Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19

Prediction of Suicidal Thoughts and Suicide Attempts in People Who Gamble Based on Biological-Psychological-Social Variables: A Machine Learning Study

Recent research has shown that people who gamble are more likely to have suicidal thoughts and attempts compared to the general population. Despite the advancements made, no study to date has predicted suicide risk factors in people who gamble using machine learning algorithms. Therefore, current study aimed to identify the most critical predictors of suicidal ideation and suicidal attempts among people who gamble using a machine learning approach. An online survey conducted a cross-sectional analysis of 741 people who gamble (mean age: 25.9 ± 5.56). To predict the risk of suicide attempts and ideation, we employed a comprehensive set of 40 biological, psychological, social, and socio-demographic variables. The predictive models were developed using Logistic Regression, Random Forest (RF), robust eXtreme Gradient Boosting (XGBoost), and ensemble machine learning algorithms. Data analysis was performed using R-Studio software. Random Forest emerged as the top-performing algorithm for predicting suicidal ideation, with an impressive AUC of 0.934, sensitivity of 0.7514, specificity of 0.9885, PPV of 0.9473, and NPV of 0.9347. Across all models, dissociation, depression, and anxiety symptoms consistently emerged as crucial predictors of suicidal ideation. However, for suicide attempt prediction, all models exhibited weaker performance. XGBoost showed the best performance in this regard, with an AUC of 0.663, sensitivity of 0.78, specificity of 0.8990, PPV of 0.34, NPV of 0.984, and accuracy of 0.8918. Depressive symptoms and rumination severity were highlighted as the most important predictors of suicide attempts according to this model. These findings have important implications for clinical practice and public health interventions. Machine learning could help detect individuals prone to suicidal ideation and suicide attempts among people who gamble, assisting in creating tailored prevention programs to address future suicide risks more effectively.

Chronic stress and lack of social support: Role in adolescent depression and suicide-related behaviors in the context of the COVID-19 pandemic

OBJECTIVE

This study aimed to examine acute and chronic stressors, and perceived lack social support, and their associations with depression and suicidal ideation in adolescents during the COVID-19 pandemic.

METHODS

Deidentified data from (N = 270,153) U.S. adolescents aged 11 to 17 who completed the Patient Health Questionnaire 9-item tool (PHQ-9) in the years 2020 and 2021 were sourced from a collection of online screening tools that are free, confidential, anonymous, and scientifically validated. In addition to depression, the survey included questions about suicidality, past/chronic stressful events, and contributors to mental health problems and sociodemographic variables. SPSS software version 28 for descriptive analyses, and Mplus version 7.31 for confirmatory factor analysis (CFA) and structural equation modeling (SEM), were respectively used.

RESULTS

Participants were predominantly female, White, and heterosexual, and exhibited a high prevalence of severe depression and a significant frequency of suicidal thoughts. Significant associations were found between past/chronic stressful events, and lack of social support, with suicidality and depression. Mental health stress due to the COVID-19 pandemic itself presented no significant associations with depression and suicidality and was weakly and negatively associated with lack of social support and past/chronic stressors.

DISCUSSION

These findings reinforce the notion that prior traumatic events can create vulnerabilities in the face of acute stressors, while social support can enhance resilience in adolescents. Factors that increase resilience, such as preventing traumatic events, reducing social stressors, and increasing social support, can serve as valuable guidelines for clinical and public health interventions.

(Dis)connected by design? Using participatory citizen science to uncover environmental determinants of social connectedness for youth in under-resourced neighbourhoods

BACKGROUND

Social isolation and loneliness are a growing public health concern. Inadequacies in neighbourhood social infrastructure can undermine social connectedness, particularly for youth, who are dependent on their local environments yet often marginalized from public spaces and city planning. Integrating citizen science with participatory action research, the Youth.hood study set out to explore how neighbourhood built environments help or hinder social connectedness from the understudied perspective of youth in under-resourced and racialized communities.

METHODS

Youth (n = 42) from three neighbourhoods in Vancouver, Canada were recruited to: (1) Assess environmental assets and barriers to connectedness in their neighbourhoods using a digital photovoice app; (2) Analyze and prioritize their collective data into themes; and (3) Design and advocate for environmental improvements through a participatory workshop and forum with residents, city planners, and elected officials. Data on participant characteristics and neighbourhood perceptions were collected via an online survey and analyzed descriptively. Participatory analysis was conducted with youth using methods from thematic analysis, photovoice, and design thinking.

RESULTS

Youth captured 227 environmental features impacting their connectedness. The most frequently reported assets were parks and nature (n = 39, 17%), including formal and informal green spaces, and food outlets (n = 25, 11%). Top barriers included poor neighbourhood aesthetics (n = 14, 6%) and inadequate streets and sidewalks (n = 14, 6%). Thematic analysis with youth underscored four themes: (1) Connecting through mobility: The fun and functionality of getting around without a car; (2) The power of aesthetics: Mediating connections to people and place; (3) Retreating to connect: Seeking out social and restorative spaces for all; and (4) Under-resourced, not under-valued: Uncovering assets for sociocultural connection. Youth described their local environments as affording (or denying) opportunities for physical, emotional, and cultural connection at both an individual and community level.

CONCLUSION

Our findings extend evidence on key environmental determinants of social connectedness for youth, while highlighting the potential of community design to support multiple dimensions of healthy social development. Additionally, this work demonstrates the resilience and agency of youth in under-resourced settings, and underscores the importance of honouring assets, co-production, and intergenerational planning when working to advance healthy, connected, and youthful cities.

Gender differences and mental distress during COVID-19: a cross-sectional study in Japan

BACKGROUND

To identify risk factors for mental distress and investigate whether the factors were different between men and women during the coronavirus disease 2019 (COVID-19), using KOKOROBO data, which is an online platform that aims to facilitate access to mental health services.

METHODS

We used baseline data on KOKOROBO users 13 years of age or older in Japan who accessed it from October 11, 2021, to April 6, 2023, excluding those receiving treatment for mental health problems. Global severity, based on the most severe measure on Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Insomnia Severity Index (ISI), was analyzed using multivariable logistic regression with baseline characteristics for each gender, and for under 30 and 30 years of age or older in women. We conducted the same analysis of suicidal ideation for each gender.

RESULTS

In the 686 men and 1274 women, 117 (17.1%) and 100 (7.8%) had minimal global severity respectively, and the rest suffered from mental distress to some extent. For women, ages under 30 years (adjusted OR (aOR): 0.352, 95%CI: 0.231-0.539, P < 0.001), marriage (aOR: 0.453, 95%CI: 0.274-0.746, P = 0.002), and concerns about COVID-19 infection were associated with global severity, while having children (aOR: 0.509, 95% CI: 0.284-0.909, P = 0.023) and decrease of going out during the COVID-19 pandemic had a protective effect on global severity and suicidal ideation for men, respectively. Living with family was a risk factor for mental distress in unmarried women over 30 years of age. Less communication with family or others and responding to the questionnaire late at night (00:00-05:59) were associated with severe global severity in both genders.

CONCLUSIONS

Age, living arrangement, marriage, having children, concerns about COVID-19 infection, and lifestyle changes during the COVID-19 pandemic had gender-specific effects on mental distress, while frequent communication and regular life rhythm maintained mental health in both genders. Young women and, unmarried middle-aged women living with their families tended to experience mental distress during the COVID-19 pandemic.

TRIAL REGISTRATION

The Ethics Committee of the National Center of Neurology and Psychiatry approved this study (approval number B2020141) on April 15, 2021.

The impact of co-occurring chronic pain and mental health symptoms on adolescent functioning, a cross-sectional survey

Adolescents who experience poor mental health may develop chronic pain. Similarly, those with chronic pain may develop mental health symptoms. Little is known concerning how these co-occurring symptoms are associated with adolescent functioning. Our online cross-sectional quantitative study compared the specific nature of challenges to psychosocial functioning, across 4 groups: (1) adolescents with co-occurring chronic pain and mental health symptoms; (2) adolescents who only experience chronic pain symptoms; (3) adolescents who only experience mental health symptoms, and (4) adolescents who do not report either symptom. Participants completed self-report questionnaires assessing pain experiences, mental health symptoms and psychosocial functioning. After controlling for pain intensity, findings revealed significant differences, in physical, social, and family functioning across all groups. Significantly worse physical functioning was reported by adolescents with co-occurring pain and mental health symptoms and those with pain-only symptoms compared with adolescents with mental health-only symptoms and those without symptoms. Social functioning was significantly worse for adolescents who experienced co-occurring chronic pain and mental health symptoms compared with adolescents who experienced pain-only symptoms, and those with no symptoms. Significantly worse family functioning was reported by adolescents with mental health-only symptoms compared with adolescents reporting pain-only symptoms and no symptoms. Results suggest the combined impact of pain and mental health symptoms mainly influences adolescent social functioning. Future research is needed to develop standardised assessment and treatment plans to facilitate a thorough understanding of symptoms presented by adolescents who experience co-occurring pain and mental health symptoms.This study identifies that the combined impact of pain and mental health symptoms influences adolescent social functioning when compared to adolescents who experience pain-only or those without symptoms. Research is needed to develop standardised assessment and treatment plans to fully understand the symptoms presented by adolescents with co-occurring symptoms.

