The pandemic is also causing an increase in mental health problems among minors

DAILYPHARMA | 07.04.2022 – 13:00

The mental health of children and adolescents in Spain has deteriorated. This is affirmed by the Multidisciplinary Working Group on Mental Health in Childhood and Adolescence, of which the Society of Child Psychiatry (SPI), dependent on the Spanish Pediatric Association, is a member; the Spanish Society of Pediatric Emergencies (SEUP) and the Spanish Association of Primary Care Pediatrics (AEPap).

According to their data, before the pandemic, it was already estimated that around 10% of children and 20% of adolescents suffered from mental disorders, with consequences that can last a lifetime. Currently, adolescents show more anxiety, depressive symptoms, self-harm and suicidal behaviors.

The work of this group also has the approval of the Spanish Society of Adolescence Medicine (SEMA) and the Society of Social Pediatrics (SPS). On the occasion of World Health Day, celebrated on April 7, they demand that the authorities increase resources to deal with the mental health of children and young people, both at hospital level and in primary care.

Pediatric emergency services (PED) and primary care centers observed, in the first months of the pandemic, a significant decrease (between 30 and 40%) in the overall volume of care. But this first phase was followed by an increase of up to 47% in mental health disorders in children, and up to 59% in suicidal behavior, compared to 2019 data. , they committed suicide in Spain 14 children under 15 years of age, twice as many as the previous year, and among young people between 15 and 29 years, suicide is already the second cause of death, surpassed only by malignant tumors.

Studies carried out by various NGOs (UNICEF, Fundación ANAR or Save the Children) have also alerted to the impact of the pandemic. It is estimated that anxiety or depressive disorders almost quadrupled (from 1.1% to 4%), as well as the diagnosis of attention deficit hyperactivity disorder (ADHD) and other behavioral disorders (from 2.5 % to 7%). Similarly, an increase in psychosomatic symptoms has been observed in pediatric patients, many of which are related to concerns about SARS-COV-2 infection. Similarly, eating disorders are more frequent and more severe than before the pandemic.

The Spanish Society of Pediatric Emergencies (SEUP) analyzed the evolution of mental health diagnoses in Spanish SUPs from March 2019 to March 2021, with the participation of fifteen SUPs. Overall, diagnoses related to mental disorders in pediatric emergency departments increased by 10%. In a disaggregated analysis, the diagnoses that increased the most were: “non-accidental drug poisoning” (122%), “suicide/suicide attempt/autolytic ideation” (56%), “eating disorder” (40%) , “depression” (19%) and “crisis of aggression” (10%).

In addition to the increased demand for care for minors for mental health reasons, it has been detected that young people go to health centers with greater severity. For example, weight loss in patients with eating disorders is, after the start of the pandemic, up to 50% higher, compared to previous figures of 20%. With regard to poisonings with suicidal intent, an increase in the number of cases, their severity and the need for admission to an intensive care unit has been observed over the past decade. A marked decrease in the average age of onset of symptoms was also detected, both in eating disorders and in self-harming behaviors.

The Multidisciplinary Working Group points to the precipitating factors of home confinement two years ago and the restrictive measures that followed, which affected “especially a population as vulnerable as children and adolescents. Disruption of routines and social restrictions have been associated with overuse of technology and limitation of physical activity. In addition, some children and adolescents were already exposed to situations of poverty, abuse or violence that have worsened with the pandemic”, explains Azucena Díez, president of the SPI and spokesperson for the Multidisciplinary Task Force on Health mentality of children and adolescents. These disorders occurred more frequently in adolescence, in patients and with a history of neurodevelopmental disorders or special needs.

Faced with this situation, the three companies of the Multidisciplinary Group are proposing to the health authorities a series of improvement strategies which, according to them, first involve an increase in mental health care resources, both at the hospital and outpatient level: adjusting the number of hospital beds and continue to develop day hospitalization and home care programs for selected cases.

Similarly, they require specific training in child and adolescent psychiatry for paediatricians, particularly in primary and emergency care. “As is the case in other countries, efforts must be combined so that all pediatric MIR programs include training rotations of at least three months in the child psychiatry departments. Subsequently, continuous training must be followed. Pediatricians should be able to recognize the most frequent disorders (anxiety, ADHD, depression) to detect suicidal behaviors and assess their risk, focusing on the management of less serious cases and referring those at risk”, explains Díez .

We must also develop early screening, as indicated by the American Academy of Pediatrics, which recommends screening all adolescents at age 12 in order to identify those who are at risk of depression and/or suicidal thoughts and intervene accordingly.

On the other hand, it considers necessary the incorporation of mental health specialists (clinical psychologists) in the primary care centers and, in this same context, the improvement of the coordination of primary care with other resources. “It is crucial to establish adequate and effective coordination between resources, such as schools, associations, social services and mental health care. Ministries of health and education should prioritize this measure. To do this, specific slots for these activities must be respected in the agendas of paediatricians”, specifies the Group spokesperson. On the other hand, “the psychologists of the primary care centers will be a fundamental part of this coordination”.

Mental health training in schools and institutes is also necessary, aimed at both teachers and parents regarding the identification and regulation of emotions, respect for diversity, etc.

Finally, the Multidisciplinary Working Group on Child and Adolescent Mental Health emphasizes that in the current situation it is necessary to work in multidisciplinary teams, analyzing possible causes, carrying out early detection and responding to suffering. minors suffering from mental disorders .mental health and their families.

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