COVID-19 pandemic impact on children and adolescents' mental health: Biological, environmental, and social factors

Generalized anxiety disorder among rural primary and middle school students during the outbreak of COVID-19: a multicenter study in three southern Chinese cities

BACKGROUND

The major public health crisis caused by the rapid spread of the coronavirus disease 2019 (COVID-19) and the large-scale public health measures such as social isolation and school closures enforced by some countries have severely affected on the physical and mental wellbeing of children and adolescents globally. This study aimed to estimate the prevalence of the psychological impact and investigate the similarities and differences in the influential factors for generalized anxiety disorder among rural adolescents as a relatively lesser noticed population the outbreak of COVID-19.

METHODS

From May 11 to 22, 2020, a total of 1,179 adolescents, including Grade 5-6 in primary school and Grade 7-8 in middle school, were selected by multistage sampling in three Southern Chinese cities (Shantou, Guangdong Province; Hezhou, Guangxi Province; Nanchong, Sichuan Province), and completed the questionnaires including sociodemographic, generalized anxiety disorder, academic stress, coronaphobia, knowledge of COVID-19, and precautionary measures. ANOVA, Chi-square test, Kruskalwallis H test and multivariate linear regression were performed in the statistical analysis.

RESULTS

The average scores of generalized anxiety disorder during the past two weeks were 3.43 (SD 4.46), 4.47 (SD 5.15), and 4.10 (SD 4.94) in Shantou, Hezhou and Nanchong, respectively. For the pooled data, academic stress (P < 0.001), coronaphobia (P < 0.001), and precautionary measures (P = 0.002) contributed to the prediction of anxiety scores. Academic stress was significantly associated to anxiety symptoms in all cities (P all < 0.001). Coronaphobia was also significantly associated to anxiety symptoms in all cities (P all < 0.001).

CONCLUSION

This study highlights the urgent need for researchers and policymakers to focus on the mental health of rural children and adolescents during the COVID-19 epidemic. The adolescents with academic stress and coronaphobia, the greater the risk that adolescents will suffer from anxiety, suggesting mental health counseling and professional family support are needed.

Affiliation to a Social Group as a Preventive Factor in Suicidal Behaviors in Children and Adolescents during the COVID-19 Pandemic

Suicide is one of the most common causes of death in the population of children and adolescents. Available data show the continuous growth of this phenomenon and the ineffectiveness of prevention programs. Additionally, the COVID-19 pandemic significantly affected young people's mental health, including an increased risk of suicidal behaviors due to limited direct contact with the school and peer groups in favor of the home environment. Therefore, the aim of this narrative review was to consider the risk factors and protective factors for suicidal behavior in the under-18 population, with a particular focus on the importance of belonging to a social group and building identification with it as a phenomenon protecting against suicidal behavior. Additionally, in this review, we evaluate how the COVID-19 pandemic affected these relationships. The PubMed database was used in the search with the following keywords: suicide, suicide behaviors, child and adolescent suicide behaviors, group affiliation, family affiliation, ethnicity, religious affiliation, and the COVID-19 pandemic, with articles published between 2002 and 2022 analyzed. Research conducted to date indicates that both sustained and stable family and peer relationships, as well as a sense of identification and belonging, noticeably reduce the risk of suicidal behavior. Ethnic or cultural affiliation seems to have been particularly important during the isolation in the home environment caused by the COVID-19 pandemic. Additionally, it has been shown that while in lockdown, contact through social media with individuals' identification groups was associated with a reduced chance of emotional crises. Furthermore, regardless of cultural background, attachment to a particular group correlates with enhanced psychiatric state of children and adolescents. Thus, available data highlight the need for building and maintaining affiliations with suitable groups as a protective factor against suicidal behaviors.

Data-Driven Assessment of Adolescents' Mental Health During the COVID-19 Pandemic

OBJECTIVE

Adolescents' mental health was severely compromised during the COVID-19 pandemic. Longitudinal real-world studies on changes in the mental health of adolescents during the later phase of the pandemic are limited. We aimed to quantify the effect of COVID-19 pandemic on adolescents' mental health outcomes based on electronic health records.

METHOD

This was a retrospective cohort study using the computerized database of a 2.5 million members, state-mandated health organization in Israel. Rates of mental health diagnoses and psychiatric drug dispensations were measured among adolescents 12 to 17 years of age with and without pre-existing mental history, for the years 2017 to 2021. Relative risks were computed between the years, and interrupted time series (ITS) analyses evaluated changes in monthly incidence rates of psychiatric outcomes.

RESULTS

The average population size was 218,146 in 2021. During the COVID-19 period, a 36% increase was observed in the incidence of depression (95% CI = 25-47), 31% in anxiety (95% CI = 23-39), 20% in stress (95% CI = 13-27), 50% in eating disorders (95% CI = 35-67), 25% in antidepressant use (95% CI = 25-33), and 28% in antipsychotic use (95% CI = 18-40). A decreased rate of 26% (95% CI = 0.80-0.88) was observed in ADHD diagnoses. The increase of the examined outcomes was most prominent among youth without psychiatric history, female youth, general secular Jewish population, youth with medium-high socioeconomic status, and those 14 to 15 years of age. ITS analysis confirmed a significantly higher growth in the incidence of psychiatric outcomes during the COVID-19 period, compared to those in previous years.

CONCLUSION

This real-world study highlights the deterioration of adolescents' mental health during the COVID-19 pandemic and suggests that youth mental health should be considered during health policy decision making.

DIVERSITY & INCLUSION STATEMENT

We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We actively worked to promote sex and gender balance in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

A dynamic causal modeling of the second outbreak of COVID-19 in Italy

While the vaccination campaign against COVID-19 is having its positive impact, we retrospectively analyze the causal impact of some decisions made by the Italian government on the second outbreak of the SARS-CoV-2 pandemic in Italy, when no vaccine was available. First, we analyze the causal impact of reopenings after the first lockdown in 2020. In addition, we also analyze the impact of reopening schools in September 2020. Our results provide an unprecedented opportunity to evaluate the causal relationship between the relaxation of restrictions and the transmission in the community of a highly contagious respiratory virus that causes severe illness in the absence of prophylactic vaccination programs. We present a purely data-analytic approach based on a Bayesian methodology and discuss possible interpretations of the results obtained and implications for policy makers.

From study abroad to study at home: Spontaneous neuronal activity predicts depressive symptoms in overseas students during the COVID-19 pandemic

The objective of this study was to evaluate symptoms of depression and anxiety as well as changes in spontaneous neuronal activity in college students studying abroad during the coronavirus 2019 (COVID-19) pandemic. We examined functional brain changes using resting-state functional magnetic resonance imaging (fMRI), the amplitude of low-frequency fluctuations (ALFF), and regional homogeneity (ReHo) in overseas students with enforced isolation due to the COVID-19 pandemic. Additionally, emotional assessments were administered to determine the severity of depression and anxiety. The questionnaire results showed that anxiety and depressive symptoms differed between overseas students (i.e., those attending an overseas college virtually) and local students (i.e., those attending a local college in person). The fMRI data revealed higher ALFF values in the bilateral superior medial frontal gyrus, bilateral pre-central gyrus, left insula, and left superior temporal gyrus as well as lower ALFF values in the bilateral paracentral lobule (supplementary motor area) in overseas students. Moreover, ReHo analysis also revealed significant differences between overseas students and local students. Compared with local students, overseas students showed significantly increased ReHo in the right inferior frontal and superior temporal gyri and decreased ReHo in the bilateral paracentral lobule, bilateral superior medial frontal gyrus (supplementary motor area), and bilateral pre-central gyrus. In addition, in overseas students, altered ReHo in the cluster including the left superior and medial frontal gyri, pre-central gyrus, and paracentral lobule was significantly positively correlated with Self-Rating Depression Scale scores. Thus, spontaneous brain activity in overseas students changed during the COVID-19 pandemic. This change in brain function might be related to depression and anxiety symptoms. These results suggest that mental health services are needed to decrease the risk of anxiety and depression among college students studying abroad during the COVID-19 pandemic.