A "silent storm": uncovering the escalating crisis in mental healthcare for children and adolescents in Slovenia during and after the COVID-19 pandemic

AIM

Our aim was to assess the burden of children and adolescents' mental health problems on the Slovenian outpatient healthcare system before, during and after the pandemic.

METHODS

In a retrospective analysis of healthcare indicators from 2008 to 2023, we analysed data from the National Institute of Public Health. Key domains included initial visits for mental and behavioural disorders (MBDs) to primary care for the population aged 0-19; the number of referrals to an initial assessment with a child and adolescent psychiatrist (CAP) at the secondary level for the population aged 0-17 along with the corresponding waiting times; and the number of urgent referrals for the population aged 0-17 to emergency mental health centres at the tertiary level. The calculations included rates per 1000 people. Descriptive statistics and diagrams were used to compare the data. Segmented linear regression analysis (SLR) was conducted on the primary healthcare data to identify the distinct temporal point indicating an increase.

RESULTS

Comparing the average rates of the 2020-2022 period to those of the 2018-2019 period, there was a 20% increase in initial visits to primary care, a 23% increase in the referral rate to a CAP at the secondary level, and a 41% increase to the tertiary level of care. In secondary care, a four- to sevenfold increase in waiting times for the initial CAP assessment was observed between 2019 and 2023. The incidence of initial visits to primary healthcare services for MBD increased from 2008 to 2019 (average annual growth rate of 4.5%). The average annual growth rate for the 2020-2022 period tripled to 13.9%. The SLR showed that the trend of accelerating growth could have begun in 2017 for the 0-5 age group and possibly for the 15-19 age group as well.

CONCLUSIONS

After the initial decline in 2020, all levels of the Slovenian healthcare system faced an increased burden of MBD in children and adolescents from 2021 to 2022 compared to pre-pandemic levels. Nevertheless, a portion of this increase aligns with longitudinal growing trends from 2008 onwards. Tackling the crisis requires urgent national action, significant improvement in organization, and investments in mental health.

Daily Social Isolation Maps Onto Distinctive Features of Anhedonic Behavior: A Combined Ecological and Computational Investigation

Background

Loneliness and social isolation have detrimental consequences for mental health and act as vulnerability factors for the development of depressive symptoms, such as anhedonia. The mitigation strategies used to contain COVID-19, such as social distancing and lockdowns, allowed us to investigate putative associations between daily objective and perceived social isolation and anhedonic-like behavior.

Methods

Reward-related functioning was objectively assessed using the Probabilistic Reward Task. A total of 114 unselected healthy individuals (71% female) underwent both a laboratory and an ecological momentary assessment. Computational modeling was applied to performance on the Probabilistic Reward Task to disentangle reward sensitivity and learning rate.

Results

Findings revealed that objective, but not subjective, daily social interactions were associated with motivational behavior. Specifically, higher social isolation (less time spent with others) was associated with higher responsivity to rewarding stimuli and a reduced influence of a given reward on successive behavioral choices.

Conclusions

Overall, the current results broaden our knowledge of the potential pathways that link (COVID-19-related) social isolation to altered motivational functioning.

The impact of positive and adverse childhood experiences on social connectedness in young adults

Establishing and maintaining social relationships is a critical developmental milestone for adolescents and young adults and can be disrupted by childhood adversities. Adverse and positive childhood experiences (ACEs and PCEs, respectively) represent independent, yet critical, domains that support the exploration of positive and adverse childhood experiences (PACEs) as pathways to social connection. Recent research has examined the impact of COVID-19 on child development. The current study expands on existing research by examining the effects that PACEs clusters and high school enrollment during COVID-19 had on social connectedness. Young adults (N = 211; Mage = 20.97 years, SD = 2.14) completed an online survey examining social functioning and childhood experiences. Two measures comprised PACEs: Benevolent Childhood Experiences (BCEs) scale and Adverse Childhood Experiences questionnaire. An adapted Berkman-Syme Social Network Index measured social connection. High school enrollment during COVID-19 was determined by graduation year. Cluster analyses identified three PACEs profiles: (1) high BCEs/low ACEs (74.9%), (2) moderate BCEs/high ACEs (14.7%), and (3) low BCEs/moderate ACEs (10.4%). Regression analyses showed that High Risk/High Protection (β = -3.326, p = .001) and Moderate Risk/Moderate Protection (β = -4.845, p < .001) profiles had significantly fewer social connections than the Low Risk/High Protection profile. High school enrollment at the COVID-19 onset did not predict social connection (β = 0.067, p = .305). Implications include clinicians considering PACEs when forming a holistic view of clients and integrating positive contexts into adversity research.

Bouncing back from COVID-19: The role of resilience in depression, substance use, and loneliness in college students amidst the pandemic

Objective: To assess the influence of specific COVID-19 impacts on college student depression, loneliness, and alcohol and cannabis use, and to investigate if resilience moderates these relationships. Participants: Data were collected from students (N = 1849, 80.9% white, 66.6% female) at a midwestern university during the 2021 winter/spring semester. Methods: Data were gathered cross-sectionally through an online survey platform. COVID-19 impacts and resilience's relationships with mental health variables were analyzed with multiple regression analysis. Moderation analyses were conducted using PROCESS. Results: The COVID-19 impacts measured in this study were significantly related to student depression and cannabis use. Resilience moderated the association between COVID-19 impacts and (a) depression and (b) cannabis use. Conclusion: Resilience may mitigate the effect of pandemic-related impacts on depression and cannabis use in college students, but not loneliness and alcohol use. These findings hold important implications for further research and practice.

Social isolation, psychological distress and resilience of Chinese college students during COVID-19 pandemic

It has been 3 years since the first appearance of COVID-19 in China. During this time, social isolation was widely used as an important method to fight it. However, this measure had many negative effects on the mental health of college students. To better understand this issue, this study aims to explore the impact of social isolation and COVID-19-related stress on psychological distress among Chinese college students. Additionally, resilience has been evaluated as a key component of stress resistance in this situation. Coronavirus Stress Measure (CSM), the Connor-Davidson Resilience Scale (CD-RISC) and the Brief Symptom Inventory (BSI) were used in this study. A total of 388 Chinese college students participated in the survey via the Internet. Two groups (isolated group vs. non-isolated group) were divided according to whether they have been isolated from their classmates and families. Data analysis adopts t-test, F test and mediate effect analysis by SPSS21.0. (1) All factors, except resilience, were found to have lower scores in the isolated group; (2) significant correlations were found between all factors; (3) resilience partially mitigated the impact of COVID-19 stress on psychological symptoms. Social isolation has been found to be a significant factor contributing to negative psychological distress in Chinese college students. The COVID-19-related stress may increase the likelihood of psychological suffering among isolated group. Resilience can help reduce the negative effects of COVID-19 stress on college students. Therefore, providing appropriate psychological support tailored to different isolation situations is crucial.

Quarantine Experience-Based Differences in Factors Associated with Depression Among Koreans During the COVID-19 Pandemic

BACKGROUND/OBJECTIVES

The strict preventive measures implemented globally during the COVID-19 pandemic affected mental health, with most countries reporting a rise in depression and suicide. This study examined factors affecting depression among Korean adults based on quarantine experiences during 2020 and identified key areas for mental health support.

METHODS

Data were obtained from South Korea's 2020 Community Health Survey. Responses from 219,228 adults (1893 with quarantine experience and 217,335 without) to questions about quarantine experience, depression (Korean version of PHQ-9 score ≥ 10 or a response of 'several days' or more on item 9), and individual/environmental factors were analyzed. Complex sampling analysis, including descriptive statistics and logistic regression, was conducted using SPSS 29.0.

RESULTS

This study found that 158 (weighted 7.5%) of those with quarantine experience, and 12,833 (weighted 5.8%) without quarantine experience, reported depression. Regardless of quarantine, being female, having a low income, a history of depression, and increased stress were associated with a higher depression rate, while good subjective health was linked to lower depression rates. Smoking, living-alone, and a lack of sleep among non-quarantined individuals were linked to increased depression risk, while adequate physical activity was linked to reduced risk. Interestingly, alcohol consumption and being overweight (BMI 23-<25) were associated with lower depression rates. Environmental factors, like unmet medical needs and reduced daily activity, were linked to increased depression. Strong social support and social distancing adherence were associated with reduced depression.

CONCLUSIONS

These findings underscore the importance of targeted interventions considering quarantine experiences to reduce depression during pandemics.

Autism or not? A case series of evaluation decision points in child and adolescent psychological assessment

Increase in the incidence of autism spectrum disorders (ASD) and increased attention to symptoms of ASD in social media have contributed to a significant rise in referrals for neuropsychological assessment of possible ASD. Many practitioners lack specific training in the assessment of ASD and may avoid addressing these concerns, despite the frequency of those referrals. This paper reviews potential contributors to the rise in referrals and several related conditions which share some overlap with features of ASD. That is followed by descriptions of four school-aged children and adolescents referred for comprehensive evaluation of suspected ASD. The authors describe decision points in the diagnostic process for those with or without proficiency in ASD-specific testing and close with a series of recommendations for the assessment of clients with complex presentations referred for suspected ASD.

