UGA study finds rising depression and anxiety rates for children were met with a lack of access to mental health care.

Despite national data showing that childhood depression and anxiety surged during the COVID-19 pandemic, a new study from the University of Georgia College of Public Health reveals that actual care during the pandemic decreased among Georgia’s most vulnerable youth. The decrease was significant for depression encounters.

Janani Rajbhandari

The study highlights a widening gap of access to care as well as the importance of school systems in bridging that gap, said corresponding author Janani Rajbhandari, Associate Professor and Director of Graduate Studies PhD program in Health Services Research and Policy.

Researchers analyzed Medicaid claims data for 48,694 children between the ages of 3 and 17. The dataset provided a “natural experiment,” including claims information from 2019 throughout 2020, including the times of school closures and reopening.

Before the pandemic, the national rates of depression and anxiety were approximately 4.4% and 9.4%, respectively, for children ages 3-17. During the pandemic, however, those numbers rose to 28% and 21%, respectively.

Over the same time period, average monthly encounters for depression dropped by 13.2% and encounters for anxiety dropped by 4.4% in Georgia. This decrease was most significant for children 3-11 years old, who saw a 32.8% relative decrease in depression-related encounters.

“My fear is that utilization is not reflective of increasing prevalence,” Rajbhandari said. “If prevalence is increasing and healthcare utilization is not, that’s definitely an access issue.”

These findings are especially prescient in Georgia, which is ranked No. 37 in access to mental health care, according to Mental Health America.

Rajbhandari also noted that while increased access to telehealth created an initial spike, it was not sustained. Access to telehealth in the study state is also inconsistent across populations.

“What we have also found is that with telehealth, access has no doubt increased for both rural and urban populations,” she said. “But the relative increase in access is higher in urban areas than in rural ones. This means at the time, telehealth was actually increasing disparity. The gap between urban and rural populations widened.”

As the year progressed, however, clinical visits began to rebound.

In August 2020, rate of encounters increased, which is an indicator of the important role played by schools in identifying depression and anxiety and connecting patients to care.

“Schools provide an avenue for very early identification of depression and anxiety, which is otherwise missed when schools are closed,” Rajbhandari said.

Researchers hope to continue studying care access through datasets in 2021 and beyond, in order to determine the state of the gap in care between mental health needs and healthcare utilization.

“If prevalence is increasing and healthcare utilization is not increasing, that’s a serious issue. It means we are missing patients who need help early on,” Rajbhandari said.