Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
Center for Health Services Research, 6720A Rockledge Drive, Suite 250, Bethesda, MD, 20817, USA.
BMC Public Health. 2023 Aug 24;23(1):1615. doi: 10.1186/s12889-023-16548-0.
Widely published findings from the COVID-19 pandemic show adverse effects on body mass index (BMI) and behavioral health in both adults and children, due to factors such as illness, job loss, and limited opportunity for physical and social activity. This study investigated whether these adverse effects were mitigated in adolescents from military families, who are universally insured with consistent access to healthcare, and who generally have at least one parent who must adhere to physical and mental fitness as a condition of employment.
We conducted a cohort study using two groups of adolescents receiving care in the U.S. Military Health System during the COVID-19 pandemic; one for changes in Body Mass Index (BMI) and the second for changes in behavioral health diagnoses, using TRICARE claims data. Beneficiaries (160,037) ages 13 to 15 years in fiscal years 2017-2018, were followed up during October 2020 to June 2021.
Among the BMI cohort, 44.32% of underweight adolescents moved to healthy weight, 28.48% from overweight to obese, and 3.7% from healthy weight to underweight. Prevalence of behavioral disorders showed an overall 29.01% percent increase during the study period, which included in mood (86.75%) and anxiety (86.49%) disorders, suicide ideation (42.69%), and suicide attempts (77.23%). Decreases in percent change were observed in conduct disorders (-15.93%) and ADD/ADHD (-8.61%).
Adolescents in military families experienced adverse health outcomes during the pandemic at approximately the same rates as those in non-military families, suggesting that universal insurance and military culture were not significantly mitigating factors. Obesity and underweight present significant opportunities to intervene in areas such as exercise and food access. Decreased conduct disorders and ADD/ADHD may reflect lower prevalence due to favorable home environment, or lower rates of diagnosis and referral; however, increased rates of anxiety, mood disorders, suicide ideation and attempt are especially concerning. Care should be taken to ensure that adolescents receive consistent opportunity for physical activity and social interaction, and those at risk for suicide should receive active monitoring and appropriate referral to behavioral healthcare providers.
新冠疫情大流行期间广泛发布的研究结果表明，成年人和儿童的身体质量指数（BMI）和行为健康都受到了负面影响，原因包括疾病、失业以及身体和社会活动机会有限等。本研究调查了这些不利影响是否在军人家庭的青少年中得到缓解，他们普遍享有医疗保险，能够持续获得医疗保健，而且他们的父母通常至少有一方必须保持身心健康，这是就业的条件。
我们在美国军人健康系统中进行了一项队列研究，纳入了在新冠疫情大流行期间接受治疗的两组青少年；一组研究 BMI 的变化，另一组研究行为健康诊断的变化，使用的是 TRICARE 理赔数据。在 2017-2018 财年，年龄在 13 至 15 岁的受益人群（160037 人）在 2020 年 10 月至 2021 年 6 月期间进行了随访。
在 BMI 队列中，44.32%的体重不足青少年体重转为健康体重，28.48%的超重青少年体重转为肥胖，3.7%的健康体重青少年体重转为体重不足。在研究期间，行为障碍的患病率总体上升了 29.01%，包括情绪（86.75%）和焦虑（86.49%）障碍、自杀意念（42.69%）和自杀企图（77.23%）。行为障碍（-15.93%）和注意力缺陷多动障碍（-8.61%）的百分比变化呈下降趋势。
在疫情期间，军人家庭的青少年经历了不利的健康结果，其发生率与非军人家庭的青少年大致相同，这表明全民保险和军人文化并不是显著的缓解因素。肥胖和体重不足为干预锻炼和食物获取等领域提供了重要机会。行为障碍和注意力缺陷多动障碍的减少可能反映了家庭环境有利，或者诊断和转介率较低；然而，焦虑、情绪障碍、自杀意念和企图的增加尤其令人担忧。应注意确保青少年有持续的机会进行身体活动和社交互动，对有自杀风险的青少年应进行积极监测并适当转介至行为健康护理提供者。
