pandemic, pandemic, and post-pandemic periods. Poisson regression models, adjusted for seasonality, were employed to calculate counterfactual quarterly rates based on historical trends, thereby assessing the impact of the pandemic. During the pandemic, antidepressant dispensing exceeded expected levels, with the most pronounced increases observed among adolescents, particularly females (Relative Risk (RR) = 1.13). Conversely, psychostimulant dispensing initially declined (RR = 0.87) before rebounding following the pandemic. The use of antipsychotics exhibited modest and ongoing increases among young boys and adolescent girls, remaining elevated compared to pre-pandemic trends (RR 1.14–1.18). The incidence of diagnoses for Attention Deficit Hyperactivity Disorder (ADHD) increased across all demographic groups. Additionally, adolescent females experienced notable surges in anxiety (RR = 1.40), depression (RR = 1.49), and eating disorders (RR = 1.86). Many of these outcomes persisted at levels exceeding pre-pandemic forecasts during the post-pandemic period. The pandemic was associated with age- and sex-specific changes in paediatric mental health, with persistent increases in internalising disorders and antipsychotic use. These patterns, particularly pronounced among adolescents, suggest heightened developmental sensitivity to large-scale environmental stressors and underscore the need for targeted service planning and ongoing monitoring.