Digital mental health service engagement changes during Covid-19 in children and young people across the UK: Presenting concerns, service activity, and access by gender, ethnicity, and deprivation.

The adoption of digital health technologies accelerated during Covid-19, with concerns over the equity of access due to digital exclusion. The aim of this study was to assess whether service access and presenting concerns differed before and during the pandemic. Sociodemographic characteristics (gender, ethnicity, and deprivation level) were examined to identify disparities in service use. To do this we utilised routinely collected service data from a text-based online mental health service for children and young people. A total of 61221 service users consented to sharing their data which represented half of the service population. We used interrupted time-series models to assess whether there was a change in the level and rate of service use during the Covid-19 pandemic (April 2020-April 2021) compared to pre-pandemic trends (June 2019-March 2020) and whether this varied by sociodemographic characteristics. The majority of users identified as female (74%) and White (80%), with an age range between 13 and 20 years of age. There was evidence of a sudden increase (13%) in service access at the start of the pandemic (RR 1.13 95% CI 1.02, 1.25), followed by a reduced rate (from 25% to 21%) of engagement during the pandemic compared to pre-pandemic trends (RR 0.97 95% CI 0.95,0.98). There was a sudden increase in almost all presenting issues apart from physical complaints. There was evidence of a step increase in the number of contacts for Black/African/Caribbean/Black British (38% increase; 95% CI: 1%-90%) and White ethnic groups (14% increase; 95% CI: 2%-27%), sudden increase in service use at the start of the pandemic for the most (58% increase; 95% CI: 1%-247%) and least (47% increase; 95% CI: 6%-204%) deprived areas. During the pandemic, contact rates decreased, and referral sources changed at the start. Findings on access and service activity align with other studies observing reduced service utilization. The lack of differences in deprivation levels and ethnicity at lockdown suggests exploring equity of access to the anonymous service. The study provides unique insights into changes in digital mental health use during Covid-19 in the UK.