The role of only-child status in the psychological impact of COVID-19 on mental health of Chinese adolescents

The network structures of mental and behavioral problems among children and adolescents in China using propensity score matching: A comparison between one-child and multi-child families based on a nationwide survey

BACKGROUND

Exploring networks of mental and behavioral problems in children and adolescents may identify differences between one-child and multi-child families. This study compared the network structures of mental and behavioral problems in children and adolescents in one-child families versus multi-child families based on a nationwide survey.

METHODS

Propensity score matching (PSM) was used to match children and adolescents from one-child families with those from multi-child families. Mental and behavioral problems were assessed using the Achenbach's Child Behavior Checklist (CBCL) with eight syndromal subscales. In the network analysis, strength centrality index was used to estimate central symptoms, and case-dropping bootstrap method was used to assess network stability.

RESULTS

The study included 39,648 children and adolescents (19,824 from one-child families and 19,824 from multi-child families). Children and adolescents from multi-child families exhibited different network structure and higher global strength compared to those from one-child families. In one-child families, the most central symptoms were "Social problems", "Anxious/depressed" and "Withdrawn/depressed", while in multi-child families, the most central symptoms were "Social problems", "Rule-breaking behavior" and "Anxious/depressed".

CONCLUSION

Differences in mental and behavioral problems among children and adolescents between one-child and multi-child families were found. To address these problems, interventions targeting "Social problems" and "Anxious/depressed" symptoms should be developed for children and adolescents in both one-child and multi-child families, while other interventions targeting "Withdrawn/depressed" and "Rule-breaking behavior" symptoms could be useful for those in one-child and multi-child families, respectively.

A cross-sectional study of non-suicidal self-injury in adolescent depression: association with demographic characteristics and physiological indicators

Introduction

Non-suicidal self-injury (NSSI) is a prevalent concern among adolescents with depression, yet its relationship with demographic characteristics and physiological indicators remains underexplored. This study aimed to investigate these relationships among inpatient adolescents aged 13 to 18 at a hospital affiliated with Guizhou Medical University.

Methods

A cross-sectional study was conducted involving 222 adolescent inpatients diagnosed with depression. Data on NSSI occurrence, demographic variables (gender, only-child status, age), and physiological indicators (ALT, TSH, FT4, PLR, TG, HDLC, LDLC, FT3, NLR, MLR) were collected and analyzed. Statistical analyses, including correlations and group comparisons, were performed to assess the associations between NSSI and these factors.

Results

The prevalence of NSSI among the participants was 40.5%. Significant correlations were found between NSSI and several demographic and physiological factors. Specifically, NSSI was significantly associated with female gender, non-only-child status, younger age, lower ALT levels, higher TSH levels, lower FT4 levels, and higher PLR values. However, no significant differences were observed in TG, HDLC, LDLC, FT3, NLR, or MLR between the NSSI and non-NSSI groups.

Discussion

The findings highlight distinct demographic and physiological profiles associated with NSSI among adolescents with depression. The prevalence rate of NSSI underscores its significance as a behavioral manifestation in this population. Further research should explore the underlying mechanisms linking these factors to better inform targeted interventions and treatment strategies for adolescents experiencing NSSI in the context of depression.

Exploring the interconnections of anxiety, depression, sleep problems and health-promoting lifestyles among Chinese university students: a comprehensive network approach

Background

Anxiety, depression, and sleep problems are prevalent comorbid mental disorders among university students. The World Health Organization (WHO) emphasized a mental health promotion objective, recommending the consideration of protective health-promoting factors in strategies aimed at preventing mental disorders. Integrating theoretically significant constructs (such as protective factors) enhances our comprehension of the intricate mechanisms that underpin mental disorders. This study employed network analysis to first identify core and bridge symptoms within comorbid mental disorders and then explore how health-promoting lifestyles (HPLs) were associated with these disorders. The ultimate goal is to offer health promotion recommendations to enhance students' quality of life.

Methods

A total of 3,896 qualified university students participated in this study. Anxiety, depression, sleep problems, and HPLs were assessed using the GAD-7, PHQ-9, PSQI, and HPLP-II scales. A Gaussian Graphical Model was used to construct the networks. The Network Comparison Test was applied to determine whether the associations between HPLs and comorbid symptoms vary by gender, educational level, family sibling, and mental health status.

Results

Low energy (PHQ4) had the highest strength centrality, followed by Daytime dysfunction (PSQI7) and Trouble relaxing (GAD4). Five bridge symptoms were identified: Daytime dysfunction (PSQI7), Self-harm even suicide (PHQ9), Sad mood (PHQ2), Low energy (PHQ4), and Feeling afraid (GAD7). Regarding protective HPLs, Physical activity, Spiritual growth, and Stress management generally emerged as the top three central mental health-promoting behaviors.

Conclusion

Targeting core and bridge symptoms with timely and appropriate interventions can alleviate anxiety, depression, and sleep problems in this population. Moreover, promoting physical activity, fostering spiritual growth, and managing stress are likely to significantly enhance the overall mental health of university students.

Associations between insufficient sleep, skipping breakfast and depressive symptoms in children and adolescents: A school-based cross-sectional study in China

OBJECTIVE

Insufficient sleep and skipping breakfast are increasingly prevalent among children and adolescents. Both behaviors are associated with the onset of depression. This study aims to examine the independent and joint associations of these two behaviors with depressive symptoms, and investigate whether these associations varied by age or sex.

METHODS

The Center for Epidemiological Studies Depression Scale (CES-D) was used to evaluate the depressive symptoms. This cross-sectional study including 11,887 students aged 11-19 years using a stratified cluster, multistage sampling method in Ningbo, China. Multiple logistic regressions were conducted to evaluate the independent and joint association between insufficient sleep, skipping breakfast and depressive symptoms. Sensitivity analyses and stratified analyses by age and sex were performed using the same modelling strategies.