Solitude and serotonin: juvenile isolation alters the covariation between social behavior and cFos expression by serotonergic neurons

Variation in the mutual responsiveness of social partners to each other can be reflected in behavioral suites that covary with neural activity in ways that track the salience or valence of interactions. Juvenile social isolation alters social behavior and neural activity during social interaction, but whether and how it alters the covariation between behavior and neural activity has not been as well explored. To address this issue, four classes of experimental subjects: isolated males, socially housed males, isolated females, and socially housed females, were paired with an opposite-sex social partner that had been socially housed. Social behaviors and c-Fos expression in the serotonergic dorsal raphe nucleus (DRN) were then measured in subjects following the social interactions. Relative to social housing, postweaning isolation led to a decrease in the density of neurons double-labeled for tryptophan hydroxylase and c-Fos in the dorsomedial subdivision of the DRN, regardless of sex. Vocal and non-vocal behaviors were also affected by isolation. In interactions with isolated males, both ultrasonic vocalization (USVs) and broadband vocalizations (squeaks) increased in conjunction with greater male investigation of females. Neural and behavioral measures also correlated with each other. In the isolated male group, the density of double-labeled neurons in the dorsomedial DRN was negatively correlated with USV production and positively correlated with a principal component of non-vocal behavior corresponding to greater defensive kicking by females and less investigation and mounting behavior. This correlation was reversed in direction for socially housed males, and for isolated males versus isolated females. These findings confirm that the dynamics of social interactions are reflected in c-Fos activation in the dorsomedial DRN, and suggest an altered responsiveness of serotonergic neurons to social interaction following social isolation in males, in parallel with an altered male response to female cues.

Supporting young people through the COVID-19 pandemic and beyond: a multi-site qualitative longitudinal study

BACKGROUND

Throughout the COVID-19 pandemic, youth have experienced substantial stress due to abrupt changes in education, finances, and social life, compounding pre-existing stressors. With youth (ages 15-26) often at critical points in development, they are vulnerable to long-term mental health challenges brought on by pandemic trauma.

METHODS

To identify youth experiences throughout the pandemic and examine changes over time, we conducted semi-structured interviews among n = 141 youth in two Canadian provinces (Ontario and British Columbia) and across the country of Ireland at three time points over the course of more than one year (August 2020-October 2021). We conducted a qualitative longitudinal analysis using an inductive content approach.

RESULTS

Categories identified were (1) coping with hardship; (2) opportunities for growth; (3) adapting to new ways of accessing services; (4) mixed views on the pandemic: attitudes, behaviour, and perception of policy response; (5) navigating COVID-19 information; (6) transitioning to life after the pandemic; and (7) youth-led recommendations for government and service response. The findings also reveal trends in health and wellness in accordance with prolonged periods of lockdown, changes in weather, and return to normalcy after the availability of COVID-19 vaccines. Key recommendations from youth include incorporating youth voice into decision making, communicating public health information effectively to youth, enhancing service delivery post-pandemic, and planning for future pandemics.

CONCLUSIONS

These results provide insights into the extensive longitudinal impacts of the COVID-19 pandemic on young people across three geographical locations. Actively involving youth in decision making roles for future pandemics or public health emergencies is critical.

Increased post-COVID-19 behavioral, emotional, and social problems in Taiwanese children

BACKGROUND

Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has remarkably impacted children's mental health. Investigating whether COVID-19-related behavioral changes persist after recovery from the acute phase of infection warrants investigation. The present study aimed to identify children's behavioral/emotional and social adjustment problems after SARS-CoV-2 infection.

METHODS

84 children aged 6-16 received assessments within 6 months after being tested positive for COVID-19. Their parents reported observations about their children 3 months before SARS-CoV-2 infection (pre-COVID condition) and the most recent 2 weeks (post-COVID condition) on a wide range of psychopathologies and social functional impairments. A control group consisted of 84 age-, sex-, and IQ-matched healthy children, with the same measures as those employed in the COVID group.

RESULTS

Compared with the control group, the COVID group in the post-COVID condition had more severe symptoms of inattention, hyperactivity-impulsivity, opposition, a wide range of emotional and behavioral problems, and poor school functions, school attitude, social interaction, school behavioral problems, and interaction problems with their parents. Compared with the pre-COVID condition, the COVID group had greater severity of inattention, somatic complaints, thought problems, internalizing problems, poor school functions, and interaction problems with their parents in the post-COVID condition.

CONCLUSIONS

The present study identified a significant link between SARS-CoV-2 infection and various post-COVID mental health sequelae in children, including behavioral/emotional and social adjustment challenges. Our results underline the importance of raising awareness about ongoing post-COVID mental health concerns in children.

Prevalence of Depressive Symptoms in a Predominantly Hispanic/Latinx South Texas Community in the Aftermath of the COVID-19 Pandemic

OBJECTIVE

COVID-19 has a lasting impact on mental health, particularly within the Hispanic/Latinx communities. This paper empirically investigates the post-COVID-19 presence and severities of depression, one of the most common mental health disorders, among adults in a predominantly U.S.-born Hispanic/Latinx community in South Texas composed primarily of Mexican Americans.

METHODS

Multiple statistic regression models were applied to data from 515 adults in Nueces County who completed all questions in a survey from convenience sampling between June 2022 and May 2023. Depression was assessed using both standard PHQ-2 and PHQ-9 measurements.

RESULTS

Of the 515 participants, 377 (64.5%) were Hispanic, and 441 (85.6%) had a high school education or higher, reflecting the county's demographics. About half of the participants (47%) reported mild/moderate to severe depression. The regression model estimation results reveal that female participants, those not in full-time employment, and individuals with disabilities were more likely to feel depressed after COVID-19. Middle-aged adults demonstrated greater resilience to depression compared to other age groups. Notably, non-Hispanic participants in the study reported higher levels of depression compared to their Hispanic counterparts. Additionally, COVID-19-related experiences, such as testing positive for the virus, being hospitalized, or having a history of depression before COVID-19, were associated with higher levels of reported depression.

CONCLUSIONS

COVID-19 has significantly impacted the mental health of this predominantly U.S.-born Hispanic/Latinx community. These findings can assist healthcare providers and policymakers in developing targeted strategies to tailor interventions aimed at enhancing mental health well-being, reducing disparities, and fostering overall improvement within the Hispanic/Latinx community.

Adolescent resilience in the face of COVID-19 stressors: the role of trauma and protective factors

BACKGROUND

The COVID-19 pandemic introduced unique stressors that posed significant threats to adolescent mental health. However, limited research has examined the impact of trauma exposure on vulnerability to subsequent stressor-related mental health outcomes in adolescents. Furthermore, it is unclear whether there are protective factors that promote resilience against the negative impacts of COVID-19 stressors in adolescents with prior trauma exposure. This preregistered study aimed to investigate the impact of trauma on COVID-19 stressor-related mental health difficulties in adolescents, in addition to the role of protective factors.

METHODS

Aims were investigated in a sample of 9696 adolescents (mean age 12.85 ± 0.88 years) from the Adolescent Brain Cognitive Development Study. Linear mixed-effects models were employed to examine (a) the associations of early trauma exposure (exposed v. non-exposed), COVID-19 stressors, and perceived stress, sadness, and positive affect levels during the pandemic period in the US, and (b) the role of protective factors (physical activity, parental support, and improvements in family and peer relationships) in these associations.

RESULTS

There was a positive association between COVID-19 stressors and sadness, which was enhanced in trauma-exposed adolescents. Improvements in family and peer relationships mitigated the association between COVID-19 stressors and poor mental health outcomes, regardless of prior traumatic experience.

CONCLUSIONS

These findings support the hypothesis that prior trauma elevates risk of mental health difficulties in the face of future stressors. Results underscore the protective role of enhanced social relationships as targets for early prevention and intervention in those experiencing acute stressors, regardless of prior traumatic experiences.

'The coronavirus is a formidable foe': children's multimodal articulations of SARS-CoV-2 virus and COVID-19 pandemic experiences in China

OBJECTIVE

This study explored children's post-pandemic articulations regarding the coronavirus along with their lived experiences during the COVID-19 pandemic.

DESIGN

A qualitative survey featuring drawings, comments, questions and follow-up interviews was employed to gather data from 108 infected children aged 13 to 14 from two middle schools in China. This multimodal approach allowed for a rich capture of the children's articulations of their pandemic experiences.

RESULTS

Children's multimodal articulations conveyed not only the biological features of, but also their emotional reactions to the coronavirus. The pandemic had disrupted children's lives, making online learning, sleep and screen engagement dominant in their daily routines, while also compounding children's unhappiness primarily due to restrictions on social interactions. Children associated the coronavirus with biological, medical, psychological and social aspects. Increased sanitisation and hygiene habits featured their pre-to-post pandemic changes. Furthermore, children exhibited an awareness regarding preventive measures and transmission modes, albeit with certain biases or gaps. Their misunderstandings about recuperative strategies merit clarification.

CONCLUSION

The COVID-19 pandemic has had profound and multifaceted impacts on children's emotional well-being, daily routines, social interactions, education, and health-related behaviors. Children's multimodal articulations revealed a spectrum of adverse effects caused by the pandemic, calling for targeted health interventions to mitigate these negative effects while also equipping children with resilience and coping skills for navigating future health crises. Incorporating children's perspectives and experiences into future pandemic preparedness and health promotion strategies is essential for addressing their vulnerabilities and ensuring their overall well-being during public health crises.

