Longitudinal increases in childhood depression symptoms during the COVID-19 lockdown

Increase in depression and anxiety disorder diagnoses during the COVID-19 pandemic in children and adolescents followed in pediatric practices in Germany

The coronavirus pandemic and related restrictions impacted the daily lives of children and youth, partly due to the closure of schools and the absence of outdoor activities. The aim of this study was to investigate, quantify, and critically discuss the effect of the pandemic and related restrictions on consultations pertaining to depression and anxiety disorders in children and adolescents. This retrospective cross-sectional study was based on medical record data from the Disease Analyzer database (IQVIA) and included all children and adolescents aged 2-17 years with at least one visit to one of 168 German pediatric practices between April 2019 and December 2019 (n = 454,741) or between April 2020 and December 2020 (n = 417,979). The number of children and adolescents with depression and anxiety disorder diagnoses per practice and the prevalence of these diagnoses were compared for April 2020-December 2020 versus April 2019-December 2019. The number of children and adolescents with depression and anxiety diagnoses per practice increased in April 2020-December 2020 compared to the same period in 2019 (anxiety: + 9%, depression: + 12%). The increase was much greater in girls than in boys (anxiety: + 13% vs. + 5%; depression + 19% vs. + 1%). The prevalence of anxiety disorder increased from 0.31 to 0.59% (p < 0.001), and that of depression from 0.23 to 0.47% (p < 0.001). The biggest increases were observed for girls (anxiety from 0.35 to 0.72% (+ 106%, p < 0.001), depression from 0.28 to 0.72% (+ 132%, p < 0.001). This study shows an increase in the number of pediatric diagnoses of depression and anxiety disorders in the pandemic year 2020 compared to the previous year.

Changes in social behavioral developmental risks in preschool children after the first COVID-19 wave: a prospective longitudinal cohort study

The impact of the COVID-19 pandemic on social-emotional developmental risks (SE-DR) of preschool children is largely unknown. Therefore, the aim of this prospective longitudinal dynamic cohort study was to assess changes in preschoolers' SE-DR from before the pandemic to after the first COVID-19 wave. SE-DR were assessed annually with the instrument "Dortmund Developmental Screening for Preschools" (DESK). Longitudinal DESK data from 3- to 4-year-old children who participated both in survey wave (SW) three (DESK-SW3, 2019) and SW four (DESK-SW4, 2020) from August 1 to November 30 were used, respectively. Additionally, data from previous pre-pandemic SW were analyzed to contextualize the observed changes (SW1: 2017; SW2: 2018). A total of N = 786 children were included in the analysis. In the pre-pandemic DESK-SW3, the proportion of children with SE-DR was 18.2%, whereas in DESK-SW4 after the first COVID-19 wave, the proportion decreased to 12.4% (p = 0.001). Thus, the prevalence rate ratio (PRR) was 0.68. Compared to data from previous SW (SW1-SW2: PRR = 0.88; SW2-SW3: PRR = 0.82), this result represents a notable improvement. However, only short-term effects were described, and the study region had one of the highest preschool return rates in Germany. Further studies are needed to examine long-term effects of the pandemic on preschoolers' SE-DR.

The Coronavirus Disease 2019 Pandemic and Mental Health-Related School-Nurse Visits in United States Schools

OBJECTIVE

No studies have examined school-nurse visits related to mental health (MH) during the coronavirus disease 2019 (COVID-19) pandemic. We examined changes in the rate of MH-related school-nurse visits before and during the COVID-19 pandemic.

METHODS

We analyzed school-nurse visit data (n = 3,445,240) for subjects Grade K-12 in US public schools using electronic health record software (SchoolCare, Ramsey, NJ). Data between January 1 and December 31 in 2019 (pre-COVID-19 pandemic) versus January 1 to December 31 in 2020 (during COVID-19 pandemic) were compared. For each year, total visits to a school-nurse were calculated for general MH, anxiety, and self-harm. The exposure was number of school-nurse visits in each time period (2019 vs 2020). The main outcome was change in the rate of general MH, anxiety, and self-harm visits in 2019 versus 2020.

RESULTS

There were 2,302,239 total school-nurse visits in 2019 versus 1,143,001 in 2020. During the COVID-19 pandemic, the rate of visits for general MH increased by 30% (4.7-6.1 per 10,000 visits, 95% confidence interval [CI] {18%, 43%}; P < .001), and visits for anxiety increased by 25% (24.8-31 per 10,000 visits, 95% CI [20%,30%]; P < .001). There was no significant difference in self-harm visits across all ages during the COVID-19 pandemic.

CONCLUSIONS

Our study found a significant increase in the rate of school-nurse visits for MH and anxiety during the COVID-19 pandemic, suggesting the pediatric population is at-risk for increased negative MH-effects associated with the pandemic and highlights a critical role of school-nurses in identifying youth with potential MH-needs.

Implementation of COVID-19 Preventive Measures and Staff Well-Being in a Sample of English Schools 2020-2021

BACKGROUND

We examined fidelity and feasibility of implementation of COVID-19 preventive measures in schools, and explored associations between adherence to these measures and staff well-being, to inform policy on sustainable implementation and staff wellbeing.

METHODS

Surveys were conducted across 128 schools in England with 107 headteachers and 2698 staff-members with reference to autumn term 2020, examining school-level implementation of preventive measures, adherence, and teacher burnout (response rates for headteacher and staff surveys were 84% and 59%, respectively).

RESULTS

The median number of measures implemented in primary and secondary schools was 33 (range 23-41), and 32 (range 22-40), respectively; most measures presented challenges. No differences were found regarding number of measures implemented by school-level socio-economic disadvantage. High adherence was reported for staff wearing face-coverings, staff regularly washing their hands, (secondary only) desks facing forwards, and (primary only) increased cleaning of surfaces and student hand-washing. Adherence to most measures was reported as higher in primary than secondary schools. Over half of school leaders and 42% (517/1234) of other teaching staff suffered from high emotional exhaustion. Higher teacher-reported school-wide adherence with measures was consistently associated with lower burnout for leaders and other teaching staff.

CONCLUSIONS

Findings indicate a tremendous effort in implementing preventive measures and an urgent need to support investments in improving teacher wellbeing.

Annual Research Review: The impact of Covid-19 on psychopathology in children and young people worldwide: systematic review of studies with pre- and within-pandemic data

BACKGROUND

The high volume and pace of research has posed challenges to researchers, policymakers and practitioners wanting to understand the overall impact of the pandemic on children and young people's mental health. We aimed to search for and review the evidence from epidemiological studies to answer the question: how has mental health changed in the general population of children and young people?

METHODS

Four databases (Medline, CINAHL, EMBASE and PsychINFO) were searched in October 2021, with searches updated in February 2022. We aimed to identify studies of children or adolescents with a mean age of 18 years or younger at baseline, that reported change on a validated mental health measure from prepandemic to during the pandemic. Abstracts and full texts were double-screened against inclusion criteria and quality assessed using a risk of bias tool. Studies were narratively synthesised, and meta-analyses were performed where studies were sufficiently similar.

RESULTS

6917 records were identified, and 51 studies included in the review. Only four studies had a rating of high quality. Studies were highly diverse in terms of design, setting, timing in relation to the pandemic, population, length of follow-up and choice of measure. Methodological heterogeneity limited the potential to conduct meta-analyses across studies. Whilst the evidence suggested a slight deterioration on some measures, overall, the findings were mixed, with no clear pattern emerging.

CONCLUSIONS

Our findings highlight the need for a more harmonised approach to research in this field. Despite the sometimes-inconsistent results of our included studies, the evidence supports existing concerns about the impact of Covid-19 on children's mental health and on services for this group, given that even small changes can have a significant impact on provision at population level. Children and young people must be prioritised in pandemic recovery, and explicitly considered in planning for any future pandemic response.

Yogic Spirituality and Positive Psychology vis-à-vis the Mental Health of Adolescents During COVID-19

COVID-19 ushered in a period of uncertainty and insecurity. It has affected the mental well-being of all, but certain groups are more vulnerable, including adolescents. Adolescence is a period of transition from childhood to adulthood in which the mental domain is still developing. The pandemic has had an adverse effect on the mental well-being of adolescents. Their normal routines are severely affected by the pandemic and related restrictions. There is a need for a coping mechanism or resources to empower this group of people. Spirituality has salubrious effect on all dimensions of health. The concept of spirituality is closely related to yoga and positive psychology. The article describes the similarities between yoga and positive psychology. It further posits that spirituality is closely related to yoga and positive psychology. The article also argues that both yoga and positive psychology could be useful in improving the mental dimension of health in adolescents in the COVID-19 era. A thorough study of the literature helped the authors to conclude that yoga and positive psychology definitely enhance mental well-being. The tenets of yoga and positive psychology can be incorporated into the daily regimen of children and adolescents to increase their resilience and mental strength. Further studies with robust study designs could ascertain the benefits of such measures.