RESULTS

The overall prevalence of depressive symptoms was 15.27%. Skipping breakfast (Odds Ratio (OR) = 2.557, 95% Confidence Interval (CI) = 2.236-2.925) and insufficient sleep (OR = 1.547, 95%CI = 1.390-1.723) was independently associated with depressive symptoms. Compared to students with "sufficient sleep and breakfast every day", the OR was 4.385 (95%CI = 3.649-5.271) for those with "insufficient sleep and skipping breakfast". Meanwhile, the joint association was moderated by age group, with a more apparent association observed in the 11-15-year-old group compared to the 16-19-year-old group.

CONCLUSIONS

These findings indicated that insufficient sleep and skipping breakfast were independently and jointly associated with depressive symptoms. Insufficient sleep and skipping breakfast could be considered as two of the predictors of depression.

Mental health among school children and adolescents in China: A comparison of one-child and multiple-children families from a nationwide survey

The influence of China's "one-child" policy on the mental health of children and adolescents is still unclear. This study examined the associations between number of children and children's mental health using data from the national school children and adolescents survey of China. Mental health was measured using the Achenbach's Child Behavior Checklist (CBCL). Linear regression models were used to explore the relationship between number of children per family and children's mental health. A total of 64,017 students were enrolled, with 68.60 % from one-child families. Compared with children from one-child families, those from multiple-children families had significantly higher scores on the total CBLC and each of its subscales (all P<0.001). Analyses suggested children from multiple-child families have a higher risk of mental health problems (total problems on the CBCL: adjusted B=2.217, 95 %CI=1.883-2.550, P<0.001). Regular mental health assessments should be implemented and effective interventions should be developed for those in need.

Empathy in undergraduate medical students: a multi-center cross-sectional study in China

BACKGROUND

Fostering empathy has been continuously emphasized in the global medical education. Empathy is crucial to enhance patient-physician relationships, and is associated with medical students' academic and clinical performance. However, empathy level of medical students in China and related influencing factors are not clear.

METHODS

This was a cross-sectional study among medical students in 11 universities. We used the Jefferson Scale of Empathy Student-version of Chinese version to measure empathy level of medical students. Factors associated with empathy were identified by the univariate and multivariate logistic regression analyses. Based on the variables identified above, the nomogram was established to predict high empathy probability of medical students. Receiver operating characteristic curve, calibration plot and decision curve analysis were used to evaluate the discrimination, calibration and educational utility of the model.

RESULTS

We received 10,901 samples, but a total of 10,576 samples could be used for further analysis (effective response rate of 97.02%). The mean empathy score of undergraduate medical students was 67.38 (standard deviation = 9.39). Six variables including gender, university category, only child or not, self-perception doctor-patient relationship in hospitals, interest of medicine, Kolb learning style showed statistical significance with empathy of medical students (P < 0.05). Then, the nomogram was established based on six variables. The validation suggested the nomogram model was well calibrated and had good utility in education, as well as area under the curve of model prediction was 0.65.

CONCLUSIONS

We identify factors influencing empathy of undergraduate medical students. Moreover, increasing manifest and hidden curriculums on cultivating empathy of medical students may be needed among medical universities or schools in China.

Interaction effect of screen time and sugar-sweetened beverages with depressive symptoms in adolescents: evidence from a large sample-based survey in China

Excessive screen time and the consumption of sugar-sweetened beverages are found to be independent predictors of depressive symptoms. However, the potential interaction effect of screen time and sugar-sweetened beverages, that is, whether one exposure factor strengthens the association of another with depressive symptoms, remains unclear. A large-scale adolescent health surveillance survey was conducted in 27 schools in eight regions across China. A total of 22,868 students were recruited to complete an eligible questionnaire to provide details of their screen time and sugar-sweetened beverage consumption. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9). Multiplicative and additive interaction models were performed to estimate the interaction effects of screen time and sugar-sweetened beverages on depressive symptoms, and whether the relationship varied by age group was also examined. The multivariate logistic regression model showed that even if the confounding factors were controlled, screen time and sugar-sweetened beverages were still risk factors for depressive symptoms in adolescents. Interaction models indicated that screen time and sugar-sweetened beverages in combination were related to greater odds of depressive symptoms. Compared with late adolescents, early adolescents had a higher probability of depressive symptoms when exposed to the joint effects. Our study may hopefully deepen the understanding of the association between screen time and sugar-sweetened beverages and depressive symptoms. Future research should further explore how and why screen time and sugar-sweetened beverages affect individuals more profoundly in early adolescence than in late adolescence and how to mitigate this.

Evidence linking COVID-19 and the health/well-being of children and adolescents: an umbrella review

BACKGROUND

Experiences during childhood and adolescence have enduring impacts on physical and mental well-being, overall quality of life, and socioeconomic status throughout one's lifetime. This underscores the importance of prioritizing the health of children and adolescents to establish an impactful healthcare system that benefits both individuals and society. It is crucial for healthcare providers and policymakers to examine the relationship between COVID-19 and the health of children and adolescents, as this understanding will guide the creation of interventions and policies for the long-term management of the virus.

METHODS

In this umbrella review (PROSPERO ID: CRD42023401106), systematic reviews were identified from the Cochrane Database of Systematic Reviews; EMBASE (OvidSP); and MEDLINE (OvidSP) from December 2019 to February 2023. Pairwise and single-arm meta-analyses were extracted from the included systematic reviews. The methodological quality appraisal was completed using the AMSTAR-2 tool. Single-arm meta-analyses were re-presented under six domains associated with COVID-19 condition. Pairwise meta-analyses were classified into five domains according to the evidence classification criteria. Rosenberg's FSN was calculated for both binary and continuous measures.

RESULTS

We identified 1551 single-arm and 301 pairwise meta-analyses from 124 systematic reviews that met our predefined criteria for inclusion. The focus of the meta-analytical evidence was predominantly on the physical outcomes of COVID-19, encompassing both single-arm and pairwise study designs. However, the quality of evidence and methodological rigor were suboptimal. Based on the evidence gathered from single-arm meta-analyses, we constructed an illustrative representation of the disease severity, clinical manifestations, laboratory and radiological findings, treatments, and outcomes from 2020 to 2022. Additionally, we discovered 17 instances of strong or highly suggestive pairwise meta-analytical evidence concerning long-COVID, pediatric comorbidity, COVID-19 vaccines, mental health, and depression.