Generational Shifts in Adolescent Mental Health: A Longitudinal Time-Lag Study

There is concern that adolescents today are experiencing a "mental health crisis" compared to previous generations. Research has lacked a longitudinal time-lag design to directly compare depressive symptoms and social anxiety of adolescents in two generations. The current study surveyed 1081 adolescents in the current generation (Mage = 14.60, SD = 0.31, 49% female) and 1211 adolescents in a previous generation (Mage = 14.40, SD = 0.51, 51% female) across the high school years (grades 9-12), 20 years apart. Mixed-effects analysis revealed that the Current-Sample reported higher and increasing mental health problems over time compared to the Past-Sample. Although most adolescents reported consistently low mental health problems, the Current-Sample had a higher proportion of adolescents who were consistently at risk across the high school years compared to the Past-Sample. These findings highlight while most adolescents in both generations do not report elevated mental health problems, there may be a small, yet growing, group of adolescents today at risk for experiencing a "mental health crisis".

Relationship between social anxiety and sleep quality in depressed adolescents: the mediating role of internet addiction

Objective

This study investigated the association between social anxiety and sleep quality and further explored the potential mediating role of internet addiction in depressed adolescents.

Methods

This study included 440 Chinese depressed adolescents (mean age = 15.0 years, SD = 2.0). Participants completed questionnaires, including Social Avoidance and Social Distress Scale, Internet Addiction Test, and Pittsburgh Sleep Quality Index. A structural equation model was used to analyze the association between social anxiety and sleep quality, with internet addiction as a mediator. Gender differences were examined by multi-group analysis.

Results

Among participants, 61.8% reported poor sleep quality. The sleep quality was significantly different on the level of gender (p = 0.016), education level (p = 0.043), and family history (p = 0.002). Sleep quality was positively associated with social anxiety (p < 0.001) and internet addiction (p < 0.001). Furthermore, internet addiction partially mediated the relationship between social anxiety and sleep quality, and the mediation effect ratio was 16.1% (p < 0.001). Finally, no significant differences were found in this mechanism.

Conclusion

We concluded that both social anxiety and internet addiction were risk factors for depressed adolescents' poor sleep quality. Social anxiety further affected sleep quality through internet addiction.

The Effect of Screen Time and Positive School Factors in the Pathway to Child and Youth Mental Health Outcomes

Beyond achievement, educational settings offer informal supports that may be critical for child and youth mental health. However, children's educational environments have experienced significant disruption with the coronavirus pandemic. School settings offer unique opportunities to support children's mental health, but research must identify powerful points of intervention. This study examined school factors (aspirations, perceived competence, sense of belonging, and emotional engagement) as predictors of children's mental health, and the potential consequences of increasing screen time in and outside of school. Participants (N = 707) were parents and their children (6-18 years) from community and clinical settings who completed prospective surveys about children's school experiences and mental health symptoms (November 2020-May 2022). Standardized measures of depression, anxiety, irritability, inattention, and hyperactivity were collected. Structural equation modelling tested longitudinal associations between screen time, school factors, and mental health outcomes. Positive associations between each of the school factors (B = 0.14 [SE = 0.04] to B = 0.43 [SE = 0.04]) suggested they may reinforce one another. Longitudinally, sense of belonging and emotional engagement at school predicted lower severity for symptoms of depression, anxiety, irritability, and inattention (B=-0.14 [SE = 0.07] to B =-0.33 [SE = 0.10]). Greater screen time was associated with lower aspirations and perceived competence (B = - 0.08 [SE = 0.04] to B = - 0.13 [SE = 0.06]). Results suggest that school factors beyond achievement may be key correlates of child and youth mental health. While curriculum expectations emphasize academic achievement, an investment in supporting positive attitudes and aspirations at school is also warranted.

Moderators of the Effects of a Digital Parenting Intervention on Child Conduct and Emotional Problems Implemented During the COVID-19 Pandemic: Results From a Secondary Analysis of Data From the Supporting Parents and Kids Through Lockdown Experiences (SPARKLE) Randomized Controlled Trial

BACKGROUND

A smartphone app, Parent Positive, was developed to help parents manage their children's conduct and emotional problems during the COVID-19 pandemic. A randomized controlled trial, Supporting Parents and Kids Through Lockdown Experiences (SPARKLE), found Parent Positive to be effective in reducing children's emotional problems. However, app effectiveness may be influenced by a range of child, family, socioeconomic, and pandemic-related factors.

OBJECTIVE

This study examined whether baseline factors related to the child, family, and socioeconomic status, as well as pandemic-related disruption circumstances, moderated Parent Positive's effects on child conduct and emotional problems at 1- and 2-month follow-up.

METHODS

This study was a secondary exploratory analysis of SPARKLE data. The data set included 646 children (4-10 years of age) with parents randomized to either Parent Positive (n=320) or follow-up as usual (n=326). Candidate baseline moderators included child age, gender, attention-deficit/hyperactivity disorder symptoms, parental psychological distress, family conflict, household income, employment status, household overcrowding, and pandemic-related disruption risk (ie, homeschooling, lockdown status, and isolation status). Child conduct and emotional problem outcomes measured at 1- (T2) and 2-months (T3) post randomization were analyzed using linear mixed-effects analysis of covariance models adjusting for baseline (T1) measure of outcome and including intervention and intervention by time point interaction terms allowing for different effects at the 2 time points. Moderation of intervention effects by baseline factors was assessed by replacing the intervention by time interaction terms with intervention by time point by baseline moderator interaction terms.

RESULTS

Child gender was a significant moderator of the Parent Positive versus follow-up as usual effect on emotional problems (B=0.72, 95% CI 0.12-1.33; P=.02). Specifically, the effect of Parent Positive was close to significant (T2: B=-0.41, 95% CI -0.82 to 0.0004; P=.05) or significant (T3: B=-0.76, 95% CI -1.22 to -0.30; P<.001) in males only when compared with females, and males experienced a significantly larger reduction in emotional problems than females in the Parent Positive arm at the 2-month post randomization time point. None of the other investigated baseline factors moderated effects on emotional problems, and no factors moderated effects on conduct problems.

CONCLUSIONS

This study highlights Parent Positive's potential for effectively reducing emotional problems in primary school-aged male children across a wide range of families. However, due to limited variability in the demographic background of the families, cautious interpretation is required, and replications are necessary in diverse samples with longer follow-up times.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04786080; https://clinicaltrials.gov/ct2/show/NCT04786080.

A digital iCBT intervention for social anxiety disorder in Quebec and Ontario: protocol for a multi-phase effectiveness-implementation study

BACKGROUND

Social anxiety disorder (SAD) is one of the most prevalent anxiety disorders in Canada. Viable therapy options for the treatment of SAD include CBT being delivered virtually. In Australia, an innovative internet-delivered cognitive-behavioral therapy (iCBT) program for social anxiety has been developed, implemented, and demonstrated as effective. To make available high-quality and real-time evidence in response to the crucial need to access psychological services to meet population mental health needs, we propose to conduct a Canadian adaptation of the iCBT Shyness Program and to examine the program's effectiveness, and implementation in two Canadian provinces (Quebec and Ontario).

METHODS

The overall study design is a hybrid effectiveness-implementation study of a quasi-experimental parallel group trial. Prior to implementing the iCBT Shyness Program, it will undergo an initial adaptation to the Canadian context and focus groups will be conducted with key actor groups to discuss the adaptations to the graphics, narration of the lessons, and this to better reflect varying socio-cultural context among Canadian French- and English-speaking populations. We will evaluate the effectiveness of the program in three parallel pathways reflecting real-world pathways: (1) self-refer to the intervention; (2) recommended by a health professional without guidance; and (3) recommended by a health professional, with low-intensity guidance. Data collection will be carried out at baseline, at the beginning of each lesson, 12-week and 6-month follow-up. Outcomes measured will include anxiety and depressive symptoms, psychological distress, disability, as well as health service utilization and satisfaction. Semi-structured interviews will then be conducted with study participants and health care providers to explore facilitating factors and barriers to the implementation of the iCBT adapted program.

DISCUSSION

This study will provide evidence on the effectiveness, barriers and facilitating factors to implementing a low-intensity iCBT in the Canadian context for SAD, which will bridge an important care gap for undeserved populations in Canada with SAD. Findings will inform the eventual scaling up of the program in community-based primary care across Canada. This would improve equity of the health care system by helping a large number of Canadians to timely access to mental health services.

TRIAL REGISTRATION

clinicaltrials.gov NCT06403995. Prospectively registered on 05/03/2024.

Adolescent mental well-being in time of crises: The role of social and residential contexts

BACKGROUND

The extent of the impact and the interconnections among factors within social and residential contexts during the COVID-19 lockdowns on mental well-being remain to be elucidated. We identified latent classes of each of social and residential context during the lockdown and examined their associations with mental well-being among adolescents in France 1-year after the first lockdown.

METHODS

We used data collected in 2021 in a cross-sectional school-based pilot study for EXIST, from 387 participants ages 12-15 years. Participants reported retrospectively on characteristics of their social and residential contexts during the lockdown, and their current mental well-being in self-report questionnaires. We used latent class analysis to identify latent classes of social and residential contexts, and linear regression models to examine the associations between these contexts and mental well-being.