Child and Maternal Mental Health Before and During the COVID-19 Pandemic: Longitudinal Social Inequalities in a Brazilian Birth Cohort

OBJECTIVE

The coronavirus disease 2019 (COVID-19) pandemic has caused major stress for families and children, particularly in the context of prolonged school closures. Few longitudinal studies are available on young children's mental health, including data both before and during the pandemic. This study examined experiences that might increase risk for mental health problems among caregivers and young children during the COVID-19 pandemic and inequalities driven by pre-pandemic disadvantage.

METHOD

This prospective, population-based birth cohort study in Pelotas, Brazil, analyzed 2,083 children and caregivers with data from before the pandemic in 2019, when children were 4 years old, and again in 2020, when schools were closed for a long period during the pandemic. Child conduct problems, emotional problems, and hyperactivity-inattention problems were assessed using the Strengths and Difficulties Questionnaire. Family financial hardship, relationship difficulties, caregiver mental health, parenting practices, and child fears and isolation were considered as potential risk factors.

RESULTS

Across the whole population, the only significant increase in mental health problems from before to during the pandemic was found for maternal depression. However, poorer families were at far greater risk of experiencing serious financial problems, food shortages, increased conflict in adult relationships, parenting problems, and child worries about food availability during the pandemic. In turn, these difficulties were associated with increases in multiple mental health problems for both caregivers and children. Increased child mental health problems were most strongly associated with concurrent maternal anxiety (β > 0.20, p < .001, for each of child conduct, emotional, and hyperactivity problems), maternal depression (β = 0.26, p < .001, for child emotional problems), partner criticism (β = 0.21, p < .001, for child conduct problems), and harsh parenting (β > 0.20, p < .001, for both child conduct and hyperactivity problems). Child worry about COVID-19 was associated with increased emotional problems (β = 0.14, p < .001), but children's isolation was not associated with their mental health.

CONCLUSION

Overall, the impact of the COVID-19 pandemic on mental health is a mixed picture, but for families in poverty, marked material and interpersonal difficulties were associated with increases in mental health problems among children and caregivers.

Longitudinal Change in Adolescent Depression and Anxiety Symptoms from before to during the COVID-19 Pandemic

This study aimed to examine changes in depression and anxiety symptoms from before to during the first 6 months of the COVID-19 pandemic in a sample of 1,339 adolescents (9-18 years old, 59% female) from three countries. We also examined if age, race/ethnicity, disease burden, or strictness of government restrictions moderated change in symptoms. Data from 12 longitudinal studies (10 U.S., 1 Netherlands, 1 Peru) were combined. Linear mixed effect models showed that depression, but not anxiety, symptoms increased significantly (median increase = 28%). The most negative mental health impacts were reported by multiracial adolescents and those under 'lockdown' restrictions. Policy makers need to consider these impacts by investing in ways to support adolescents' mental health during the pandemic.

'Everything turned upside down': A thematic analysis of adolescents' experiences of everyday life during COVID-19 restrictions

BACKGROUND

At the beginning of the COVID-19 pandemic, people were encouraged to practice social distancing, and schools and leisure venues closed.

AIMS

We aimed to explore the everyday experiences of Norwegian adolescents during COVID-19 restrictions, when in-person contact with peers was severely limited.

METHODS

A total of 622 high-school students (16-18 years of age) replied to an online survey containing open-ended questions about the changes they experienced in everyday life during the first three months of the pandemic.

RESULTS

Reflexive thematic analysis resulted in four themes: (a) 'Everyday life turned upside down - everything is on hold'; (b) 'Alone with my thoughts - new concerns'; (c) 'A loss of social life - a fear of wasting important time'; and (d) 'Gratitude - new perspectives in life'. The results are discussed according to mental-health concerns and psychological developmental challenges during adolescence, such as social exploration of roles with peers, autonomy and identity formation during a crisis.

CONCLUSIONS

The results underline individual variations and positive experiences among adolescents during the COVID-19 pandemic, despite social restrictions. Still, the lack of in-person contact with friends is related to an increased experience of loneliness and mental-health concerns for many adolescents.

Mental Health Trajectories of Latinx Female Caregivers and Young Children During COVID-19: A Longitudinal Analysis

Studies of the impact of COVID-19 on mental health symptoms suggest that there may be a unique impact of COVID-19 on minoritized individuals, young children (children five and younger), and their caregivers. Longitudinal studies with representative samples including minoritized populations are needed to accurately reflect the experience of families during COVID-19. The current study used a longitudinal design to assess trajectories of mental health among Latinx female caregivers and their young children over time, beginning prior to the onset of the COVID-19 pandemic and over the course of 12 months. In fall of 2019, Latinx female caregivers (N = 213; 93.0% biological mother) of young children (M age  = 5.38, SD = 0.34) reported on their own and their child's (52.6% female) mental health symptoms, as well as parenting stress, at three time points through Fall of 2020. Growth curve models showed that self-report of caregiver global mental health worsened over time, though caregiver depression and parenting stress did not change significantly, nor did caregiver-report of their children's mental health. Results suggest that while female caregiver well-being was adversely affected by COVID-19, caregivers showed resilience in the face of this pandemic, which in turn may have buffered the impact of the pandemic on Latinx child mental health. Methodological and contextual implications of these results are considered.

Child and family factors associated with child mental health and well-being during COVID-19

Understanding the implications of the COVID-19 pandemic on the current generation of youth is critical for post-pandemic recovery planning. This study aimed to identify the most salient child (i.e., connectedness to caregivers, screen time, sleep, physical activity, peer relationships, and recreational activities) and family (i.e., COVID-19 financial impact, maternal depression and anxiety) factors associated with children's mental health and well-being during the COVID-19 pandemic, after controlling for pre-pandemic mental health. This study included 846 mother-child dyads (child age 9-11) from the All Our Families cohort. Mothers reported on the child's pre-pandemic mental health at age 8 (2017-2019) and during COVID-19 (May-July 2020), the family's financial impact due to COVID-19, and maternal depression and anxiety. During COVID-19 (July-August 2020), children reported on their screen time, sleep, physical activity, peer and family relationships, and recreational activities, as well as their happiness, anxiety and depression. After controlling for pre-pandemic anxiety, connectedness to caregivers (B - 0.16; 95% CI - 0.22 to - 0.09), child sleep (B - 0.11; 95% CI - 0.19 to - 0.04), and child screen time (B 0.11; 95% CI 0.04-0.17) predicted child COVID-19 anxiety symptoms. After controlling for pre-pandemic depression, connectedness to caregivers (B - 0.26; 95% CI - 0.32 to - 0.21) and screen time (B 0.09; 95% CI 0.02-0.16) predicted child COVID-19 depressive symptoms. After controlling for covariates, connectedness to caregivers (B 0.36; 95% CI 0.28-0.39) predicted child COVID-19 happiness. Fostering parent-child connections and promoting healthy device and sleep habits are critical modifiable factors that warrant attention in post-pandemic mental health recovery planning.

SARS-CoV-2 pandemic as a catalyst? Development of emotional problems of preschool children of mothers with childhood maltreatment experiences in the course of the pandemic-a longitudinal analysis

Background

SARS-CoV-2 pandemic have posed great challenges for all families and children. Health risks and fears associated with SARS-CoV-2 negatively affect the parental mental health and perceived stress, which in turn influence parental coping and thereby impairs the mental health and well-being of their children. Additional risk factors within the parents, such as maternal childhood maltreatment (CM) experiences, may increase the risk of children to develop emotional problems during the pandemic.

Objective

The purpose of this longitudinal study is to determine whether preschool children of mothers with CM are at higher risk of developing emotional problems during the pandemic than preschool children of mothers without CM.

Method

74 mothers from a birth cohort examining pathways to resilience or vulnerability in the transgenerational transmission of CM, provided information on emotional problems of their children (aged 3-7 years) at two measurement time points (t1: May 2020, t2: March 2021) as part of an online "SARS-CoV-2 pandemic" survey. In addition, parents were asked for a retrospective assessment of their children's emotional problems before the pandemic at time t1. Children's emotional problems were assessed using the "emotional problems" scale of the German version of the Strengths and Difficulties Questionnaire (SDQ) and linked to previously collected data on mothers' childhood maltreatment experiences, which were collected using the German short version of the Trauma in Childhood Questionnaire (CTQ).