The associations of everyday and major discrimination exposure with violence and poor mental health outcomes during the COVID-19 pandemic

Research on discrimination and risks for violence and mental health issues under the pandemic is notably absent. We examined the relative effects of perceived everyday discrimination (e.g., poorer service, disrespectful treatment in a typical week) and major experiences of race-based discrimination (e.g., racial/ethnic discrimination in housing or employment at any point in the lifetime) on experiences of violence and the PHQ-4 assessment of symptoms of depression and anxiety under the pandemic. We analyzed state-representative cross-sectional survey data from California adults (N = 2114) collected in March 2021. We conducted multivariate regression models adjusting for age, race/ethnicity, gender, sexual identity, income, and disability. One in four Californians (26.1%) experienced everyday discrimination in public spaces, due most often to race/ethnicity and gender. We found that everyday discrimination was significantly associated with past year physical violence (single form Adjusted Odds Ratio [AOR] 5.0, 95% CI 2.5-10.3; multiple forms AOR 2.6, 95% CI 1.1-5.8), past year sexual violence (multiple forms AOR 2.5, 95% CI 1.4-4.4), and mental health symptoms (e.g., severe symptoms, multiple forms AOR 3.3, 95% CI 1.6-6.7). Major experiences of race-based discrimination (reported by 10.0% of Californians) were associated with past year sexual violence (AOR 2.0, 95% CI 1.1-3.8) and severe mental health symptoms (AOR 2.7, 95% CI 1.2-6.2). Non-race-based major discrimination (reported by 23.9% of Californians) was also associated with violence and mental health outcomes Everyday discrimination, more than major experiences of discrimination, was associated with higher risk for violence and poor mental health outcomes during the pandemic. Non-race-based forms of major discrimination independently were also associated with these negative outcomes. Findings indicate that efforts to reduce and ultimately eliminate discrimination should be a focus of public health and COVID-19 rebuilding efforts.

European Working Group on SARS-CoV-2: Current Understanding, Unknowns, and Recommendations on the Neurological Complications of COVID-19

The emergence of COVID-19 was rapidly followed by infection and the deaths of millions of people across the globe. With much of the research and scientific advancement rightly focused on reducing the burden of severe and critical acute COVID-19 infection, the long-term effects endured by those who survived the acute infection has been previously overlooked. Now, an appreciation for the post-COVID-19 condition, including its neurological manifestations, is growing, although there remain many unknowns regarding the aetiology and risk factors of the condition, as well as how to effectively diagnose and treat it. Here, drawing upon the experiences and expertise of the clinicians and academics of the European working group on COVID-19, we have reviewed the current literature to provide a comprehensive overview of the neurological sequalae of the post-COVID-19 condition. In this review, we provide a summary of the neurological symptoms associated with the post-COVID-19 condition, before discussing the possible mechanisms which may underly and manifest these symptoms. Following this, we explore the risk factors for developing neurological symptoms as a result of COVID-19 and the post-COVID-19 condition, as well as how COVID-19 infection may itself be a risk factor for the development of neurological disease in the future. Lastly, we evaluate how the post-COVID condition could be accurately diagnosed and effectively treated, including examples of the current guidelines, clinical outcomes and tools that have been developed to aid in this process, as well as addressing the protection provided by COVID-19 vaccines against post-COVID-19 condition. Overall, this review provides a comprehensive overview of the neurological sequalae of the post-COVID-19 condition.

How to Make the Unpredictable Foreseeable? Effective Forms of Assistance for Children with Autism Spectrum Disorder (ASD) during the COVID-19 Pandemic

Symptomatology in patients with the diagnosis of autism spectrum disorder (ASD) is very heterogeneous. The symptoms they present include communication difficulties, behavior problems, upbringing problems from their parents, and comorbidities (e.g., epilepsy, intellectual disability). A predictable and stable environment and the continuity of therapeutic interactions are crucial in this population. The COVID-19 pandemic has created much concern, and the need for home isolation to limit the spread of the virus has disrupted the functioning routine of children/adolescents with ASD. Are there effective diagnostic and therapeutic alternatives to limit the consequences of disturbing the daily routine of young patients during the unpredictable times of the pandemic? Modern technology and telemedicine have come to the rescue. This narrative review aims to present a change in the impact profile in the era of isolation and assess the directions of changes that specialists may choose when dealing with patients with ASD.

A mixed-method study on adolescents' well-being during the COVID-19 syndemic emergency

In this study, we set out to investigate adolescents' levels of perceived well-being and to map how they went about caring for their well-being during the COVID-19 syndemic. Participants were 229 Italian adolescent high school students (48.9% males, mean age = 16.64). The research design was based on an exploratory, parallel, mixed-method approach. A multi-method, student-centered, computer-assisted, semi-structured online interview was used as the data gathering tool, including both a standardized quantitative questionnaire on perceived well-being and an open-ended question about how adolescents were taking charge of their well-being during the COVID-19 health emergency. Main findings reveal general low levels of perceived well-being during the syndemic, especially in girls and in older adolescents. Higher levels of well-being are associated with more affiliative strategies (we-ness/togetherness) whereas low levels of well-being are linked with more individualistic strategies (I-ness/separatedness) in facing the health emergency. These findings identify access to social support as a strategy for coping with situational stress and raise reflection on the importance of balancing the need for physical distancing to protect from infection, and the need for social closeness to maintain good mental health.

A Following Wave Pattern of Suicide-Related Pediatric Emergency Room Admissions during the COVID-19 Pandemic

The COVID-19 pandemic and response, which included physical distancing and stay-at-home orders, disrupted the daily lives of children and adolescents, isolating them from their peers, school, and other meaningful contacts. The present study aims to add to the accumulating evidence on the pandemic's impact on child and adolescent suicidal behavior. Data were extracted from Schneider Children's Medical Center of Israel's pediatric emergency room (ER) admissions for psychiatric consultation for suicidal-risk assessment between 1 January 2020, and 16 April 2022. We applied time-lagged cross-correlation analysis and a Granger causality test to assess the temporal relationships between COVID-19 infection waves and patterns of suicide-related ER admissions. The results revealed a significant lagged correlation between national COVID-19 infection rates and ER admission rates. The highest correlation was above 0.4 and was found with a lag of 80 to 100 days from infection rate to ER admission rate. The findings show that the effects of public crises change over time and may be lagged. This may have important implications for mental health services' readiness to serve growing numbers of children and adolescents at risk for suicide.

Predictors of Adolescent Resilience During the COVID-19 Pandemic in a Community Sample of Hispanic and Latinx Youth: Expressive Suppression and Social Support

The COVID-19 pandemic has created unprecedented disruptions in the daily lives and mental health of adolescents. Less attention has been given to the psychosocial resources that may mitigate the impact of COVID-19 on adolescent mental health, particularly among minoritized populations. In the present study, 259 youth (aged 11-18) were recruited from a community center for integrated prevention and intervention services in a predominantly Latinx and Hispanic community. Youth completed questionnaires about the impact COVID-19 has had on their lives, psychosocial resources (humor, optimism, emotion regulation, social support), and psychiatric symptoms (depressive symptoms, anxiety symptoms, sleep disturbances, aggression). After accounting for age, sex, and exposure to early life adversity, higher reported COVID-19 impact was associated with more depressive symptoms, b = 6.37 (SE = 1.67), 95% CI [3.08, 9.66], p < 0.001, more anxiety symptoms, b = 9.97 (SE = 1.63), 95% CI [6.75, 13.18], p < 0.001, and more sleep disturbances, b = 1.24 (SE = 0.34), 95% CI [0.57, 1.91], p < 0.001. Youth that reported infrequent expressive suppression and the lowest scores on giving social support were at the greatest risk for aggressive behavior in the context of high COVID-19 impact, ps < 0.007. Increasing emotion regulation skills, such as expressive suppression, and opportunities to give social support may promote resilience among high risk youth in the context of this ongoing community stressor.

Bibliometric and visualization analysis of research trend in mental health problems of children and adolescents during the COVID-19 pandemic

Objectives

To analyze the evolution of research on children and adolescents mental health issues during COVID-19 pandemic and discuss research hotspots and cutting-edge developments.

Methods

The literature obtained from the web of science core collection as of June 28, 2022, was analyzed using Citespace, VOSviewer bibliometric visualization mapping software.

Results

A total of 6,039 relevant papers were found, of which 5,594 were included in the study. The number of literatures is growing since 2020; and the country, institution, and journal publications were analyzed. The co-citation analysis shows that there are more research articles among the highly cited articles and a lack of systematic reviews that use critical thinking for review. In the cluster analysis, mental health and life change were the most representative. The timeline view of the keywords shows that Online learning (#0), Public health (#1), and Mental health (#2) are the three largest clusters and shows the change over time.

Conclusion

This study helped analyze the mental health of children and adolescents during the COVID-19 pandemic and identified hot trends and shortcomings, which are important references for the theoretical basis of future research and decision making and technical guidance for systematic reviews.

