510 - Long-term Impact of the Coronavirus Disease 2019 Pandemic on Mental Health Visits in Pediatric Primary Care (2019-2025)

Publication Number: 4500.510

Jane B. Gould, Boston Children's Hospital, Wellesley Hills, MA, United States; Emily T. Correa, Boston Children's Hospital, Wellesley, MA, United States; Jonathan Hatoun, Pediatric Physicians' Organization at Children's, Boston, MA, United States; Michelle L. Lock, Pediatric Physicians' Organization at Children's, Wellesley Hills, MA, United States; Louis Vernacchio, Pediatric Physicians' Organization at Boston Children's, Wellesley, MA, United States

Background: We previously analyzed the rate of visits to pediatric primary care offices for mental health conditions during the COVID-19 pandemic (Jan 2019-Sep 2021). As of 2021, we had noted significant increases in visits for eating disorders and mood disorders and decreases in visits for alcohol and substance use disorders during the pandemic period.

Objective: This study aims to evaluate the long-term impact of COVID-19 on youth mental health by comparing pediatric primary care visits from the pre-pandemic period (Jan 2019-Feb 2020) to the post-pandemic period (Jun 2023-Sep 2025).

Design/Methods: We used electronic health record data from a pediatric primary care network in Massachusetts to perform an interrupted time series analysis on the rate of pediatric mental health visits before and after the COVID-19 pandemic. Three time periods were defined: the pre-pandemic period (Jan 2019-Feb 2020); the pandemic period (Mar 2020-May 2023); and the post-pandemic period (Jun 2023-Sep 2025). Eligible in-person and telehealth visits included those conducted by network physicians, nurse practitioners, and physician assistants with any of the following visit diagnoses: alcohol and substance use disorders, anxiety disorders, attention-deficit hyperactivity disorders (ADHD), behavior disorders, eating disorders, mood disorders, and stress/trauma disorders.

Results: Significant decreases in level and slope (both P < 0.001) were observed for alcohol and substance use disorder visits from the pre- to the post-pandemic period. For ADHD visits, a decrease in the level of the visit rate was observed (P = 0.03) coincident with an increase in the slope (P = 0.008) in the post-pandemic period (Table and Figure). Post-pandemic levels of visits for all other diagnosis groupings were statistically similar in the post-pandemic period, compared to the pre-pandemic period.

Conclusion(s): The rate of visits to pediatric primary care offices for alcohol and substance use disorders continued to decline long-term in the post-pandemic period, reversing a previously increasing trend in the pre-pandemic period. ADHD visits dropped modestly after the pandemic, but the rate increased significantly during the post-pandemic period. The rate of visits for eating disorders appears to have returned to its pre-pandemic baseline after a sharp increase during the pandemic period (presented in our previous study). The pandemic appears not to have significantly affected long-term trends for pediatric primary care visits related to anxiety disorders, behavior disorders, mood disorders, and stress/trauma disorders.

Table 1. Rates of Pediatric Mental Health Visit Diagnoses in the Pre-Pandemic and Pandemic Periods, with an ITS Analysis of Level and Slope Changes


Figure 1. Monthly Rates of Seven Pediatric Mental Health Visit Diagnoses, January 2019-September 2025
Symbol: Δ = Change. The white area represents the pre-pandemic period (Jan 2019-Feb 2020); the dark gray represents the pandemic period (Mar 2020-May 2023); and the light gray represents the post-pandemic period (Jun 2023-Sep 2025). P-values bolded in red highlight statistically significant changes.