For much of the pandemic, children have been seen as getting off comparatively easier than adults if they get infected with coronavirus. But a nationwide analysis suggests contracting COVID-19 can nearly triple children’s risk of new mental health problems.
The findings, published last week in the journal Psychiatric Services, come as educators are already scrambling to cope with widespread rises in mental health problems and school behavior issues among young people. However, these results are among the first to point to mental health problems related to COVID itself, as opposed to school and family disruptions, social isolation, and economic instability caused by the pandemic.
Researchers led by Mir Ali, a health economist at the US Department of Health and Human Services, analyzed health claims data from more than 3.3 million children 17 and younger in all 50 states and Washington, DC, who had received a COVID-19 test. These data were part of US Open Source Claims, a “multipayer, preadjudicated health insurance claims database.”
None of the children or adolescents had been diagnosed with a mental health disorder or had needed mental health services in the year before they were tested for the coronavirus. But more than 7 percent of those who tested positive for COVID-19 had a new mental health diagnosis, on average within 30 days. By contrast, only 3.4 percent of children whose tests were negative had new mental health issues. Those who did experience problems experienced them an average of four months later.
After adjusting for other factors like genetics, researchers found contracting COVID-19 nearly tripled children’s risk of mental health problems. More than a third of the affected children were subsequently diagnosed with attention-deficit hyperactivity disorder; 2 in 5 had an anxiety disorder, and another 1 in 5 had a trauma or stress disorder.
Risks increase with age
Moreover, the older the child, the more having COVID-19 increased their mental health risks. Compared to children under 5 who tested positive for the virus, infected children ages 6-11 had a fivefold higher risk and adolescents ages 12-17 had a sevenfold increase in risk of new and recurring mental health diagnoses.
“The high rate of new onset of mental health conditions among youths with no recent mental health history suggests the need for emotional and behavioral health supports, such as screening, assessment, and treatment,” Mir and his colleagues concluded.
While depression and anxiety disorders were highest among the adolescents who tested positive for the coronavirus, ADHD affected nearly 57 percent of infected children ages 6-11 and more than a third of adolescents.
The study comes as child vaccinations against the virus that causes COVID-19 have largely stalled and school outbreaks have ticked up. As of this week, less than 30 percent of elementary-age children and less than 60 percent of middle and high school adolescents have been fully vaccinated—far below the immunity cushion needed to prevent outbreaks.
“I still hear in my clinic, parents are like, oh no, I’m not gonna get the vaccine. Kids don’t get sick with COVID,” said Dr. Tina Tan, a professor of pediatric infection diseases at Ann & Robert H. Lurie Children’s Hospital of Chicago and the Northwestern University Feinberg School of Medicine, who was not part of the study. “But that’s not true; kids do get sick. … And as we are learning more, we are now seeing kids that are having different long-term effects after having COVID.”
While prior research has found so-called “long COVID” can have cognitive effects on adults, Mir noted that the current study did not look at what could be driving COVID-related mental health problems in children infected with the virus. It’s not clear, for example, whether the virus itself causes neurological problems, or if children develop stress and trauma from being diagnosed with an illness known to be dangerous or fatal. The study also did not distinguish between children who had more severe or less severe cases of the illness. I cautioned that because the study was based on health insurance data, it may underestimate the mental health effects of the pandemic for children who don’t have health insurance.
“Prolonged loneliness and social isolation have been associated with future mental health problems up to nine years later, which suggests that children and adolescents would be at risk for mental health conditions long after the social restrictions for the pandemic have ended,” Mir and his colleagues noted in a separate briefing on the study.