Tobacco, Alcohol, Cannabis, and Other Drug Use in the US Before and During the Early Phase of the COVID-19 Pandemic

IMPORTANCE

Information about national substance use trends among youths and adults after mid-March 2020 is limited due to constraints on surveillance during the COVID-19 pandemic.

OBJECTIVE

To evaluate whether substance use prevalence in the early part of the pandemic (2020) differed from the prepandemic periods of 2018 to 2019 and 2016 to 2018.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study was a repeated analysis of 2016 to 2020 data from a nationally representative sample of youths and adults in the Population Assessment of Tobacco and Health (PATH) Study. Participants were representative of the US civilian noninstitutionalized population. Household residents age 13 years or older were interviewed in person from 2016 to 2019 and via telephone in 2020.

EXPOSURES

Age, calendar year.

MAIN OUTCOMES AND MEASURES

Past 30-day self-reported use of any tobacco, any alcohol, binge drinking, cannabis, and any other illegal or misused prescription drugs.

RESULTS

The overall nationally representative 2020 sample included 7129 youths (ages 13-17 years), 3628 young adults (ages 18-20 years), and 8874 adults (ages ≥21 years). Comparing 2018 to 2019 with 2020 among youths, prevalence of all substances used declined (eg, cannabis use declined in those aged 16-17 years from 14.9% to 7.6%; absolute difference, -7.3 percentage points [95% CI -8.8 to -5.8 percentage points]). Among young adults, prevalence of all substances other than any alcohol decreased significantly (eg, tobacco use declined from 37.8% to 22.8%; absolute difference, -15.1 percentage points [95% CI -16.8 to -13.3 percentage points]). In adults ages 21 to 24 years, any tobacco use declined from 39.0% to 30.9% (absolute difference, -8.2 percentage points [95% CI, -10.6 to -5.7 percentage points]), and alcohol use increased from 60.2% to 65.2% (absolute difference, 5.0 percentage points [95% CI, 2.3 to 7.7 percentage points]). Among adults aged 25 years or older, any tobacco use declined from 39.0% to 30.9% (absolute difference, -8.2 percentage points [95% CI, -10.6 to -5.7 percentage points]), cannabis use increased from 11.3% to 12.4% (absolute difference, 1.2 percentage points [95% CI, 0.3 to 2.0 percentage points]), and other substance use declined from 5.8% to 3.7% (absolute difference, -2.1 percentage points [95% CI, -2.9 to -1.4 percentage points]).

CONCLUSIONS AND RELEVANCE

In this cross-sectional study, substance use decreased between 2019 and 2020 among those aged 13 to 20 years; consistent declines were not seen in older persons other than tobacco use reductions, and cannabis use increased among adults ages 25 years and older. While social changes during the COVID-19 pandemic could have affected substance use, findings should be interpreted with caution due to differences in data collection methods in 2016 to 2019 and 2020.

Impact of COVID-19 inequalities on children: An intersectional analysis

Societal concerns about the effects of the COVID-19 pandemic have largely focussed on the social groups most directly affected, such as the elderly and health workers. However, less focus has been placed on understanding the effects on other collectives, such as children. While children's physical health appears to be less affected than the adult population, their mental health, learning and wellbeing is likely to have been significantly negatively affected during the pandemic due to the varying policy restrictions, such as withdrawal from face to face schooling, limited peer-to-peer interactions and mobility and increased exposure to the digital world amongst other things. Children from vulnerable social backgrounds, and especially girls, will be most negatively affected by the impact of COVID-19, given their different intersecting realities and the power structures already negatively affecting them. To strengthen the understanding of the social determinants of the COVID-19 crisis that unequally influence children's health and wellbeing, this article presents a conceptual framework that considers the multiple axes of inequalities and power relations. This understanding can then be used to inform analyses and impact assessments, and in turn inform the development of effective and equitable mitigation strategies as well as assist to be better prepared for future pandemics.

Investigation of factors associated with mental health during the early part of the COVID-19 pandemic in South Korea based on machine learning algorithms: A cohort study

Objective

The coronavirus disease 2019 (COVID-19) pandemic is among the most critical public health problems worldwide in the last three years. We tried to investigate changes in factors between pre- and early stages of the COVID-19 pandemic.

Methods

The data of 457,309 participants from the 2019 and 2020 Community Health Survey were examined. Four mental health-related variables were selected for examination as a dependent variable (patient health questionnaire-9, depression, stress, and sleep time). Other variables without the aforementioned four variables were split into three groups based on the coefficient values of lasso and ridge regression models. The importance of each variable was calculated and compared using feature importance values obtained from three machine learning algorithms.

Results

Psychiatric and sociodemographic variables were identified, both during the pre- and early pandemic periods. In contrast, during the early pandemic period, average sleep time variables ranked the highest with the dependent variables regarding the experience of depression. The difference in sleep time before and after the pandemic was validated by the results of paired t-tests, which were statistically significant (p-value < 0.05).

Conclusions

Changes in the importance of mental health factors in the early pandemic period in South Korea were identified. For each mental health-dependent variable, average sleep time, experience of depression, and experience of accidents or addictions were found to be the most important factors. House type and type of residence were also found in regions with larger populations and a higher number of confirmed cases.

Cyber-Victimization and Mental Health Concerns among Middle School Students Before and During the COVID-19 Pandemic

The COVID-19 pandemic had significant impacts on adolescents' mental health and social interactions; however, little is known about cyber-victimization and mental health concerns from before to during the pandemic. The current study addressed this gap, while also examining how social media use and disagreements with friends during the pandemic were associated with cyber-victimization and mental health outcomes. Participants included 272 youth in the U.S. (56% female; 32% White), surveyed in fall 2019 (M_age = 11.75, SD = 0.68) and spring 2021 (M_age = 13.11, SD = 0.75). Adolescents reported increases in mental health symptoms and decreases in cyber-victimization. Experiencing more cyber-victimization before the pandemic was associated with significant increases in anxiety, depression, and social stress. The results suggest bolstering violence prevention programming in schools to reduce the likelihood of cyber-victimization and associated mental health outcomes.

Trends in health behaviors and mental health among Korean adolescents in Korea over 5 years, 2017-2021: focusing on the comparisons before and during the COVID-19 pandemic

Objectives

We investigated recent trends in health behaviors and mental health conditions among Korean adolescents from 2017 to 2021 and compared the changes before and during the coronavirus disease 2019 (COVID-19) pandemic.

Methods

Data analysis was conducted on 289,415 adolescents participating in the Korea Youth Risk Behavior Web-Based Survey, an annual cross-sectional study from 2017 to 2021. All analysis was conducted using sex stratification, and the annual percentage change (APC) was calculated.

Results

Alcohol consumption and smoking decreased in the first year of the COVID-19 pandemic compared with before, except for girls from the low-income level. The prevalence of inadequate physical activity for both boys and girls increased in 2020 compared with the pre-COVID-19 period and decreased again by 2021. The prevalence of obesity in both sexes increased regardless of the period (boys, APC = 8.2%, 95% confidence intervals (CI), 6.4-10.1; girls, APC = 3.3%, 95% CI, 1.8-4.8). The prevalence of stress, depression, and suicidal ideation, plans, and attempts for both sexes decreased in 2020 compared to the pre-COVID-19 period. By 2021, this prevalence had returned to a level similar to before the pandemic. No significant APC changes were observed in the prevalence of mental health.

Conclusions

These findings demonstrate the trends and APCs in health behaviors and mental health conditions among Korean adolescents over the last 5 years. We must pay attention to the heterogeneous and multifaceted features of the COVID-19 pandemic.

Overcoming Isolation: Teenagers' Connectedness to Others During the COVID-19 Pandemic

The COVID-19 pandemic was characterized by loneliness, especially among teenagers. This study explored the coping mechanisms, activities, challenges, places visited, and sources of support that predicted teenagers feeling connected to others during COVID-19. Data come from surveys administered in the United States and Canada in summer 2022. Multivariate logistic regression showed that producing personal protective equipment, supporting siblings, getting involved in the local community, becoming more politically active, and taking language classes were positively associated with connectedness. In addition, teens in Canada were more likely to feel connected to others than teens in the United States. These findings can inform policies to enhance resilience in teenagers during protracted crises.

