Two new studies led by a researcher from CHU Sainte-Justine paint a more nuanced picture of the impact that the COVID-19 epidemic has had on the mental health of young people.
Overall, both studies show a decline in hospitalization rates among young Canadians for mental health issues between 2020 and 2023.
The picture is not uniform, however. We are seeing an increase in hospitalizations for eating disorders, both for boys and girls.
“We see that some hospitalization rates have decreased and others have increased,” summarized Dr. Nadia Roumeliotis, who is a clinician-researcher at CHU Sainte-Justine and who carried out this work with her colleague, Dr. Caroline Quach-Thanh.
Published by the medical journal JAMA Network Openthe first study analyzed data from six million young Canadians. The authors found, by comparing a pre-pandemic period (1er April 2016 to March 31, 2020) and the pandemic period (1er April 2020 to March 31, 2023), a 7.2% decrease in hospitalization rates for a mental health problem. There are also decreases for mood disorders, substance abuse and schizophrenia.
In contrast, the authors measured an increase in hospitalizations among girls for symptoms of anxiety and self-destructive or suicidal behavior.
“We have also seen an increase in anxiety disorders, personality disorders and suicide or self-harm disorders,” said Dr. Roumeliotis.
But it was especially hospitalizations for eating disorders (such as anorexia or bulimia) that exploded, with a jump of 64.6% on average between the two periods – among boys and girls, but mainly among adolescent girls aged 12 to 17.
It was to try to better understand this leap that Doctors Roumeliotis, Quach-Thanh and their colleagues carried out a second study, the results of which were revealed by the journal JAMA Pediatrics.
The team found a significant increase in the hospitalization rate for girls aged 12 to 17 after March 2020. The increase was 42% in Quebec, 50% in Ontario and 41% in the Prairies. The analysis shows that hospitalization rates peaked a year after the start of the pandemic. In all Canadian regions studied, the team notes, the rates were more than double what was predicted by pre-pandemic trends.
Finally, the study shows an association between the Bank of Canada’s COVID-19 Health Measures Stringency Index and the rate of hospitalization for eating disorders. Thus, for each 10% increase in this stringency index, we see a 5% increase in hospitalization rates in Quebec and Ontario, 8% in the Prairies and 11% in British Columbia.
“That’s a very good question, and I think it varies across different mental health disorders,” says Dr. Roumeliotis when asked how to explain all these numbers.
The researchers have only hypotheses at this point. The reduction in hospitalizations for substance use problems could, for example, be due to the fact that young people had less access to alcohol, to establishments that sell it and to other young people with whom to socialize during the pandemic. Certain health measures, such as school closures, could also have protected young people from depression.
As for the increase in eating disorders, it’s hard to say which factor has weighed most heavily in the balance, Dr. Roumeliotis admitted. School closures, diminished peer relationships, the suspension of sports activities and so on probably all have something to do with it.
Moreover, when the authors spoke with young people hospitalized for an eating disorder, several mentioned that the scarcity of relationships with peers had pushed them towards social networks, where they were possibly exposed to messages and images that harmed their mental health.
“They also talked a lot about control,” Roumeliotis said. “They no longer had control over what was happening outside of their lives, but they could control their diet. That’s very impressive. They told us that was the only control they had as young people.”
These results, according to the authors of these studies, highlight the importance of taking into account the indirect effects of health measures when managing pandemics, in order to prevent the spread of the virus while taking care of the well-being of young people.
All the more so, recalled Dr. Roumeliotis, because the studies only focused on “hospitalizations”, therefore on the most serious cases.
“For example, we don’t talk about consultations with the family doctor or with the CLSC,” she pointed out. “So this is probably just the tip of the iceberg, even if it’s at least reassuring to know that hospitalizations have not increased.”