Impact of SARS-CoV-2 on Child and Adolescent Mental, Behavioral, and Neurodevelopmental Disorders: A MarketScan by Merative Bayesian Structural Time-Series Analysis

OBJECTIVES: To estimate the impact of SARS-CoV-2 policies and disruptions on the prevalence of mental, behavioral and neurodevelopmental disorders among children and adolescents with commercial insurance in the United States.

METHODS: From 2017 to 2022, Merative^TM MarketScan^Ò commercial claims data were stratified into annual quarters. The pre-COVID period was the first quarter of 2017 to the first quarter of 2020 and the post-COVID period was the second quarter of 2020 to the fourth quarter of 2022. The prevalence of speech language disorders, disruptive behavior disorders, anxiety, and depression per 10,000 children (ages: 4-11) and adolescents (ages: 12-17) were determined using ICD-10-CM diagnostic codes. The average prevalence difference and 95% Bayesian credible intervals between the observed post-COVID prevalence and estimated post-COVID prevalence of outcomes had policies and disruptions not occurred were reported using Bayesian structural time-series models.

RESULTS: A total of 8.8 million children and adolescents were eligible for the study. Among children, the average impact of SARS-CoV-2 was an increase in the prevalence of speech language disorders for both boys [38 per 10,000 (95% CrI: 27-50)] and girls [20 per 10,000 (95% CrI: 15-25)]. Girls also had a higher prevalence of disruptive behaviors [18 per 10,000 (95% CrI: 10-26)] and anxiety [34 per 10,000 (95%CrI: 19-49)]. For adolescents, the observed prevalence of anxiety was higher than estimated for both boys [37 per 10,000 (95% CrI: 11-62)] and girls [250 per 10,000 (95% CrI: 200-300)]. Girls also had a higher observed prevalence of disruptive behaviors [70 per 10,000 (95% CrI: 60-80)] and depression [66 per 10,000 (95%CrI: 52-80)].

CONCLUSIONS: The observed prevalence of speech language disorders was higher than estimated in the post-COVID period for all children. Compared to boys, the observed post-COVID increase in the prevalence of disruptive behaviors, anxiety, and depression suggests COVID era disruptions disproportionally impacted.