The Effect of Risk and Protective Factors on Primary School Students' COVID-19 Anxiety: Back to School After the Pandemic

This study aimed to analyze the risk and protective factors affecting the COVID-19 anxiety of primary school students after the reopening. It was investigated how primary school students' parents' vaccination, and COVID-19 cases seen at school, knowledge and awareness directly or indirectly explained their individual and social COVID-19 anxiety. The data were obtained from 227 primary school students living in different regions of Turkey. Pandemic Awareness Scale, Pandemic Anxiety Scale, Pandemic Information Test and Information Form were used to obtain the data. The data were analyzed by path analysis. According to the results, the case seen at school, knowledge and awareness of COVID-19 directly and significantly predicted primary school students' individual and social COVID-19 anxiety. Vaccination of parents, on the other hand, directly significantly predicted social COVID-19 anxiety of primary school students, but did not significantly predict individual COVID-19 anxiety. In addition, in this effect, awareness of COVID-19 mediates the knowledge of COVID-19, and cases seen at school mediate the vaccination of parents. The obtained model showed a good fit. According to the results, primary school students' knowledge and awareness about COVID-19 and parents' vaccination reduced their anxieties, and COVID-19 cases seen at school increased their anxiety.

Sense of Coherence and Self-Rated Aggression of Adolescents during the First Wave of the COVID-19 Pandemic, with a Focus on the Effects of Animal Assisted Activities

The COVID-19 pandemic has caused extreme deviations from everyday life. The aim of this study was to investigate how these deviations affected adolescents' sense of coherence and their level of aggression, and whether this was influenced by their relationship with animals, especially horses. In two random samples of students from vocational schools in Hungary, taken in June 2018 and June 2020 (n1 = 525, n2 = 412), separate groups were drawn from those who had regularly engaged in equine-assisted activities (ES) and those who had not (OS) before the pandemic. Data were collected using an anonymous, paper-based questionnaire, and during the pandemic an online version of the Sense of Coherence (SOC13) and Bryant-Smith (B12) scales. During the pandemic, boys' sense of coherence weakened and their aggressiveness increased. Multiple linear regression analyses showed that, regardless of gender and age group, increased time spent using the internet (p < 0.001), a lack of classmates (p = 0.017), reduced time spent outdoors (p = 0.026) and reduced physical activity (p < 0.038) during the pandemic significantly increased the tendency for aggressive behavior, whereas being with a horse or pet was beneficial (p < 0.001). The changes imposed by the curfew were rated as bad by 90% of the pupils, however, those with a strong sense of coherence felt less negatively about them. Schools should place a great emphasis on strengthening the students' sense of coherence.

Exploring Tech-Savviness and Digital Mental Health: The moderating role of Innovation Adoption and Digital Nudging

Objectives: Employees in China face significant difficulties in adapting to the dynamism of organizational culture. Organizational culture standards have improved due to the modernization and integration of technology. The purpose of this study was to examine the relationship between tech-savviness (TS) and digital mental health (DMH) as moderated by innovation adoption (IA) and digital nudging (DN). Methods: A total of 900 questionnaires were delivered using a random sampling technique to collect primary data on the Likert scale questionnaire. Employees of private-sector manufacturing businesses in the Chinese province of Shanghai constitute the research population. Results: The study finds that the organizational culture in China can be improved with the use of IA and DN by providing DMH services for employees. Conclusion: This study provides a substantial theoretical framework of significant variables that describe the link between TS and DMH in Chinese organizational culture. Additionally, the research has important theoretical implications for knowledge and practical consequences for enhancing employee performance in China.

School resources, self-control and problem behaviors in Chinese adolescents: a longitudinal study in the post-pandemic era

The outbreak of COVID-19 has brought many challenges to youth development. During this specific period, adolescents have suffered from numerous behavioral problems, which will lead to more maladaptive consequences. It is necessary to explore several protective factors to prevent or reduce the occurrence of problem behaviors in adolescence. The current study combined school resources and self-control to evaluate the multiple protective effects on adolescents' problematic behaviors in a two-wave longitudinal study. A sample of 789 Chinese adolescents (Mage = 14.00 years, SD = 2.05, 418 boys) were recruited via the random cluster sampling method to participate in the survey. The results confirmed the assumptions about the multiple protective effects of school resources and self-control on adolescents' problem behaviors. Specifically, school resources could negatively predict IGD and victimization, and self-control mediated these associations. Moreover, one problematic behavior could also mediate the associations between self-control and another problematic behavior. This is the first study to focus on the multiple protective effects of positive factors on adolescents' problem behaviors during the post-pandemic period, which has made several contributions to the literature and practice.

Problematic internet use and depressive symptoms among the school-going adolescents in Bangladesh during the COVID-19 pandemic: A cross-sectional study findings

Background and Aims

Problematic internet use (PIU) by children and adolescents is a concern for many parents. Several factors, including students' education level, the method of instruction, the dependence on the internet, and their intended use of the internet, could all be contributing factors to PIU and depression. Disturbed mental health may be attributed to the cancellation of physical education classes because of the COVID-19 outbreak. This study aimed to assess the association of COVID-19 pandemic with PIU and depressive symptoms in adolescent students.

Methods

We performed this cross-sectional study among 491 school-going adolescents of 10 to 16 years. Self-administered questionnaires were applied to collect sociodemographic information and the internet usage pattern of the participants. We measured the prevalence of PIU and depressive symptoms using the PIU questionnaire (PIUQ-SF-6) and patient health questionnaire-9 (PHQ-9).

Results

The estimations of the risk group for PIU and depressive symptoms among school-going adolescents were 80.04% and 77.80%, respectively. The latent profiling of PIU scores for obsession, neglect, and control sub-groups were 5.82, 6.12, and 6.35, respectively. Moreover, we observed mild, moderate, and severe depressive symptoms in 48.68%, 27.70%, and 1.43% of cases. Age, education level, medium of education, financial impression, internet connection, the device used, the purpose for internet use, and the living status of respondents were significantly associated with the PIU. Reported mental health issues was associated with education level, medium of education, financial impression, and internet connection.

Conclusion

The present study revealed an association of PIU and depressive symptoms with sociodemographic factors and internet usage patterns. Therefore, these results might have practical implications in clinical psychology, psychiatry, and psychotherapy. The healthcare professional can develop a context-specific comprehensive clinical intervention plan for children and adolescents.

Swedish High School Students' Drug and Alcohol Use Habits throughout 2020

This study describes gender-specific patterns in alcohol and drug use among Swedish high school students throughout 2020 and questions the current cutoffs for identifying addiction in this population. From September 2020 to February 2021, 1590 Swedish upper secondary high school students (mean age 17.15 years, age range 15-19 years, 39.6% male, and 60.4% female) completed the anonymous, electronic survey of the Mental and Somatic Health without borders study. The respondents reported their substance use habits during the previous 12 months using the Drug Use Disorders Identification Test (DUDIT) and Alcohol Use Disorders Identification Test (AUDIT). They also answered questions about changes in their alcohol and illegal drug use habits after the COVID-19 outbreak. No gender differences were detected in the prevalence and degree of alcohol use. Compared to female adolescents, significantly more male adolescents used drugs (and to a significantly higher degree, although with a small effect size). Substance use problems peaked in females at age 17 and in males at age 18. The COVID-19 outbreak affected alcohol consumption and illegal drug use in male and female adolescents similarly. For both genders, of those who used illegal drugs, over 40% reported increased use after the outbreak. Our results reinforce previous suggestions of the narrowing of gender differences in Swedish adolescents' risk behaviors and challenge the previously validated gender-specific cutoffs for the AUDIT and DUDIT. An improved understanding of the impacts of gender diversity and evolving gender roles and norms on behaviors and mental health is warranted.

Perceived stress, coping strategies, and mental health status among adolescents during the COVID-19 pandemic in Switzerland: a longitudinal study

This longitudinal, prospective study investigated associations between perceived COVID-19-related stress, coping strategies, and mental health status among adolescents during the first lockdown of the COVID-19 pandemic and one year after the lockdown in Switzerland within a large, national sample. A self-report on-line survey was completed by 553 adolescents (age-range 12-18 years in 2021) in the summers of 2020 and 2021, assessing symptoms of various mental health problems, perceived COVID-19-related stressors, and coping strategies. Overall, participants reported less COVID-19 related stress one year after the lockdown, though mental health status remained stable. 'Challenges at home or with others' were significantly associated with mental health problems in both genders, whereas 'trouble getting medical care or mental health services 'was associated with mental health problems in girls. Perceived stress and pre-existing psychiatric problem were significantly linked to all mental health outcomes at both time points. Parents' poor relationships with partners during the lockdown was associated with increased anxiety symptoms in their children. Using cognitive restructuring to cope with stress was associated with less, while negative coping was associated with more anxiety, depression, and attention deficit hyperactivity disorder (ADHD) symptoms one year post lockdown. Girls appear to have been more affected by the pandemic than boys, with youths with pre-existing psychiatric problems especially vulnerable to its detrimental effects. Healthcare and school professionals should support to identify high-risk adolescents with negative and avoidant coping strategies and train youths to use positive coping strategies.