CONCLUSIONS

The findings of our study advocate for the implementation of surveillance systems to track health consequences associated with COVID-19 and the establishment of multidisciplinary collaborative rehabilitation programs for affected younger populations. In future research endeavors, it is important to prioritize the investigation of non-physical outcomes to bridge the gap between research findings and clinical application in this field.

Depression, anxiety, stress symptoms and their determinants among secondary students with vision impairment in rural Northwestern China during the COVID-19 pandemic

Objective

The measures implemented to control the spread of Coronavirus disease 2019 (COVID-19) could affect children's mental and vision health. Youth particularly from minority and socioeconomically disadvantaged backgrounds were more likely to be impacted by these measures. This study aimed to examine the mental health of children with vision impairment and associated factors in North-western China during the COVID-19 pandemic.

Methods

A cross-sectional study was conducted among 2,036 secondary school children living in Ningxia Hui Autonomous Region. Participants completed a survey on sociodemographic and lifestyle information and answered the Chinese version of the 21-item Depression Anxiety Stress Scales (DASS-21) questionnaire. Presenting visual acuity was measured by a trained enumerator. Multivariate logistic regression analysis was used to identify potential risk factors for mental health problems.

Results

Responses from 1,992 (97.8%) children were included in the analysis after excluding those with incomplete mental health outcome data. The prevalence of depression, anxiety and stress symptoms within the dataset were 28.9, 46.4, and 22.3%, respectively. The distribution of children with different stress levels differed significantly between those with and without vision impairment (p = 0.03). Multivariable logistic regression analyses revealed that depression symptoms decreased with higher parental education (OR, 0.76, 95% confidence intervals (CI):0.63-0.96), longer sleep duration (OR, 0.90, 95% CI: 0.81-0.97) and longer study time (OR, 0.82, 95% CI: 0.74-0.91), whereas they increased with higher recreational screen time (OR, 1.19, 95% CI: 1.08-1.32). Anxiety symptoms decreased with higher parental education (OR, 0.80, 95% CI: 0.66-0.96) and increased with higher recreational screen time (OR, 1.15, 95% CI: 1.04-1.27) and being a left-behind child (OR, 1.26, 95% CI: 1.04-1.54). In addition, stress symptoms decreased with longer sleep duration (OR, 0.92, 95%CI: 0.85-0.99) and increased with higher number of siblings (OR, 1.10, 95% CI: 1.01-1.19), higher recreational screen time (OR, 1.15, 95% CI: 1.04-1.28) and older age (OR,1.12, 95% CI: 1.004-1.24).

Conclusion

A considerable proportion of our sample experienced mental health problems during the pandemic. Healthcare planners in China should consider interventions such as reducing recreational screen time, ensuring sufficient sleep, and timely detection of mental health symptoms among socioeconomically disadvantaged groups.

A decision tree model of hypertension among college students in Yunnan Province, China

PURPOSE

Previous studies have indicated that the prevalence rate of hypertension in adolescents is high, but it has not received much attention and the influencing factors are unclear, especially in Yunnan Province, China.

MATERIALS AND METHODS

A cluster sampling method was used to investigate 4781 freshmen in a college in Kunming, Yunnan Province from November to December. Demographic and lifestyle data were collected using questionnaires, and height, weight and blood pressure were measured. Decision tree model of hypertension in college students was established by Chi-square automatic interactive detection method.

RESULTS

Prevalence of prehypertension of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were detected in 33.9% and 32.1%, respectively. Prevalence of hypertension of SBP and DBP was detected in 1.2% and 7.2%, respectively. The hypertension and prehypertension decision tree of SBP has gender (χ2 = 728.64, p < .001) at the first level and body mass index (BMI) (boys: χ2 = 55.98, p < .001; girls: χ2 = 79.58, p < .001) at the second level. The hypertension and prehypertension decision tree of DBP has gender (χ2 = 381.83, p < .001) at the first level, BMI (boys: χ2 = 40.54, p < .001; girls: χ2 = 48.79, p < .001) at the second level, only children (χ2 = 6.43, p = .04) and red wine consumption (χ2 = 8.17, p = .017) at the third level.

CONCLUSIONS

The present study suggests that gender, BMI, only children and red wine consumption were the main factors affecting hypertension in college students in southwest border areas of China.

The roles of parenting, resilience, and interpersonal relationships on adolescents' mental health and stress-related growth during COVID-19

BACKGROUND

The present longitudinal study investigated parenting style as a precursor for Chinese adolescents' stress-related growth and mental health difficulties during the COVID-19 pandemic, as well as the mediating roles of intrapersonal resilience and interpersonal relationships (i.e., peer and parent-adolescent).

METHODS

Chinese adolescents in a middle school (7th grade) and their parents in Beijing, China, were invited to complete a survey at two time points (T1: September 2020, T2: June 2021). A total of 206 adolescents (52.9% boys; Mage  = 12.90 years, SDage  = 0.33) and parents (17.5% fathers, 82.4% mothers; Mage  = 43.50 years, SDage  = 4.76 years) were included in this study.

RESULTS

Results showed that Chinese parents' authoritarian, not authoritative parenting, predicted adolescents' mental health difficulties nine months later. In addition, parent-adolescent relationships, but not peer relationships nor resilience, mediated the relations between parenting style and stress-related growth. Adolescents' resilience predicted fewer mental health difficulties.

CONCLUSION

It is important to target multiple ecologies (e.g., family) of adolescents for promoting positive adjustment.

Psychological Health and Risk Factors of College Students within the Context of the COVID-19 Pandemic: A Cross-Sectional Study

BACKGROUND

Students are a priority population in mental health research. This study aimed to explore the risk factors of anxiety and depression symptoms among college students in Chongqing, a megacity under the impact of COVID-19, and to provide a basis for determining the priorities of public health policies and implementing effective educational health care interventions.

METHODS

In this cross-sectional study conducted in Chongqing, China, the data came from web-based stratified random sampling. Anxiety and depression symptoms were measured by the Self-Rating Anxiety Scale (SAS) and the Center for Epidemiological Studies Depression Scale (CES-D), respectively, and risk factors were analyzed by logistic regression.

