{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T01:15:30Z","timestamp":1791335730096,"version":"4.3.1"},"reference-count":105,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2025,2,13]],"date-time":"2025-02-13T00:00:00Z","timestamp":1739404800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100011705","name":"MQ: Transforming Mental Health","doi-asserted-by":"publisher","award":["MQBF\/3 ADP"],"award-info":[{"award-number":["MQBF\/3 ADP"]}],"id":[{"id":"10.13039\/100011705","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012068","name":"Health and Care Research Wales","doi-asserted-by":"publisher","award":["HCRW; SCF-22-10"],"award-info":[{"award-number":["HCRW; SCF-22-10"]}],"id":[{"id":"10.13039\/100012068","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100018814","name":"MRC-PHE Centre for Environment and Health","doi-asserted-by":"publisher","award":["MR\/W014386\/1"],"award-info":[{"award-number":["MR\/W014386\/1"]}],"id":[{"id":"10.13039\/501100018814","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>The adoption of digital health technologies accelerated during Covid-19, with concerns over the equity of access due to digital exclusion. The aim of this study was to assess whether service access and presenting concerns differed before and during the pandemic. Sociodemographic characteristics (gender, ethnicity, and deprivation level) were examined to identify disparities in service use. To do this we utilised routinely collected service data from a text-based online mental health service for children and young people. A total of 61221 service users consented to sharing their data which represented half of the service population. We used interrupted time-series models to assess whether there was a change in the level and rate of service use during the Covid-19 pandemic (April 2020-April 2021) compared to pre-pandemic trends (June 2019-March 2020) and whether this varied by sociodemographic characteristics. The majority of users identified as female (74%) and White (80%), with an age range between 13 and 20 years of age. There was evidence of a sudden increase (13%) in service access at the start of the pandemic (RR 1.13 95% CI 1.02, 1.25), followed by a reduced rate (from 25% to 21%) of engagement during the pandemic compared to pre-pandemic trends (RR 0.97 95% CI 0.95,0.98). There was a sudden increase in almost all presenting issues apart from physical complaints. There was evidence of a step increase in the number of contacts for Black\/African\/Caribbean\/Black British (38% increase; 95% CI: 1%-90%) and White ethnic groups (14% increase; 95% CI: 2%-27%), sudden increase in service use at the start of the pandemic for the most (58% increase; 95% CI: 1%-247%) and least (47% increase; 95% CI: 6%-204%) deprived areas. During the pandemic, contact rates decreased, and referral sources changed at the start. Findings on access and service activity align with other studies observing reduced service utilization. The lack of differences in deprivation levels and ethnicity at lockdown suggests exploring equity of access to the anonymous service. The study provides unique insights into changes in digital mental health use during Covid-19 in the UK.<\/jats:p>","DOI":"10.1371\/journal.pone.0316468","type":"journal-article","created":{"date-parts":[[2025,2,13]],"date-time":"2025-02-13T13:26:12Z","timestamp":1739453172000},"page":"e0316468","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Digital mental health service engagement changes during Covid-19 in children and young people across the UK: Presenting concerns, service activity, and access by gender, ethnicity, and deprivation"],"prefix":"10.1371","volume":"20","author":[{"given":"Duleeka","family":"Knipe","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6660-2109","authenticated-orcid":true,"given":"Santiago","family":"de Ossorno 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Cooper","year":"2012","journal-title":"A hierarchy of wants: Towards an integrative framework for counselling, psychotherapy and social change"},{"issue":"3","key":"pone.0316468.ref026","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1016\/j.jaac.2018.07.906","article-title":"Ethnic Differences in Referral Routes to Youth Mental Health Services.","volume":"58","author":"J Edbrooke-Childs","year":"2019","journal-title":"J Am Acad Child Adolesc Psychiatry."