Adversity in Infancy and Childhood Cognitive Development: Evidence From Four Developing Countries

Objectives: We investigated whether adverse experiences at age 1 (AE-1) affect the level of and change in cognition during childhood using harmonized data from four developing countries. Methods: Data included children born in 2001/2002 and were followed longitudinally in 2006/2007 and in 2009/2010 by Young Lives study in Ethiopia, India, Peru, and Vietnam. Childhood cognition was measured using the Peabody Picture Vocabulary Test (PPVT) at ages 5 (PPVT-5) and 8 (PPVT-8). We also examined the effect on a change in cognition between age 5-8 (PPVT-Change). The AE-1 scores were constructed using survey responses at age 1. The ordinary least squares regression was used for estimation. Results: We found that children with higher adversities as infants had lower cognition scores at ages 5 and 8. The change in cognition between the two ages was also generally smaller for those with severe adversities at infancy. The negative association between adversities and childhood cognition was strongest for India. Conclusion: The results provide policy relevant information for mitigation of undesirable consequences of early life adversities through timely interventions.

A review of COVID vaccines: success against a moving target

BACKGROUND

Multiple vaccine platforms against COVID-19 have been developed and found safe and efficacious at a record speed. Although most are effective, they vary in their ease of production and distribution, their potential speed of modification against new variants, and their durability of protection and safety in certain target groups.

SOURCES OF DATA

Our discussion is based on published reports of clinical trials and analyses from national and global health agencies.

AREAS OF AGREEMENT

The production of neutralizing antibodies against the viral spike protein is protective, and all vaccines for which published data exist have been found to be effective against severe disease caused by the viral strain they target.

AREAS OF CONTROVERSY

The degree to which vaccines protect against emerging variants, moderate disease and asymptomatic infection remains somewhat unclear.

GROWING POINTS

Knowledge of the duration of protection and its decay is increasing, and discussions of booster frequency and target strains are ongoing.

AREAS TIMELY FOR DEVELOPING RESEARCH

The global effort to combat transmission and disease continues to rely upon intense epidemiological surveillance, whilst real-world data and clinical trials shape vaccination schedules and formulae.

COVID anxiety and its predictors among Slovak adolescents

Introduction

The COVID-19 pandemic and its related restrictions, mainly social distancing, had an impact on the mental health of various groups, including adolescents.

Methods

The main goal of our study was to explore the impact of gender, age, resilience (measured using the Brief Resilience Scale), attachment anxiety, attachment avoidance (both measured using the Experiences in Close Relationships Revised Scale for adolescents), and mental and general health (measured using items of SF-8 Health Survey) on COVID anxiety (measured using the COVID Anxiety Scale) among a sample of Slovak adolescents (N = 1,786, age 15 to 19, mean age = 16.8, SD = 1.2). The data were collected online between 13 April and 24 May 2021.

Results

Four nested linear regression models were fitted to the data and evaluated. The significant predictors that had a greater effect than our smallest effect size of interest (β  = 0.10) were gender (β  = -0.26, p  < 0.001, where boys had lower scores in COVID anxiety), general and mental health (β  = -0.13 and β  = -0.14, respectively, both with p  < 0.001), resilience (β  = -0.12, p  < 0.001), and attachment avoidance (β  = -0.11, p  < 0.001). Similarly, age and attachment anxiety were significant predictors with a lower effect size (β  = 0.06, p  = 0.003, and β  = 0.09, p  < 0.001, respectively).

Discussion

Our results are in line with previous research findings highlighting the importance of prevention and interventions programs focused mainly on preventing loneliness and social disconnection, fostering secure attachment with parents and peers, and increasing the resilience of adolescents, especially in the stressful time of a pandemic, to promote their mental health.

Psychological and Behavioral Impacts of the COVID-19 Pandemic on Children and Adolescents in Turkey

The present study aimed to investigate the physical, psychological, and behavioral alteration in children in the age range between 3 and 18 years before and during the COVID-19 pandemic from the perspective of parental perception. In this study, the survey model was used as a quantitative research method. A snowball sampling method was used, and 841 mothers participated. Descriptive statistics, one-way analysis of variance, related samples t-test, Wilcoxon signed-rank test, and stepwise regression analysis were used to analyze the data. It was found that the physical, psychological, and behavioral negative impacts of the COVID-19 pandemic varied depending on the developmental stages of the children. Compared to the pre-pandemic period, an increase in children's screen time, as well as a decrease in their physical activity time, was observed during the pandemic. In addition, it was found that screen time, physical activity time, and the square meters of the house are among the significant predictors of mood, behavioral changes, and nutritional problems in children. In terms of anxiety symptoms, physical activity time and screen time were found to be significant predictors. In addition, screen time, age, and physical activity time were observed to be significant predictors of cognitive change symptoms.

COVID-19 lockdowns and children's health and well-being

This paper studies the health and well-being of children during the COVID-19 lockdowns in a developing country context. Using surveys for low-income households in rural areas of Pakistan, we find that lockdowns are associated with worsened health and well-being of children. Exploring potential economic and noneconomic mechanisms behind this negative association, we find that children participating in the labor market due to extreme poverty suffer the worst impact from lockdowns. These results call for policies that target resources towards households where children's participation in the labor market is more likely since leaving vulnerable children behind will have a lasting economic impact for developing economies.

Anxiety symptoms among children visiting a pediatric emergency center in Qatar during the COVID-19 pandemic: A cross-sectional study

Although the evidence base regarding the impact of the COVID-19 pandemic on children has been growing, descriptions of their experiences remain scarce. In this cross-sectional study, the authors used the Child-Reported Spence Children's Anxiety Scale to collect data from 91 children visiting a pediatric emergency center in Qatar during the pandemic. Around 25% of the children reported elevated levels of overall anxiety. Obsessive-compulsive symptoms were the most common, with 59.3% of children reporting elevated symptoms. The mean score of physical injury fears was significantly affected by gender, with females having higher scores. Overall rates for elevated anxiety symptoms were similar in natives and expatriate children. The findings suggest that the effects of the pandemic on children may depend on several vulnerability factors, including developmental age and gender. This study highlights the need to plan multidisciplinary strategies to enhance children's access to mental health services during and after the current health crisis.

Should I Help? Prosocial Behaviour during the COVID-19 Pandemic

The Movement Control Order (MCO) enacted during the COVID-19 pandemic has profoundly altered the social life and behaviour of the Malaysian population. Because the society is facing huge social and economic challenges that need individuals to work together to solve, prosocial behaviour is regarded as one of the most important social determinants. Because it is related with individual and societal benefits, participating in prosocial activities may be a major protective factor during times of global crisis. Rather than focusing only on medical and psychiatric paradigms, perhaps all that is necessary to overcome the COVID-19 risks is for individuals to make personal sacrifices for the sake of others. In reality, a large number of initiatives proven to be beneficial in decreasing viral transmission include a trade-off between individual and collective interests. Given its crucial importance, the purpose of this concept paper is to provide some insight into prosocial behaviour during the COVID-19 period. Understanding prosocial behaviour during the COVID-19 pandemic is crucial because it may assist in the establishment of a post-COVID society and provide useful strategies for coping with future crises.