RESULTS

Data were obtained from 915 college students (34.75% were male, and 65.25% were female) with age (20.29 ± 1.51) in Chongqing, China. The prevalence rates of anxiety and depression were 19.78% and 22.62%, respectively. Logistic regression analysis revealed that the risk factors of anxiety symptoms were associated with junior years, sleep time of less than 6 h a day, influence on career planning, and depression symptoms. Comprehensive, science and engineering, and medicine disciplines, having siblings, poorer mastery of study, and anxiety symptoms were risk factors for developing depression symptoms.

CONCLUSIONS

During the pandemic, college students experienced varying degrees of anxiety and depression. Our research findings highlight the necessity of universities and relevant departments providing precise mental health education for college students under major public health emergencies.

COVID-19 Distress Impacts Adolescents' Depressive Symptoms, NSSI, and Suicide Risk in the Rural, Northeast US

OBJECTIVE

Widespread concern exists about the impacts of COVID-19 and related public health safety measures (e.g., school closures) on adolescent mental health. Emerging research documents correlates and trajectories of adolescent distress, but further work is needed to identify additional vulnerability factors that explain increased psychopathology during the pandemic. The current study examined whether COVID-19-related loneliness and health anxiety (assessed in March 2020) predicted increased depressive symptoms, frequency of non-suicidal self-injury (NSSI), and suicide risk from pre-pandemic (late January/early February 2020) to June 2020.

METHOD

Participants were 362 middle and high school adolescents in rural Maine (M age = 15.01 years; 63.4% female; 76.4% White). Data were collected during a time in which state-level COVID-19 restrictions were high and case counts were relatively low. Self-reports assessed psychopathology symptoms, and ecological momentary assessment (EMA) was used to capture COVID-19-related distress during the initial days of school closures.

RESULTS

Loneliness predicted higher depressive symptoms for all adolescents, higher NSSI frequency for adolescents with low pre-pandemic frequency (but less frequent NSSI for adolescents with high pre-pandemic frequency), and higher suicide risk for adolescents with higher pre-pandemic risk. Health anxiety predicted higher NSSI frequency for adolescents with high pre-pandemic frequency, and secondary analyses suggested that this pattern may depend on adolescents' gender identity.

CONCLUSIONS

Results underscore the impact of COVID-19 on adolescent mental health, with benefits for some but largely negative impacts for most. Implications for caretakers, educators, and clinicians invested in adolescent mental health are discussed.

The impacts of typically developing siblings on the developmental outcomes of children with disability: A scoping review

BACKGROUND

Siblings represent an important influence on children's development. It is possible that sibling influence on developmental outcomes differs in sibling pairs when one of the children has a disability. Previous research has tended to focus on outcomes for typically developing siblings when they have a brother/sister with a disability.

AIMS

The purpose of this scoping review was to explore empirical studies reporting on the impact of siblings on the developmental outcomes of children with disability to better understand the areas that are influenced by siblings and the factors that contribute to this influence.

METHOD

To identify relevant studies, the electronic databases of EBSCO, ERIC, Informit, Ovid, ProQuest and Scopus were searched. These searches were supplemented by direction from the authors on relevant literature and citation searches of papers identified for inclusion. Descriptive details were extracted, followed by details related to research design and findings of the studies.

OUTCOMES AND RESULTS

Twenty-two papers were determined to meet inclusion criteria. Investigations of sibling influence have concentrated on children with ASD; other groups are not well represented. There is some evidence that having older siblings may be protective for children with ASD; however, this was not an invariable finding. There is too little consistency across studies to determine whether and how siblings influence development of children with disability.

CONCLUSIONS AND IMPLICATIONS

Further work is required to understand the potentially crucial influence that siblings may have on developmental outcomes of children with disability.

Investigation of contemporary college students' mental health status and construction of a risk prediction model

BACKGROUND

Due to academic pressure, social relations, and the change of adapting to independent life, college students are under high levels of pressure. Therefore, it is very important to study the mental health problems of college students. Developing a predictive model that can detect early warning signals of college students' mental health risks can help support early intervention and improve overall well-being.

AIM

To investigate college students' present psychological well-being, identify the contributing factors to its decline, and construct a predictive nomogram model.

METHODS

We analyzed the psychological health status of 40874 university students in selected universities in Hubei Province, China from March 1 to 15, 2022, using online questionnaires and random sampling. Factors influencing their mental health were also analyzed using the logistic regression approach, and R4.2.3 software was employed to develop a nomogram model for risk prediction.

RESULTS

We randomly selected 918 valid data and found that 11.3% of college students had psychological problems. The results of the general data survey showed that the mental health problems of doctoral students were more prominent than those of junior college students, and the mental health of students from rural areas was more likely to be abnormal than that of urban students. In addition, students who had experienced significant life events and divorced parents were more likely to have an abnormal status. The abnormal group exhibited significantly higher Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 scores than the healthy group, with these differences being statistically significant (P < 0.05). The nomogram prediction model drawn by multivariate analysis included six predictors: The place of origin, whether they were single children, whether there were significant life events, parents' marital status, regular exercise, intimate friends, and the PHQ-9 score. The training set demonstrated an area under the receiver operating characteristic (ROC) curve (AUC) of 0.972 [95% confidence interval (CI): 0.947-0.997], a specificity of 0.888 and a sensitivity of 0.972. Similarly, the validation set had a ROC AUC of 0.979 (95%CI: 0.955-1.000), with a specificity of 0.942 and a sensitivity of 0.939. The H-L deviation test result was χ2 = 32.476, P = 0.000007, suggesting that the model calibration was good.

CONCLUSION

In this study, nearly 11.3% of contemporary college students had psychological problems, the risk factors include students from rural areas, divorced parents, non-single children, infrequent exercise, and significant life events.

