Mental health changes during and after the COVID-19 pandemic in children and adolescents with mental disorders

Background The COVID-19 pandemic negatively affected child and adolescent mental health, but it is unclear which subgroups were affected most. We investigated to what extent psychiatric diagnosis was related to the severity of mental health problems during and after the pandemic in children in psychiatric outpatient care. Methods We collected data at seven time points (from April 2020 to April 2023) in a total sample of 2,545 children (8-18 years old) in psychiatric outpatient care. We grouped diagnostic classifications in four categories: Autism, ADHD, Anxious/Depressive disorders, or ‘Other’. Mental health was assessed with parent‐reported data on internalizing and externalizing problems with the Brief Problem Monitor, and with self‐reported data on Anxiety, Depressive symptoms, Sleep‐related impairments, Anger, Global health, and Peer relations with the Patient‐Reported Outcomes Measurement Information System (PROMIS®). We tested for overall main effects in mental health outcomes between diagnostic categories, and for different trajectories over time. Results We found that mental health outcomes varied substantially between diagnostic categories as expected, with internalizing problems being largest in children with Anxious/Depressive disorders, and externalizing problems being largest in children with Autism and ADHD. However, we found no evidence for differences between diagnostic categories in trajectories in mental health outcomes during and after the COVID-19 pandemic. Discussion Differences between diagnostic categories were as expected, however trajectories over time during and after the pandemic were not different for diagnostic categories in our sample. This suggests that the pandemic had an overall negative effect on mental health outcomes in children and adolescents in psychiatric outpatient care, rather than different effects for children with specific mental disorders. Regular high-quality monitoring is vital to recognize changing trajectories of youth mental health and to adapt to crisis situations.