Sex-Specific Changes in Outpatient and Inpatient Care for Depressive Disorders in Children and Adolescents in Germany During the COVID-19 Pandemic

Abstract: Objectives: The coronavirus disease 2019 (COVID-19) pandemic affected the mental health of children and adolescents in Germany by increasing depressive symptoms and altering their access to treatment. However, representative data on pandemic-related changes in care for children and adolescents are scarce. This study examines the service utilization of children and adolescents with depressive disorders during the COVID-19 pandemic. Methods: We analyzed anonymized insurance data (outpatient and inpatient cases) for depressive disorders in children and adolescents during pre-COVID (01/2018 – 03/2020; N = 142,257) and intra-COVID (04/2020 – 12/2021; N = 139,690) periods, stratified by age (0.0 – 9.9; 10.0 – 13.9; 14.0 – 17.9 years) and sex. We analyzed the differences between time periods descriptively (%-changes, odds ratios) and using χ² tests, Welch tests, and interrupted time series analysis. Results: The prevalence of depressive disorders decreased from pre-COVID to intra-COVID periods, particularly among males (female children: 2.8 %, n = 1,932 vs. 2.8 %, n = 1,964; female adolescents: 8.9 %, n = 6,149 vs. 8.7 %, n = 5,914; male children: 1.6 %, n = 1,165 vs. 1.2 %, n = 914; male adolescents: 4.0 %, n = 2,888 vs. 3.0 %, n = 2,205). The quarterly incidence showed significant positive trends for female children (β 1 = +2.83, p < .01; β 3 = +2.93, p = .030) and adolescents (β 3 = +5.52, p = .031) following the onset of the intra-COVID period (Q2/2020). There were significant proportional increases in inpatient and outpatient cases for female and male adolescents in child and adolescent psychiatry as well as among specialized providers, i.e., pediatricians, child and adolescent psychiatrists/psychotherapists. Conclusions: The data showed declines in the prevalence and incidence of depressive disorders, potentially reflecting care avoidance or reduced treatment capacities, particularly among boys. Differences emerged in service utilization by care provider, with proportionate increases for specialized providers and reductions for general practitioners. We need further research to address potential ongoing treatment gaps and to support at-risk children and adolescents.