},{"issue":"1","key":"pone.0316468.ref027","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1186\/1471-2458-8-258","article-title":"Child mental health differences amongst ethnic groups in Britain: a systematic review.","volume":"8","author":"A Goodman","year":"2008","journal-title":"BMC Public Health."},{"key":"pone.0316468.ref028","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1016\/j.jad.2018.05.077","article-title":"Help-seeking intention for depression in early adolescents: Associated factors and sex differences","volume":"238","author":"S Ando","year":"2018","journal-title":"J Affect Disord"},{"key":"pone.0316468.ref029","article-title":"Help seeking for mental health problems in an adolescent population: the effect of gender.","author":"L Haavik","year":"2017","journal-title":"J Ment Health [Internet]."},{"issue":"3","key":"pone.0316468.ref030","doi-asserted-by":"crossref","first-page":"e18848","DOI":"10.2196\/18848","article-title":"Digital Mental Health and COVID-19: Using Technology Today to Accelerate the Curve on Access and Quality Tomorrow.","volume":"7","author":"J Torous","year":"2020","journal-title":"JMIR Ment Health."},{"key":"pone.0316468.ref031","author":"E. Frith","year":"2017","journal-title":"About the Education Policy Institute"},{"issue":"3","key":"pone.0316468.ref032","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1007\/s40501-019-00181-z","article-title":"Use of Digital Mental Health for Marginalized and Underserved Populations.","volume":"6","author":"SM Schueller","year":"2019","journal-title":"Curr Treat Options Psychiatry."},{"issue":"8","key":"pone.0316468.ref033","first-page":"1253","article-title":"The emergence of a \u201cdigital underclass\u201d in Great Britain and Sweden: Changing reasons for digital exclusion","volume":"19","author":"EJ Helsper","year":"2016"},{"issue":"1","key":"pone.0316468.ref034","first-page":"e11696","volume":"21","author":"B Greer","year":"2019","journal-title":"Digital Exclusion Among Mental Health Service Users: Qualitative Investigation. J Med Internet Res"},{"issue":"2","key":"pone.0316468.ref035","first-page":"87","article-title":"An overview of and recommendations for more accessible digital mental health services.","volume":"1","author":"EG Lattie","year":"2022","journal-title":"Nat Rev Psychol 2022 12."},{"key":"pone.0316468.ref036","article-title":"A qualitative study to investigate in what ways are the distinctive features of synchronous text-based counselling experienced as being helpful and\/or unhelpful by young people?","author":"M. Dhesi","year":"2021"},{"issue":"1","key":"pone.0316468.ref037","doi-asserted-by":"crossref","first-page":"25456","DOI":"10.2196\/25456","article-title":"It Is Time to REACT: Opportunities for Digital Mental Health Apps to Reduce Mental Health Disparities in Racially and Ethnically Minoritized Groups.","volume":"8","author":"EA Friis-Healy","year":"2021","journal-title":"JMIR Ment Health."},{"issue":"11","key":"pone.0316468.ref038","first-page":"e6511","article-title":"Do We Still Have a Digital Divide in Mental Health? A Five-Year Survey Follow-up.","volume":"18","author":"D Robotham","year":"2016","journal-title":"J Med Internet Res 20161811e309 Httpswwwjmirorg201611e309."},{"key":"pone.0316468.ref039","article-title":"Clinical Commissioning Group (CCG) IMD 2019 (WGS84) [Internet].","author":"Communities M of H, Government L","year":"2019","journal-title":"Dataset"},{"issue":"1","key":"pone.0316468.ref040","article-title":"Moderated online social therapy.","volume":"21","author":"R Lederman","year":"2014","journal-title":"ACM Trans Comput-Hum Interact TOCHI [Internet]."},{"issue":"6","key":"pone.0316468.ref041","doi-asserted-by":"crossref","first-page":"916","DOI":"10.1177\/1049732318756302","article-title":"Why Come for Treatment?\u201d Clients\u2019 and Therapists\u2019 Accounts of the Presenting Problems When Seeking Mental Health Care.","volume":"28","author":"O Nakash","year":"2018","journal-title":"Qual Health 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health, and health service utilisation: a prospective cohort study of older adults with multimorbidity in primary care.","volume":"70","author":"SYS Wong","year":"2020","journal-title":"Br J Gen Pract."},{"key":"pone.0316468.ref046","first-page":"1752","article-title":"Proliferation of Social Media during the COVID-19 Pandemic: A Statistical Enquiry.","volume":"XII","author":"K Gupta","year":"2020","journal-title":"Xian Jianzhu Keji Daxue XuebaoJournal Xian Univ Archit Technol."