Data Insight: Effects of the Covid-19 pandemic on the mental health of children that are clinically extremely vulnerable or living with clinically extremely vulnerable people in Wales

This Data Insight examines the impact of the Covid-19 pandemic on the mental health of clinically extremely vulnerable children and children living with clinically extremely vulnerable people in Wales, using data linkage methods. It is intended as a summary of a research article recently published in BMJ Open.

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Background

In March 2020, people deemed clinically extremely vulnerable (CEV) to severe illness or death from Covid-19 were advised to ‘shield’ at home, remaining indoors and minimising contact with others. CEV people were identified in two ways: by applying an algorithm based on clinical code lists to routine electronic health records, and by health professionals based on their clinical judgement.

Restrictions imposed by the shielding guidance, coupled with a higher risk of severe illness, may have exacerbated feelings of loneliness and isolation and contributed to poorer mental health amongst CEV children compared to non-CEV children. In addition, children living with a CEV person may have been at greater risk of mental health difficulties. This is due to both restrictions to protect their vulnerable household members and fears of causing them harm. 

Research examining the impact of the pandemic on the mental health of the population is ongoing, including the impact on children. Previously, no studies had examined the impact specifically on CEV children or children living with a CEV person.

Our study looked at the impact of the Covid-19 pandemic on use of healthcare services for anxiety or depression in Wales, for: 

• CEV children
• children living with a CEV person 
• children in the general population. 

Such insights for this population are important to inform responses to potential future public health emergencies.

What we found 

There was no statistically significant difference in the risk of having a record for anxiety or depression in primary or secondary care between children living with a CEV person and children in the general population. This was after adjusting for demographic characteristics and history of anxiety or depression.

During the pandemic (2020/21), CEV children were found to be at a statistically significantly higher risk of having a record for anxiety or depression compared to children in the general population. however, this significantly increased risk of anxiety and depression for CEV children was also evident pre-pandemic in 2019/2020.

Relative to the general population, the risk of having a record of anxiety or depression for CEV children increased from 2019/20 to 2020/2021. In 2019/20, CEV children were almost two times more likely to have a record for anxiety or depression than children in the general population. In 2020/21, CEV children were over three times more likely to have a record for anxiety or depression than children in the general population.

However, over this time, the period prevalence of anxiety or depression increased only slightly amongst CEV children (from 4.17% to 4.22%), but declined amongst children in the general population (from 2.19% to 1.39%). 

We conclude that the higher risk among the CEV children was largely driven by a reduction in presentations to healthcare services by children in the general population during the pandemic – rather than a marked increase in presentations for anxiety or depression amongst the CEV children.

Why it matters

This novel linked data study contributes to our understanding of mental health amongst CEV children, and those living in a household with a CEV person in Wales during the Covid-19 pandemic. 

Firstly, in both years, CEV children were at greater risk of having a record of anxiety and depression than children in the general population. Given that these children are likely to have greater contact with healthcare services, signposting across services, including mental health services, is likely to be beneficial.

When considering changes in presentations for anxiety or depression during the pandemic among CEV children and children in the general population, the difference in risk between the two groups was greater during the pandemic compared to pre-pandemic. However, this was explained by a marked decline among children in the general population presenting to healthcare services with anxiety or depression during this time. This reduction in presentations for anxiety and depression among children in the general population may reflect reduced access to NHS services during the pandemic, and a lack of access to mental health care for children and young people. 

We are mindful that routinely collected data does not capture self-reported health. In addition, other evidence suggests increased demand and an unmet need for mental health support in the UK, for children with and without pre-existing mental health problems, since 2020.

Therefore, this evidence should be considered and interpreted alongside evidence from other population-wide data linkage studies and national surveys. This would contribute to a comprehensive understanding of the relationship between mental health support needs, expressed demands, and care provision to better target services to those who need them the most.