RESULTS

Four social context classes were identified: class 1 "Low opportunity for social contact at home," class 2 "Moderate opportunity for social contact at home," class 3 "High opportunity for social contact at home," and class 4 "Very high opportunity for social contact at home." Relative to class 4, lower levels of mental well-being were observed among adolescents in class 1 (b = -4.08, 95% CI [-8.06; -0.10]) 1 year after the lockdown. We identified four residential context classes based on proximity to nature, type of residence (e.g., apartment, house), and level of neighborhood deprivation. No association was detected between residential context during the lockdown and adolescent mental well-being one-year later.

CONCLUSION

A limited social context may negatively impact adolescent mental well-being during crises.

Impact of COVID-19 on referrals to paediatric liaison psychiatry at Children's Health Ireland at Crumlin as the pandemic moved to endemic status

BACKGROUND

Rates of acute mental health presentations in youth were increasing pre-pandemic internationally. Longitudinal studies following COVID-19 attest to ongoing deterioration in youth mental health, recognising adverse unintended consequences following public health restrictions.

AIMS

To examine whether the initial post-COVID-19 increase in mental health presentations persisted following the reclassification of COVID-19 to endemic status, accompanied by the removal of most restrictions.

METHOD

All referrals to paediatric liaison psychiatry (PLP) between January 2018 and December 2022 in a Dublin tertiary children's hospital were included in the study. An interrupted time series analysis with autoregressive integrated moving average models was conducted, examining referrals with respect to different phases of COVID-19 and application of public health restrictions.

RESULTS

Some 1385 referrals to PLP were received over the 5-year study. There was a significant decrease in PLP referrals immediately post-COVID-19, followed by a significant and sustained increase as the pandemic progressed and moved to endemic status. Public health restriction phases had a unique effect on those presenting with suicidal ideation, with a significant increase in the number of referrals. There was no effect of restrictions on other clinical profiles.

CONCLUSIONS

Increased referrals for youth with mental health difficulties, reported during the COVID-19 pandemic, persisted into the early endemic stage, after COVID-19 public health restrictions ceased. Specific impacts of restrictions on suicidal ideation referrals require further study. Investment in child and adolescent mental health services remains a priority, and future pandemic response strategies need to examine unintended consequences of any enforced public health measure.

Strategies and sacrifices of family caregiving in the Somali-American community: a qualitative study

BACKGROUND

Among the many pressing concerns of the Somali-American community, and other similar immigrant and refugee communities as they grow in the United States, is the provision of care for older adults and adults with disabilities. The implications of effective caregiving range from the facilitation of community building and place-making to the delivery and management of healthcare on a systemic level. However, little is currently known about Somali-American family caregivers, including their duties and responsibilities, primary concerns, and the impacts of surrounding influences on their ability to fulfill their role.

METHODS

Semi-structured interviews were conducted with 10 Somali-American family caregivers in Somali language. The resulting transcripts were translated into English by a professional interpreter and analyzed using an inductive thematic analysis approach. A key informant from the community was additionally consulted for insights regarding cultural nuances and interpretations of idiomatic expressions and concepts.

RESULTS

Thematic analysis of the reports revealed the principal themes of visitation, patient accompaniment, and self-sacrifice through acceptance and God-consciousness as pervasive and salient concerns across participants. Furthermore, the heightened stresses of the COVID-19 pandemic revealed just how severe the consequences can be when access to culturally habituated navigational tools and coping mechanisms are restricted.

CONCLUSIONS

In light of our findings, the growing concern for discrimination and sociocultural discord in the Somali-American community presents a particularly prescient threat to the well-being and sustainability of family caregivers. Their experiences must be understood and used to promote education and partnership between the healthcare system and the community in order to build trust and ensure a healthy future for this indispensable population.

The roles of dating and victimization on adverse mental health among teens: Survey findings during the COVID-19 pandemic

INTRODUCTION

The relationship between romantic involvement, dating violence, other victimizations, and mental health among adolescents in the context of the COVID-19 pandemic is understudied.

METHODS

This study analyzed 2021 survey data collected from a representative sample of 9th-12th grade students (n = 10,792) from 24 high schools in a US Midwestern state. Most respondents identified as White, heterosexual, and US-born, with more than three-quarters aged 15-17 years. Guided by the poly-victimization framework, this study explored: (a) How do youth victimizations and mental health concerns differ by their experience of dating and dating violence? (b) What are the associations between youth mental health concerns, victimizations, and dating?

RESULTS

Youths reported mental health concerns and victimizations at considerable rates during the COVID-19 pandemic when in-person interactions were limited. Those who experienced dating violence were at a higher risk of reporting other victimizations (i.e., unwanted sexual comments, unwanted sexual contact, sexual photos/videos, sex trading for compensation, discrimination, and bullying). The number of victimizations demonstrated a cumulative effect on teen mental health. Most individual victimizations showed significant net associations with mental health concerns, even when controlling for other differing victimizations.

CONCLUSIONS

Dating violence plays a critical role in the interconnectedness of victimizations, and the number of victimizations has a cumulative effect on teen mental health. The high prevalence of youth victimizations during the time when in-person interactions were limited suggests that victimizations may transfer from in-person forms to virtual forms and occur offline. Implications for individual and community prevention and interventions are discussed.

[Loneliness as health risk: a narrative review]

Loneliness is increasingly recognized as a significant health risk. This review provides an overview of current research on the impact of loneliness on mental and physical health. The findings indicate that loneliness is a significant risk factor of both mental and physical health. Previous reviews focusing on mental health effects reveal that loneliness is associated with the onset of depression, social anxiety, and cognitive decline. Furthermore, loneliness can impede recovery from mental disorders in general, which can be partly attributed to the bidirectional interplay between loneliness and mental health. Regarding physical health, consequences of loneliness have been mostly studied in relation to cardiovascular diseases. Loneliness predicts the onset of cardiovascular diseases and impedes recovery from them. Reviews also highlight that loneliness enhances the likelihood of suicidality and mortality. However, this article also points out the shortage of longitudinal studies, complicating the investigation into how loneliness causally affects future health problems. The health implications of loneliness outlined in this review, some of which are irreversible and can induce suffering and impairment, underscore the importance of interventions aimed at alleviating loneliness as a preventive strategy against both mental and physical illnesses.

Peruvian Adolescent Mental Health Across Two Years of the COVID-19 Pandemic: A Four Time-Point Longitudinal Study

PURPOSE

This study investigated symptoms of anxiety and depression, feelings of loneliness, and life satisfaction among low-to-middle income Peruvian adolescents during 2 years of remote schooling due to the COVID-19 lockdown.

METHODS

We used a four-wave longitudinal observational approach. Data were collected in April 2020, October 2020, June 2021, and November 2021 in Perú. A total of 2,392 adolescents (ages 10-15; 57% female) participated in the study. We described longitudinal changes in symptoms of anxiety and depression, feelings of loneliness, and life satisfaction across the four time points and investigated sex and school grade differences.

RESULTS

Symptoms of anxiety, depression, and loneliness increased, and life satisfaction decreased over the course of 2 years of remote education. The rate of change was different for each outcome of well-being. We found robust sex differences for all outcomes. In addition, we found school grade differences for anxiety and depression.

DISCUSSION

The mental health and well-being of Peruvian adolescents, particularly female adolescents, declined during 2 years of remote education, despite loosening of other pandemic restrictions. Depression appears to have the earliest impacts, with anxiety levels showing even some improvement for male adolescents. School grade differences in levels of anxiety and depression for seventh and eighth graders in 2020 and 2021 provide initial evidence to disentangle pandemic from developmental effects.

Exploring the Impact of COVID-19-Related Changes on the Well-Being of Korean Adolescents: An Analysis Using a Serial Mediation Model

PURPOSE

Few studies have investigated both the positive and negative impacts of perceived changes related to the COVID-19 pandemic on adolescents' wellbeing. This study aimed to comprehensively identify the factors associated with the overall wellbeing of the youth population.

METHODS

A cross-sectional study design was employed using data from the 2020 Korean Survey of Children and Youth. Data were collected from N = 7,170 adolescents (aged 9-24 years) during the implementation of social distancing measures in response to the COVID-19 pandemic. Participants provided self-reported data about their COVID-19-induced perceived changes, wellbeing, parental support, and self-esteem between November 2020 and February 2021. The effect of COVID-19-induced perceived changes on adolescents' wellbeing during the pandemic was assessed by evaluating the mediating roles of parental support and self-esteem.

RESULTS

The findings highlighted a serial mediating effect of parental support and self-esteem on the relationship between adolescents' COVID-19-related perceived changes and wellbeing.

DISCUSSION

This study deepens the understanding of the intricate interplay between pandemic-related perceived changes, mediating factors, and wellbeing among adolescents. The findings imply that a comprehensive approach combining interventions aimed at enhancing self-esteem at the individual level with parental support may be most effective in improving adolescents' wellbeing.

Reported Impact of COVID-19 Workload and Stressors on School Nurses' Provision of Care During the 2021-2022 School Year: A Secondary Analysis of U.S. School Nurse Survey Data

Many school nurses experienced increased work burden and stress during the COVID-19 pandemic. This analysis examined data from a Centers for Disease Control and Prevention cross-sectional, nationwide survey of school nurses in March 2022 to examine associations between school nurses' ability to conduct their core responsibilities and selected nurse and school factors among school nurses during the 2021-2022 school year and COVID-19 pandemic. Perceived adequate staffing and financial compensation reduced the odds of reported difficulties across all core school nursing tasks. Nurses without a registered nurse license and with higher caseloads were more likely to report difficulty in implementing specific tasks. The impact of these factors varied, with inadequate financial compensation having the largest association with school nurses' difficulty implementing all the core responsibilities. The study results improve our understanding of school nurses' challenges in implementing core school nursing responsibilities during the COVID-19 pandemic in the 2021-2022 school year.