Results

Our analyses showed that children's emotional problems increased significantly over the SARS-CoV-2 pandemic [F(1.86, 116.88) = 3.72, p = 0.030 η ² = 0.06] and were rated significantly higher in the group of children of mothers with CM, than in the group of mothers without CM [F(1, 63) = 126.06, p < 0.001 η ²= 0.67]. Furthermore children's emotional problems of mothers with CM increased significantly more and reached a clinically significant value during the pandemic than for children of mothers without CM [F(1.86, 116.88) = 8.89, p < 0.001, η ²= 0.12].

Conclusions

Children of mothers with CM appear to be at increased risk of developing emotional problems during the pandemic. CM therefore needs to be considered as an additional risk factor in the impact of the pandemic on children.

What Mediates the Effect of Family Disruption in the COVID-19 Pandemic on Children’s Prosocial Behavior

Abstract. At the start of the COVID-19 pandemic, unprecedented social distancing rules (including mass school closures) dramatically constrained children’s social lives, jeopardizing human connections that foster prosocial development. This study of 2,516 families of 3–8-year-olds from six countries (China, Sweden, Australia, Italy, the USA, and the United Kingdom) examined whether children’s understanding or feelings about COVID-19 regulations mediated the expected association between COVID-19-related family disruption and children’s prosocial behavior, as indexed by parental ratings. For all six sites, family disruption indirectly predicted reduced prosocial behavior. Negative feelings about COVID-19 regulations mediated this association in all sites except China. Contrariwise, understanding of COVID-19 regulations was not implicated in the link between family disruption and reduced prosocial behavior.

Increase of depression among children and adolescents after the onset of the COVID-19 pandemic in Europe: a systematic review and meta-analysis

BACKGROUND

Research points to a high depression burden among youth during the COVID-19 pandemic; however, a lack of systematic evidence exists. We determine the change in depression symptoms among children and adolescents during COVID-19 compared to pre-pandemic baselines. By using country differences in pandemic-related restrictions and school closures in Europe as quasi-experimental design, we evaluate policy impacts on depression.

METHODS

In this systematic review and meta-analysis, following the PRISMA statement, we searched six databases (MEDLINE, EMBASE, PsycINFO, Cochrane Central, Web of Science, WHO COVID-19) using a peer-reviewed search string up until March 18, 2022 with citation tracking and grey literature searches. No limitations regarding language and effect measures existed. We included studies that compared (1) general depression symptoms or (2) clinically relevant depression rates in children and adolescents (≤ 19 years) before and during the COVID-19 pandemic in Europe. The validated Oxford Stringency Index was used as indicator for pandemic-related restrictions. Screening for eligibility, extracting data from published reports and from unpublished data requested directly from study authors, assessing the study risk of bias and grading certainty of evidence using the GRADE approach, were all done in duplicate. Data were pooled in a random-effects model.

PROSPERO

CRD42022303714.

RESULTS

Of 7,422 nonduplicate records, 22 studies with data from 868,634 participants pre-pandemic and 807,480 during pandemic, met full inclusion criteria. For the comparison of depression symptoms before and during the COVID-19 pandemic, moderate certainty of evidence was observed for general depression symptoms (standardized mean difference, 0.21 [95%CI, 0.12-0.30]; I2 = 94%) and low certainty of evidence for clinically relevant depression rates (odds ratio, 1.36 [95%CI, 1.05-1.76]; I2 = 95%) for total population. Increase in general depression symptoms was higher for male adolescents, whereas increase in clinically relevant depression rates was higher for females. Effect estimates were significantly higher when pandemic-related restrictions were more stringent or school closure occurred.

CONCLUSION

An increase in depression symptoms occurred in a pre-pandemic vs. during-pandemic comparison within the COVID-19 pandemic, whereby pandemic-related restrictions (such as school closures) resulted in a considerable effect increase. Ensuring adequate supply of mental health recovery services and long-term monitoring is of high public health relevance.

Young children's traumatic stress reactions to the COVID-19 pandemic: The long reach of mothers' adverse childhood experiences

BACKGROUND

The COVID-19 pandemic has negatively impacted parental and child mental health; however, it is critical to examine this impact in the context of parental histories of adversity. We hypothesized that maternal adverse childhood experiences (ACEs) and pandemic-related negative life events would predict child traumatic stress symptoms (TSS) and tested potential mediating pathways through maternal pandemic-related TSS and/or poorer maternal sensitivity during the pandemic.

METHODS

Data were collected from a longitudinal sample of low-income, racially/ethnically diverse mothers and their children. Between May and November 2020, mothers (n = 111) of young children (M age = 7.42 years, SD = 0.45) completed questionnaires to assess their own and their child's pandemic-related TSS, exposure to pandemic-related negative events, and parent-child relationship quality. Maternal ACEs, maternal depression, parent-child relationship quality, and child internalizing symptoms had been assessed approximately 1-3 years prior.

RESULTS

Structural equation analyses revealed that pandemic negative life events were indirectly associated with child TSS via greater maternal TSS. For mothers, recent pandemic-related negative events were associated with their own TSS, whereas maternal ACEs were not. Maternal ACEs directly predicted greater child TSS, with no evidence of mediation by either maternal TSS or maternal sensitivity.

LIMITATIONS

All measures were parent report, and pandemic-related measures were collected at the same time point.

CONCLUSIONS

Findings underscore the long reach of mothers' own adverse childhood experiences, highlighting the negative consequences of these prior traumatic exposures alongside current pandemic-related maternal trauma symptoms for children's adjustment during the pandemic.

Longitudinal impact of COVID-19 pandemic on mental health of children in the ABCD study cohort

A large longitudinal study on the impact of the COVID-19 pandemic on mental health in children is limited. This large-scale longitudinal observational study examines the pandemic's effects on children's mental health while considering the effects of parental care styles. The Adolescent Brain Cognitive Development Study is a large-scale, longitudinal multicenter study in the United States. Of the 11,875 children aged 9-12 years in its database, 4702 subjects were selected for this study. The child behavior checklist and parental monitoring questionnaire (PMQ) were used to assess children's mental health and parental support styles, respectively. Data collected before and during the pandemic were compared. Withdrawn/depressed and attention problems significantly worsened during compared to before the COVID-19 pandemic (p < 0.001, withdrawn/depressed; 53.4 ± 5.7 to 53.7 ± 5.9, attention problems; 53.4 ± 5.4 to 53.6 ± 5.6). However, the T scores are in the normal range both before and during the crisis. Simple slope analysis found withdrawn/depressed problems and aggressive behavior worsened when the PMQ was 1 SD below the mean, and rule-breaking behavior was improved when the PMQ was 1 SD above the mean. While the COVID-19 pandemic exacerbated children's depressive symptoms and attention issues, the effects may be minor. Additionally, parental involvement serve as a protective factor for the child's mental health even during the pandemic.

Child and Adolescent Mental Health During the COVID-19 Pandemic: Results of the Three-Wave Longitudinal COPSY Study

PURPOSE

The German population-based longitudinal COVID-19 andPsychological Health study monitors changes in health-related quality of life (HRQoL) and mental health of children and adolescents during the COVID-19 pandemic and identifies vulnerable groups.

METHODS

A nationwide, population-based survey was conducted in May 2020 to June 2020 (Wave 1), December 2020 to January 2021 (Wave 2), and September 2021 to October 2021 (Wave 3). In total, n = 2,097 children and adolescents aged 7-17 years were investigated using measures to assess HRQoL (KIDSCREEN-10), mental health problems (SDQ), anxiety (SCARED), depressive symptoms(PHQ-2), and psychosomatic complaints(HBSC-SCL).

RESULTS

The prevalence of low HRQoL increased from 15% prepandemic to 40% and 48% in Waves 1 and 2 and improved slightly to 35% in Wave 3 (all differences significant). Similarly, overall mental health problems increased from 18% prepandemic to 29% in Wave 1 and 31% in Wave 2 to 28% in Wave 3 (all differences significant, except Wave 3 vs. 2), anxiety increased from 15% prepandemic to 24% and 30% in Waves 1 and 2 and was still 27% in Wave 3. Depressive symptoms increased from 10% prepandemic to 11% and 15% in Waves 1 and 2 and were 11% in Wave 3. A group with low parental education, restricted living conditions, migration background, and parental mental health problems was at significantly increased risk of HRQoL and mental health impairments.

DISCUSSION

The prevalence of low HRQoL, mental health problems, and anxiety has been elevated throughout the pandemic. Thus, mental health promotion, prevention, and intervention strategies need to be implemented to support adolescents-particularly those at risk.

