Child and adolescent psychiatry consultations during the COVID-19 pandemic

This study aimed to identify the biopsychosocial stressors influencing child and adolescent mental health during periods when facetoface education was suspended and to evaluate the psychological sequelae of school closures and related restrictions. We conducted a retrospective observational study at Kartal Dr. Lütfi Kırdar City Hospital, a tertiary care center in İstanbul, reviewing all patients referred to the child and adolescent consultation-liaison psychiatry (CLP) unit between March 2020 and March 2022. We assessed associations between psychiatric diagnoses and health-related stressors, school closure status, age, and sex using both frequentist and Bayesian methods. During the study period, 264,013 pediatric admissions were recorded, of whom 270 (0.10%) required psychiatric consultation. The proportions of suicide attempts and anxiety diagnoses did not differ between periods of open and closed schools (BF10 = 0.21 and 0.138, respectively; moderate evidence for the null). Multivariate analysis showed that the odds of suicide attempts were higher in patients exposed to family or schoolrelated stressors (OR = 6.63, 95% CI 2.72-16.19), in females (OR = 8.10, 95% CI 4.16-15.77), and with increasing age (OR = 1.32 per year, 95% CI 1.16-1.50). Female sex (OR = 4.17, 95% CI 2.03-8.55) and older age (OR = 1.30 per year, 95% CI 1.12-1.50) were also associated with depression. Anxiety was more likely in those facing isolation or healthrelated stressors (OR = 3.91, 95% CI 1.66-9.22). These findings highlight the differential impact of stressor type on internalizing symptoms and may inform resource allocation and crisisresponse planning in child mental health services.