},{"issue":"11","key":"pone.0316468.ref047","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1089\/cyber.2020.0284","article-title":"How Parents and Their Children Used Social Media and Technology at the Beginning of the COVID-19 Pandemic and Associations with Anxiety.","volume":"23","author":"M Drouin","year":"2020","journal-title":"Cyberpsychology Behav Soc 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time design.","volume":"11","author":"I Bakolis","year":"2021","journal-title":"BMJ Open"},{"issue":"5","key":"pone.0316468.ref060","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1017\/dmp.2013.74","article-title":"Community Support as a Moderator of Postdisaster Mental Health Symptoms in Urban and Nonurban Communities.","volume":"7","author":"JS West","year":"2013","journal-title":"Disaster Med Public Health Prep."},{"issue":"4","key":"pone.0316468.ref061","doi-asserted-by":"crossref","DOI":"10.2196\/16460","article-title":"Digital peer support mental health interventions for people with a lived experience of a serious mental illness: Systematic review.","volume":"7","author":"KL Fortuna","year":"2020","journal-title":"JMIR Ment Health."},{"issue":"1","key":"pone.0316468.ref062","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1186\/s12888-024-05497-6","article-title":"Changes in mental health services in response to the COVID-19 pandemic in high-income countries: a rapid review.","volume":"24","author":"E Stepanova","year":"2024","journal-title":"BMC Psychiatry."},{"key":"pone.0316468.ref063","first-page":"1","article-title":"Mental health before and during the COVID-19 pandemic in two longitudinal UK population cohorts.","author":"ASF Kwong","year":"2020","journal-title":"Br J Psychiatry."},{"issue":"6","key":"pone.0316468.ref064","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1192\/bjp.2020.212","article-title":"Mental health and well-being during the COVID-19 pandemic: longitudinal analyses of adults in the UK COVID-19 Mental Health & Wellbeing study.","volume":"218","author":"RC O\u2019Connor","year":"2021","journal-title":"Br J Psychiatry."},{"issue":"2","key":"pone.0316468.ref065","doi-asserted-by":"crossref","first-page":"e124","DOI":"10.1016\/S2468-2667(20)30288-7","article-title":"Effects of the COVID-19 pandemic on primary care-recorded mental illness and self-harm episodes in the UK: a population-based cohort 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Garstang","year":"2020","journal-title":"BMJ Open"},{"issue":"3","key":"pone.0316468.ref072","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1111\/papt.12467","article-title":"Emotion self-stigma as a unique predictor of help-seeking intentions: A comparative analysis of early adolescents and young adults.","volume":"96","author":"LJ Harvey","year":"2023","journal-title":"Psychol Psychother."},{"key":"pone.0316468.ref073","article-title":"Mental Health Service Use and Barriers to Accessing Services in a Cohort of Transgender, Gender Diverse, and Non-binary Adults in Australia","author":"TJ Cronin","year":"2023","journal-title":"Sex Res Soc Policy [Internet]."},{"issue":"6","key":"pone.0316468.ref074","doi-asserted-by":"crossref","first-page":"754.e1","DOI":"10.1016\/j.jadohealth.2005.08.011","article-title":"Stigma starts early: gender differences in teen willingness to use mental health services.","volume":"38","author":"A Chandra","year":"2006","journal-title":"J Adolesc Health Off Publ Soc Adolesc Med."},{"issue":"3S","key":"pone.0316468.ref075","doi-asserted-by":"crossref","first-page":"S9","DOI":"10.1016\/j.jadohealth.2017.07.024","article-title":"Adolescent and Young Adult Male Mental Health: Transforming System Failures Into Proactive Models of Engagement.","volume":"62","author":"SM Rice","year":"2018","journal-title":"J Adolesc Health Off Publ Soc Adolesc Med."},{"issue":"2\u20133","key":"pone.0316468.ref076","first-page":"241","article-title":"A comparison of mental health symptomatology and levels of social support in young treatment seeking transgender individuals who identify as binary and non-binary.","volume":"20","author":"N Thorne","year":"2018","journal-title":"Int J Transgenderism."},{"issue":"3","key":"pone.0316468.ref077","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1037\/a0023688","article-title":"\u2018Boys don\u2019t cry\u2019: examination of the links between endorsement of masculine norms, self-stigma, and help-seeking attitudes for men from diverse backgrounds.","volume":"58","author":"DL Vogel","year":"2011","journal-title":"J Couns Psychol."