Department of Child Psychiatry and INVEST Research Flagship Center, University of Turku and Turku University Hospital, Turku, Finland.
Finnish Institute of Health and Welfare, Helsinki, Finland.
PLoS Med. 2023 Feb 27;20(2):e1004072. doi: 10.1371/journal.pmed.1004072. eCollection 2023 Feb.
Coronavirus Disease 2019 (COVID-19) restrictions decreased the use of specialist psychiatric services for children and adolescents in spring 2020. However, little is known about the pattern once restrictions eased. We compared new psychiatric diagnoses by specialist services during pandemic and pre-pandemic periods.
This national register study focused on all Finnish residents aged 0 to 17 years from January 2017 to September 2021 (approximately 1 million a year). The outcomes were new monthly diagnoses for psychiatric or neurodevelopmental disorders in specialist services. These were analyzed by sex, age, home location, and diagnostic groups. The numbers of new diagnoses from March 2020 were compared to predictive models based on previous years. The predicted and observed levels in March to May 2020 showed no significant differences, but the overall difference was 18.5% (95% confidence interval 12.0 to 25.9) higher than predicted in June 2020 to September 2021, with 3,821 more patients diagnosed than anticipated. During this period, the largest increases were among females (33.4%, 23.4 to 45.2), adolescents (34.4%, 25.0 to 45.3), and those living in areas with the highest COVID-19 morbidity (29.9%, 21.2 to 39.8). The largest increases by diagnostic groups were found for eating disorders (27.4%, 8.0 to 55.3), depression and anxiety (21.0%, 12.1 to 51.9), and neurodevelopmental disorders (9.6%, 3.0 to 17.0), but psychotic and bipolar disorders and conduct and oppositional disorders showed no significant differences and self-harm (-28.6, -41.5 to -8.2) and substance use disorders (-15.5, -26.4 to -0.7) decreased in this period. The main limitation is that data from specialist services do not allow to draw conclusions about those not seeking help.
Following the first pandemic phase, new psychiatric diagnoses in children and adolescents increased by nearly a fifth in Finnish specialist services. Possible explanations to our findings include changes in help-seeking, referrals and psychiatric problems, and delayed service access.
2020 年春季，新冠肺炎（COVID-19）限制措施减少了儿童和青少年对专科精神卫生服务的使用。然而，一旦限制措施放宽，其模式鲜为人知。我们比较了大流行期间和流行前期间专科服务的新精神科诊断。
本全国登记研究主要关注 2017 年 1 月至 2021 年 9 月期间的所有芬兰 0 至 17 岁居民（每年约 100 万）。结果是专科服务中新的每月精神或神经发育障碍诊断。按性别、年龄、家庭所在地和诊断组对此进行分析。2020 年 3 月的新诊断数量与前几年的预测模型进行了比较。2020 年 3 月至 5 月的预测和观察结果没有显著差异，但 2020 年 6 月至 2021 年 9 月的总差异比预测值高 18.5%（95%置信区间为 12.0 至 25.9），有 3821 名患者的诊断比预期的多。在此期间，女性（33.4%，23.4 至 45.2）、青少年（34.4%，25.0 至 45.3）和 COVID-19 发病率最高地区的患者（29.9%，21.2 至 39.8）的增幅最大。按诊断组划分，最大的增幅出现在饮食障碍（27.4%，8.0 至 55.3）、抑郁和焦虑（21.0%，12.1 至 51.9）和神经发育障碍（9.6%，3.0 至 17.0），但精神病和双相情感障碍以及行为和对立障碍没有显著差异，自我伤害（-28.6，-41.5 至-8.2）和物质使用障碍（-15.5，-26.4 至-0.7）在此期间减少。主要限制是专科服务的数据不允许对那些不寻求帮助的人得出结论。
在第一波大流行之后，芬兰专科服务中新的儿童和青少年精神科诊断增加了近五分之一。对我们研究结果的可能解释包括寻求帮助、转介和精神问题的变化，以及服务获取的延迟。
