28.7 Distinct Patterns of Emotional and Behavioral Change During the COVID-19 Pandemic in Child Psychiatry Outpatients

Reports of the impact of the COVID-19 pandemic on child mental health have called for attention to vulnerable subpopulations, including youth with prior neuropsychiatric symptoms. We aimed to extend the literature by examining patterns of multivariate symptom change in child psychiatry outpatients. Participants were 172 youth (10.6 ± 3.1 years; 38.6% girls) consecutively referred for neuropsychiatric evaluation who enrolled in research. Parents completed a questionnaire with 8 psychiatric and 6 psychosocial domains rated retrospectively prior to the pandemic and concurrently during a 6-month period starting in the fall of 2021. Analyses determined: 1) change in severity of the 14 individual domains using Wilcoxon signed-ranks tests; 2) the extent to which there were distinct patterns of mental health symptom change, using a latent profile analysis (LPA); and 3) factors associated with the LPA-derived groups (eg, prior symptoms, financial stress), using multinomial logistic regression. Models controlled for age, sex, and date of questionnaire, with Bonferroni correction for multiple testing. Increases (p ≤ 0.0002) in severity were found on 10 of the 14 individual domains. LPA resulted in a 4-class solution (bootstrapped LRT [4- vs 3-class] = 163.7; p < 0.0001), with a small group (6.4%) improving on most symptoms, a large group (72.2%) remaining relatively stable, and 2 groups showing distinct constellations of worsening symptoms. Both groups that became worse were likely to show increases in depression, anxiety, and oppositional behavior; however, 1 group (11.6%) was more likely to experience more inattention and hyperactivity, and the other (9.3%) had a high likelihood of greater hopelessness and irritability. Prior oppositionality and hyperactivity increased the risk of being in the worse group with hyperactivity vs the stable group (over 6- and 11-fold, respectively; p's ≤ 0.002). Prior problems with hopelessness increased the risk of being in the worse group with hopelessness (over 12-fold). On average, most mental health and psychosocial dimensions worsened during the pandemic; however, some youth outpatients experienced greater symptom change than others across multiple domains. Findings suggest that different groups of outpatients may have unique needs as they emerge from this period.