Parallel Mediating Effects of Sleep Quality, Psychological Distress, and Self-Stigma in the Associations Between Long COVID Symptoms and Quality of Life Among Taiwanese Individuals With Mental Health Illness

BACKGROUND

Long COVID symptoms (i.e., experiencing symptoms of COVID-19 for 3 months post-COVID-19) affect individuals' health and their quality of life (QoL). However, the pathways through which it does so are not fully known.

AIM

The present study examined the mediating roles of sleep quality, psychological distress, and self-stigma in the associations between long COVID symptoms and QoL among individuals with mental illness.

METHOD

Individuals with mental illness (n = 333) were recruited from a psychiatric center in southern Taiwan to participate in the study. Data were collected regarding sleep quality, psychological distress, self-stigma, and QoL. Independent t-tests, Pearson correlations, and regression with Hayes' Process Macro were used to compare groups, examine relationships, and parallel mediation models, respectively.

RESULTS

Participants with long COVID symptoms had significantly worse sleep quality, psychological distress, physical QoL, and psychological QoL compared to those without symptoms. There were significant relationships between sleep quality, psychological distress, self-stigma, and QoL. Sleep quality significantly mediated the associations between long COVID symptoms and physical and social QoL. Psychological distress significantly mediated the associations between long COVID symptoms and all domains of QoL, but not self-stigma.

CONCLUSION

There are alternative pathways (e.g., sleep quality and psychological distress) through which long COVID symptoms may affect the QoL of individuals with mental illness. The findings suggest that individuals with long COVID symptoms have a higher chance of having poor QoL. Therefore, there may be the need for counseling and possible therapy for those who contract COVID-19, especially among individuals who already have mental illness.

Trends in Pediatric Electronic Device-Related Burns: An Investigation of 21,962 Cases

INTRODUCTION

The Consumer Product Safety Improvement Act (CPSIA) was passed in 2008 to establish safety standards and improve the quality of children's products. Coronavirus Disease 2019 (COVID-19) led to a "stay-at-home" quarantine. The purpose of this study is to evaluate trends of pediatric burns and analyze the relationship with the CPSIA and COVID-19.

METHODS

The National Electronic Injury Surveillance System database was used to identify thermal and electric pediatric burns from 2002 to 2021. To evaluate the association of the CPSIA and COVID-19, burns before and after the law was passed, and the pandemic, were analyzed. Sex, ethnicity, age, injured body part, product, and disposition were determined. Chi-squared analysis was performed.

RESULTS

A total of 21,962 burns met inclusion criteria, with 1409 electrical and 20,553 thermal burns. Majority of cases were male (58.3%) and involved household appliances (34.2%). For the CPSIA cohort, there was an average of 1274.1 burns per year before 2009, which decreased to 1003.3 burns per year after 2009. Before 2009, most burns affected the hand (44.5%), which increased after 2009 and remained the most-affected body part (48.1%, P < 0.001). For the COVID-19 cohort, there was an average of 1133.5 burns per year before 2020, which decreased to 779.5 burns per year after 2020.

CONCLUSIONS

The CPSIA and COVID-19 pandemic may have led to a decreased incidence of pediatric burns from electronic devices. Pediatric populations are still at high risk for hand burns and household appliance burns. Providers should be aware of burn trends to inform guardians about the risks.

Longitudinal change in symptoms of depression, anxiety and post-traumatic stress disorder during the COVID-19 pandemic among Mexican college students

Longitudinal studies suggest the psychological difficulties precipitated by the COVID-19 pandemic have gradually declined, but our understanding of the factors that predict change in mental health is limited. We evaluated the mental health of Mexican college students during the early stage of the pandemic and 4 months later, as well as predictors of change in students' mental health. Participants were 648 students (71% women, Mage = 21.46) from a private University in Northern Mexico who completed online surveys from May 2020 to September 2020. Students' self-reported levels of mental health symptoms (depression, anxiety and post-traumatic stress disorder) significantly decreased from May to September. Poor physical health, more COVID-related worry and higher initial levels of peer social support predicted less change in psychological symptoms. On the other hand, more hours of sleep per night and a pre-existing mental health diagnosis predicted steeper decreases in symptoms. Findings suggest reductions in mental health difficulties that are consistent with theoretical frameworks of resilience among Mexican college students. In addition, results underscore the interplay between physical, psychological and social functioning, and the need for continued monitoring of mental health and intervention efforts that address physical health, sleep and pandemic-related worry in University settings.

[Strategies against loneliness-examples from an international comparative perspective]

The extent of loneliness differs internationally. Especially in the developed welfare states of Northern Europe, loneliness levels in the population are comparatively low. However, the increase in loneliness in many countries shows that existing concepts are not sufficient to provide effective protection against loneliness. Younger people also need to be strengthened so that they do not withdraw when they experience social exclusion and loneliness. This requires qualified specialists in kindergartens, schools, sports clubs, and other leisure facilities who help children and young people to establish social contacts. Friendship and neighborhood models have proven to be successful when it comes to strategies to combat loneliness. Greater identification with the neighborhood and a feeling of security help build social networks and reduce loneliness. For older people it is important to be able to stay in their usual social environment and maintain their social contacts. To this end, accessible public spaces must be combined with home care and support services that are tailored to the needs and wishes of older people.

Implementing Foundry: A cohort study describing the regional and virtual expansion of a youth integrated service in British Columbia, Canada

AIM

Integrated youth services (IYS) have been identified as a national priority in response to the youth mental health and substance use (MHSU) crisis in Canada. In British Columbia (BC), an IYS initiative called Foundry expanded to 11 physical centres and launched a virtual service. The aim of the study was to describe the demographics of Foundry clients and patterns of service utilization during this expansion, along with the impact of the COVID-19 pandemic.

METHODS

Data were analysed for all youth (ages 12-24) accessing both in-person (April 27th, 2018-March 31st, 2021) and virtual (May 1st, 2020-March 31st, 2021) services. Cohorts containing all clients from before (April 27th, 2018-March 16th, 2020) and during (March 17th, 2020-March 31st, 2021) the COVID-19 pandemic were also examined.

RESULTS

A total of 23 749 unique youth accessed Foundry during the study period, with 110 145 services provided. Mean client age was 19.54 years (SD = 3.45) and 62% identified as female. Over 60% of youth scored 'high' or 'very high' for distress and 29% had a self-rated mental health of 'poor', with similar percentages seen for all services and virtual services. These ratings stayed consistent before and during the COVID-19 pandemic.

CONCLUSIONS

Foundry has continued to reach the target age group, with a 65% increase in number of clients during the study period compared with the pilot stage. This study highlights lessons learned and next steps to promote youth-centred data capture practices over time within an integrated youth services context.

Depression, Anxiety and Associated Factors Among Korean Adolescent Students During COVID-19

Objectives

Depression and anxiety are emotional difficulties that are common among adolescents. Adolescents suffering from depression and anxiety can exhibit problems such as antisocial behavior, aggression, and academic slump. This study aimed to explore the factors influencing adolescents' depression and anxiety during the coronavirus disease 2019 (COVID-19) pandemic.

Methods

This study examined the data from an online student health survey conducted by the Ministry of Education in 2022. The survey participants were 131194 students ranging from the first grade of middle school to the third grade of high school. The influence of each variable on depression and anxiety was examined.

Results

Factors that predicted depression and anxiety were sex (female), grade level (higher), financial difficulties (existing or unknown), physical activity (higher), sleep time (shorter), media usage time (higher), family/friends relationship (worse), and change in the health status of family, friends, and oneself due to COVID-19 (worse).

Conclusion

These results may help identify patterns of depression and anxiety among adolescents caused by COVID-19 and maximize the intervention effect.

Youth Mental Health in the Wake of the COVID-19 Pandemic

Objective

In this article we examine the current state of youth mental health across the United States and in Delaware, and discuss the impact of the COVID-19 pandemic on the mental health and well-being of children and adolescents.

Methods

We review available literature detailing the short- and long-term effects of the COVID-19 pandemic on youth mental health and discuss the resultant programmatic and legislative efforts in Delaware and nationally.

Results

The COVID-19 pandemic had a severe impact on the mental health of young people. The prevalence of depression and anxiety among children and adolescents, which was already increasing pre-pandemic, spiked after the pandemic's onset. Even as public health precautions have lifted, young people continue to struggle with mental health in conjunction with lower levels of educational achievement, hindered social development, increased screen time, diminished access to effective mental healthcare, and economic instability. The negative impact of the pandemic will continue to have ramifications on the health and wellbeing of young people for years to come.

Conclusions

Compiling evidence examining mental health trends is an important first step to understanding the impact of the pandemic on child and adolescent mental health and developing effective solutions.

Policy Implications

Although the official state of emergency is over, the effects of the COVID-19 pandemic are far-reaching and long-lasting. It is imperative that legislators and program administrators in Delaware and nationally work to ensure that young people and their families have access to affordable, high quality mental healthcare.