Adolescent Anxiety and TikTok: An Exploratory Study

Introduction Social media is ubiquitous in adolescents' lives. TikTok is a medium primarily used by adolescents and young adults under 30 years. TikTok is thus an appropriate social media platform with which to examine discussions of anxiety among this age cohort. In this exploratory mixed-methods study we aimed to evaluate the scope of anxiety content available on TikTok in English in December 2021, and to further develop methods for analysing TikTok content. Methods We analysed a data set of 147 TikToks with the hashtag #anxiety. The data set consisted both of metadata and TikTok videos. This data set represented 18% of all TikToks featuring the hashtag #anxiety in December 2021. We examined the following research questions (RQs). RQ1: What are the creator identities reflected in the final data set in this study?; RQ2: What are the metadata characteristics of the TikToks in the final data set?; RQ3: What are the anxiety content themes in the final data set?; and RQ4: What are the characteristics of the data set based on an anxiety management reference checklist? This study involves public data that can reasonably be observed by strangers. This study does not include any identifiable human participants. Results Influencers were the most frequent creator identity in our data set. Influencers comprised 85.5% of the 147 TikToks in our final data set. We coded 79 female (54%) and 45 male (31%) influencers. We found male influencers created the most played (mean 8,114,706), and most liked (mean 1,510,585) TikToks. We found content themes varied by influencer gender. The notable findings were (a) the greater use of humour by males (22.7% males; n=10, and females 12.6%; n=10); and (b) inspiration (38.7%; males n=17; and 13.9%; females n=11). Among female influencers, we identified self-disclosure as the most common theme (n= 40 and 50.7% compared with n=11 and 25% male influencers). Overall, we found limited references to evidence-based anxiety self-care content in our final data set. Discussion We suggest that the TikToks in our data set were primarily directed at raising awareness of and de-stigmatising anxiety symptoms. TikTok anxiety content may be viewed by adolescents for emotional self-regulation beyond evidence-based health information seeking. Self-disclosure on TikTok may also provide symptomatic relief to adolescents with anxiety. We suggest that gender is a salient consideration when considering TikTok content. Conclusions Our findings are consistent with existing literature on adolescent social media use and epidemiological data on anxiety. This research also provides methodological insights for researchers and clinicians seeking to understand TikTok, and to develop engaging content targeted at the specific concerns and preferences of adolescent TikTok consumers.

Effects of COVID-19 on children with autism

The coronavirus disease 2019 (COVID-19) pandemic affects all countries and populations worldwide, significantly impacting people with autism with a high risk of morbidity and mortality due to COVID-19. Approximately 25% of children with autism have an asymptomatic or symptomatic immune deficiency or dysfunction. In addition, they frequently have various comorbid conditions that increase the severity of COVID-19. In addition, severe COVID-19 during pregnancy may increase the risk of autism in the offspring. Furthermore, severe acute respiratory syndrome coronavirus 2 could target human nervous system tissues due to its neurotrophic effects. The COVID-19 pandemic intensely impacts many patients and families in the autism community, especially the complex management of autism-associated disorders during the complete lockdown. During the complete lockdown, children with autism had difficulties coping with the change in their routine, lack of access to special education services, limited physical space available, and problems related to food and sleep. Additionally, children with autism or intellectual disabilities are more liable to be abused by others during the pandemic when the standard community supports are no longer functioning to protect them. Early detection and vaccination of children with autism against COVID-19 are highly indicated. They should be prioritized for testing, vaccination, and proper management of COVID-19 and other infectious diseases. In this review, we discuss the various effects of COVID-19 on children with autism, the difficulties they face, the increased risk of infection during pregnancy, how to alleviate the impact of COVID-19, and how to correct the inequalities in children with autism.

Rural Children's Well-Being in the Context of the COVID-19 Pandemic: Perspectives from Children in the Midwestern United States

Children in rural areas are more likely to experience a variety of risk factors that increase their vulnerability to physical and mental health disparities. Bronfenbrenner's ecological model (1986) was used as a framework for understanding rural children's perceptions and well-being within multiple interactive contexts during the COVID-19 pandemic. This phenomenological study was designed to explore rural children's perceptions of their well-being and the impact of the COVID-19 pandemic on their contexts and well-being. This sub-study of the Children's Understandings of Well-Being project followed the standard qualitative interview protocol with additional prompts related to the pandemic. Rural children (age 8 to 18, N = 72) from the Midwestern United States participated from March 2020 to November 2021 via teleconferencing. Phenomenological analyses of transcripts focused on the essence of children's understanding of well-being and their perception of the impact of the pandemic on their contexts and well-being. Each transcript was coded by author 1 and verified by author 2, and discrepancies were identified, discussed, and resolved. The third author served as an external auditor to enhance trustworthiness. First-cycle coding focused on children's specific references to well-being experiences during COVID-19. Second-cycle selective coding focused on specific well-being experiences and contexts that were impacted by COVID-19. These codes were used to develop two broad themes, "Well This Kinda Stinks, But We Just Adapt" and "Safety Means Something Different to Me Now." The meaning of themes and subthemes are explored, with implications for researchers, practitioners, and policymakers.

Persistent symptoms after SARS-CoV-2 infection in children: a cross-sectional population-based serological study

OBJECTIVES

To estimate the prevalence of children and adolescents reporting persistent symptoms after SARS-CoV-2 infection.

DESIGN

A random sample of children and adolescents participated with their family members to a serological survey including a blood drawing for detecting antibodies targeting the SARS-CoV-2 nucleocapsid (N) protein and a questionnaire on COVID-19-related symptoms experienced since the beginning of the pandemic.

SETTING

The study took place in the canton of Geneva, Switzerland, between June and July 2021.

PARTICIPANT

660 children aged between 2 and 17 years old.

PRIMARY AND SECONDARY OUTCOME

The primary outcome was the persistence of symptoms beyond 4 weeks comparing seropositive and seronegative participants. The type of declared symptoms were also studied as well as associated risk factors.

RESULTS

Among seropositive children, the sex-adjusted and age-adjusted prevalence of symptoms lasting longer than 2 weeks was 18.3%, compared with 11.1% among seronegatives (adjusted prevalence difference (ΔaPrev)=7.2%, 95% CI: 1.5% to 13.0%). Among adolescents aged 12-17 years, we estimated the prevalence of experiencing symptoms lasting over 4 weeks to be 4.4% (ΔaPrev,95% CI: -3.8% to 13.6%), whereas no seropositive child aged 2-11 reported symptoms of this duration. The most frequently declared symptoms were fatigue, headache and loss of smell.

CONCLUSIONS

We estimated the prevalence of experiencing persistent symptoms lasting over 4 weeks to be around 4% among adolescents, which represents a large absolute number, and should raise awareness and concern. We did not observe meaningful differences of persistent symptoms between seropositive and seronegative younger children, suggesting that they may be less affected than their older counterparts.

Mental health problems of preschool children during the COVID-19 home quarantine: A cross-sectional study in Shanghai, China

OBJECTIVE

As the coronavirus disease 2019 (COVID-19) pandemic spread across Shanghai, China, in late February 2022 and protective measures to mitigate its impact were enacted, this study aimed to estimate how home quarantine affected the mental health of preschool children in Shanghai, China and explore the association between lifestyle factors and mental health during this special period.

METHODS

A cross-sectional online survey of 2,110 preschool students from Shanghai, China, was conducted during May 20-25,2022. Preschooler' mental health (Strengths and Difficulties Questionnaire, SDQ) and daily activities were reported by parents.

RESULTS

The sample involved 2,110 children with a mean age of 4.65 years [standard deviation (SD): 0.91, range: 3-6 years]. Boys and children whose mother's education level were college and high school had higher rate of mental health problems. Boys had significantly higher rates of peer problems and prosocial behaviors than girls. The 3-year-old group had significantly higher rates of prosocial behaviors than other groups. As compared to the Shanghai norm and the SDQ results of preschool children in Shanghai in 2019 (SH2019), there were a significant decrease in emotional symptoms score, as well as a significant increase in conduct problems score. Additionally, peer problems score significantly increased compared to SH2019. Decreased time spent on daily sleep was associated with the increased risk for preschoolers' mental health problems.

CONCLUSION

There was an increase in the frequency of emotional and behavioral problems, especially regarding conduct problems and peer problems, in preschool children during the COVID-19 home quarantine in Shanghai, China. Boys, younger preschool children and children whose mother's education level were college and high school may be especially vulnerable to emotional and behavioral problems. It was also found that decreased time spent on sleep may aggravate preschool children's mental health problems. It may be beneficial to differentiate and focus on conducting psychoeducation and implementing psycho-behavioral interventions to solve these issues.

COVID-19 and mental health disorders in children and adolescents (Review)

The new coronavirus has been present for two years and has had a widespread and sustained impact worldwide. There is growing evidence in the literature that COVID-19 may have negative effects on mental illness in patients and in healthy populations. The unprecedented changes brought about by COVID-19, such as social isolation, school closures, and family stress, negatively affect people's mental health, especially that of children and adolescents. The purpose of this paper is to review the literature and summarize the impact of COVID-19 disorders on children's and adolescents' mental health, the mechanisms and risk factors, screening tools, and intervention and prevention. We hope that the mental dysfunction caused by the pandemic will be mitigated through appropriate and timely prevention and intervention.

