Effects of the COVID-19 pandemic on the mental health of shielded children and children living in shielded households in Wales: a data linkage study

BACKGROUND: The COVID-19 pandemic has had a detrimental effect on children's mental health. Shielded children or those living with a shielded person might be particularly susceptible to mental health difficulties arising as a result of strict public health restrictions. However, studies examining mental health outcomes in these children are scarce. We aimed to address this evidence gap. METHODS: We linked the COVID-19 Shielded Patient List to demographic and health-care datasets within the Secure Anonymised Information Linkage (SAIL) databank. We constructed three cohorts of children aged 2–17 years who were living in Wales and registered with a general practitioner that provides data to SAIL when shielding was introduced on March 23, 2020: shielded children, children living with a shielded person, a general population group of registered children who were neither shielding or living with a shielded person. We used published Read codes to identify children with primary care diagnoses or prescriptions relating to anxiety or depression, before and during the pandemic. We compared the difference in proportions of new diagnoses or prescriptions during COVID-19 between groups. FINDINGS: Before the COVID-19 pandemic (March 23, 2019, to March 23, 2020), 155 (4·2%) of 3721 shielded children received diagnoses or prescriptions for anxiety or depression, compared with 128 (3·4%) of 3721 children during the pandemic (March 23, 2020, to Jan 31, 2021); 71 (2·0%) of 3566 had new diagnoses or prescriptions during the pandemic. For children in shielded households, these values were 489 (2·5%) of 19 954 children before COVID-19 and 301 (1·5%) of 19 954 children during COVID-19, with 218 (1·1%) of 19 456 having new diagnoses or prescriptions during the pandemic. For the general population, these values were 8001 (2·0%) of 411 680 children before COVID-19 and 5420 (1·3%) of 411 680 children during COVID-19, with 4070 (1·0%) of 403 679 having new diagnoses or prescriptions during the pandemic. The difference in the proportion of new diagnoses or prescriptions between shielded children and the general population was significant (χ(2) 35·40 [95% CI 0·59–1·51], p<0·0001). INTERPRETATION: Our findings show a decrease in diagnoses or prescriptions for anxiety or depression during COVID-19, which could be partly attributed to a reluctance to seek health care during this time. The prevalence of anxiety or depression was highest in shielded children, and the rate of new diagnoses or prescriptions during COVID-19 was significantly higher among shielded children. Future work could involve longitudinal follow-up of these children to assess future trends in health-care use for mental health-related conditions and longer-term health and education outcomes among these groups. FUNDING: Health and Care Research Wales.