An Investigation of Adolescent Mental Health In a New York City Cohort Before and During the COVID-19 Pandemic in the Primary Care Setting.

Objectives: To investigate differences in the prevalence of positive depression screens before and during the COVID-19 pandemic within primary care and assess patient characteristics based on depression screen results in both time periods.

Methods: This was a retrospective cohort study of patients ages 12-21 years-old from two urban primary care clinics seen for well-child visits and who had completed depression screens before and during the pandemic. Additional variables evaluated included demographics, substance use, and mental health (MH) conditions such as anxiety, depression, and suicidal ideation (SI). Paired analyses using McNemar's Chi-squared test and paired t-test evaluated differences in variables between time periods. Patients were also categorized into four groups determined by their depression screen result in each period and characteristics between the four groups were compared using the Fisher's exact test.

Results: Of 1621 patient charts reviewed with documented depression screens, there were 232 patients who had screens completed during both time periods. Twenty three (9.9%) patients screened positive for depressive symptoms before the pandemic and 38 (16.4%) screened positive during the pandemic. More patients had SI, depression, anxiety, and substance use during the pandemic. Patients who had at least one positive depression screen had more MH conditions than patients who had negative depression screens during both time periods.

Conclusions: Among a cohort of adolescents seen in primary care before and during the pandemic, more patients screened positive for depression and there were more MH conditions during the pandemic, demonstrating a need to prioritize MH resources for adolescents in the primary care setting.