Tran Phuong Tm, Amill-Rosario Alejandro, dosReis Susan
Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, 220 Arch St, 12th Floor, Baltimore, MD, 21201, USA.
Child Adolesc Psychiatry Ment Health. 2024 Aug 1;18(1):95. doi: 10.1186/s13034-024-00787-z.
Child and adolescent antidepressant use increased post-pandemic, but it is unknown if this disproportionally affected those who develop post-acute sequelae of coronavirus disease 2019 (COVID) or long COVID. This study compared the risk of antidepressant initiation among children and adolescents with long COVID with those who had COVID but did not have evidence of long COVID.
Our retrospective cohort study of children and adolescents aged 3-17 years at the first evidence of COVID or long COVID from October 1, 2021 through April 4, 2022 was conducted within Komodo's Healthcare Map database. The index date was the earliest date of a medical claim associated with a COVID (COVID comparators) or long COVID diagnosis (long COVID cases). The baseline period was six months before the index date. The outcome was antidepressant initiation within twelve months after the index date. Due to the large number of COVID relative to long COVID cases, COVID comparators were randomly selected with a ratio of 2 COVID to 1 long COVID. We used propensity score matching to control for confounding due to imbalances in the baseline covariates. Log-binomial models estimated the relative risk (RR) of antidepressant initiation in the propensity score matched sample. We conducted several sensitivity analyses to test the robustness of our findings to several assumptions.
Our child and adolescent sample included 18 274 with COVID and 9137 with long COVID. Compared with those with COVID, a larger proportion of long COVID children and adolescents had psychiatric disorders, psychotropic use, medical comorbidities, were previously hospitalized, or visited the emergency department. In the propensity score-adjusted analysis, the long COVID group had a statistically significant higher risk of antidepressant initiation relative to the COVID comparator (adjusted-RR: 1.40, 95% CI = 1.20, 1.62). Our findings were robust across sensitivity analyses.
The increased risk of antidepressant initiation following long COVID warrants further study to better understand the underlying reasons for this higher risk. Emerging evidence of long COVID's impact on child mental health has important implications for prevention and early interventions.
疫情后儿童和青少年抗抑郁药的使用有所增加，但尚不清楚这是否对那些出现2019冠状病毒病（COVID）急性后遗症或长期新冠症状（long COVID）的人群产生了不成比例的影响。本研究比较了患有长期新冠症状的儿童和青少年与感染过新冠但无长期新冠症状证据的儿童和青少年开始使用抗抑郁药的风险。
我们在科莫多医疗地图数据库中对2021年10月1日至2022年4月4日首次出现新冠或长期新冠症状的3至17岁儿童和青少年进行了回顾性队列研究。索引日期是与新冠（新冠对照组）或长期新冠诊断（长期新冠病例）相关的医疗索赔最早日期。基线期是索引日期前六个月。结局是索引日期后十二个月内开始使用抗抑郁药。由于新冠病例相对于长期新冠病例数量众多，新冠对照组按2:1的比例随机选取。我们使用倾向评分匹配来控制基线协变量不平衡导致的混杂因素。对数二项模型估计了倾向评分匹配样本中开始使用抗抑郁药的相对风险（RR）。我们进行了多项敏感性分析，以检验我们的研究结果对若干假设的稳健性。
我们的儿童和青少年样本包括18274例新冠患者和9137例长期新冠患者。与新冠患者相比，更大比例的长期新冠儿童和青少年患有精神疾病、使用精神药物、有合并症、曾住院或去过急诊科。在倾向评分调整分析中，长期新冠组相对于新冠对照组开始使用抗抑郁药的风险在统计学上显著更高（调整后RR：1.40，95%CI = 1.20，1.62）。我们的研究结果在敏感性分析中具有稳健性。
长期新冠后开始使用抗抑郁药的风险增加，值得进一步研究以更好地理解这种较高风险的潜在原因。长期新冠对儿童心理健康影响的新证据对预防和早期干预具有重要意义。
