As Canada reflects on the lessons of the global COVID-19 pandemic, one thing has become clear: It’s time to step up efforts to address the country’s mental health crisis. Canada is not alone in this predicament: More than two years ago, the World Health Organization reported a 25% increase in the prevalence of anxiety and depression around the world linked to the pandemic.
For Canadian youth (children, adolescents, and young adults), these increases are just the tip of the iceberg. Results of two related studies published this month show: JAMA Network Open and JAMA Pediatrics Increased rates of hospital admissions for anxiety disorders, personality disorders, suicide and self-harm were highlighted. The data also showed that hospital admissions for eating disorders were particularly high among girls aged 12 to 17, with eating disorders accounting for more than three-quarters of all hospital admissions nationwide between April 2020 and March 2023.
“These findings suggest that the effects of bronchodilator therapy on the development of bronchial asthma are not yet fully understood,” said Nadia Roumeliotis, MD, a pediatric intensive care physician at Sainte-Justine Hospital in Montreal, Quebec, Canada, and lead author of both studies. Medscape Medical News “Females appear to have fared worse during the pandemic in terms of anxiety disorders, suicide and self-harm, personality disorders, and eating disorders. It’s interesting to see what the gender differences in how male and female adolescents have fared through the pandemic might mean.”
Hospitalization rates and eating disorders soar
Roumeliotis and colleagues conducted a cross-sectional study evaluating the pre-pandemic and COVID-19 epidemic periods (April 1, 2016 to March 31, 2023) to estimate differences in crude hospitalization rates for mental illness among 6.3 million youth and young adults (ages 6-20) across all Canadian provinces and territories.
Of the 218,101 psychiatric hospitalizations they identified, the relative increase over the study period was most pronounced among 12-17 year olds (ranging from 65.8% in the past four years to 68.4% during the three-year COVID period). Most of these hospitalizations were female, with the proportion increasing from 63.8% to 69.0% between pre-COVID and COVID (36.2% to 31.0% for males and 36.2% to 31.0% for females). P < .001).
“Most hospitals are seeing high school students, making up 85 to 90 percent of hospital admissions, which is not surprising because this age group is more likely to experience mental health decline and is also more likely to be female,” Roumeliotis said. “This age group is very vulnerable to the loss of social interaction and interaction with their team and peers,” she added.
In the second study, researchers looked at the relationship between eating disorder hospitalizations and stringency of public health measures among school-age adolescents and young adults ages 6 to 20 between April 1, 2016 and March 31, 2023. To better understand whether hospitalizations were new or recurrent, researchers looked back to April 1, 2014 for mental health symptoms, including eating disorders.
Overall, 11,289 people were hospitalized for an eating disorder among 6.3 million youth across Canada. In both study periods (i.e., pre-COVID and COVID), more than half (58.6%) of hospitalized patients had not previously been hospitalized for an eating disorder. Additionally, 90.4% of hospitalized patients were female (9.6% male), and 77% of hospitalized patients were aged 12-17 years.
These findings are consistent with a meta-analysis published in February. Journal of the American Academy of Child and Adolescent Psychiatry We examined eating disorder-related health care visits among children and adolescents in 15 countries, including Canada.
“We found a 54 per cent increase in eating disorders among children and adolescents during the pandemic,” said co-author Tracy Vaillancourt, PhD, Canada Research Chair in School-Based Mental Health and Violence Prevention at the University of Ottawa and the Canadian Institutes of Health Research in Ottawa, Ontario, Canada. Vaillancourt is also chair of the Royal Society of Canada’s COVID-19 Task Force. The larger increase was seen among girls (proportionately [RR]1.48; 95% CI, 1.28-1.71) than boys (RR, 1.24; 95% CI, 1.06-1.45) and adolescents aged 12 to 19 years (RR, 1.53; 95% CI, 1.29-1.81).
Looking to the future
An important factor in these numbers is the control group, says Vaillancourt, who was not involved in the cross-sectional study. “Maybe you have underlying conditions, but now you can’t go to the gym or play soccer, and the media is telling you you’re going to get fat,” she says. “All of this is not good for someone at risk for an eating disorder.”
Another factor was Canada’s regional stringency (i.e. government policies and restrictions measured systematically across time and place), which was the most stringent and lasted the longest among G10 countries.
“As restrictions have been tightened, we’ve seen an increase in eating disorder symptoms, and I think we can infer a lot from that,” said Rachel Hannah Mitchell, MD, a child and adolescent psychiatrist at Sunnybrook Health Sciences Centre in Toronto and an assistant professor of psychiatry at the University of Toronto in Toronto, Ontario, Canada, who was also not involved in the cross-sectional study. “Clinically, we’ve seen so many cases over the course of the pandemic that I believe the signs are real, and we need to pay attention to these signs in our pandemic preparedness going forward,” she added.
Prevention and capacity issues may have also played a role. “I chaired the Royal Society’s COVID report for school children, and one of the things we advocated for was prevention, including universal school-based mental health programs,” Vaillancourt said. “We can also increase capacity in terms of program delivery,” she added, pointing to staffing shortages and underfunding of training programs.
“The period between now and the next pandemic is a time to think about care delivery and how we make sure we build resilience in children so they don’t fall into a mental health crisis,” she said.
Fortunately, the Canadian government is preparing. Medscape Medical NewsRepresentatives from Health Canada and the Public Health Agency of Canada said they are working in a coordinated effort to fund new and existing programs.
“Through Budget 2024, our government will invest $500 million over five years in a new Youth Mental Health Fund to ensure Canadian youth have access to mental health care, and $7.5 million over three years in Kids Help Phone, which will provide 24/7 mental health, counselling and support to youth, including supports for Indigenous youth, racial minorities, 2SLGBTQ+ youth and newcomers who are impacted by structural inequalities.”
The government is also “investing in strengthening the Integrated Youth Services model, which provides young people with rapid access to integrated and culturally safe youth services, including mental health and substance use support, and engages with young people where they are – in their communities,” they wrote.
In the meantime, it’s important to catch the early warning signs.
Roumeliotis said it’s important to continue screening adolescents for eating disorders regardless of gender, sociodemographic class, weight or race. “It’s also important to maintain community, clinical and parent support.” [in coordination] “We are working with GPs. If the pandemic returns we need to ensure that our services are maintained, particularly for young people at risk of eating disorders, anxiety and self-harm, so they can be treated at home or in the community before their condition becomes serious enough to require hospitalisation.”
Vaillancourt had some additional advice: “It’s important that GPs, parents and teachers know how to talk to children about mental health issues – if a child is distressed, listen, make them feel acknowledged, be present in the moment and put in place an appropriate response plan,” she said.
“Every interaction is an opportunity,” Mitchell added.
This research was supported by the Canadian Institutes of Health Research (CIHR). Roumeliotis reports grants from the Fonds de Recherche du Québec—Santé, Junior 1 Research Scholar, and CIHR, outside the current research. Vaillancourt and Mitchell report no relevant financial relationships.
Liz Scherer is an independent health journalist based in the US.
