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Diagnoses of depression and anxiety among kids, teens, and young adults increased from 2017 to 2021, especially during the COVID-19 pandemic, according to a cohort study in Southern California.

Among 1.7 million participants, the overall incidence of depression diagnosed clinically increased by 55.6% (from 1.35% to 2.10%) over this time period, and the prevalence of depression clinically diagnosed increased by 60% (from 2.55% to 4.08%; P<0.001 for trend for both), reported Anny H. Xiang, PhD, of Kaiser Permanente Southern California (KPSC) in Pasadena, and co-authors in .

Over that same period, the incidence of diagnoses of anxiety without depression increased by 31.1% (from 1.77% to 2.32%), while the prevalence increased by 35.2% (from 3.13% to 4.22%; P<0.001 for trend for both).

Co-author Sid Kumar, MD, also of KPSC, told MedPage Today that there was already a youth mental health crisis before the pandemic, but the demand for psychiatric services grew with the onset of COVID-19.

The mean incidence and prevalence of depression was significantly higher during the pandemic than before the pandemic (P<0.001 for both), but the increase in incidence rate from 2020-2021 was not significantly higher than the increase in rate from 2017-2019 (0.26% vs 0.21% per year, P=0.81). On the other hand, the increase in prevalence rate during the pandemic was significantly greater than the increase in rate before the pandemic (0.55% vs 0.36% per year, P=0.004).

For anxiety without depression, the means for both the incidence and prevalence were significantly higher during the pandemic than before the pandemic (P<0.001 for both), and the rates of change in the incidence and prevalence were significantly greater during the pandemic than before the pandemic (0.39% vs 0.17% per year for incidence and 0.61% vs 0.31% per year for prevalence; P<0.001 for both).

Kumar said the study was developed to better understand the increased demand that clinicians were experiencing, and focused on youths because their lives were "completely disrupted."

From ages 5 through 15, there are "huge developmental changes," and each person responds to changes in their environments differently, he noted. By homing in on demographic and health factors, the study authors sought to develop infrastructure that would best address the needs of these populations, he said.

For each calendar year, the incidence of depression was highest among the two oldest age groups -- 14 to 17 and 18 to 22 -- and among females, American Indian or Alaska Native participants and white participants, those with higher household incomes, those with obesity, and those with a history of comorbidities.

The increase in the incidence of anxiety without depression was highest in the 18-to-22 subgroup, females, white participants, and those with higher household incomes, underweight, and a history of comorbidities.

Pointing to obesity and underweight being risk factors, Kumar pointed out that "when you are home all day and looking at yourself on a video in a school class, the first thing you notice is how you are looking ... in that age group, your self-consciousness is even more dominant."

Asked why white participants had more diagnoses of depression and anxiety, he explained that there is more stigma around help-seeking for mental health for some races than others.

As for implications for practice, Kumar noted that he and his colleagues want to focus both upstream and downstream. "Our goal is to catch these problems early ... while [patients] are sitting in a pediatrician or primary care office ... so that the burden of illness does not continue," he said.

For this study, Xiang and colleagues included all members of KPSC ages 5 to 22 on January 1 for every calendar year from 2017 to 2021. Of the 1,703,090 unique members, 78% were members for more than 1 year. Mean age was about 14, and 51% were male. For each study year, roughly 50% were Hispanic, 23% were white, 8% were Asian, and 8% were Black.

For each study year, most participants had an annual household income of $50,000-$99,999, 39-50% were normal weight, 18-19% had obesity, and 7-9% had comorbidities.

Because all participants lived in Southern California, these results may not be generalizable to the rest of the country, Xiang and team noted.

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