Mental health and healthcare use during COVID‐19 among neurodivergent youth and youth with pre‐existing psychiatric disorders: A systematic review

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Abstract
Background: Neurodivergent youth and youth with pre‐existing psychiatric disorders may have faced additional challenges in navigating the demands and restrictions of the COVID‐19 pandemic. However, less is known about how mental health outcomes and psychiatric healthcare utilization differed across diagnostic groups and other youth‐related factors. This systematic review synthesizes evidence on mental health symptoms and psychiatric healthcare use among youth with pre‐existing conditions during the pandemic. Methods: We searched PubMed, Web of Science and additional sources for cross‐sectional and longitudinal studies with data collected between March 2020 and May 2023. Eligible studies included neurodivergent youth and/or youth with psychiatric disorders confirmed through clinician diagnosis or medical records prior to the pandemic. Given the clinical and methodological diversity of studies, findings were synthesized narratively. Results: Forty‐eight studies met the inclusion criteria. Mental health outcomes showed mixed patterns both across and within diagnostic groups, with individual studies reporting symptom increase, stability and improvements. Evidence on psychiatric healthcare utilization was more limited and suggested different patterns between service use and psychotropic medication use. Compared to boys, girls were more likely to experience COVID‐related distress and increases in psychiatric service use during the pandemic. Age‐related findings varied across developmental stages and outcome domains. Most studies ( n = 40; 83.3%) had a moderate overall risk of bias (RoB), while seven (14.6%) had a high overall RoB. Conclusion: Mental health outcomes among youth with pre‐existing conditions during the COVID‐19 pandemic varied both within and across diagnostic groups. Outcomes were also associated with individual, developmental, contextual and service‐related factors. These findings suggest the importance of considering such factors alongside diagnosis when identifying clinical needs and planning support during large‐scale societal disruptions. Evidence on psychiatric healthcare utilization remains limited. More methodologically robust research is needed to clarify mental health and healthcare‐use patterns during major public health emergencies.
Funding Information
  • NordForsk (138929)
  • NordForsk (147386)
  • NordForsk (156298)
  • NordForsk (164218)
  • NordForsk (230738)
  • Helse Sør-Øst RHF (2025010)

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