Assessment of Factors Associated With Mental Well-Being Among Chinese Youths at Individual, School, and Province Levels

Importance

Although rapid urbanization in China provided improved economic prosperity and educational opportunities, it was associated with increased internalizing and externalizing problems among youths, with negative outcomes for mental well-being. Previous studies suggested that factors in individual, school, and regional levels were associated with mental well-being, and comprehensively examining these factors may provide evidence for policies for improving youth mental health.

Objective

To investigate factors associated with mental well-being at individual, school, and province levels among Chinese youths.

Design, Setting, and Participants

This cross-sectional study analyzed nationally representative data collected December 1, 2021, to January 1, 2022, from schools in China. Among 435 schools, 144 institutions had primary school students, 107 institutions had middle school students, 95 institutions had primary and middle school students, and 89 institutions had high school students. A total of 398 520 students were included.

Exposures

Characteristics at individual, school, and province levels.

Main outcomes and measures

The main outcome was mental well-being, assessed by the Short Warwick-Edinburgh Mental Well-being Scale. Linear mixed-effects models were used to investigate individual, school, and regional disparities in mental well-being among youths.

Results

There were 398 520 participants (194 460 females [48.80%]; mean [SD; range] age, 13.78 [2.40; 9-20] years). At the school level, 352 443 students (88.44%) were in public school and 291 354 students (73.11%) were in urban schools. Drinking (coefficient = -1.08; 95% CI, -1.12 to -1.05; P < .001), smoking (coefficient = -0.89; 95% CI, -0.96 to -0.83; P < .001), and increased age (coefficient per 1-year increase in age = -0.02; 95% CI, -0.03 to -0.01; P < .001) were associated with worse mental well-being. Male sex (coefficient = 1.01; 95% CI, 0.98 to 1.04; P < .001), being in a 1-child family (coefficient = 0.17; 95% CI, 0.13 to 0.20; P < .001), being in the Han group (coefficient vs other ethnic groups = 0.20; 95% CI, 0.14 to 0.26; P < .001), a higher frequency and coverage of psychological courses (eg, ≥2/wk for all students vs none: coefficient = 1.02; 95% CI, 0.36 to 1.69; P = .003), and a higher level of self-rated popularity in school (coefficient per 1-unit increase in score = 0.89; 95% CI, 0.88 to 0.89; P < .001) were associated with improved mental well-being. However, age (eg, age and 1 courses/2 wk for all students: coefficient per 1-year increase in age = -0.047; 95% CI, -0.089 to -0.005; P = .03) and sex (eg, female sex and ≥2 courses/wk for some students: coefficient = -0.184; 95% CI, -0.323 to -0.046; P = .009) had interactions with the association between psychological courses and mental well-being.

Conclusions and relevance

This study found that social disparities in mental well-being existed and that various factors at different levels were associated with mental well-being among Chinese youths. These findings suggest that public mental health programs may be recommended for associated improvements in regional disparities in mental health resources.

The role of only-child status in the effect of childhood trauma and parental rearing style on depressive symptoms in Shanghai adolescents

Introduction

After decades of the one-child policy, China changed its rules to allow two children in 2016, which altered family dynamics. Few studies have examined the emotional problems and the family environment of multi-child adolescents. This study aims to explore the role of only-child status in the impact of childhood trauma and parental rearing style on depressive symptoms of adolescents in Shanghai, China.

Methods

A cross-sectional study was conducted on 4,576 adolescents (M = 13.42 years, SD = 1.21) from seven middle schools in Shanghai, China. Childhood Trauma Questionnaire-Short Form, the Short Egna Minnen Beträffande Uppfostran, and Children's Depression Inventory were used to evaluate childhood trauma, perceived parental rearing style, and depressive symptoms of adolescents, respectively.

Results

Results showed that girls and non-only children reported more depressive symptoms, while boys and non-only children perceived more childhood trauma and negative rearing styles. Emotional abuse, emotional neglect, and father's emotional warmth significantly predicted depressive symptoms in both only children and non-only children. Father's rejection and mother's overprotection were related to adolescents' depressive symptoms in only-child families, but not non-only child families.

Discussion

Therefore, depressive symptoms, childhood trauma, and perceived negative rearing styles were more prevalent among adolescents in non-only child families, while negative rearing styles were especially associated with depressive symptoms in only children. These findings suggest that parents pay attention to their impacts on only children and give more emotional care to non-only children.

Long-Lasting Effects of Changes in Daily Routine during the Pandemic-Related Lockdown on Preschoolers’ Language and Emotional–Behavioral Development: A Moderation Analysis

The quantity and quality of environmental stimuli and contexts are crucial for children’s development. Following the outbreak of SARS-CoV-2 (COVID-19), restrictive measures have been implemented, constraining children’s social lives and changing their daily routines. To date, there is a lack of research assessing the long-lasting impacts that these changes have had on children’s language and emotional–behavioral development. In a large sample of preschoolers (N = 677), we investigated (a) the long-lasting effects of changes in family and social life and in daily activities over the first Italian nationwide COVID-19-pandemic-related lockdown upon children’s linguistic and emotional–behavioral profiles and (b) how children’s demographic variables and lifelong family characteristics moderated these associations within a multiple-moderator framework. Our findings showed a relationship between the time spent watching TV/playing video games and affective problems that was moderated by the number of siblings. Our findings showed that children who could be at high risk in more normal circumstances, such as only children, have been particularly harmed. Therefore, assessing the long-term effects of lockdown-related measures and how these could have been moderated by potential risk/protective factors added significant information to the existing literature.

Digital game addiction of preschool children in the Covid-19 pandemic: social emotional development and parental guidance

The Covid 19 pandemic has caused children to spend more time at home and an increase in their digital addiction tendencies. Children's digital game addictions were affected by parents' strategies and negatively affected their social and emotional development. The study was carried out in order to determine the digital game addiction tendency levels of children and the strategies applied by the parents, and to examine the correlation between the results obtained and the social-emotional development of the children. The study was designed as a cross-sectional study. 142 children attending pre-school education for 60-72 months were included in the study. Personal Information Form, Digital Game Addiction Tendency Scale, Digital Game Parental Mediation Scale and Ages & Stages Questionnaires: Social-Emotional were used. As a result, the increase in digital game addiction in children has negatively affected social and emotional development. The level of digital game addiction tendency is associated with parents' digital game manipulation strategies. Active parental guidance strategy prevented children's digital game addiction tendency, while digital oriented guidance and free parental strategies increased addiction tendency.