},{"issue":"2","key":"pone.0316468.ref078","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1037\/sgd0000467","article-title":"Mental health among transgender and gender diverse youth: An exploration of effects during the COVID-19 pandemic.","volume":"8","author":"LD Hawke","year":"2021","journal-title":"Psychol Sex Orientat Gend Divers"},{"issue":"4","key":"pone.0316468.ref079","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1111\/1467-9566.13615","article-title":"Stigma, mental illness & ethnicity: Time to centre racism and structural stigma.","volume":"45","author":"D Kapadia","year":"2023","journal-title":"Sociol Health Illn."},{"issue":"8","key":"pone.0316468.ref080","doi-asserted-by":"crossref","first-page":"e0271661","DOI":"10.1371\/journal.pone.0271661","article-title":"The mental health burden of racial and ethnic minorities during the COVID-19 pandemic.","volume":"17","author":"LH Nguyen","year":"2022","journal-title":"PLOS ONE."},{"key":"pone.0316468.ref081","first-page":"hcaa203","article-title":"The mental health impact of the COVID-19 epidemic on immigrants and racial and ethnic minorities","author":"S Rothman","year":"2020","journal-title":"QJM Int J Med"},{"issue":"3","key":"pone.0316468.ref082","doi-asserted-by":"crossref","first-page":"287","DOI":"10.5172\/hesr.2012.21.3.287","article-title":"Understanding and addressing the stigma of mental illness with ethnic minority communities.","volume":"21","author":"L Knifton","year":"2012","journal-title":"Health Sociol Rev"},{"issue":"3\u20134","key":"pone.0316468.ref083","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1002\/ajcp.12516","article-title":"Systematic Review of Cultural Aspects of Stigma and Mental Illness among Racial and Ethnic Minority Groups in the United States: Implications for Interventions.","volume":"68","author":"S Misra","year":"2021","journal-title":"Am J Community Psychol."},{"issue":"1","key":"pone.0316468.ref084","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1037\/a0031169","article-title":"Racial and ethnic minority college students\u2019 stigma associated with seeking psychological help: Examining psychocultural correlates.","volume":"60","author":"HL Cheng","year":"2013","journal-title":"J Couns Psychol."},{"issue":"3","key":"pone.0316468.ref085","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1136\/ebmental-2020-300174","article-title":"COVID-19, mental health and ethnic minorities.","volume":"23","author":"K Smith","year":"2020","journal-title":"Evid Based Ment Health."},{"issue":"7","key":"pone.0316468.ref086","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1016\/S2215-0366(21)00151-6","article-title":"Mental health responses to the COVID-19 pandemic: a latent class trajectory analysis using longitudinal UK data","volume":"8","author":"M Pierce","year":"2021","journal-title":"Lancet Psychiatry"},{"issue":"3","key":"pone.0316468.ref087","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1136\/jech-2020-215060","article-title":"Mental health and health behaviours before and during the initial phase of the COVID-19 lockdown: longitudinal analyses of the UK Household Longitudinal Study.","volume":"75","author":"CL Niedzwiedz","year":"2021","journal-title":"J Epidemiol Community Health."},{"key":"pone.0316468.ref088","article-title":"Mental health after covid-19","volume":"376","author":"S. Weich","year":"2022","journal-title":"BMJ [Internet]."},{"key":"pone.0316468.ref089","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/j.bbi.2022.01.009","article-title":"The digital divide impacts on mental health during the COVID-19 pandemic","volume":"101","author":"A Cheshmehzangi","year":"2022","journal-title":"Brain Behav Immun"},{"issue":"4","key":"pone.0316468.ref090","first-page":"413","article-title":"Exploring the relationship between social class, mental illness stigma and mental health literacy using British national survey data","volume":"19","author":"D. Holman","year":"2015","journal-title":"Health Lond Engl 1997."},{"issue":"3","key":"pone.0316468.ref091","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1177\/070674370705200312","article-title":"Socioeconomic status and self-reported barriers to mental health service use","volume":"52","author":"L Steele","year":"2007","journal-title":"Can J Psychiatry Rev Can Psychiatr"},{"key":"pone.0316468.ref092","doi-asserted-by":"crossref","first-page":"102199","DOI":"10.1016\/j.pmedr.2023.102199","article-title":"Exploring the relationship between mental health literacy and psychological distress in adolescents: A moderated mediation model.","volume":"33","author":"X Zhang","year":"2023","journal-title":"Prev Med Rep."