What happens post-lockdown for people with disability? Autonomy, quality of life, service access and health changes for people with spinal cord injury in Victoria, Australia after COVID-19 social distancing restrictions

Social distancing restrictions are undoubtedly important for controlling the spread of COVID-19 however, they are also adversely impacting population health and health service access. It is important that priority populations with a disability which may already have adverse health, access to health services, and autonomy and participation compared to those without disability, are able to receive preventative health and social care during periods of restriction. The impact of social distancing restrictions on people with disability is not uniform nor well-understood. Research has been cross-sectional and considered data gathered during social distancing restrictions, or longitudinal, considering data gathered during a pre-pandemic baseline. This longitudinal study investigated the impact of lifting social distancing restrictions on priority domains for people with disability including autonomy and participation, access to health services, health issues and quality of life. People with spinal cord injury in Victoria, Australia (n = 71) completed a survey towards the end of social-distancing restrictions (T1) and 6-months post social distancing restrictions (T2). Non-parametric tests for significant differences confirmed that 6-months post-lifting social distancing restrictions participants experienced a significant increase in health conditions, a significant decrease in the number of inaccessible health services, and a significantly lower level of limitations across participation and autonomy, outdoor autonomy and work and education domains. QOL improved 6-months post lifting restrictions, however not to a significant level. The adverse health experienced by people with spinal cord injury after lifting restrictions may in part result from limited health service access and reduced participation during the time of restrictions. Clear definitions of what constitutes as essential care may ensure that eligible and required care remains received during lockdown or instances when service provision is compromised. Health and social care providers should be equipped with the knowledge of priority populations so that their support can be targeted to those most in need.

The association of physical activity, sleep, and screen time with mental health in Canadian adolescents during the COVID-19 pandemic: A longitudinal isotemporal substitution analysis

BACKGROUND

The impact of COVID-19 on adolescent mental health is a global concern. Increased screen time and reduced physical activity due to the lockdown measures have been linked to detrimental mental health outcomes; however, the literature remains limited by cross-sectional and retrospective designs, and consideration of behaviours in isolation. Prospective evidence is necessary to examine whether moderate-to-vigorous physical activity (MVPA), sleep and screen time influenced changes in mental health.

METHOD

Analyses used data from a prospective cohort study of secondary school students in Canada with baseline data from the 2018-2019 school year and linked follow-up data from online surveys completed during the initial COVID-19 outbreak (May-July 2020). Multilevel linear regression models were used to evaluate the within- and between-person isotemporal substitution effects of sleep, MVPA and screen time behaviours on depression, anxiety, subjective well-being, and trait emotional dysregulation.

RESULTS

Linked longitudinal data from 2645 students attending 44 schools were available. Between-person effects indicated that individuals who engaged in more MVPA and sleep while minimizing screen time had lower depression scores, less severe emotional dysregulation, and better subjective well-being. While controlling for between-person effects, within-person year-on-year change suggests those who increased screen time while decreasing either MVPA or sleep experienced mental health decline on all outcomes.

CONCLUSION

MVPA and sleep were associated with youth mental health during the early COVID-19 lockdown. Increasing MVPA and sleep (or at least mitigating the increase of screen time) compared to the prior year was associated with better mental health during the early pandemic. A limitation to consider is that the screen time measure represents a combination of screen behaviours, and effects of replacing screen time may have varied if distinctions were made.

Long term mental health trajectories after disasters and pandemics: A multilingual systematic review of prevalence, risk and protective factors

The patterns of long-term psychological response after disasters and pandemics remain unclear. We aimed to determine the trajectories for post-traumatic stress symptoms (PTSS), depression and anxiety prevalence following disasters and pandemic exposure; and identify associated risk and protective factors. A systematic review of the English, Chinese, and Japanese longitudinal mental health literature was conducted. We searched Cochrane, MEDLINE, ProQuest, PsycINFO, PubMed, Web of Science, and CINAHL (English), CNKI and SINOMED (Chinese) and CiNii (Japanese) for studies published between January 2000 and May 2022. Following a pre-specified protocol (PROSPERO: CRD42020206424), conditional linear growth curve models and ANOVA analyses were conducted. The search identified 77,891 papers, with a final sample of 234: 206 English, 24 Chinese, and 4 Japanese-language papers. PTSS rates improved for all ages (p = .018, eta² = 0.035). In contrast, depression and anxiety prevalence remained elevated for years following exposure (p = .424, eta² = 0.019 and p = .051, eta² = 0.064, respectively), with significantly higher rates for children and adolescents (p < .005, eta² > 0.056). Earthquakes and pandemics were associated with higher prevalence of PTSS (p < .019, eta² > 0.019). Multi-level risk and protective factors were identified. The chronicity of mental health outcomes highlights a critical need for tailored, sustainable mental health services, particularly for children and adolescents, in disaster- and pandemic-affected settings.

Impact of the COVID-19 Pandemic on Mental Health in Childhood and Adolescence: The Reality of a Portuguese School

Background

The coronavirus disease 2019 (COVID-19) outbreak has led to social isolation, with the potential to increase depressive symptoms, even at the pediatric age. Before the COVID-19 pandemic, the rate of depressive symptoms in large youth cohorts was 12.9% worldwide.

Aims

This study aims to characterize the impact of the COVID-19 pandemic on the pediatric population’s mental health.

Materials and methods

This was an observational, descriptive, and cross-sectional study conducted through the use of a questionnaire, including the Children's Depression Inventory (CDI), between April 5 and May 5, 2021. The study was conducted on children and adolescents aged 7 to 17 years old in a school in the geographical area of ​​a Portuguese grade II hospital. Incomplete data were excluded. Data were statistically analyzed using the IBM SPSS® program (version 28; IBM Corp., Armonk, NY), considering statistical significance if p<0.05.

Results

A total of 228 children and adolescents were included; 113 were female (49.6%). The average age of the population was 12.2 years. Fifteen point four percent (15.4%) had depressive symptoms, of which 51,9% were female. Of the children and adolescents with depressive symptoms, 5.7% had a personal history of past COVID-19 infection and 42.9% had at least one family member with a history of past COVID-19 infection. Seventeen point one percent (17.1%) had at least one family member involved in pandemic-related work. Children and adolescents who were infected with COVID-19 had more depressive symptoms than noninfected children and adolescents (p=0.013). At the same time, children and adolescents, with at least one family member with a history of past COVID-19 infection, had more depressive symptoms than children and adolescents without a family history of past COVID-19 infection (p=0.004). Children and adolescents with a family member involved in pandemic-related work had more depressive symptoms than children and adolescents without any family member involved in pandemic-related work (p=0.004).

Conclusions

COVID-19 infection, whether personal or familiar, has an impact on mental health, even in the pediatric age, and it is imperative to know the consequences of emotional and mental changes in this population.

Health Problems of Students during Distance Learning in Central and Eastern Europe: A Cross-Sectional Study of Poland and Ukraine

The COVID-19 pandemic has significantly disrupted the functioning of society. Issues of deteriorating health were among the main problems resulting from restrictions such as self-isolation, social distancing, and remote education. The aim of this research was to attempt to probe the psychophysical condition of students after more than a year of remote education. The survey method (CAPI) was used to collect the data on a representative sample of 1000 students in Poland and 1022 in Ukraine. The research sample was selected in a randomly stratified manner, taking into account such characteristics as: gender, age, and place of residence. The results of the research showed that 44% of Polish and 50% of Ukrainian students experienced health problems. The burden of remote education mainly contributed to the reduction of physical fitness. Young Poles more often paid attention to the deterioration of mental well-being, and Ukrainians to the deterioration of their physical condition. Based on the conducted analyses, it was also established that health problems appeared more often among the females, students with lower social support and with lower trust levels. The main risk factors were Internet addiction, secondary effects of the pandemic, and negative remote education experiences. Research has shown that remote education and problems that arise in students' households during the pandemic may have significantly contributed to the deterioration of their psychophysical condition.

From best practice to next practice: implementing Comprehensive School Health in rural and remote northern communities

INTRODUCTION

Northern communities in Canada experience a disproportionate burden of chronic diseases including mental illness. To mitigate the growing health inequalities, an ongoing Comprehensive School Health program promoting healthy lifestyle behaviours and mental health and well-being was expanded to rural and remote northern communities. We report on the program's impact on knowledge, attitudes, lifestyle behaviours (healthy eating, physical activity, screen time), weight status and the mental health and well-being of elementary school students during the first four years of implementation.

METHODS

Following a repeated cross-sectional design, we surveyed 440, 352 and 384 Grade 4 to 6 students (9-12 years old) from eight schools in 2016, 2018 and 2020/21, respectively. Students were approximately equally represented by girls and boys.

RESULTS

Between 2016 and 2018, students reported modest increases in vegetable and fruit consumption and dietary variety; declines in screen time; no changes in physical activity; and declines in attitudes toward healthy lifestyle and in mental health and well-being. Between 2018 and 2020/21, lifestyle behaviours deteriorated substantially, while attitudes and mental health and well-being continued to decline.