Prevalence of mental health symptoms in children and adolescents during the COVID-19 pandemic: A meta-analysis

The COVID-19 pandemic and its accompanying infection control measures introduced sudden and significant disruptions to the lives of children and adolescents around the world. Given the potential for negative impacts on the mental health of youths as a result of these changes, we conducted a systematic review and meta-analysis to examine the prevalence of depressive symptoms, anxiety symptoms, and sleep disturbances in children and adolescents during the pandemic. We searched major literature databases for relevant cross-sectional or longitudinal studies that included primary and secondary school students or children and adolescents ≤18 years of age. Prevalence values were extracted, logit-transformed, and pooled. Based on 191 included studies with 1,389,447 children and adolescents, we found the pooled prevalence of depressive symptoms, anxiety symptoms, and sleep disturbances to be 31%, 31%, and 42%, respectively. Age, grade levels, education levels, gender, geographical regions, and electronics use were correlated with the prevalence of mental health symptoms. The prevalence of mental health symptoms also increased with time, although signs of recovery and stabilization were also observed. Overall, the results from this review demonstrate the need for increased mental health research, monitoring, and intervention for children and adolescents during the current and future pandemics.

Anxiety and Depression Among College Students During the COVID-19 Lockdown: A Cross-Sectional Survey in Jiangsu, China

Background

This study aimed to explore the levels of anxiety and depression in a sample of home-quarantined college students to identify the risk factors for psychological distress during the COVID-19 lockdown.

Methods

A total of 1156 college students studying in Jiangsu, China, participated from August 5 to August 14. A structured questionnaire was used to collect data anonymously, including demographic characteristics, the generalized anxiety disorder-7 (GAD-7) questionnaire, the patient health questionnaire-9 (PHQ-9), a physical activity scale, and items related to COVID-19. The chi-square test and Fisher's exact test were employed to establish the differences in levels of anxiety and depression across sociodemographic characteristics. Binary logistic regression was applied to measure the predictors of levels of anxiety and depression, and associations were considered significant at p <0.05.

Results

The estimates of anxiety and depression were 48.1% and 57.6%, respectively. The univariate analysis indicated a significant difference in anxiety levels across student grades, whether the student was an only child, the distance from the worst-hit areas, and physical activity/exercise intensity. Physical activity intensity and living in communities with infected people were statistically correlated with the level of depression. Binary logistic regression results indicated that the predictive factors for anxiety were living within a short distance from the worst-hit areas (10~20 km), engaging in higher education (graduate students), and low-intensity daily exercise. Factors statistically predicting depression symptoms were having siblings, a COVID-19 diagnosis in the community and low-intensity daily exercise.

Conclusion

During outbreaks, students in an extremely stressful state are more likely to develop anxiety and depression, particularly postgraduates. Psychological interventions to reduce fears and encourage exercise should be available to home-quarantined college students. Students who live in the worst-hit areas and are not the only child in the family should be prioritized.

Association of Major Disease Outbreaks With Adolescent and Youth Mental Health in Low- and Middle-Income Countries: A Systematic Scoping Review

IMPORTANCE

Adolescents and young people have been historically understudied populations, and previous studies indicate that during epidemics, these populations, especially in low- and middle-income countries (LMICs), are at high risk of developing mental disturbances.

OBJECTIVE

To identify the existing evidence regarding the association of mental health with outbreaks of the influenza A (H1N1), Zika, Ebola, and SARS-CoV-2 virus in exposed youth and adolescents in LMICs.

EVIDENCE REVIEW

Across 6 databases (Embase, Cochrane Library, PubMed, PsycINFO, Scopus, and Web of Science), the mental health outcomes of adolescents and youth (aged 10-24 years) associated with 4 major pandemic outbreaks from January 2009 to January 2021 in LMICs were reviewed. A group of 3 authors at each stage carried out the screening, selection, and quality assessment using Joanna Briggs Institute checklists. The social determinants of adolescent well-being framework was used as a guide to organizing the review.

FINDINGS

A total of 57 studies fulfilled the search criteria, 55 related to the SARS-CoV-2 (COVID-19) pandemic and 2 covered the H1N1 influenza epidemics. There were no studies associated with Zika or Ebola outbreaks that met screening criteria. The studies reported high rates of anxiety and depressive symptoms among adolescents, including posttraumatic stress disorder, general stress, and health-related anxiety. Potential risk factors associated with poor mental health outcomes included female sex; home residence in areas with strict lockdown limitations on social and physical movement; reduced physical activity; poor parental, family, or social support; previous exposure to COVID-19 infection; or being part of an already vulnerable group (eg, previous psychiatric conditions, childhood trauma, or HIV infection).

CONCLUSIONS AND RELEVANCE

Results of this systematic scoping review suggest that the COVID-19 pandemic and H1N1 epidemic were associated with adverse mental health among adolescents and youth from LMICs. Vulnerable youth and adolescents may be at higher risk of developing mental health-related complications, requiring more responsive interventions and further research. Geographically localized disease outbreaks such as Ebola, Zika, and H1N1 influenza are highly understudied and warrant future investigation.

