Data-Driven Assessment of Adolescents’ Mental Health During the COVID-19 Pandemic

Yonatan Bilu, Natalie Flaks-Manov*, Maytal Bivas-Benita, Pinchas Akiva, Nir Kalkstein, Yoav Yehezkelli, Miri Mizrahi-Reuveni, Anat Ekka-Zohar, Shirley Shapiro Ben David, Uri Lerner, Gilad Bodenheimer, Shira Greenfeld

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objective: Adolescents’ mental health was severely compromised during the COVID-19 pandemic. Longitudinal real-world studies on changes in the mental health of adolescents during the later phase of the pandemic are limited. We aimed to quantify the effect of COVID-19 pandemic on adolescents’ mental health outcomes based on electronic health records. Method: This was a retrospective cohort study using the computerized database of a 2.5 million members, state-mandated health organization in Israel. Rates of mental health diagnoses and psychiatric drug dispensations were measured among adolescents 12 to 17 years of age with and without pre-existing mental history, for the years 2017 to 2021. Relative risks were computed between the years, and interrupted time series (ITS) analyses evaluated changes in monthly incidence rates of psychiatric outcomes. Results: The average population size was 218,146 in 2021. During the COVID-19 period, a 36% increase was observed in the incidence of depression (95% CI = 25-47), 31% in anxiety (95% CI = 23-39), 20% in stress (95% CI = 13-27), 50% in eating disorders (95% CI = 35-67), 25% in antidepressant use (95% CI = 25-33), and 28% in antipsychotic use (95% CI = 18-40). A decreased rate of 26% (95% CI = 0.80-0.88) was observed in ADHD diagnoses. The increase of the examined outcomes was most prominent among youth without psychiatric history, female youth, general secular Jewish population, youth with medium−high socioeconomic status, and those 14 to 15 years of age. ITS analysis confirmed a significantly higher growth in the incidence of psychiatric outcomes during the COVID-19 period, compared to those in previous years. Conclusion: This real-world study highlights the deterioration of adolescents’ mental health during the COVID-19 pandemic and suggests that youth mental health should be considered during health policy decision making. Diversity & Inclusion Statement: We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We actively worked to promote sex and gender balance in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

Original languageEnglish
Pages (from-to)920-937
Number of pages18
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Issue number8
StatePublished - Aug 2023
Externally publishedYes


  • COVID-19
  • cohort study
  • mental health


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