Post–COVID-19 Mental Health Distress in 13 Million Youth: A Retrospective Cohort Study of Electronic Health Records

Abstract

ObjectiveTo investigate the impact of the SARS-CoV-2 infection on the rates of mental disorders in youth. MethodThe study involved 7,519,465 children and 5,338,496 adolescents from the TriNetX Research Network, all without prior mental disorder histories. Among them, 290,145 children and 223,667 adolescents had SARS-CoV-2 positive tests or confirmed COVID-19 diagnoses. We utilized Kaplan-Meier survival analysis to evaluate the probability of developing new mental disorders (any codes in ICD-10-CM F01-F99 category and suicidal behaviors ) within two years post-infection, compared to the propensity score matched youth who were never infected. ResultsWithin two years post-SARS-CoV-2 infection, children had a probability of 0.15 in acquiring new psychiatric diagnoses, compared to 0.026 for matched non-infected children; adolescents had a 0.19 probability against 0.05 for their non-infected counterparts. The hazard ratio (HR) was 6.0 (95% confidence interval, 95%CI: 5.8-6.3) for children and 4.2 for adolescents (95%CI: 4.1-4.4), with children vs. adolescents HR of 1.4 (95%CI: 1.36-1.51). Elevated HRs were observed for almost all sub-categories of mental disorders and suicidal behaviors, with variations based on sex, severity of SARS-CoV-2 infection, and viral variants. COVID-19 was similar to other respiratory infections in increasing the rate of mental disorders in adolescents but had a significantly higher effect on children (HR 1.57, 95%CI:1.53-1.61). ConclusionOur study revealed significant mental health distress following SARS-CoV-2 infection in youth, more pronounced for children than adolescents. These findings underscore the urgent need to support at-risk youth, particularly those who contracted SARS-CoV-2 at younger ages and had more severe infections.