Lockdown in Chinese university dormitories: Significant increase in negative feelings and time perception distortion

The COVID-19 pandemic has led to a global crisis resulting in lockdowns worldwide. Studies found that these could amplify negative affects predictive of disturbances in time perception. However, all existing studies on this topic concentrated on the general population during a lockdown at home. There was no research on university students living in dormitories. This study fills a gap in the literature by investigating the affective states and awareness of the passage of time of Chinese university students during an exceptional dormitory lockdown. Using a snowball sampling approach, this web-based study recruited 225 volunteers (136 girls, 17-27 years old) during a dormitory lockdown. The online survey consisted of questions on demographic information, affective states (the Chinese version of the depression anxiety stress scales-21 (DASS-21) on depression, anxiety, and stress), and sense of the passage of time (the translated version of the assessment of passage of time over daily, weekly and yearly periods). The researchers shared the questionnaire link via the social media application WeChat. The study applied descriptive statistics and column charts to represent students' affective states and sense of the passage of time under extreme conditions and Pearson's correlation analysis to examine the impact of affective states on their sense of time. The study's results indicate that the dormitory lockdown caused a significant increase in all depression, anxiety, and stress categories of the DASS-21, as well as a distortion of the sense of time passing. However, the direction of the distortion differed from that in previous studies. Moreover, a Pearson correlation analysis showed that none of the three negative affects could be associated with students' sense of time. The findings of this study indicate an increased vulnerability of students due to the lockdown. Their emotions were strongly affected, requiring particular interventions to preserve their mental well-being. In addition, they showed a different distortion direction of time passage. Finally, they differed in the correlations between negative affect and the sense of passage of time compared to the general population in lockdown at home. This shows a need to investigate the impact of psychological states on students' routines and quality of life in emergencies. This study's scope should be expanded by incorporating additional factors pertaining to the passage of time and by integrating cross-cultural comparisons.

Investigating adolescent mental health of Chinese students during the COVID-19 pandemic: Multicenter cross-sectional comparative investigation

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has caused significant challenges for adolescent mental health.

AIM

To survey adolescent students in China to determine the effects of the COVID-19 pandemic on their mental health.

METHODS

A multicenter cross-sectional comparative investigation was conducted in March 2022. We collected demographic information and survey data related to the COVID-19 pandemic. The Patient Health Questionnaire-9 and Generalized Anxiety Disorder Screener scales were used for objective assessment of depression and anxiety.

RESULTS

We collected mental health questionnaires from 3184 students. The investigation demonstrated that adolescents most strongly agreed with the following items: Increased time spent with parents, interference with academic performance, and less travel. Conversely, adolescents most strongly disagreed with the following items: Not having to go to school, feeling an increase in homework, and not socializing with people; 34.6% of adolescents were depressed before COVID-19, of which 1.9% were severely depressed. After COVID-19, 26.3% of adolescents were prone to depression, of which 1.4% were severely depressed. 24.4% of adolescents had anxiety before COVID-19, with severe anxiety accounting for 1.6%. After COVID-19, 23.5% of adolescents were prone to anxiety, of which 1.7% had severe anxiety.

CONCLUSION

Chinese adolescents in different grades exhibited different psychological characteristics, and their levels of anxiety and depression were improved after the COVID-19 pandemic. Changes in educational management practices since the COVID-19 pandemic may be worth learning from and optimizing in long-term educational planning.

Association of single child family with subjective health complaints in children and adolescents

The number of single-child families has been increasing across developing countries during the last decades. We aimed to examine the association between being a single child (SC) and subjective health complaints (SHCs) in Iranian children and adolescents. This study was conducted as a part of the fifth survey of a national surveillance program entitled Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable disease (CASPIAN-V). This national survey included a total of 14,400 students 7-18 years and their parents from rural and urban areas in 30 provinces of Iran. Data on demographic characteristics, lifestyle variables, and SHCs were measured using the questionnaire of the World Health Organization on Global School-based Health Survey (WHO-GSHS). Multivariate logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (95%CI) for the association of being an SC with SHCs. Data on 14,151 participants were available for this study, of whom 7.7% (1092) were SCs. The most frequent SHCs were irritability (37.1%, 95%CI: 36.3-37.9%), feeling nervous 32.5%, 95% CI: (31.7-33.3%), and headache 24.3%, 95%CI: (23.6-25.0% ). In the multivariate model, being an SC significantly increased the odds of dizziness [adjusted OR (95% CI): 1.37(1.08-1.72)] and backache complaint [1.22(1.01-1.47)]. The association of being an SC with other SHCs (feeling low, irritability, feeling nervous, difficulty in getting to sleep, headache, stomachache) was not statistically significant (p value > 0.05). Our results suggest that being an SC may be associated with higher odds of dizziness and backache complaints.

Eighteen Months of COVID-19 Pandemic Through the Lenses of Self or Others: A Meta-Analysis on Children and Adolescents' Mental Health

Background

The COVID-19 pandemic can have a serious impact on children and adolescents' mental health. We focused on studies exploring its traumatic effects on young people in the first 18 months after that the pandemic was declared, distinguishing them also according to the type of informants (self-report and other-report instruments).

Objective

We applied a meta-analytic approach to examine the prevalence of depression, anxiety, posttraumatic stress disorder, and psychological distress among children and adolescents during the COVID-19 pandemic, considering the moderating role of kind of disorder and/or symptom, type of instrument, and continent.

Method

We used PsycINFO, PubMed, and Scopus databases to identify articles on the COVID-19 pandemic, applying the following filters: participants until 20 years of age, peer-review, English as publication language. Inclusion required investigating the occurrence of disorders and/or symptoms during the first 18 months of the pandemic. The search identified 26 publications.

Results

The meta-analysis revealed that the pooled prevalence of psychological disorders and/or symptoms for children and adolescents, who were not affected by mental health disturbances before the outbreak of the COVID-19 pandemic, was .20, 95% CI [.16, .23]. Moreover, we found a moderating role of type of instrument: occurrence was higher for self-report compared to other-report instruments.

Conclusions

The study presented an analysis of the psychological consequences for children and adolescents of the exposure to the COVID-19 pandemic, soliciting further research to identify factors underlying resilience. Notwithstanding limitations such as the small number of eligible articles and the fact that we did not examine the role of further characteristics of the studies (such as participants' age or design), this meta-analysis is a first step for future research documenting the impact of such an unexpected and devastating disaster like the COVID-19 pandemic.

Mobile phone addiction and depression among Chinese medical students: the mediating role of sleep quality and the moderating role of peer relationships

The literature has shown that mobile phone addiction is an important risk factor for depression. However, the internal mechanisms of mobile phone addiction leading to depression are still not clear. This study examined the mediating role of sleep quality and moderating role of peer relationships in the association between mobile phone addiction and depression. A sample of 450 Chinese medical students were recruited to complete measures of mobile phone addiction, depression, sleep quality and peer relationships. In this study, SPSS 25.0 and macro PROCESS were used to conduct statistical analysis on the collected data. The results showed that sleep quality partially mediated the association between mobile phone addiction and depression. Moreover, the effect of sleep quality on depression was moderated by peer relationships. The present study can advance our understanding of how and when mobile phone addiction leads to depression. Limitations and implications of this study are discussed.