Association between childhood trauma and depressive symptoms in adolescents during the post COVID-19 pandemic: the mediating role of social peer rejection

This study aimed to investigate the associations of childhood trauma and its facets with depressive symptoms in depressed adolescents during the post COVID-19 epidemic, and explore the potential mediating role of social peer rejection in these associations. A total of 413 adolescents with depressive disorders completed the Chinese version of the Child Trauma Questionnaire Short Form, the Social Peer Rejection, and the Children's Depression Inventory. Childhood trauma (β = 0.42, p < 0.01) and social peer rejection (β = 0.18, p < 0.01) were positively related to depressive symptoms, after adjustment for demographic factors. Furthermore, social peer rejection partly mediated the relationship between childhood trauma and depressive symptoms, and the mediation effect ratio was 17.0% (p < 0.001). This study found that childhood trauma and social peer rejection are both risk factors for depressive symptoms, and social peer rejection played a mediating role in the relationship between childhood trauma and depressive symptoms.

Assessment of Children and Adolescents' Admissions to Pediatric Psychiatric Emergency Department

OBJECTIVE

Emergencies in child and adolescent psychiatry are prevalent, and pediatric psychiatric emergency departments play a crucial role in acute intervention during mental health-related crises. This retrospective cross-sectional study aimed to analyze the characteristics of children and adolescents who were admitted to a pediatric psychiatric emergency department.

METHOD

The data were collected from the records of 8803 patients (females 56.6%, Mage = 15.07 ± 2.6) admitted to our pediatric psychiatry emergency department between 2014 and 2021. Diagnoses were made using the International Statistical Classification of Diseases, 10th Revision. We used descriptive statistics to determine patient characteristics and conducted a regression analysis to compare the changes in the admissions numbers by the year.

RESULTS

It was found that depressive disorder was the highest psychiatric diagnosis, with a percentage of 21.4%. Depressive disorder, autism spectrum disorder, and obsessive-compulsive disorder have shown an increase over the years. In 2020, with the onset of the COVID-19 pandemic, psychiatric admissions reached their lowest level. The percentage of hospitalizations was 21.1% for the total of all years. No significant change was found in the total number of admissions, sex, and age.

CONCLUSIONS

The number of admissions for female adolescents who were diagnosed with depressive disorder to our pediatric psychiatry emergency department is shown to be high. The fact that these patients seek help more frequently should be taken into consideration during the planning of mental health services for outpatient and inpatient clinics as well as pediatric psychiatry emergency services.

Post-traumatic Reactions and Social-Emotional Competence Among Chinese High School Students Experiencing COVID-19 Lockdown: A Network Analysis

In the post-pandemic era, psychological traumas have emerged as major mental health issues. However, the post-traumatic reactions and their connections with social-emotional competence among high school students experiencing COVID-19 lockdown have not been adequately explored. This study aimed to reveal the characteristics of their positive and negative post-traumatic reactions, and their connections with social-emotional competence. Network analysis was used on data from 1096 Chinese high school students who experienced COVID-19 lockdown. Measures included the DSECS-S, the PTGI and the PC-PTSD-5. The results revealed that "Valuing life" and "Recalling unwillingly" were identified as core factors of post-traumatic reactions, while "Having close friendships", "Getting along well with others" and "Respecting others' emotions" played a bridging role in connecting the communities of social-emotional competence and post-traumatic reactions. This study enriches research on post-traumatic reactions, emphasizing the importance of implementing social-emotional competence programs to tackle mental health crises.

Loneliness in the college student population: Prevalence and associations with substance use outcomes

Objectives: We assessed the prevalence of loneliness by gender and gender-specific associations between loneliness and substance use in university students. Participants: Participants were students enrolled in colleges and universities throughout the United States (n = 84,481). Methods: Gender was self-reported and categorized as male, female, and transgender/nonbinary. Descriptive analyses were conducted, and logistic regression was used to measure associations between loneliness and substance use by gender and substance. Results: Loneliness prevalence was 58% in the sample, and loneliness was most prevalent among transgender/nonbinary students (79%). Loneliness was associated with reduced odds of alcohol use and increased odds of benzodiazepine use in all genders, and increased odds of marijuana, stimulant, and opioid misuse in females and males. Conclusions: Loneliness is prevalent in college students, especially in transgender/nonbinary students, and it is associated with increased odds of substance use. College administrators should consider implementing interventions to reduce loneliness in this population.

The impact of the pandemic on psychophysical well-being and quality of learning in the growth of adolescents (aged 11-13): a systematic review of the literature with a PRISMA method

Introduction

This study examines the social impact and psychological effects of the COVID-19 pandemic on the growth of adolescents students, aged 11-13, on well-being and learning.

Methods

Said review, therefore, will consider all the report of scientific works published since 2020 on the following platforms: SCOPUS, PsycoInfo, and Web of Science. Specifically, the research has selected all studies concerning students aged 11-13. Furthermore, the authors have restricted the scope of the study to two fundamental aspects of the above-mentioned subjects, such as their physical and psychological well-being and didactic learning following the COVID-19 pandemic. The justification for choosing such themes lies in the fact that the SARS-CoV-2 pandemic and the ensuing measures adopted to curb its spread have had -and very likely will continue having- sizable repercussions in the life of each individual, especially in students considered, whose psychological and physical well-being has been considerably affected.

Results

In particular, during the peak of the pandemic and its subsequent phases, the various measures issued to limit contagion have completely compromised and disregarded the rights of children and youngsters. Suddenly, leisure, sport, play, relations, and socialization disappeared from their lives. Besides, in the early stages of the pandemic, remote teaching replaced face-to-face teaching, later to become an intermittent system in the red- and orange-labelled areas of the country. Consequently, such measures have severely limited opportunities for learning, growth, curiosity and creating relationships that are typical of both a school and outside environment. Concerning the well-being of the subjects considered, a review of the target literature indicates a wide range of psychological and physical disorders, such as malaise, eating and sleep disorders, addiction to games, internet, alcohol, and drugs. For what regards, instead, the realm of learning, most studies highlight a diminished school performance as the main implication of remote teaching. Furthermore, a remarkable number of studies reveals substantial social inequalities; specifically, students coming from middle class families have managed to maintain higher quality educational standards in a critical context such as the pandemic, while those students coming from socially disadvantaged families have had fewer learning opportunities both in terms of time and range of experiences (due to lack of electronic devices, Internet connectivity, homework, continuity of after-school activities). In summary, if the school system pre-COVID-19 already presented significant limitations in its ability to reduce existing social inequalities, school closures during lockdowns pose enormous challenges in developing effective policies to compensate learning losses and inequalities.

Discussion

Therefore, based on the results shown, the necessity arises of an emergency plan with social and educational objectives to restore those social, emotional, and cognitive abilities that are compromised. In general, it is the responsibility of countries and governments to guarantee the right to education in these difficult times, while avoiding any type of inequalities and establishing a digital learning system, that allows to face situations such as those generated by the Coronavirus, thus preventing those situations of serious anxiety and stress that have affected most subjects.

Predictive relationship between COVID-19 anxiety and psychological distress in adolescents during the COVID-19 pandemic

COVID-19 was a novel stressor that gave rise to pandemic related anxiety and increased the risk of mental health issues, particularly in youth. It is important to understand how such events contribute to psychological distress in young people to adequately intervene in the aftermath and to plan for future similar events. Using cross-sectional data from the CoSPACE Ireland study dataset this paper reports on the predictive relationship between COVID-19 anxiety and psychological distress for Irish adolescents (N = 314, M = 14.05, SD = 2.7, 11-18 years), while controlling for other influencing factors across multiple levels of a bioecological systems approach. Covariates were age, gender, ethnicity, social economic status, Peer Support, School Support and Parent-Child Closeness. Findings indicate that COVID-19 anxiety was a significant predictor of adolescents' psychological distress. Specifically, Consequence Anxiety (worries about the indirect consequences of COVID-19) was found to be a predictor of adolescents' psychological distress rather than Disease Anxiety (worries about the COVID-19 virus itself). Individual factors (e.g., age, ethnicity, special educational needs) and microsystem factors (e.g., parent child closeness, peer support) were also found to impact on adolescents' levels of psychological distress. A significant moderation analysis revealed that greater parent-child closeness reduced the strength of the positive association between Consequence Anxiety and psychological distress. These findings suggest that strategies to alleviate adolescents' psychological distress during pandemics should focus on reducing pandemic-related anxiety, specifically Consequence Anxiety. A multisystemic approach is also recommended to reduce the negative mental health impacts of the pandemic on adolescents.

The development of depression and social anxiety symptoms in adolescents and the negative impact of the COVID-19 pandemic and desire for peer contact

Introduction

Adolescence is a dynamic developmental phase in which contact with peers is crucial for socio-emotional development and wellbeing. Depression and social anxiety show patterns of high onset during this period, and more for girls than boys. Here we examine this development among Dutch adolescents, as well as how desire for more peer contact as a result of social distancing measures during the COVID-19 pandemic contributed to this increase.

