Referral patterns surrounding the COVID-19 pandemic to a child and adolescent mental health clinic in Gauteng, South Africa.

The COVID-19 pandemic and related lockdown period had global health and psychosocial consequences, with specific effects on the mental health and development of children and adolescents. However, little is known about the impact of this period on longitudinal patterns of presentation to mental health services in children and adolescents. The aim of this study is to describe the patterns of referrals to a single tertiary specialist child and adolescent mental health clinic in Johannesburg, Gauteng, South Africa, before, during, and after the national COVID-19 lockdown. Data comprised a longitudinal analysis of 739 complete telephonic referral forms for children and adolescents, ages 4 to 18, over a four-year period, from 1 April 2019 to 31 March 2023. There was an initial inverse relationship between lockdown stringency and referral numbers. As restrictions eased, a gradual increase in referral activity was observed. This pattern did not continue with subsequent lockdown level adjustments later in 2020 and onwards. There were more male referrals (62%) across all periods compared to females (38%), with a noted rise in female referrals during, and after lockdown. Mood-related symptoms increased from 21.97% pre-lockdown to 38.36% during lockdown year 1 (p = 0.0022). Anxiety-related symptoms also increased significantly (p = 0.0007). There was an initial absence of substance related symptoms during total restrictions of movement and ban on alcohol, with a subsequent increase in year two of lockdown and post-lockdown. Disruptive, impulse control and conduct symptoms decreased during lockdown year 1 (p = 0.0004), as did neuro-developmental related symptoms (p=0.0005). These findings suggest a possible pandemic-related shift in symptoms and referral patterns in a tertiary child and adolescent out-patient setting and are explored within the context of health seeking behavior and pathways to care during the COVID-19 pandemic in South Africa. Relevant socioeconomic changes impacting child and adolescent mental health and access to care during this period are described as plausible contributing factors to these patterns. This analysis, while limited and not generalizable, contributes to the existing literature reflecting patterns during the COVID-19 pandemic and related lockdowns in child and adolescent mental health, providing data for future planning and support.