The hidden pandemic: changes in outpatient mental health care among French children and adolescents.

The COVID-19 pandemic significantly worsened mental health (MH) challenges among young people. We aimed to assess changes in mental health-related outpatient care before and after the onset of the pandemic. In this nationwide cross-sectional study, we retrieved visits to general practitioners (GP) resulting in the coding of a MH disorder and/or the prescribing of any psychotropic medication for children aged 6 to 17 years, from January 1, 2016 to May 31, 2022 in France. Interrupted time series analysis of monthly rates of MH-related outpatient visits (per 100,000) was conducted to assess changes in trends overall and by age and sex group (girls/boys- 6 to 11 years; girls/boys- 12 to 17 years). Rate ratios (RR) were also calculated to compare estimated rates after the pandemic onset with expected rates. In total, 5,271,958 MH-related outpatient visits were analyzed. We noted an immediate decrease of the outpatient visit rate by 30.8% in the initial pandemic period (March-May 2020). Hereafter, visit rates increased by 0.4% per month, eventually exceeding expected levels by 6% overall. Notably, outpatient visit rates for adolescent girls (12-17 years) rose 20% above expected levels, while rates for younger girls (6-11 years) declined by 6%. Trends remained stable for other age-sex groups. These findings indicate a persistent increase in outpatient mental healthcare use in children, especially adolescent girls, more than two years after the pandemic onset. Future research should explore the factors contributing to the increased mental health burden in adolescent girls and the potential resilience observed in boys.