Author:
Koehlmoos Tracey Pérez,Madsen Cathaleen,Banaag Amanda,Adirim Terry
Abstract
Abstract
Background
Widely published findings from the COVID-19 pandemic show adverse effects on body mass index (BMI) and behavioral health in both adults and children, due to factors such as illness, job loss, and limited opportunity for physical and social activity. This study investigated whether these adverse effects were mitigated in adolescents from military families, who are universally insured with consistent access to healthcare, and who generally have at least one parent who must adhere to physical and mental fitness as a condition of employment.
Methods
We conducted a cohort study using two groups of adolescents receiving care in the U.S. Military Health System during the COVID-19 pandemic; one for changes in Body Mass Index (BMI) and the second for changes in behavioral health diagnoses, using TRICARE claims data. Beneficiaries (160,037) ages 13 to 15 years in fiscal years 2017–2018, were followed up during October 2020 to June 2021.
Results
Among the BMI cohort, 44.32% of underweight adolescents moved to healthy weight, 28.48% from overweight to obese, and 3.7% from healthy weight to underweight. Prevalence of behavioral disorders showed an overall 29.01% percent increase during the study period, which included in mood (86.75%) and anxiety (86.49%) disorders, suicide ideation (42.69%), and suicide attempts (77.23%). Decreases in percent change were observed in conduct disorders (-15.93%) and ADD/ADHD (-8.61%).
Conclusions
Adolescents in military families experienced adverse health outcomes during the pandemic at approximately the same rates as those in non-military families, suggesting that universal insurance and military culture were not significantly mitigating factors. Obesity and underweight present significant opportunities to intervene in areas such as exercise and food access. Decreased conduct disorders and ADD/ADHD may reflect lower prevalence due to favorable home environment, or lower rates of diagnosis and referral; however, increased rates of anxiety, mood disorders, suicide ideation and attempt are especially concerning. Care should be taken to ensure that adolescents receive consistent opportunity for physical activity and social interaction, and those at risk for suicide should receive active monitoring and appropriate referral to behavioral healthcare providers.
Funder
U.S. Defense Health Agency
Publisher
Springer Science and Business Media LLC
Subject
Public Health, Environmental and Occupational Health
Reference35 articles.
1. Ghandour RM, Sherman LJ, Vladutiu CJ, Ali MM, et al. Prevalence and treatment of depression, anxiety, and conduct problems in U.S. Children. J Pediatrics. 2019;206:256–67. https://doi.org/10.1016/j.jpeds.2018.09.021.
2. Wang Y, Beydoun MA, Min J, Xue H, et al. Has the prevalence of overweight, obesity and central obesity levelled off in the United States? Trends, patterns, disparities, and future projections for the obesity epidemic. Int J Epidemiol. 2020;49(3):810–23. https://doi.org/10.1093/ije/dyz273.
3. Calderon VJ. “US Parents Say COVID-19 Harming Child’s Mental Health.” Gallup News, Wellbeing. June 16, 2020. from https://news.gallup.com/poll/312605/parents-say-covid-harming-child-mental-health.aspx Accessed 20 Sept 2021.
4. Weaver RG, Hunt ET, Armstrong B, Beets MW, et al. COVID-19 leads to accelerated increases in children’s BMI z-score gain: an interrupted time-series study. Am J Prev Med. 2021;61(4):e161–9. https://doi.org/10.1016/j.amepre.2021.04.007.
5. Panchal M, Kamal R, Cox C, Garfield R, et al. Mental health and substance use considerations among children during the COVID-19 pandemic. Issue Brief: Kaiser Family Foundation, May 26, 2021. from https://www.kff.org/coronavirus-covid-19/issue-brief/mental-health-and-substance-use-considerations-among-children-during-the-covid-19-pandemic/ Accessed 20 Sept 2021.