Prior to the pandemic, the incidence and prevalence of mental health disorders were relatively flat.Ben Goode/Getty Images/iStockphoto
The Canadian Paediatric Society released new guidelines on Thursday for diagnosing and managing anxiety disorders in children and adolescents.
The guidelines, set out in two documents, are the first from the organization to specifically address anxiety disorders, which are among the most common mental health conditions affecting Canadian children and teens.
“We hoped by developing these guidelines, we would be able to help health care providers and caregivers start the conversations and know where to find resources in regards to next steps,” said Susan Bobbitt, a developmental pediatrician in Saskatoon and lead author, adding that addressing mental health is an important part of pediatric health care.
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Early detection and management of anxiety disorders are critical for preventing more significant problems later in life, Dr. Bobbitt said. However, the demand for mental health services among children and adolescents in the country far outstrips the care that physicians and other professionals can provide.
The pediatric society noted that psychotherapy and parenting programs offered by accredited providers, such as clinical psychologists and social workers, are often only accessible to families with private insurance or who can otherwise pay for them. Most Canadian children and adolescents can’t get timely, quality, first-line treatments for anxiety disorders, it said.
A 2020 report from Children’s Mental Health Ontario found that children under 18 in that province were waiting up to 2.5 years to receive mental health treatment, and the time and number of young patients waiting had reached an all-time high. Similar waits are likely to occur across the country, Dr. Bobbitt said.
Data available so far during the pandemic provide an incomplete picture of the current situation. According to the Canadian Institute for Health Information (CIHI), the number of hospitalizations and emergency department visits for children and young people (ages 5 to 24) with mental health disorders declined slightly in the first year. But when examining them as a proportion of hospitalizations for all conditions in this age group, the percentage edged up to 23 per cent in 2020 from 21 per cent in 2019.
“What that really says is the need is pretty stable,” said Tracy Johnson, director of health system analytics at CIHI. In spite of an overall dip in hospitalizations, “we still admitted these kids in higher numbers than other conditions.”
Prior to the pandemic, the incidence (or rate at which diagnoses are made) and prevalence (the number of children already living with a condition) of mental health disorders were relatively flat, Ms. Johnson said. However, from about 2017 until the start of the pandemic, hospitalizations for mental health conditions and substance use among children and young people rose each year, suggesting these patients weren’t getting adequate help in the community, she added.
Although the reasons are unclear, the dip in hospitalizations CIHI recorded in the first year of the pandemic could, in part, be explained by improvements in the mental health of some children because they weren’t exposed to stressors associated with interacting with peers, Ms. Johnson suggested. Additional resources, such as the expansion of online mental health services, may also be a contributing factor, she said.
It is yet to be seen whether hospitalizations for mental health conditions will return to prepandemic levels, and whether the incidence and prevalence of anxiety disorders in children have changed, now that in-person health care services have resumed, and school and social activities are unrestricted.
While the new guidelines from the Canadian Paediatric Society will not necessarily improve access to mental health services, they do outline tangible steps that physicians and caregivers can take to help children manage their anxiety, Dr. Bobbitt said. For example, they include tips for parents, such as helping children and adolescents recognize their feelings and reinforcing positive routines such as shared meals, regular sleep and exercise.
They also outline a step-wise approach to care, from psychotherapy as first-line treatment for patients with mild to moderate symptoms, to medications for those whose symptoms are moderate or more severe.