The COVID-19 pandemic transformed ordinary life for children and young people almost overnight, yet the scale of the pandemic's effect on youth mental health in primary care data was poorly understood in real time. CHOOSE - CHildren and yOung peOple pSychiatric diagnoses before and during the Covid-19 pandEmic, set out to quantify that effect, using GP records to compare mental health diagnoses, prescriptions, and referrals before and after March 2020 across England.
The pandemic did not affect all young people equally. Understanding who was most affected, and in what ways, is key.
The Research
CHOOSE drew on the Clinical Practice Research Datalink (CPRD), a large database of anonymised primary care records from GP practices across the UK, covering children and young people aged 1–24. The study examined mental health diagnoses (including depression, anxiety, ADHD, eating disorders, autism spectrum disorder, personality disorder, and substance misuse), psychotropic medication prescriptions, self-harm and suicidality, and mental health referrals, comparing rates before the pandemic with those observed during the period March 2020 to early 2022.
The project was led by Louise Jane Hussey (University of Manchester) in collaboration with Professor Carolyn Chew-Graham (Keele University), Pearl Mok (University of Manchester), Evangelos Kontopantelis, Darren Ashcroft, Matthew Carr, Nav Kapur, and further collaborators at Keele, Exeter, McPin Foundation, and NIHR's School for Primary Care Research and Greater Manchester Patient Safety Research Collaboration.
Key Findings
Three headline findings emerged from the data:
- Fewer young people sought GP help at the start of the pandemic. The initial lockdown period saw a marked reduction in help-seeking from primary care, a pattern consistent with avoidance of health services during the emergency phase, but concerning in its downstream implications.
- Eating disorders, self-harm, and ADHD in females increased. Across the pandemic period, GP records showed a notable increase in the recording of eating disorders, self-harm, and attention deficit hyperactivity disorder specifically in female patients. The increase in eating disorders was most pronounced in girls aged 13–19; the self-harm spike was sharpest in girls aged 13–15.
- Young males were underrepresented in help-seeking both before and during the pandemic. The number of young males seeking mental health support from GPs remained lower than their female peers throughout; a gap that widened rather than narrowed during the pandemic period.
The project also examined these findings by area-level deprivation, finding relatively little variation in self-harm rates by deprivation, but a slightly greater increase in eating disorder recording in less deprived areas, a counterintuitive finding that provoked substantial discussion in YPAG sessions about socioeconomic access to diagnosis and the role of healthcare-seeking behaviour.
Dissemination
The project produced tailored dissemination materials for four audiences, young people, parents and carers, teachers, and clinicians, translating the same core findings into accessible formats appropriate for each group. A public seminar presenting the findings was held online. Academic outputs include a paper in Lancet Child & Adolescent Health on eating disorders and self-harm trends during the pandemic, and a paper in the Journal of Child Psychology and Psychiatry (Hussey et al., 2024) examining socio-demographic variation in mental health diagnoses and prescribing across the pandemic period. McPin has published a summary of key findings. The project also received coverage from the BBC.
My Involvement
I was involved in this project as a member of the Young People's Advisory Group (YPAG), convened through McPin, one of eight young people with lived experience of mental health issues who advised throughout the research. The YPAG met at key stages of the project to interpret and contextualise findings, with a particular focus on the eating disorder and self-harm data. Sessions involved reviewing preliminary analyses, discussing potential explanations for the patterns observed (including the role of social media, the effects of lockdown on social comparison, and the meaning of 'control' during periods of high uncertainty), and considering how findings should be communicated to different audiences without reinforcing stigma or placing responsibility on individual young people or their families.
The YPAG also contributed to the design of the public-facing dissemination materials, including feedback on language, framing, and the balance between highlighting risk and providing actionable guidance. The dissemination event was open to all YPAG members, and there were opportunities to contribute to the end-of-project seminar where findings and recommendations were presented to external stakeholders.