French National Trends in Neurodevelopmental and Mental Health-Related Healthcare Center Visits among Youth, 2014-2022: Towards Sex Specificities in the Care Pathway

Abstract

Background: Neurodevelopmental disorders (NDD) and mental health (MH)-related conditions among children and adolescents, represent a global public health burden, that was worsened by the COVID-19 pandemic due to disruptions in access to healthcare, support services, and increased stressors exacerbating symptoms and challenges. However, few studies have examined in France, NDD and MH’s diagnoses and care pathway in youth attending public healthcare center (HCC) services. Methods: An annual cross-sectional analysis was performed in youth aged 0 to 17 years on health information, that were extracted from the French PMSI database (DIAMANT database) between January 1, 2014, and December 31, 2022, using the MH-related ICD-10 diagnosis codes, including NDD, mood-, behavior-, anxiety-, and other-disorders (sleep and eating). Trends in healthcare center visits for NDD and MH-related conditions, were evaluated according to age, sex, diagnoses, and care pathway over the 10-year period using ANOVAs. Findings: Out of the 17,707,806 total HCC-visits across a 10-year period, 289,382 visits (1,6%) were related to youth with diagnoses for NDD or MH disorders of the study interest. Among them, 57% were girls and 43% boys. The total number of pediatric HCC-visits related to NDD and MH has remained stable from 2014 to 2022. However, the proportion of visits has doubled for adolescent girls with internalizing disorders (anxiety and mood) while a 5-fold decrease in the proportion of visits for NDD, was observed for boys aged 0 to 12 years. The HCC-admission mainstream for internalizing disorders was the emergency department and was “home” for the NDD. While the HCC-discharge accounted for 9% of patients being hospitalized, most of them were sent home (90.7%) with a strong age- and sex-specificities. Interpretation: Over the last 10 years, the proportion of HCC visits for NDD and MH remained stable, but strong age- and sex-effects were found on diagnoses visits and care pathway. These findings are essential to improve emergency and outpatient service capacity dedicated to youth. They could help European and national policies to patient-tailor care pathway depending on sex and diagnosis from screening, interventions, and monitoring during this sensitive period of development.