Methods

We used a longitudinal three-wave design to examine 406 typically developing Dutch adolescents across two consecutive cohorts; Cohort 1: 2016-2019 (N = 138, 53.6% girls, age at T0 M = 13.00, SD = 0.42), Cohort 2: 2017-2020 (N = 268, 63.1% girls, age at T0 M = 13.05, SD = 0.39), final wave during spring 2020 during the first COVID-19 lockdown. Self-report questionnaires were used to measure depression and social anxiety symptoms, desire for change in the amount of peer contact during lockdowns, and emotion regulation. Parallel process dual latent growth models and autoregressive cross-lagged models were used to test the hypotheses.

Results

Results showed that symptoms of both depression and social anxiety increase during adolescence. Gender analysis reveal a higher initial level and increase in depression symptoms for girls, while levels for boys decreased. Adolescents exposed to the pandemic showed a steeper increase in depression but not in social anxiety. Desire for more peer contact was related to an increase in depression and social anxiety, though only in girls. No evidence was found for moderation of emotion regulation skills concerning COVID evoked emotions on the association between desire for peer contact and anxiety and depression symptom development.

Discussion

Symptoms of social anxiety increased during adolescence in boys and girls. Symptoms of depression increased for girls, but decreased for boys. The increase in depression was greater in a cohort who experienced the COVID-19 pandemic. For girls, a desire for more peer contact was associated with an increase of depression and social anxiety symptoms in times of social restrictions.

Prevalence and factors associated with depression and anxiety among the Bangladeshi university entrance test-taking students using GIS technology

This study focuses on Bangladeshi university entrance test-taking students mental health problems and explores the geographical distribution of these problems using GIS technique. A cross-sectional survey was conducted among 1523 university entrance test-taking students. Data were collected on participants' socio-demographic characteristics, COVID-19-related factors, admission tests, depression, and anxiety. Chi-square tests and logistic regression were performed using SPSS software. GIS mapping was used to visualize the distribution of mental health problems across districts using ArcGIS. The study found that the prevalence rates of depression and anxiety among university entrance examinees were 53.8% and 33.2%, respectively. Males exhibited higher rates of depression and anxiety compared to females, while repeat test-taking students were more susceptible to these mental health issues compared to first-time test-takers. Factors such as urban residence, personal/familial COVID-19 infections, and COVID-19 deaths in close relationships were associated with increased mental health problems. District-based distribution showed no significant variation in depression, but anxiety varied significantly. Post-hoc GIS analysis revealed variations in the distribution of depression and anxiety among males, as well as variations in anxiety distribution based on student status across districts. This study emphasizes the high prevalence of depression and anxiety among university entrance examinees, emphasizing the importance of addressing mental health risks in this population. It also suggests the need for reforms in the university entrance test-taking system to reduce psychological problems and advocates for a more inclusive approach to student admissions to alleviate mental health burdens.

Social isolation and loneliness among people living with experience of homelessness: a scoping review

Social isolation and loneliness (SIL) are public health challenges that disproportionally affect individuals who experience structural and socio-economic exclusion. The social and health outcomes of SIL for people with experiences of being unhoused have largely remained unexplored. Yet, there is limited synthesis of literature focused on SIL to appropriately inform policy and targeted social interventions for people with homelessness experience. The aim of this scoping review is to synthesize evidence on SIL among people with lived experience of homelessness and explore how it negatively impacts their wellbeing. We carried out a comprehensive literature search from Medline, Embase, Cochrane Library, PsycINFO, CINAHL, Sociological Abstracts, and Web of Science's Social Sciences Citation Index and Science Citation Index for peer-reviewed studies published between January 1st, 2000 to January 3rd, 2023. Studies went through title, abstract and full-text screening conducted independently by at least two reviewers. Included studies were then analyzed and synthesized to identify the conceptualizations of SIL, measurement tools and approaches, prevalence characterization, and relationship with social and health outcomes. The literature search yielded 5,294 papers after removing duplicate records. Following screening, we retained 27 qualitative studies, 23 quantitative studies and two mixed method studies. SIL was not the primary objective of most of the included articles. The prevalence of SIL among people with homelessness experience varied from 25 to 90% across studies. A range of measurement tools were used to measure SIL making it difficult to compare results across studies. Though the studies reported associations between SIL, health, wellbeing, and substance use, we found substantial gaps in the literature. Most of the quantitative studies were cross-sectional, and only one study used health administrative data to ascertain health outcomes. More studies are needed to better understand SIL among this population and to build evidence for actionable strategies and policies to address its social and health impacts.

Impact of the COVID-19 health crisis on psychotropic drug use in children and adolescents in France

BACKGROUND

In 2019, the world faced a pandemic brought about by a severe acute respiratory infection caused by SARS-CoV-2 virus. The spread of this virus has profoundly affected societies, particularly in terms of their economic, human and social dimensions, as well as their healthcare systems. Several restrictive measures (reduced social interaction, periodic school closures,…) had to be taken to contain the spread of the virus. These measures have had an impact on the psychological well-being of both adults and children. The aim of this study was to assess the changes in psychotropic drugs prescriptions for children and adolescents living in Limousin, a French region, over the period 2018 to 2021.

METHODS

The consumption of psychotropic drugs was studied using a national database of drug reimbursement. These data were extracted and supplied from the nationwide French reimbursement healthcare system database (SNDS). The following therapeutic classes were studied: N05A (antipsychotics), N05B (anxiolytics), N05C (hypnotics and sedatives), N06A (antidepressants) and N06B (psychostimulants). Data were collected for insured persons under the age of 18 who received at least one reimbursement for a psychotropic drug between 2018 and 2021.

RESULTS

Over a 4-year period, 7949 patients under the age of 18 were included with an average age of 12.1 years and a sex ratio of 0.97 M/F. The number of patients increased from 2018 to 2021, as did the number of reimbursements. We observed a statistically significant difference of means of patients reimbursed per week for on five therapeutic classes, with the greatest difference in 2021 (p < 0.0001). An increase in the number of patients of between + 20.7% and + 689% was observed, depending on the drug classes studied. Comparisons between the COVID-19 and pre-COVID-19 periods showed a significantly higher COVID average for psychotropic drugs reimbursements in general and individually for all classes except psychostimulants.

CONCLUSION

The results show a significant increase in the consumption of psychotropic drugs among youth. The increase in psychotropic drug use was continuous and progressive throughout the pandemic. All five classes were increased, but particularly anxiolytics and antidepressants. The COVID-19 context may have been at the origin of a deterioration in the mental health of children and adolescents, or of a heightened awareness of psychiatric care among young people.

Loneliness and posttraumatic stress in U.S. adolescents: A longitudinal study

BACKGROUND

Loneliness and posttraumatic stress (PTS) are common in adolescence. However, there has been little longitudinal research on their association. To address this deficit, this study examined the longitudinal association between these phenomena in a sample of U.S. school students while also exploring if gender was important in this context.

METHODS

Data were analysed from 2807 adolescents (52.1 % female; age at baseline 11-16 years (M = 12.79)) who were followed over a one-year period. Information was obtained on loneliness in year 1 using a single-item question, while PTS was assessed with the self-report Child Post-Traumatic Stress - Reaction Index (CPTS-RI). A full path analysis was performed to assess the across time associations.

RESULTS

Almost one-third of the students reported some degree of loneliness while most students had 'mild' PTS. In the path analysis, when controlling for baseline PTS and other covariates, loneliness in year 1 was significantly associated with PTS in year 2 (β = 0.06, 95%CI: 0.02, 0.09). Similarly, PTS in year 1 was significantly associated with loneliness in year 2 (β = 0.19, 95%CI: 0.15, 0.23). An interaction analysis further showed that loneliness was higher in girls with PTS than in their male counterparts.

LIMITATIONS

The use of a single-item measure to assess loneliness that used the word 'lonely' may have resulted in underreporting.

CONCLUSION

Loneliness and PTS are bidirectionally associated in adolescence. Efforts to reduce loneliness in adolescence may help in combatting PTS, while clinicians should intervene to address loneliness if detected in adolescents with PTS.

The Relationship between Family Functioning, Emotional Intelligence, Loneliness, Social Support, and Depressive Symptoms among Undergraduate Students

The transition from adolescence to college is a significant developmental stage marked by challenges such as high academic pressure, changes in living environments, and social support systems. These challenges can lead to increased rates of depression among college students. This study investigates the relationships between family functioning, emotional intelligence, loneliness, social support, and depressive symptoms in Chinese college students. A cross-sectional design was employed, with data collected via questionnaires from undergraduate students at Xi'an Jiaotong University. Variables such as family functioning, emotional intelligence, loneliness, social support, and depressive symptoms were assessed. Statistical analyses, including correlation and hierarchical regression, were conducted to explore these relationships. The study found a diverse distribution of depressive symptoms among students, with significant gender differences indicating higher depression rates in females. No significant differences were observed across academic disciplines, grades, or between only children and non-only children. Family functioning, emotional intelligence, and social support were negatively correlated with depressive symptoms, while loneliness was positively correlated. Hierarchical regression analysis confirmed that social support significantly moderated the relationship between family functioning and depressive symptoms. Mediation analysis showed that emotional intelligence and loneliness mediated this relationship. The findings highlight the complex interplay between family dynamics, emotional capabilities, social connectedness, and mental health. Enhancing family functioning, emotional intelligence, and social support can effectively reduce depressive symptoms among college students. These results underscore the need for holistic interventions that address multiple aspects of students' social and emotional lives.