CONCLUSION

A program that was successful in socioeconomically disadvantaged urban neighbourhoods had a favourable, though modest, impact on selected lifestyle behaviours, but not on attitudes and mental health and well-being, in rural and remote northern communities. In light of cultural differences and logistical challenges in Canada's North, systematic and proactive adaptations to local contexts, increased intensity, and longer program delivery are essential to facilitate sustainable improvements in lifestyle behaviours and mental health and well-being.

Adolescent social emotional skills, resilience and behavioral problems during the COVID-19 pandemic: A longitudinal study in three European countries

Objectives

The consequences of long-lasting restrictions related to the COVID-19 pandemic have become a topical question in the latest research. The present study aims to analyze longitudinal changes in adolescents' social emotional skills, resilience, and behavioral problems. Moreover, the study addresses the impact of adolescents' social emotional learning on changes in their resilience and behavioral problems over the course of seven months of the pandemic.

Methods

The Time 1 (T1) and Time 2 (T2) measuring points were in October 2020 and May 2021, characterized by high mortality rates and strict restrictions in Europe. For all three countries combined, 512 questionnaires were answered by both adolescents (aged 11-13 and 14-16 years) and their parents. The SSIS-SEL and SDQ student self-report and parent forms were used to evaluate adolescents' social emotional skills and behavioral problems. The CD-RISC-10 scale was administered to adolescents to measure their self-reported resilience. Several multilevel models were fitted to investigate the changes in adolescents' social emotional skills, resilience, and behavioral problems, controlling for age and gender. Correlation analysis was carried out to investigate how changes in the adolescents' social emotional skills were associated with changes in their resilience and mental health adjustment.

Results

Comparing T1 and T2 evaluations, adolescents claim they have more behavioral problems, have less social emotional skills, and are less prosocial than perceived by their parents, and this result applies across all countries and age groups. Both informants agree that COVID-19 had a negative impact, reporting an increment in the mean internalizing and externalizing difficulties scores and reductions in social emotional skills, prosocial behavior, and resilience scores. However, these changes are not very conspicuous, and most of them are not significant. Correlation analysis shows that changes in adolescents' social emotional skills are negatively and significantly related to changes in internalized and externalized problems and positively and significantly related to changes in prosocial behavior and resilience. This implies that adolescents who experienced larger development in social emotional learning also experienced more increase in resilience and prosocial behavior and a decrease in difficulties.

Conclusion

Due to its longitudinal design, sample size, and multi-informant approach, this study adds to a deeper understanding of the pandemic's consequences on adolescents' mental health.

Effects of the COVID-19 Restrictions on Eating Behaviour and Eating Disorder Symptomology in Female Adolescents

Confinement due to the COVID-19 pandemic imposes a burden on adolescents worldwide and may seriously impact patients with an eating disorder (ED). The current FRanconian Anorexia Nervosa during COVID-19 (FRANCO) study explored (1) perceived change of depressive and ED symptomology during lockdown, (2) the role of social media, and (3) coping strategies of anorexia nervosa (AN) patients and clinical as well as healthy comparison groups. From June 2021 to September 2021, 222 female adolescents (19 with AN, 20 with depression, 45 with a self-reported psychiatric disorder (SRPD), and 138 controls) aged 11.2 to 18.9 years completed a one-time anonymous survey retrospectively reporting back on ED and depressive symptomology before and during the pandemic, the impact of social media, and coping strategies. A reduced quality of life (QoL) due to confinement was observed in almost half of female adolescents. All groups reported a significant perceived increase of disordered eating, overeating, anxiety, and depressive symptoms and emotion-regulation problems. In AN patients, significantly higher percentual deterioration of disordered eating and anxiety and depressive symptoms was found. For controls, a younger age and higher susceptibility of the sociocultural body image significantly correlated with increased disordered eating. Large-scale media literacy interventions are recommended.

Risks and Resources for Depressive Symptoms and Anxiety in Children and Adolescents During the COVID-19 Pandemic - Results of the Longitudinal COPSY Study

Background

Mental health during the COVID-19 pandemic is of particularly high relevance. Especially for children and adolescents, the pandemic and its restrictions represent a significant burden. The present study aims to identify risks and resources for depressive symptoms and anxiety in children and adolescents during the pandemic in Germany.

Materials and Methods

Self-reported data from the first wave of the longitudinal COVID-19 and Psychological Health (COPSY) study were used to investigate risks and resources among n = 811 children and adolescents aged 11-17 years. Depressive symptoms and anxiety were measured at the first follow-up 6 months later. Multivariate linear regression analyses were performed to investigate the effects of risks and resources on depressive symptoms and anxiety.

Results

Parental depressive symptoms predicted depressive symptoms and anxiety in children and adolescents 6 months later. Female gender was identified as a risk factor for anxiety during the pandemic. None of the potential resources were associated with depressive symptoms or anxiety at the follow-up.

Conclusion

The findings provide evidence of risk factors for depressive symptoms and anxiety during the COVID-19 pandemic. Children and adolescents who face risk factors need to be identified early and monitored during the pandemic. Family-based intervention programs are needed to help vulnerable children and adolescents cope with the challenges of the pandemic.

COVID-19 Experiences and Health-Related Implications: Results From a Mixed-Method Longitudinal Study of Urban Poor Adolescents in Shanghai

PURPOSE

This analysis aimed to investigate gender differences in adolescents' concerns and the health implications of COVID-19.

METHODS

We used two rounds of the Global Early Adolescent Study (GEAS) collected in Shanghai in 2018 and 2020. We analyzed data from 621 adolescents, comparing boys' and girls' concerns about COVID-19 and examining trends in general health and mental health by sex between the pre-COVID-19 and COVID-19 periods. Changes in health indicators over time were assessed using generalized estimating equation (GEE) models.

RESULTS

Adolescent girls reported more health concerns (52.0% vs. 42.7%) and educational concerns (61.0% vs. 46.3%) than boys, whereas boys expressed more worries about the economic consequences of COVID-19 (32.9% vs. 25.4%). Changes in health-related outcomes during the pandemic compared to the prepandemic era differed by sex and varied by COVID-related experiences. Boys reported improved overall health (OR: 1.54, 95% CI: 1.00, 2.35) in the COVID-19 period relative to the pre-COVID-19 period. Such improvements were only observed among boys who reported no family economic hardships (OR: 2.10, 95% CI: 1.24, 3.58). We found no significant change for girls (OR: 1.14, 95% CI: 0.83, 1.55), regardless of COVID-19 economic impacts. In contrast, girls reported increased anxiety (OR: 1.63, 95% CI: 1.09, 2.45), especially among those who were concerned about their academic performance (OR: 1.85, 95% CI: 1.16, 2.97). Boys experienced no such increase (OR: 0.92, 95% CI: 0.55, 1.54), regardless of their education concerns.

DISCUSSION

Adolescents' COVID-19 experiences are highly gendered and result in increased health inequalities, with greater mental health implications for girls.

Jeopardized mental health of children and adolescents in coronavirus disease 2019 pandemic

The coronavirus disease 2019 (COVID-19) outbreak became a worldwide pandemic in 2020. Social distancing measures, such as self-quarantine, lockdowns, and school closures, which have proven efficacy in various pandemic situations, remain in use in Korea. These measures prevented viral transmission to some extent; however, adverse effects have also resulted. First, the negative effect of social isolation on mental health is evident. This influences the psychiatric milieu of parents and children directly and indirectly. The most stressful factor among Korean youth was the restriction of outdoor activities. Increasing parenting burden result in increased screen time among youth, and social isolation created depressive mood with symptoms similar to those of attention deficit hyperactivity disorder and anxiety. Second, symptoms of posttraumatic stress disorder (PTSD) and somatization are prevalent among children and adolescents. The sense of threatened health and life during the pandemic, one symptom of PTSD, is a strong risk factor for somatization. Finally, the increased pattern of child abuse in pandemic indicates increased levels of emotional/psychological abuse and nonmedical neglect. Social isolation makes people less aware of these events. Because pediatricians evaluate pediatric patients and their families, they should regularly assess emotional/stress factors, especially when somatization is prominent during the pandemic, and cautiously recommend that families seek advice from mental health professionals when warranted. Primary physicians must understand the characteristics and aspects of child abuse in the COVID-19 pandemic, make efforts to identify signs of child abuse, and deliver accurate information and preventive strategies for child abuse to caregivers, thereby functioning as a professional guardian. To promote the mental health of parents and children during the COVID-19 pandemic, more research and cooperation among health professionals, families, governments, and schools are needed in the future.

