Impact of SARS-CoV-2 (COVID-19) Infections on Mental Health Diagnoses in Youth With Chronic Illness

Abstract

Objective

Stressors from the COVID-19 pandemic and limited availability of mental health care services have negatively impacted youth mental health in a significant way. In the first year of the pandemic, global prevalence of anxiety and depression increased by roughly 25% in pediatric populations. While the general trend is clear, this research aimed to explore the added mental health burden of acute COVID-19 on pediatric patients with chronic conditions and describe the differences in mental health outcomes between pediatric patients with 2 common chronic conditions (asthma and diabetes) to better understand specific factors that may increase susceptibility to mental health concerns.

Method

Using the TriNetX database, data were extracted for all pediatric patients (aged 5-17 years) with a positive SARS-CoV-2 infection (COVID-19) within a 1-year time frame (April 7, 2021, to April 6, 2022). These patients were divided into 4 cohorts based on the presence of chronic conditions before COVID-19 infection: diabetes (n = 1,587), asthma (n = 13,217), diabetes plus asthma (n = 626), and neither diabetes nor asthma (n = 104,427). For all cohorts, patients with other chronic illness and previous mental health diagnoses were excluded using relevant ICD-10 codes. After matching for demographics, comorbid conditions, and body mass index, odds ratios (ORs) of the following outcomes were compared between cohorts after 6 months: new psychiatric diagnosis using relevant ICD-10 codes, hospitalization within 1 week, and mortality.

Results

After matching, there were statistically significant differences in outcomes between patients with chronic illness and healthy controls after 6 months. Compared with healthy controls, the asthma cohort OR of developing a new psychiatric diagnosis was 1.4 (95% CI 1.15-1.71, p < .001), and the diabetes cohort OR was 1.81 (95% CI 1.11-2.94, p = .015). The new psychiatric diagnosis OR of the asthma cohort compared with the diabetes cohort was 0.62 (95% CI 0.39-0.99, p = .045), suggesting that patients in the diabetes cohort were particularly susceptible to additional mental health diagnoses after an acute COVID-19 infection.

Conclusion

Compared with healthy controls, pediatric patients with asthma and pediatric patients with diabetes experienced increased odds of developing a new psychiatric diagnosis after an acute COVID-19 infection.

Plain language summary

Adverse mental health outcomes have been reported in adults after a COVID-19 infection, but its effect on children with pre-existing chronic conditions is unclear. This study examined data from the TriNetX database, focusing on 5-to-17 year-old SARS-CoV-2 patients with pre-existing chronic conditions and without mental health diagnoses prior to infection, to identify factors associated with increased risk of mental health concerns. They studied 1,587 children with diabetes, 13,217 with asthma, 626 with both, and 104,427 with neither. Results showed that patients with asthma and diabetes had higher odds of developing new psychiatric diagnoses after COVID-19 infection compared to healthy individuals. These findings highlight the importance of tailored mental health support for this patient population.