Global burden of mental health problems among children and adolescents during COVID-19 pandemic: An umbrella review

Mental health problems among children and adolescents are increasingly reported amidst the coronavirus disease (COVID-19) pandemic. In this umbrella review, we aimed to synthesize global evidence on the epidemiologic burden and correlates of child and adolescent mental health (CAMH) problems during this pandemic from existing systematic reviews and meta-analyses. Adopting the Joanna Briggs Institute (JBI) methodology, we evaluated 422 citations and identified 17 eligible reviews with medium to high methodological quality. Most of the reviews reported a high prevalence of anxiety, depression, sleep disorders, suicidal behavior, stress-related disorders, attention-deficit/hyperactivity disorder, and other mental health problems. Also, factors associated with CAMH such as age, gender, place of residence, educational attainment, household income, sedentary lifestyle, social media and internet use, comorbidities, family relationships, parents' psychosocial conditions, COVID-19 related experiences, closure of schools, online learning, and social support were reported across reviews. As most studies were cross-sectional and used nonrepresentative samples, future research on representative samples adopting longitudinal and intervention designs is needed. Lastly, multipronged psychosocial care services, policies, and programs are needed to alleviate the burden of CAMH problems during and after this pandemic.

“Freedom and Dignity Are Worth More than Life”: The Dramatic Suicide of an Anti-Vax Man

Since the beginning of the COVID-19 public health emergency, we have witnessed an increase in psychiatric problems and pathologies, such as depression, anxiety, isolation, posttraumatic stress disorder, substance abuse, and burnout. The world’s collective sentiment finally turned toward optimism after authorization was granted for the COVID-19 vaccines’ emergency use by the FDA in December 2020. With the increase in vaccine coverage in Western countries, case counts and deaths gradually plummeted while activity restrictions were progressively lifted. At the same time, however, a new COVID-19-related public health issue has arisen, as a substantial number of eligible individuals refused vaccination. Behaviors assumed by the so-called anti-vax people in manifesting their own opposition towards COVID-19 vaccination are various, and sometimes assume the forms of dramatic gestures with symbolic value, such as suicide. Here, we present the case of a healthy, convinced anti-vax, 58-year-old man, who allowed himself to be run over by a moving train in the presence of eyewitnesses, bringing with him a demonstrative note of his reasons. The present article aims to raise awareness against the social and psychological impact of COVID-19 vaccination refusal and to point out the need of a specific support net to avoid the spread of psychological impairment, social isolation and suicidal behaviors among the “anti-vax community”.

Are Children Harmed by Being Locked up at Home? The Impact of Isolation during the COVID-19 Pandemic on the Phenomenon of Domestic Violence

The phenomenon of violence against children is a very complex one. There are many types of child abuse, and they are culturally dependent to a significant degree. Although studies show that children generally only suffer from mild COVID-19 infection, some social restrictions introduced during the pandemic, such as home isolation, may have many severe consequences on the population's mental health. Studies on this topic suggest that violence against children increased during lockdown due to the COVID-10 pandemic. This narrative review summarizes this available literature on the subject and discusses the different forms of violence against children, their cultural aspects, the impact of the COVID-19 pandemic on the phenomenon of violence, the long-term consequences of the above, and forms of assistance for abused minors.

Bireylerin Aşılara Yönelik Tutumları Üzerine COVID-19 Korkusunun Etkisi

Giriş: Covid-19 hastalığının psikolojik etkileri devam etmektedir. Hastalığa ilişkin yaşanılan korku bireylerin Covid-19 aşılarına yönelik tutumlarını etkilemektedir. Amaç: Bireylerin Covid-19 aşısına yönelik tutumları üzerine Covid-19 korkusunun etkisini belirlemektir. Yöntem: Niceliksel araştırma yöntemlerinden tanımlayıcı tipte bir araştırmadır. Çalışmanın verileri 1 Temmuz- 31 Ağustos 2021 tarihleri arasında kartopu örnekleme tekniği kullanılarak online olarak toplanmıştır. Belirtilen süre içerisinde araştırmaya gönüllü olarak katılmayı kabul eden ve formu eksiksiz dolduran 221 kişi araştırmanın örneklemini oluşturmuştur. Veri toplama araçları “Katılımcı Bilgi Formu”, “Covid-19 Korku Ölçeği” ve “Covid-19 Aşısına Yönelik Tutumlar Ölçeği” dir. Bulgular: Araştırmaya katılan bireylerin Covid-19 korku ölçeği puan ortalaması 17.84 ± 6.65; Covid-19 aşısına yönelik olumlu tutum alt boyut puan ortalaması 3.79 ± 1.12; Covid-19 aşısına yönelik olumsuz tutum alt boyut puan ortalaması 3.57 ± 1.23 olarak tespit edilmiştir. Covid-19 korku ve Covid-19 aşısına yönelik olumlu tutum değişkenleri arasında pozitif yönde, anlamlı (r = .28; p = .000) bir ilişki saptanmıştır. Ayrıca, Covid-19 korkusunun bireylerin Covid-19 aşına yönelik olumlu tutum düzeyi üzerinde anlamlı bir etkiye sahip olduğu görülmüştür (t = 4.396; p = .000). Sonuç: Covid-19 korkusu bireylerin Covid-19 aşısına yönelik tutumunu olumlu şekilde etkilemiştir

Social responsibility and subjective well-being of volunteers for COVID-19: The mediating role of job involvement

Aim

Our study aimed to investigate the effect of social responsibility on the subjective well-being of volunteers for COVID-19 and to examine the mediating role of job involvement in this relationship.

Background

Nowadays, more and more people join volunteer service activities. As we all know, volunteer work contributes to society without any return. Volunteers often have a strong sense of social responsibility and reap subjective well-being in their dedication. Although research shows that social responsibility will drive them to participate in volunteer work actively, it is less clear whether job involvement will impact their subjective well-being.

Methods

The data were collected in the precaution zone in Shanghai, China, from April to May 2022. A sample of 302 volunteers for COVID-19 completed the social responsibility scale, subjective well-being scale and job involvement scale in the form of an electronic questionnaire on their mobile phones. A structural equation model was adopted to verify the research hypotheses.

Results

Social responsibility was significantly and positively related to volunteers’ subjective well-being and job involvement (p &lt; 0.05). Job involvement fully mediates the relationship between volunteers’ social responsibility and subjective well-being.

Conclusion

Social responsibility is critical to predicting volunteers’ subjective well-being. Job involvement plays an intervening mechanism in explaining how social responsibility promotes volunteers’ subjective well-being.

Brief internet-delivered cognitive-behavioural intervention for children and adolescents with symptoms of anxiety and depression during the COVID-19 pandemic: a randomised controlled trial protocol

BACKGROUND

The COVID-19 pandemic has had major impacts in many different spheres, including mental health. Children and adolescents are especially vulnerable because their central nervous system is still in development and they have fewer coping resources than do adults. Increases in the prevalence of depressive and anxiety symptomatology have been reported worldwide. However, access to mental health care is limited, especially for the paediatric population and in low- and middle-income countries. Therefore, we developed a brief internet-delivered cognitive-behavioural intervention for children and adolescents with symptoms of anxiety and depression. The aim of this proposed study is to test the efficacy of the intervention.

METHODS

We will conduct a two-arm, parallel randomised controlled trial involving children and adolescents (8-11 and 12-17 years of age, respectively) with symptoms of anxiety, depression or both, according to the 25-item Revised Child Anxiety and Depression Scale (t-score > 70). A total of 280 participants will be randomised to the intervention group or the active control group, in a 1:1 ratio. Those in the intervention group will receive five weekly sessions of cognitive-behavioural therapy via teleconference. The sessions will focus on stress responses, family communication, diaphragmatic breathing, emotions, anger management, behavioural activation and cognitive restructuring. Participants in both groups will have access to 15 videos covering the same topics. Participant-guardian pairs will be expected to attend the sessions (intervention group), watch the videos (control group) or both (intervention group only). A blinded assessor will collect data on symptoms of anxiety, depression and irritability, at baseline, at the end of the intervention and 30 days thereafter. Adolescents with access to a smartphone will also be invited to participate in an ecological momentary assessment of emotional problems in the week before and the week after the intervention, as well as in passive data collection from existing smartphone sensors throughout the study.

DISCUSSION

Internet-delivered interventions play a major role in increasing access to mental health care. A brief, manualised, internet-delivered intervention might help children and adolescents with anxiety or depressive symptomatology, even outside the context of the COVID-19 pandemic.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05139433. Registered prospectively in November 2021. Minor amendments made in July 2022.

Family, Neighborhood and Parent Resilience Are Inversely Associated With Reported Depression in Adolescents Exposed to ACEs

OBJECTIVE

To examine the association of 1) extrinsic resilience factors and 2) adverse childhood experiences (ACEs) with a caregiver reported diagnosis of depression in a nationally representative sample of adolescents.