Emotions and Incivility in Vaccine Mandate Discourse: Natural Language Processing Insights

Background

Despite vaccine availability, vaccine hesitancy has inhibited public health officials' efforts to mitigate the COVID-19 pandemic in the United States. Although some US elected officials have responded by issuing vaccine mandates, others have amplified vaccine hesitancy by broadcasting messages that minimize vaccine efficacy. The politically polarized nature of COVID-19 information on social media has given rise to incivility, wherein health attitudes often hinge more on political ideology than science.

Objective

To the best of our knowledge, incivility has not been studied in the context of discourse regarding COVID-19 vaccines and mandates. Specifically, there is little focus on the psychological processes that elicit uncivil vaccine discourse and behaviors. Thus, we investigated 3 psychological processes theorized to predict discourse incivility-namely, anxiety, anger, and sadness.

Methods

We used 2 different natural language processing approaches: (1) the Linguistic Inquiry and Word Count computational tool and (2) the Google Perspective application programming interface (API) to analyze a data set of 8014 tweets containing terms related to COVID-19 vaccine mandates from September 14, 2021, to October 1, 2021. To collect the tweets, we used the Twitter API Tweet Downloader Tool (version 2). Subsequently, we filtered through a data set of 375,000 vaccine-related tweets using keywords to extract tweets explicitly focused on vaccine mandates. We relied on the Linguistic Inquiry and Word Count computational tool to measure the valence of linguistic anger, sadness, and anxiety in the tweets. To measure dimensions of post incivility, we used the Google Perspective API.

Results

This study resolved discrepant operationalizations of incivility by introducing incivility as a multifaceted construct and explored the distinct emotional processes underlying 5 dimensions of discourse incivility. The findings revealed that 3 types of emotions-anxiety, anger, and sadness-were uniquely associated with dimensions of incivility (eg, toxicity, severe toxicity, insult, profanity, threat, and identity attacks). Specifically, the results showed that anger was significantly positively associated with all dimensions of incivility (all P<.001), whereas sadness was significantly positively related to threat (P=.04). Conversely, anxiety was significantly negatively associated with identity attack (P=.03) and profanity (P=.02).

Conclusions

The results suggest that our multidimensional approach to incivility is a promising alternative to understanding and intervening in the psychological processes underlying uncivil vaccine discourse. Understanding specific emotions that can increase or decrease incivility such as anxiety, anger, and sadness can enable researchers and public health professionals to develop effective interventions against uncivil vaccine discourse. Given the need for real-time monitoring and automated responses to the spread of health information and misinformation on the web, social media platforms can harness the Google Perspective API to offer users immediate, automated feedback when it detects that a comment is uncivil.

Depression and Self-Efficacy Among Iranian Children During the Prevalence of COVID-19 Disease

The coronavirus disease 2019 (COVID-19) outbreak has quickly endangered the physical and mental health of people in the community, particularly vulnerable people such as children. This study was carried out to investigate the depression and self-efficacy of Iranian children during the COVID-19 outbreak. This cross-sectional research was conducted on 321 students aged 8 to 17 in southeast Iran. A social media-based online questionnaire was used to collect data. The information was gathered using demographic and COVID-related items, the Children's Depression Inventory (CDI), and the Self-Efficacy Questionnaire for Children (SEQ-C). No significant correlation was observed between depression and self-efficacy of children (P = 0.23). However, in subscale of CDI, negative mood, ineffectiveness and negative self-esteem had a significant correlation with self-efficacy (<0.001). Depression had a significant correlation with family income (p = 0.017), being at risk of coronavirus infection (p = 0.036), effectiveness of preventive measures (p = 0.015) and how information about the coronavirus disease was obtained (p = 0.018). According to the results, the mean score of depression was higher than the midpoint of the questionnaire in Iranian children, therefore, it is needed to take the necessary measures and treatment plans to reduce the rate of depression in children. Further research is needed to assess and prevent childhood depression.

The impact of COVID-19 pandemic on psychopathological symptoms in mothers and their school-age children before, during and after the COVID-19 pandemic peak

The COVID-19 pandemic had an impact on children's and caregivers' mental health. We investigated psychopathological symptoms in a group of non-at-risk and a group of at-risk mothers and their school-age children from the pre-pandemic period to the lockdown period and to the post-lockdown period. We used the SCL-90/R to assess mothers' psychological symptoms, the CBCL 1½-5, and the CBCL 6-18 for the perceived children's emotional-behavioral functioning. Analysis of variance was conducted to assess significant differences in the groups over the three assessment points. Linear regressions were run to investigate the effect of maternal psychological symptoms on their children's functioning. In the non-at-risk group, maternal psychopathological symptoms significantly varied during the pandemic. Children's Aggression scores decreased after the lockdown, while Depression scores significantly increased during lockdown and after. The mothers in the at- risk group presented overall decreasing scores over the three assessment points. Children's Aggression scores did not increase during lockdown. Depression scores did not show significant changes over the three assessment points. Overall, our results showed that mothers' psychopathological risk did not influence specific areas of children's emotional/behavioral functioning, but it had an effect on the general offspring psychological well-being.

Children Exposed to Intimate Partner Violence During Confinement: Characteristics by Age and Sex

The COVID-19 pandemic and restrictions imposed to stop its advance have affected the entire population. Children living with difficulties or in vulnerable situations prior to the pandemic might have suffered an even greater impact. This present study examines the psychological impact of quarantine on children and adolescents exposed to intimate partner violence against their mothers. Participants were 185 mothers who reported 269 children, as well as 108 children who self-reported. An emotional and behavioral checklist was administered to both mothers and children throughout confinement. Results show mothers observed changes in their children's psychological state. Children, in turn, reported an increase in different variables. Mothers reported a higher percentage of overall increase for both general and severe symptoms than their children. Differences were found by sex and age. Future research with similar population groups is necessary to establish the support and intervention children require in similar contexts, as well as to clarify possible causes of differences found by age and sex.

Children and Adolescents' Mental Health Following COVID-19: The Possible Role of Difficulty in Emotional Regulation

The COVID-19 pandemic has shattered routines throughout the world, creating closures and social isolation. Preliminary studies conducted during the pandemic have shown that children and adolescents are mainly affected by social distancing and the lack of a supportive framework. The purpose of the present study was to compare mental health symptoms of 430 children and adolescents who sought mental health services in the community before vs. during the pandemic. The study examined children's perceived burden of the pandemic, reports of emotional and behavioral problems (SDQ) anxiety (SCARED), depressed moods (SMFQ-C), and difficulty in emotional regulation (DERS), as well as intervening variables such as age and gender. Furthermore, the effect of difficulty in emotional regulation on children's mental health symptoms was explored. Findings indicate an increase in all mental health symptoms excluding anxiety, during the pandemic. Boys reported more difficulty in emotional regulation during the pandemic than before, and girls reported more emotional and behavioral problems. Children reported an increase in emotional and behavioral problems and adolescents in peer relationship problems. Difficulty in emotional regulation predicted all mental health symptoms in both samples, more so in girls and adolescents. These initial findings support the need for further studies to examine the long-term mental health effects of COVID-19 pandemic on children and adolescents.

The Impact of Family Factors on Children’s Mental Health during Home Quarantine: An Empirical Study in Northwest China

(1) Aims: This paper aims to analyze the factors affecting children’s mental health during home quarantine from the perspective of family composition in a specific Chinese context where historically, families are small in size. (2) Methods: Here, 10,210 online questionnaires from 3 junior high schools in Xi’an and Hanzhong from 23 to 27 February 2020, were collected to explore the impact of family factors on children’s mental health in Northwest China during home quarantine based on the ecosystem theory, by using OLS, logit regression models, and the Shapley value decomposition method. (3) Results: The mental health of northwestern Chinese children changed significantly after home quarantine. We also found that during home quarantine, some factors, such as a high-income family, lack of siblings, living with parents, mothers with middle- or high-level occupations, frequent parent–child communication, and better parent–child relationships, were positively related to children’s mental health. (4) Conclusions: Different from previous studies, this paper found that the psychological condition of children in Northwest China tended to be improved during the epidemic. In addition, family factors, especially the parent–child interaction, played an important role in the mental health of children during the epidemic.

Mental Health during COVID-19 Pandemic: Qualitative Perceptions among Lithuanian Adolescents

BACKGROUND

Since the COVID-19 pandemic emerged, humanity has had to face unprecedented change in daily routines. Therefore, the pandemic has also had an impact on mental health. Most of the literature analyzes adult experiences during the COVID-19 pandemic, while the youth is less investigated. The purpose of this study was to reveal adolescent experiences during COVID-19.

METHODS

This qualitative study consisted of 19 adolescents from 11-17 years old. Semi-structured in-depth interviews were conducted, and thematic analysis was applied.

