Six-year (2016–2022) longitudinal patterns of mental health service utilization rates among children developmentally vulnerable in kindergarten and the COVID-19 pandemic disruption

Introduction: In the context of the COVID-19 pandemic, it becomes important to comprehend service utilization patterns and evaluate disparities in mental health-related service access among children. Objective: This study uses administrative health records to investigate the association between early developmental vulnerability and healthcare utilization among children in Alberta, Canada from 2016 to 2022. Methods: Children who participated in the 2016 Early Development Instrument (EDI) assessment and were covered by public Alberta health insurance were included (N = 23 494). Linear regression models were employed to investigate the association between service utilization and vulnerability and biological sex. Separate models were used to assess vulnerability specific to each developmental domain and vulnerability across multiple domains. The service utilization was compared between pre- and post-pandemic onset periods. Results: The analysis reveals a significant decrease in all health services utilization from 2016 to 2019, followed by an increase until 2022. Vulnerable children had, on average, more events than non-vulnerable children. There was a consistent linear increase in mental health-related utilization from 2016 to 2022, with male children consistently experiencing higher utilization rates than females, particularly among vulnerable children. Specifically, there was a consistent linear increase in the utilization of anxiety-related services by children from 2016 to 2022, with females having, on average, 25 more events than males. The utilization of ADHD-related services showed different patterns for each group, with vulnerable male children having more utilization than their peers. Conclusion: Utilizing population-wide data, our study reveals sex specific developmental vulnerabilities and its impact on children’s mental health service utilization during the COVID-19 pandemic, contributing to the existing literature. With data from kindergarten, we emphasize the need for early and targeted intervention strategies, especially for at-risk children, offering a path to reduce the burden of childhood mental health disorders. Author summary: The mental health of children and adolescents is increasingly recognized as a critical public health concern, especially in the wake of the COVID-19 pandemic. This study investigates mental health service utilization among children in Alberta, Canada, focusing on those identified as developmentally vulnerable during early childhood. Our research highlights a significant increase in mental health-related service use, particularly among developmentally vulnerable children, compared to their non-vulnerable peers. We also observed notable sex differences, with male children generally exhibiting higher utilization rates, although females showed a sharp increase in services post-pandemic. The findings emphasize the need for targeted interventions that address both developmental vulnerabilities and sex-specific needs. By linking early developmental assessments to later healthcare utilization, our study underscores the importance of early identification and support to mitigate long-term mental health challenges. These insights are crucial for policymakers and healthcare providers as they strive to enhance mental health services and ensure equitable access for all children, particularly those at heightened risk.