On March 11th, 2020, the World Health Organization declared COVID-19 a pandemic. In response, health officials and leaders worldwide introduced measures to slow the spread of the virus. These measures included avoiding contact with other people, wearing masks, and closing and reopening places like daycares, schools, and universities.
These actions, known as non-pharmaceutical interventions (NPIs), disrupted almost every aspect of daily life, especially for mothers with young children, kids, teenagers, and young adults. There's concern that these disruptions may have increased feelings of anxiety and depression, leading more people to seek mental health services. Additionally, there's worry that these impacts might be worse for poorer people than for people who are rich.
Our research aims to use health data from England and Ontario to:
- Understand how the COVID-19 measures affected the use of mental health services by mothers of young children, children, teens, and young adults in these regions.
- See if changes in mental health service use are linked to poverty and if poor people had more problems during the pandemic that rich people.
- Create a plan to share our findings with the people who can benefit from this information.
The study in England will replicate the time-series design and outcomes measures from recently published research on the association between COVID-related NPI and mental health service utilization conducted in Ontario Canada.
Study Populations:
1. Mothers of young children aged 0 to 5 and mothers of children aged 6 to 12.
2. Children: aged 6 – 12, adolescents: aged 13 -18, Young adults: aged 19 -24
Outcomes:
Visits to general practitioners by the study populations for specific mental health diagnoses. The analysis in Ontario used diagnostic codes based on ICD codes.
Exposure:
The exposure in this study is the imposition and continued application of NPI. Based on the Oxford restriction index for England this was from late March 2020 to March of 2022.
Analysis:
Similar to the published studies from Ontario, we will examine the outcomes of interest quarterly for each study population. Data for 20 quarters prior to March 2020 constitutes the pre-exposure period, eight quarters from March 2020 to March 2022 the exposure period, and as many quarters of data as available after March 2022 as the post-exposure period. Negative binomial regression with time and season as predictor variables, will be used to model pre-exposure trends. The residuals are modeled as an autoregressive process to account for serial correlation and seasonality. The pre-exposure fitted model are used to predict the expected rates of use from March 2020 to the last quarter available. The primary outcomes will be the actual observed rates of use after exposure compared to expected rates. The analysis will be stratified by Index of Multiple Deprivation deciles, study group and sex. Additional individual level characteristics such as ethnicity will be included in the model.
Hospitalization for mental health disorders including: Bipolar Disorder; Anxiety and related disorders; Depressive or other non-psychotic disorders; Personality Disorder; Sexual deviations; Psychosomatic illness; Adjustment reaction; Alcoholism; Drug dependence; Economic problems; Marital difficulties; Parent-child problems; Problems with aged parents or in-laws; Family disruption/divorce; Other problems of social adjustment; Assault related injuries (victims of violence); Deliberate self-harm; Eating disorders.
Geoffrey Anderson - Chief Investigator - University of Toronto
Geoffrey Anderson - Corresponding Applicant - University of Toronto
Renzo Calderon Anyosa - Collaborator - University of Toronto
HES Admitted Patient Care;HES Outpatient;Patient Level Index of Multiple Deprivation Domains;CPRD Aurum Mother-Baby Link