RESULTS

Five themes were identified: ambivalent feelings; daily routine changes; disappointment with distance education; coping strategies; and discoveries.

CONCLUSION

The study revealed adolescents' mostly negative feelings such as sadness, anger, loneliness, or boredom. They shared about frustrating daily routine changes and shifting to a distance education mode that was quite limited in effectiveness and convenience. Nonetheless, communication with family, peers, pets, active leisure, and favorite activities helped them to cope with the difficulties during COVID-19. During this period, adolescents had more free time for themselves and personal growth, found new activities, or improved some relationships. Overall, the COVID-19 pandemic had mostly negative side effects, and regardless of positive experiences, it was mainly considered by adolescents as an adversity for their mental health.

Impact of School and Peer Connectedness on Adolescent Mental Health and Well-Being Outcomes during the COVID-19 Pandemic: A Longitudinal Panel Survey

School closures and social distancing measures during the pandemic have disrupted young people’s daily routines and social relationships. We explored patterns of change in adolescent mental health and tested the relationship between pre-pandemic levels of school and peer connectedness and changes in mental health and well-being between the first lockdown and the return to school. This is a secondary analysis of a longitudinal 3-wave panel survey. The study sample included 603 students (aged 13–14) in 17 secondary schools across south-west England. Students completed a survey pre-pandemic (October 2019), during lockdown (May 2020) and shortly after returning to school (October 2020). Multilevel models, with random effects, were conducted for anxiety, depression and well-being outcomes with school and peer connectedness as predictor variables. Symptoms of anxiety decreased from pre-pandemic to during the first UK lockdown and increased on the return to school; anxious symptoms decreased the most for students reporting feeling least connected to school pre-pandemic. Students reporting low levels of school and peer connectedness pre-pandemic experienced poorer mental health and well-being at all time points. Low school connectedness pre-pandemic was associated with a greater increase in anxious and depressive symptoms between lockdown and the return to school when compared to students with medium levels of school connectedness. No associations were found with high school connectedness or with low/high peer connectedness. For adolescents with poor school connectedness, the enforced time away from school that the pandemic caused led to reduced anxiety. Going forwards, we need to consider ways in which to promote connection with school as a way of supporting mental health and well-being.

Students’ Mathematics Anxiety at Distance and In-Person Learning Conditions during COVID-19 Pandemic: Are There Any Differences? An Exploratory Study

The COVID-19 pandemic has caused unprecedented changes in the educational system, requiring students to continually switch between distance and in-person learning conditions. Recent studies have revealed that students experienced severe levels of anxiety in the COVID-19 period. Considering the close relationship that has always linked anxiety to mathematics, the present study explores the differences in the anxiety levels of students towards mathematics during distance or in-person school learning. During the second wave of COVID-19, 405 students, recruited from twelve middle schools of Catania province (Italy), completed an online version of the MeMa questionnaire, answering each item twice and imagining themselves to be, respectively, in distance and in-person learning conditions. The items explored generalized school anxiety, learning and evaluation mathematics anxiety, mental states, and the metacognitive awareness associated with mathematical tasks. The results showed a minor state of anxiety experienced during distance learning. However, the students who preferred to learn mathematics in person revealed less mathematics anxiety and better mental states and metacognitive awareness; the same results were found in those who reported higher math marks and who preferred scientific subjects. It seems that math anxiety is not one of the various flaws that are imputed to distance learning. Our findings encourage a reflection on possible interventions to reduce students’ anxiety by working on motivation and dysfunctional beliefs.

Changes in children's wellbeing in Bradford during COVID-19: The Born in Bradford COVID-19 longitudinal research study

Background: Concerns have been raised about the potential impact of COVID-19 and associated lockdown measures on child mental wellbeing, but emerging evidence suggests mixed results and there is a dearth of information from ethnically diverse samples. The current study aims to explore the impact of the pandemic on wellbeing using longitudinal data collected from the multi-ethnic Born in Bradford family cohort study. Methods: Within-child changes in wellbeing were explored using data collected pre-pandemic and again during the first UK lockdown for 500 children aged 7-13 from a range of ethnic and socioeconomic backgrounds, using self-reported feelings of happiness and sadness. Associations between changes in wellbeing, demographic factors, quality of social relationships and physical activity levels were explored using multinomial logistic regression models. Results: In this sample, 55% of children reported no change in their wellbeing from pre-pandemic to during the first lockdown (n=264). Children of Pakistani heritage were more than twice as likely to report feeling sad less often than White British children (RRR: 2.61, 95% CI: 1.23, 5.51) during the first lockdown. Those who reported being left out by other children before the pandemic were over three times as likely than those who did not (RRR: 3.72: 1.51, 9.20) to report feeling sad less often during the pandemic. Around a third of children reported feeling happier (n=152, 31.6%), but these changes did not relate to any of the explanatory variables included in this analysis. Conclusion: Many children in this study reported no changes in their wellbeing during the first UK lockdown compared to before the pandemic and some described improved wellbeing. These findings suggest that children have coped well with the significant changes over the past year, though targeted support, particularly for those children who felt excluded before the pandemic, would be beneficial.

The Link between Subjective Religiosity, Social Support, and Mental Health among Young Students in Eastern Europe during the COVID-19 Pandemic: A Cross-Sectional Study of Poland and Ukraine

Religiousness has a positive effect on the mental health of an individual and social groups in many difficult situations. In the conducted research, we wanted to check, inter alia, whether religiosity and social support are positively related to the mental health of students during the COVID-19 pandemic in Poland and Ukraine. The research was conducted at a time (August 2021) when the very contagious Delta variant was spreading over Europe, and numerous pandemic-related personal restrictions and obligations (such as using facemasks in selected places, social distancing, and obligatory self-isolation of the ill or those who had contact with the pathogen) were in force in both countries. For this purpose, a representative survey was carried out using the CAPI technique on a sample of 1000 students in Poland (50% boys and 50% girls in the age range 10–19) and 1022 in Ukraine (51% boys and 49% girls in the age range 10–18). The results of the research shows that depression measured by the PHQ-9 scale was experienced by 20% of students in Poland, and 13% in Ukrainian. Anxiety, measured with the GAD-7 scale, was experienced by 9% of the Polish and 6% of the Ukrainian students. The performed regression analysis showed that religiosity had no effect on the mental health of students. The main risk factor for mental disorders was the lack of social support.

Family Thriving During COVID-19 and the Benefits for Children's Well-Being

Although the COVID-19 pandemic has raised deserved concern regarding adverse impacts on parents' and children's mental health, regulations like "sheltering-in-place" may have afforded parents novel opportunities to foster positive family connections, thereby bolstering well-being. Using latent profile analysis (LPA), we (a) distinguished family thriving during shelter-in-place (May-June 2020) from other patterns of family functioning, (b) tested potential predictors of family functioning profiles, and (c) examined if family thriving predicted subsequent child adjustment (September-October 2020). 449 parents in two-parent U.S. families with children aged 2-18 years completed online surveys assessing (a) parent-child relationship quality, parents' positive psychological adjustment, children's emotional well-being, and parenting efficacy and satisfaction as family functioning indicators, (b) financial, marital, parental psychosocial assets, and child (age, gender, and temperament) predictors of family functioning, and (c) child adjustment. LPA identified four family functioning profiles: Thriving, Managing, Struggling, and Distressed. Thriving families evinced higher scores on all functioning indicators. Logistic regressions revealed that parents in Thriving families reported significantly lower financial anxiety, less dissatisfaction with partner's help, less child emotionality, and greater use of cognitive reappraisal, as well as more positive child adjustment in Fall 2020. These findings underscore the multidimensional nature of coping and well-being during COVID-19. Utilizing these levers to promote mental health in families languishing during comparable future crises could promote resilience, thereby protecting children's well-being.

Editorial Perspective: Rapid responses to understand and address children and young people's mental health in the context of COVID-19

Prior to the pandemic, we already had good reason to be concerned about the mental health of children and young people. As an example, the 2017 Mental Health of Children and Young People (MHCYP) survey in England, comprising a large, national probability sample, identified that one in nine children had a probable mental health disorder, with a 49% increase in emotional disorders compared to a previous survey in 2004 (Sadler et al., 2018). The pandemic has clearly brought a broad range of challenges to children and young people. These include the direct viral threat to self, friends, and family (with recent estimates of a 17.5%-20.2% increase in parental bereavement in the United States; Kidman et al, 2021), as well as disruptions to school work, social interactions, family pressures, economic impacts, a lack of opportunity and ongoing uncertainty, and reduced access to mental health and other support from outside the home. So how have these experiences affected the mental health of children and young people?

