The impact of COVID-19 on psychiatric clinical encounters among low-income racially-diverse children

Serena A. Rusk, Jessica DiBari, Dana M. Mason, Mengmeng Li, Xiumei Hong, Guoying Wang, Colleen Pearson, Gabrielle Mirolli, Tina L. Cheng, Michael D. Kogan, Barry Zuckerman, Xiaobin Wang

Research output: Contribution to journalArticlepeer-review


Background: There is a lack of longitudinal data to examine the impact of COVID-19 on all types of clinical encounters among United States, underrepresented BIPOC (Black, Indigenous, and people of color), children. This study aims to examine the changes in all the outpatient clinical encounters during the pandemic compared to the baseline, with particular attention to psychiatric encounters and diagnoses. Method: This study analyzed 3-year (January 2019 to December 2021) longitudinal clinical encounter data from 3,394 children in the Boston Birth Cohort, a US urban, predominantly low-income, Black and Hispanic children. Outcomes of interest were completed outpatient clinical encounters and their modalities (telemedicine vs. in person), including psychiatric care and diagnoses, primary care, emergency department (ED), and developmental and behavioral pediatrics (DBP). Results: The study children's mean (SD) age is 13.9 (4.0) years. Compared to 2019, psychiatric encounters increased by 38% in 2020, most notably for diagnoses of adjustment disorders, depression, and post-traumatic stress disorders (PTSD). In contrast, primary care encounters decreased by 33%, ED encounters decreased by 55%, and DBP care decreased by 16% in 2020. Telemedicine was utilized the most for psychiatric and DBP encounters and the least for primary care encounters in 2020. A remarkable change in 2021 was the return of primary care encounters to the 2019 level, but psychiatric encounters fluctuated with spikes in COVID-19 case numbers. Conclusions: Among this sample of US BIPOC children, compared to the 2019 baseline, psychiatric encounters increased by 38% during 2020, most notably for the new diagnoses of adjustment disorder, depression, and PTSD. The 2021 data showed a full recovery of primary care encounters to the baseline level but psychiatric encounters remained sensitive to the pandemic spikes. The long-term impact of the pandemic on children's mental health warrants further investigation.

Original languageEnglish (US)
Pages (from-to)631-643
Number of pages13
JournalJournal of Child Psychology and Psychiatry and Allied Disciplines
Issue number5
StatePublished - May 2024


  • Covid
  • Longitudinal
  • children
  • health care utilization
  • health equity
  • mental health

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Developmental and Educational Psychology
  • Pediatrics, Perinatology, and Child Health


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