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

Abstract

Objective

To investigate the impact of the SARS-CoV-2 infection on the rates of mental disorders in youth.

Method

The 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. Kaplan–Meier survival analysis was used to evaluate the probability of developing new mental disorders (any codes in International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) F01-F99 category and suicidal behaviors) within 2 years post infection, compared to the propensity score–matched youth who were never infected.

Results

Within 2 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% 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 subcategories 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 and was associated with a similarly increased rate of mental disorders in adolescents, but had a significantly higher effect on children (HR = 1.57, 95% CI =1.53-1.61).

Conclusion

This study revealed significant mental health distress following SARS-CoV-2 infection in youth, which was more pronounced in children than in 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.

Plain language summary

The authors of this study conducted analyses using electronic medical records from the TriNetX Research Network to investigate the impact of SARS-CoV-2 infection on the rates of mental health disorders in youth. Within 2 years after SARS-CoV-2 infection, children and adolescents were 6.0 and 4.2 times more likely to acquire a new psychiatric diagnosis, respectively. While the risk of being diagnosed with a mental health disorder following SARS-CoV-2 infection in adolescents was comparable to other respiratory infections, it had a more pronounced effect on children.