Rates, perceptions and predictors of depression, anxiety and Post Traumatic Stress Disorder (PTSD)-like symptoms about Covid-19 in adolescents

Increasing evidence has shown that the Covid-19 outbreak, and subsequent school closures and exam cancellations that followed, has impacted adolescent mental health. The current cross-sectional study examined rates of depression, anxiety and Post Traumatic Stress Disorder (PTSD)-like symptoms about Covid-19 in adolescents and whether current or past mental health support, additional support in school, keyworker status, poorer household relationships since the outbreak of Covid-19 or reduced physical activity were associated with elevated levels of depression, anxiety or PTSD-like symptoms. Lastly, it examined perceived changes in mental health due to the Covid-19 pandemic, school closures and the cancellation of exams. A total of 899 adolescents (14–18 years) took part in the ’in isolation instead of in school’ (INISS) project. Findings indicated that older adolescents, females, those who currently or previously received mental health support or additional support in school and adolescents who reported poorer relationships at home since Covid-19 were more likely to meet clinical threshold levels for their mental health. Adolescents highlighted worsening of their mental health due to Covid-19 and school closures with mixed positive and negative impact of exam cancellations. Adolescents experiencing clinical threshold levels of depression and anxiety uniquely reported worsening of their mental health since the Covid-19 pandemic, school closures and exam cancellations. Understanding the rates, perceptions and factors associated with increases in depression, anxiety and PTSD-like symptoms in adolescents during the Covid-19 pandemic will inform national policy in supporting adolescent mental health and recovery from the Covid-19 pandemic.

Potential indirect impacts of the COVID-19 pandemic on children: a narrative review using a community child health lens

▪In this narrative review, we summarise the vast and burgeoning research on the potential and established indirect impacts on children of the COVID-19 pandemic. We used a community child health lens to organise our findings and to consider how Australia might best respond to the needs of children (aged 0-12 years). ▪We synthesised the literature on previous pandemics, epidemics and natural disasters, and the current COVID-19 pandemic. We found clear evidence of adverse impacts of the COVID-19 pandemic on children that either repeated or extended the findings from previous pandemics. ▪We identified 11 impact areas, under three broad categories: child-level factors (poorer mental health, poorer child health and development, poorer academic achievement); family-level factors that affect children (poorer parent mental health, reduced family income and job losses, increased household stress, increased abuse and neglect, poorer maternal and newborn health); and service-level factors that affect children (school closures, reduced access to health care, increased use of technology for learning, connection and health care). ▪There is increasing global concern about the likely disproportionate impact of the current pandemic on children experiencing adversity, widening existing disparities in child health and developmental outcomes. ▪We suggest five potential strategy areas that could begin to address these inequities: addressing financial instability through parent financial supplements; expanding the role of schools to address learning gaps and wellbeing; rethinking health care delivery to address reduced access; focusing on prevention and early intervention for mental health; and using digital solutions to address inequitable service delivery.

Identifying factors related to school closures due to COVID-19 in the Middle East and North Africa region

The COVID-19 pandemic has had devastating effects on the Middle East and North Africa (MENA) region, and MENA states have taken dramatic steps in response. This study focuses on school closures, an intervention that all MENA states adopted, some much earlier than others. It seeks to identify policy factors related to MENA governments' decisions to close schools during the first wave of the pandemic. Results suggest external issues regarding temporal and geographic diffusion played the largest role. They also indicate that factors related to disease risk, the economy, political institutions, and women's position in society mattered as well, all of which suggest the decisions were complex.

Racial and demographic disparities in emergency department utilization for mental health concerns before and during the COVID-19 pandemic

This study investigated whether emergency department (ED) visits for mental health concerns increased during the COVID-19 pandemic, taking a health disparities lens. ED encounters from the only academic medical center in Mississippi were extracted from March-December 2019 and 2020, totaling 2,842 pediatric (ages 4-17) and 17,887 adult (ages 18-89) patients. Visits were coded based on primary ED diagnosis. For adults, there were fewer depression/anxiety ED visits during the pandemic, not moderated by any demographic factor, but no differences for serious mental illness or alcohol/substance use. For youth, there were significantly fewer ED visits for behavior problems during the pandemic among children in the lower socioeconomic status (SES) category; there were no differences for depression/anxiety. Regardless of year, adults in the lower SES category were more likely to visit the ED for mental health, Black adults were less likely to visit the ED for depression/anxiety or alcohol/substance use, and Black children were less likely to visit the ED for behavioral concerns. Results suggest that access to outpatient and telehealth services remains critical for mental health care during the pandemic and underline the importance of race- and SES-related factors in use of the ED for mental health concerns beyond the pandemic.

Effects of COVID-19 pandemic on mental health of children and adolescents: A systematic review of survey studies

Objective

Mental health problems among children and adolescents are increasingly observed during the outbreak of COVID-19, leading to significant healthcare concerns. Survey studies provide unique opportunities for research during this pandemic, while there are no existing systematic reviews in this setting. The objective was to summarize existing survey studies addressing the effects of the current COVID-19 pandemic on the mental health of children and adolescents.

Methods

For this systematic review, we performed an electronic search in multiple databases from December 2019 to December 2020. The quality appraisal of the included studies was performed with the Critical Appraisal Skills Programme Qualitative Checklist. Because of the high methodological heterogeneity between studies, a narrative synthesis of the qualitative data was used.

Results

In total, 35 survey studies with 65,508 participants, ranging from 4 to 19 years of age, are included in this review. Anxiety (28%), depression (23%), loneliness (5%), stress (5%), fear (5%), tension (3%), anger (3%), fatigue (3%), confusion (3%), and worry (3%) were the most common mental health issues reported. Children and adolescents with psychiatric and/or developmental disorders, such as severe obesity, chronic lung disease, attention deficit hyperactivity disorder, cystic fibrosis, and obsessive-compulsive disorders, were especially vulnerable to the mental health effects of the COVID-19 pandemic. Age, gender, psychological quality, and negative coping strategies were identified as risk factors for the development of mental health problems. Social and family support, along with a positive coping style, was associated with better outcomes.

Conclusion

The impact of the COVID-19 pandemic on mental health of children and adolescents is multifaceted and substantial. Survey studies regarding child and adolescent mental health amid COVID-19 indicated that anxiety, depression, loneliness, stress, and tension are the most observed symptoms. Positive coping strategies with family and social support may be important to achieving better outcomes. Due to limited available evidence, more well-designed studies in this area are urgently needed.

Mental Health Consequences of the COVID-19 Pandemic Among Ontario’s Youth: A Cross-Sectional Study

The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on the mental health and wellbeing of Ontario's youth. Our study investigated the psychological impacts of COVID-19 on the pediatric population of Ontario, using a survey derived from the Revised Children's Anxiety and Depression Scale (RCADS) system to identify children who may benefit from seeking professional help. Our cross-sectional study examined the potential risk factors that contributed to worsening mental health and wellbeing in children, including changes in sleep patterns, appetite, and physical activity levels, as well as the diagnosis of a family member with COVID-19. Our study found that 24%, 9.4%, and 15.5% of participants exhibited symptoms of depression, anxiety, and obsessive-compulsive disorder (OCD), respectively, according to the RCADS system. Furthermore, there were significant associations between the presence of symptoms and the diagnosis of a family member with COVID-19 or a frontline worker in the family. This suggests a need to create interventions to support the families of frontline workers and those directly affected by a COVID-19 diagnosis.

Happier during lockdown: a descriptive analysis of self-reported wellbeing in 17,000 UK school students during Covid-19 lockdown

Relatively little research has focused on children and young people (CYP) whose mental health and wellbeing improved during Covid-19 lockdown measures. We aimed to (1) determine the proportion of CYP who self-reported improvement in their mental wellbeing during the first Covid-19 lockdown and (2) describe the characteristics of this group in relation to their peers. We conducted a descriptive analysis of data from the 2020 OxWell Student Survey, a self-report, cross-sectional survey of English CYP. A total of 16,940 CYP primarily aged 8-18 years reported on change in mental wellbeing during lockdown. We characterised these CYP in terms of school, home, relational, and lifestyle factors as well as feelings about returning to school. One-third (33%) of CYP reported improved mental wellbeing during the first UK national lockdown. Compared with peers who reported no change or deterioration, a higher proportion of CYP with improved mental wellbeing reported improved relationships with friends and family, less loneliness and exclusion, reduced bullying, better management of school tasks, and more sleep and exercise during lockdown. In conclusion, a sizeable minority of CYP reported improved mental wellbeing during lockdown. Determining the reasons why these CYP felt they fared better during lockdown and considering how these beneficial experiences can be maintained beyond the pandemic might provide insights into how to promote the future mental health and wellbeing of school-aged CYP. All those working with CYP now have an opportunity to consider whether a systemic shift is needed in order to understand and realise any learnings from experiences during the pandemic.