Children and young people with pre-existing mental health and neurodevelopmental conditions, including depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), and those on the autism spectrum, have worse mental health outcomes than their peers without these conditions. Research on this group of children and young people has found that the pandemic had mixed effects on their mental health – over time, some experienced worse mental health and others better.
However, it is unclear what factors may explain who does worse over long periods of time, or longitudinally. Specifically, what factors predict worse mental health outcomes longitudinally in children and young people with pre-existing conditions during the pandemic?
Trajectories of emotional and behavioural symptoms over time
In a recent study, published in JCPP Advances, we explored this question by linking data from the Maudsley Child and Young People Health and Experience Research (CYPHER) survey and electronic health records data of child and adolescent mental health service users in South London & Maudsley NHS Foundation Trust.
The Maudsley CYPHER survey collected data from child and adolescent mental health service users and their caregivers in South London around their pandemic experiences between 2020-2022. The data collected provided important insights into their mental health during the pandemic.
We used a nested survey method, a novel approach where survey data for a defined cohort was collected and ingested into electronic health records. This allowed us to enrich data of child and adolescent mental health service users by incorporating survey data and clinical data from their electronic health records.
By doing this, we were able to see what sociodemographic and clinical factors may predict worse trajectories of emotional (such as low mood and worries) and behavioural (such as inattention and irritability) symptoms between before and during pandemic timepoints. Trajectories here refers to longitudinal patterns of emotional and behavioural symptoms across time.
The role of age, sex, neighbourhood deprivation, and diagnosis
Our method identified 388 child and adolescent mental health service users who had sufficient data to analyse between 2019-2021 – only around 7% of the entire child and adolescent mental health service sample had enough longitudinal mental health data to analyse during our study window.
Emotional and behavioural symptoms were consistently high across before and during pandemic timepoints. This highlights that although children and young people with pre-existing conditions’ mental health may not have changed significantly during the pandemic compared to before, they experience high mental health needs consistently over time.
Emotional symptoms over time were relatively worse in those who were female, lived in deprived neighbourhoods, and had a diagnosis for autism, compared to those who were male, did not live in deprived neighbourhoods, and had a diagnosis for an emotional disorder,
Behavioural symptoms over time were relatively worse in those who were younger and had a diagnosis for ADHD or autism, compared to those who were older and had a diagnosis for an emotional disorder.
What is the longitudinal mental health impact of the pandemic?
Our study findings provide evidence that there are variations in trajectories of emotional and behavioural symptoms in children and young people with pre-existing conditions before and during the pandemic. These factors may include key sociodemographic and clinical characteristics, such as age, sex, neighbourhood deprivation, and diagnosis.
Surprisingly, we did not find an overall effect of ethnicity and intellectual disability diagnosis, which we know also play a role in mental health over time. However, rather than these factors not predicting symptom trajectories, we suspect their role may vary across time – we did find some potential time-dependent effects of ethnicity, where those who were Black had relatively higher decreases in emotional symptoms between 2019-2020 compared to White counterparts.
Additionally, we may find more precise findings in larger samples with more data. This has improved significantly with the implementation of myHealthE in 2021, a digital platform for families to access advice and support from referral to child and adolescent mental health services and provide routine mental health data in South London and Maudsley NHS Foundation Trust.
Ultimately, this work contributes to the literature around how the pandemic affected the mental health of clinical groups of children and young people. The mental health impact was complex and there are certain subgroups that may have had worse outcomes indicated by sociodemographic and clinical characteristics.
There are still many questions that are unanswered, such as what are the impact of specific pandemic-events (e.g. lockdowns), the longer-term impacts beyond 2021, and the impact on other mental health outcomes (e.g. like self-harm and service use)? Our team is working on unravelling these using linked data and both quantitative and qualitative methods.
This research will better our understanding of the longitudinal impact of the pandemic on the mental health of children and young people with pre-existing mental health and neurodevelopmental conditions. Critically, findings may inform policies to protect the mental health of children and young people in similar future pandemics and crises.