},{"issue":"6","key":"pone.0316468.ref093","first-page":"1251","article-title":"Inequity and inequality in the use of health care in England: an empirical investigation.","volume":"60","author":"S Morris","year":"2005","journal-title":"Soc Sci Med 1982."},{"key":"pone.0316468.ref094","article-title":"Independent Healthcare Providers Network","year":"2023","journal-title":"Going Private 2023 [Internet]."},{"issue":"1","key":"pone.0316468.ref095","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1038\/s41562-017-0189-z","article-title":"Redefine statistical significance.","volume":"2","author":"DJ Benjamin","year":"2018","journal-title":"Nat Hum Behav."},{"key":"pone.0316468.ref096","doi-asserted-by":"crossref","first-page":"e12288","DOI":"10.1002\/jcv2.12288","article-title":"Exploring adolescents\u2019 and stakeholders\u2019 perceptions of online and school-based mental health provision.","author":"BT Bell","year":"2024","journal-title":"JCPP Adv."},{"key":"pone.0316468.ref097","article-title":"Exploring young people\u2019s perspectives on digital technology and mental healthcare: pilot study findings.","author":"C Maddison","year":"2023"},{"key":"pone.0316468.ref098","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1038\/s44184-023-00030-1","article-title":"Increasing digital mental health reach and uptake via youth partnerships.","volume":"2","author":"C Stiles-Shields","year":"2023","journal-title":"Npj Ment Health Res"},{"issue":"1","key":"pone.0316468.ref099","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12913-022-07584-4","article-title":"Towards digital health equity\u2014a qualitative study of the challenges experienced by vulnerable groups in using digital health services in the COVID-19 era.","volume":"22","author":"AM Kaihlanen","year":"2022","journal-title":"BMC Health Serv Res."},{"key":"pone.0316468.ref100","doi-asserted-by":"crossref","first-page":"578902","DOI":"10.3389\/fdgth.2020.578902","article-title":"Early Warning Signs of a Mental Health Tsunami: A Coordinated Response to Gather Initial Data Insights From Multiple Digital Services Providers","volume":"2","author":"B. Inkster","year":"2021","journal-title":"Front Digit Health."},{"key":"pone.0316468.ref101","article-title":"The Need for a Mental Health Technology Revolution in the COVID-19 Pandemic.","volume":"11","author":"CA Figueroa","year":"2020","journal-title":"Front Psychiatry [Internet]."},{"key":"pone.0316468.ref102","doi-asserted-by":"crossref","first-page":"359","DOI":"10.2147\/IJGM.S449474","article-title":"Integrated Digital Mental Health Care: A Vision for Addressing Population Mental Health Needs.","volume":"17","author":"CT Lim","year":"2024","journal-title":"Int J Gen Med."},{"issue":"1","key":"pone.0316468.ref103","article-title":"Digital mental health: challenges and next steps","volume":"26","author":"KA Smith","year":"2023","journal-title":"BMJ Ment Health [Internet]."},{"key":"pone.0316468.ref104","doi-asserted-by":"crossref","first-page":"104961","DOI":"10.1016\/j.childyouth.2020.104961","article-title":"Psychosocial outcomes of mental illness stigma in children and adolescents: a mixed-methods systematic review.","volume":"113","author":"J Ferrie","year":"2020","journal-title":"Child Youth Serv Rev."},{"issue":"11","key":"pone.0316468.ref105","doi-asserted-by":"crossref","first-page":"e012337","DOI":"10.1136\/bmjopen-2016-012337","article-title":"Perceived barriers to accessing mental health services among black and minority ethnic (BME) communities: a qualitative study in Southeast England.","volume":"6","author":"A Memon","year":"2016","journal-title":"BMJ Open"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0316468","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,13]],"date-time":"2025-02-13T13:26:42Z","timestamp":1739453202000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0316468"}},"subtitle":[],"editor":[{"given":"Patrick","family":"Goymer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,2,13]]},"references-count":105,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2,13]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0316468","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2023.08.11.23293977","asserted-by":"object"}]},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,13]]}}}