METHODS

A cross sectional analysis of the 2016-2017 National Survey of Children's Health, restricted to adolescents 12 to 17 years old was conducted. The dependent variable was caregiver reported depression: no current diagnosis vs. current diagnosis of depression. Independent variables were reported ACEs dichotomized as lower (0-3) or higher (4 or more), and specific resilience factors: family resilience, neighborhood cohesion and caregiver emotional support. Resilience factors were analyzed as a composite score dichotomized as lower (0-3) or higher (4 or more) and individually. Purposeful selection multivariable logistic regression model building was used to estimate the associations between reported diagnosis of depression, ACEs and resilience factors adjusting for demographic covariates.

RESULTS

Study sample consisted of 29,617 (weighted N = 24,834,232) adolescents, 6% with current reported diagnosis of depression, 8% with higher ACEs and 91% with higher resilience. Family resilience, neighborhood cohesion and caregiver emotional supports were each independently associated with lower odds of reported diagnosis of depression. However, with all resilience factors in the model, only family resilience and neighborhood cohesion (specifically school safety) remained significantly associated with lower odds of reported diagnosis of depression.

CONCLUSION(S)

In this nationally representative sample, family resilience and neighborhood cohesion were associated with lower odds of a reported diagnosis of depression even with confounding ACEs exposure. These factors may be important targets for future intervention.

COVID-19 pandemic-related aspects and predictors of emotional and behavioural symptoms in youth with pre-existing mental health conditions: results from Georgia, Lithuania, Romania, Serbia, and Turkey

OBJECTIVE

This study evaluated levels of and predictors of emotional and behavioral symptoms in youth with pre-existing mental health conditions over the early phase of the COVID-19 pandemic in 2020 across Georgia, Lithuania, Romania, Serbia, and Turkey.

METHODS

The study included 421 children and adolescents aged 5 - 18 years with pre-existing mental health conditions and corresponding ongoing treatments. We used a parent- and/or child-report, which taps into a broad range of mental health symptoms and contextual factors thought to be particularly pertinent during periods of social restrictions. Data were collected simultaneously across the countries from May 2020 to August 2020.

RESULTS

According to parents, 121 (33.1%) children had deteriorations in the overall quality of mental health over the COVID-19, 156 (43.1%) deteriorations in the quantity of mental health care received, while 82 (25.1%) mental health care received did not meet the needs. For 121 (49.8%) of children, there was worsening in the main presenting psychiatric symptom compared to January 2020, while for 64 (26.3%) there was some improvement. In total, 128 (43.9%) children reported worsened emotional and 118 (40.6%) behavioral symptoms. The COVID-related worry, parental emotional difficulties, and parent-child relationships emerged as the most relevant predictors for higher levels of emotional and behavioral difficulties.

CONCLUSIONS

This study found that the COVID-19 pandemic has considerably changed the daily lives of some children with pre-existing mental health conditions, where almost every second child had deteriorations in overall mental health or worsening of psychiatric symptoms.

Changes in the Prevalence of Overweight and Obesity among Peruvian Children under Five Years before and during the COVID-19 Pandemic: Findings from a Nationwide Population-Based Study

This study aimed to identify changes in the prevalence of childhood (children under five years of age) overweight and obesity in Peru as a whole and at the departmental level, before and during the coronavirus disease (COVID-19) pandemic. We performed a secondary data analysis of two Demographic and Family Health Surveys (2019 and 2021) in Peru. The outcome was childhood overweight and obesity, defined as a weight-for-height score greater than 2 standard deviations. Poisson log generalized linear regression models adjusted for sex and/or age in months of the child were fitted to obtain the prevalence ratios of the changes in childhood overweight and obesity from 2019 to 2021. The analysis included 41,533 (2019: 20,414; 2021: 21,119) participants. The prevalence of childhood overweight and obesity was 6.4% in 2019 and 7.8% in 2021. Female children, aged 2, 3 and 4 years, and mothers who self-identified as non-native, had secondary and higher education, belonged to the middle and richer wealth quintile and resided in an urban area, in a village, in a small city and in the coastal region showed the largest increases in the prevalence of childhood overweight and obesity in 2021 compared to 2019. The departments of Pasco, Apurímac, Junín, Cusco, Lambayeque and La Libertad presented the largest increases in the prevalence of these nutritional disorders. During the pandemic, an increase in the prevalence of childhood overweight and obesity was observed, with demographic and socioeconomic factors accounting for the largest increases in the prevalence rates. A restructuring of overweight and obesity control strategies is required to curb this steady increase.

Core belief challenge moderated the relationship between posttraumatic growth and adolescent academic burnout in Wenchuan area during the COVID-19 pandemic

This study investigates the characteristics of posttraumatic growth (PTG) and academic burnout among adolescents in an ethnic minority area in China during the COVID-19 pandemic, and examines the moderating role of core belief challenge on the association between PTG and academic burnout. This study surveyed 941 secondary school students in Wenchuan using the posttraumatic growth inventory, adolescent academic burnout inventory, core beliefs inventory, and a self-designed demographic questionnaire. The results showed that: (1) Five months after the COVID-19 outbreak in China, the level of PTG among adolescents in the Wenchuan area was high and its prevalence was 32.3%. Among them, the dimension of perceived changes in self was the highest, and the PTG level of junior high school students was higher than that of high school students. The academic burnout level of adolescents, particularly emotional exhaustion, was also high. The academic burnout level of the high school students was higher than that of junior high school students. (2) There was a significant negative correlation between PTG and academic burnout among adolescents. (3) Core belief challenge moderated the relationship between PTG and academic burnout. PTG had a significant negative predictive effect on adolescents’ academic burnout only when the core belief challenge was above a moderate level. These results showed the uniqueness of PTG and psychological behavioral problems of adolescents in ethnic minority areas during the COVID-19 pandemic. They also emphasized the key role of core belief challenge in the process of PTG in reducing adolescents’ academic burnout. Based on these results, recommendations are provided to alleviate academic burnout among adolescents in Wenchuan against the background of the COVID-19 pandemic. While providing full play to ethnic minority cultural characteristics to promote posttraumatic growth, guiding adolescents’ value reflection and cognitive reconstruction should be focused on.

Screening, Brief Intervention, and Referral to Treatment Model Based on ICD-11 Criteria of Gaming Disorder and Hazardous Gaming During the COVID-19 Pandemic

Purpose of Review

This commentary aimed to propose the screening, brief intervention, and referral to treatment (SBIRT) model for gaming disorder (GD) and hazardous gaming (HG) on the basis of the International Classification of Disease, 11th version (ICD-11) classification.

Recent Findings

COVID-19 and its preventive measures increase the risk of GD and the treatment needs could exceed the capacities of mental health systems. Brief intervention could be provided for adolescents with HG after screening. Psychiatrists make diagnoses of GD or HG and then refer them to school counselors, specialized psychologists, or integrated teams based on the severity, comorbidity, and complication of GD.

Summary

The classification of GD and HG was suitable to develop a SBIRT model intervention. The SBIRT should work through the shortage of resources and provide a brief intervention guild to make it practical.

Incorporating MOOC and COVID-19-Related Scientific Papers into Veterinary Microbiology Teaching to Enhance Students' Learning Performance and Professional Recognition

The COVID-19 pandemic has exerted a huge adverse influence on global teaching activities and students' psychological status. Veterinary microbiology is mainly concerned with bacterial and viral diseases, including coronavirus diseases. An innovative online-to-offline teaching approach for this course was established to stimulate students' learning initiative and mitigate their anxiety about COVID-19. A well-established massive open online course (MOOC) was first adopted as preview material before class, followed by in-person teaching. Additionally, COVID-19-related scientific papers were also used as pre-class reading material in veterinary microbiology and were further explained in class. The effect of this innovative teaching mode was systematically evaluated by final examination scores and questionnaires. The average score (81.75) and excellence score rating (> 85 scores, 37.3%) resulting from this blended teaching mode were not statistically higher than those of the online-only (79.19, p = .115; 28.6%, p = .317) or offline-only (79.47, p = .151; 27.9%, p = .269) teaching modes. This may be due to the sample size investigated; however, the results indicate that the innovative teaching mode did not decrease teaching quality. Additionally, most subjects (72.9%) were satisfied with the blended mode and supported its future use. Intriguingly, the introduction of COVID-19-related scientific papers helped students understand virology, relieve their anxiety, and increase their professional identity. Collectively, the innovative approach to teaching veterinary microbiology in this study provides a beneficial reference for other teachers to maintain and improve teaching quality.