Adversity and Risk of Adolescent Mental Health Admission During COVID-19.

Adolescent mental health was a major problem during the COVID-19 pandemic. We determined the extent to which adolescents with a history of adversity were at risk of mental health hospitalization during the pandemic. We conducted a longitudinal cohort study of 303,378 adolescents from Quebec, Canada, who were age 10-14 years at the start of the pandemic. The main exposure was early life adversity, which included childhood adversity as well as maternal history of adversity or mental illness. The main outcome was hospitalization for a psychiatric disorder, substance use disorder, or suicide attempt between March 2020 and March 2023. We used Cox regression models to compute adjusted hazard ratios (HR) and 95% confidence intervals (CI) for the association of adversity with risk of mental health admission during the pandemic. Adolescents with a history of childhood adversity were 6-9 times more likely to be admitted for a psychiatric disorder (HR 5.79, 95% CI 4.82-6.95), substance use disorder (HR 8.89, 95% CI 6.36-12.43), or suicide attempt (HR 6.93, 95% CI 4.85-9.90) during the pandemic, compared with other adolescents. Adolescents whose mothers experienced adversity or whose mothers had mental illness were 2-6 times more likely to be admitted for mental disorders. Associations were present for both sexes, although adversity was particularly associated with substance use disorders among males. Having a history of childhood or maternal adversity was a strong risk factor for mental health hospitalization among adolescents during the pandemic.