Post-traumatic stress disorder in German youth: representative claims data pre- vs. intra-COVID-19-pandemic.

Abstract

Background: COVID-19-exposure and related restrictions may have contributed to the development or exacerbation of post-traumatic stress disorders (PTSD), especially in youth. However, data in this population is lacking.Objective: This study aimed to provide a thorough insight into the epidemiology and psychiatric comorbidities of PTSD as well as in- and outpatient treatment utilisation by those affected during vs. before COVID-19 in a representative sample of children and adolescents statutorily insured in Germany.Methods: The study is based on anonymized claims data of statutory insured youth aged 0.0-17.9 years from the InGef research database, which is representative of the German population. Prevalence, incidence, comorbidities of PTSD (ICD-10: F43.1, F43.8, F43.9) and in- and outpatient treatment for those affected were compared pre-COVID (01/2018-03/2020; N = 710.629) vs. intra-COVID (04/2020-12/2021; N = 698.108) using descriptive statistics, χ² tests, Welch-tests and interrupted time series analyses stratified by sex, age (children: 0-13 years; adolescents: 14-17 years), and socio-economic status (SES).Results: PTSD prevalence decreased intra-COVID (girls: 0.8%, n = 2.595 vs. 0.6%, n = 1.965; OR = 0.77 [0.73, 0.82]; boys: 0.6%, n = 2.066 vs. 0.4%, n = 1.547; OR = 0.76 [0.71, 0.81]). Quarterly incidence in female children with high SES showed a significant increase in slope pre-COVID to intra-COVID (p = .018). Externalising comorbidities increased especially in female adolescents (OR = 1.34 [1.05, 1.72]). Psychotherapy utilisation decreased in male children with low SES (OR = 0.63 [0.41, 0.98]) and increased in adolescent girls with low SES (OR = 1.73 [1.09, 2.74]). Hospitalisations among female adolescents only decreased for those with low SES (OR = 0.67 [0.38, 1.19]).Conclusions: We observed similar decreases in clinical PTSD-diagnoses for girls and boys, possibly reflecting overstretched health services, particularly at an early stage of COVID-19. However, treatment utilisation shows sex and SES differences that cannot be fully explained by our data.