Leveraging Longitudinal Survey and EHR data to Dissect the Impact of COVID-19 related Stressors and Infections on Child Mental Health and Suicide Risks

The adverse impact of the COVID-19 pandemic on child mental health has become a public health priority. Suicidal ideation and suicide attempts among children increased by 70-130% in 2020-2021 compared to the pre-pandemic period. Pre-existing social determinants of health (SDoH) and changes in pandemic-related SDoH have exacerbated child mental health disparities. However, the long-term impact of COVID, including Long COVID, the broader secondary impact of the lingering pandemic, and pandemic policies on child mental health, is largely unknown. It is urgent and time-sensitive to identify high-risk children and modifiable targets to reduce COVID-related new/worsening mental health and suicidal ideation and suicide attempts that could have major consequences for the transition to adulthood. This proposed project will identify urgent and modifiable factors to alleviate the negative impact of COVID-19 on child mental health. Our specific objective is to examine the long-term impact of pandemic-related SDoH and policies on child mental health and suicidal ideation, and suicide attempts. Our central hypothesis is that children who were girls, racial/ethnic minorities, with pre-existing mental illness, infected by SARS-CoV-2, and exposed to greater SDoH and containment policies will have new and worsening mental health and suicidal ideation and suicide attempts in the long term. These hypotheses have been formulated on the basis of our strong preliminary data from the proposed population-level data from the Adolescent Brain Cognitive Development study (>11000 children) and electronic health records in the National COVID Cohort Collaborative (>170000 children). Our recent JAMA Psychiatry study strengthens the evidence that pandemic-related SDoH worsened child mental health disproportionately among those who were females, Black, Hispanic children, and those living in deprived areas. This R01 application will extend our prior empirical and methodological expertise in the following specific aims: 1) quantify new and worsening child mental health and suicidal ideation and suicide attempts, as well as their trajectories across the COVID pandemic. 2) examine the direct and indirect (mediation/moderation) impact of pandemic-related SDoH on child mental health and suicidal ideation and suicide attempts, and 3) determine the effects of COVID-19 policies on child mental health and suicidal ideation and suicide attempts. The key innovation is to apply novel causal models from epidemiology and economics to estimate the long-term impact of COVID-19 infections, pandemic-related SDoH, and policies on mental health and suicidal ideation and suicide attempts among children from two large-scale, nationwide, longitudinal datasets. We will reduce data dimensionality and create novel SDoH and policy indexes to capture the time-varying exposures to changes in SDoH. Our findings will meet urgent and critical public health needs to prevent the widening mental health disparities worsened by the COVID-19 pandemic, by refocusing on SDoH and informing structural and psychosocial interventions. Addressing minority mental health is closely aligned with the NIMH Strategic Plan.