Psychometric evaluation of the Chinese version of social anxiety scale for social media users and cross-sectional investigation into this disorder among college students

BACKGROUND

Recent years have seen an increased incidence of social anxiety due to increasing intensive use of social media, especially among young adults.

OBJECTIVE

The present study aimed to translate the original English version of Social Anxiety Scale for Social Media Users (SAS-SMU) into Chinese, examine its applicability among Chinese College students via reliability and validity indexes, and investigate the influencing factors contributing to SAS-SMU.

METHODS

A cross-sectional study was conducted among a cohort of 1307 Chinese college students, 486 males and 821 females, aged 20.75 ± 3.13 years old. The original version of SAS-SMU was translated into Chinese using the backward and forward translation procedure. An exploratory factor analysis (EFA) and a confirmatory factor (CFA) analysis were used for construction of underlying factor structure. Criterion-related validity was assessed using Interaction anxiousness scale (IAS) and the "extraversion" domain of Eysenck Personality Short Scale (EPQ-R-S). Cronbach's alpha coefficient was computed for evaluation of internal consistency. A multivariate stepwise linear regression analysis was conducted for determining the potential correlates of SMU-related social anxiety.

RESULTS

The final Chinese version of SAS-SMU had 21 items. Item analysis, exploratory factor, EFA, and CFA jointly supported a three-factor structure of the translated version, defined as social recognition anxiety, interaction anxiety, and privacy concern anxiety, respectively. The three-factor structure of this scale showed configural, metric, scalar measurement invariance across gender. Cronbach's alpha coefficient of the scale and its three subscales were 0.96, 0.93, 0.94, and 0.91, respectively. The mean SAS-SMU overall score for each college student was 51.63 ± 16.32, with 21.64 ± 7.24 (recognition anxiety), 17.10 ± 6.30 (interaction anxiety), 12.90 ± 4.61 (privacy concern anxiety) for each subscale, respectively. IAS score, mobile phone addiction index (MPAI) score, EPQ-E score, time spent on social media per week, relationship with parents, childhood life status, whether being an only child, and cyber bullying experience can explain 51.1% of the variance of SMU related social anxiety.

CONCLUSION

Based on the data, the Chinese version of SAS-SMU has shown to be satisfactory in psychometric properties. Subjects prone to interaction anxiousness, addictive smartphone use, extraversion personality trait, bad relationship with parents, unfortunate childhood life, only-child status, and having cyberbullying experience tend to have a higher level of SMU related social anxiety.

Network Analysis of the Relationship Between Trait Depression and Impulsiveness Among Youth

Objective

Both impulsiveness and trait depression are the trait-level risk factors for depressive symptoms. However, the two traits overlap and do not affect depressive symptoms independently. This study takes impulsiveness and trait depression into a whole construct, aiming to find the complex associations among all facets and explore their relative importance in a trait network. It can help us find the key facets that need consideration in preventing depression.

Materials and Methods

We used the Barratt Impulsiveness Scale (BIS) and Trait Depression Scale (T-DEP) as measuring tools, conducted network analysis, and applied the Graphic Least Absolute Shrinkage and Selection Operator (GLASSO) algorithm to estimate the network structure and compute the linkage and centrality indexes. The accuracy and stability of the indexes were estimated through bootstrapping. All the computations were performed by R script and packages.

Results

We found that "trait anhedonia" was connected with "non-planning" and "cognitive" impulsiveness, while "trait dysthymia" was connected with "motor" impulsiveness. "Cognitive" impulsiveness had a statistically significant higher expected influence than "motor" impulsiveness and had the trend to be dominant in the network. "Trait dysthymia" had a statistically significant higher bridge expected influence than "cognitive" impulsiveness and had the trend to be the key facet linking impulsiveness with trait depression. "Non-only children" had higher network global strength than "only children." All indexes were accurate and stable.

Conclusion

The present study confirms the complex associations among facets of trait depression and impulsiveness, finding that "cognitive" impulsiveness and "trait dysthymia" are the two key factors in the network. The results imply that different facets of impulsiveness should be considered respectively regarding anhedonia and dysthymia. "Cognitive" impulsiveness and "trait dysthymia" are critical to the prevention of depression.

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

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

Review: Mental health impacts of the COVID-19 pandemic on children and youth - a systematic review

BACKGROUND

The COVID-19 pandemic has posed an unprecedented threat to global mental health. Children and adolescents may be more susceptible to mental health impacts related to their vulnerable developmental stage, fear of infection, home confinement, suspension of regular school and extracurricular activities, physical distancing mandates, and larger scale threats such as global financial recessions and associated impacts. Our objective was to review existing evidence of the COVID-19 pandemic's global impact on the mental health of children and adolescents <19 years of age and to identify personal and contextual factors that may enhance risk or confer protection in relation to mental health outcomes.

METHODS

We conducted a search of peer-reviewed and preprint research published in English from January 1, 2020, to February 22, 2021. We included studies collecting primary data on COVID-19-related mental health impacts on children and adolescents. We graded the strength of included articles using the Oxford Centre for Evidence-Based Medicine rating scheme.

RESULTS

Our search and review yielded 116 articles presenting data on a total of 127,923 children and adolescents; 50,984 child and adolescent proxy reports (e.g., parents, healthcare practitioners); and >3,000 chart reviews. A high prevalence of COVID-19-related fear was noted among children and adolescents, as well as more depressive and anxious symptoms compared with prepandemic estimates. Older adolescents, girls, and children and adolescents living with neurodiversities and/or chronic physical conditions were more likely to experience negative mental health outcomes. Many studies reported mental health deterioration among children and adolescents due to COVID-19 pandemic control measures. Physical exercise, access to entertainment, positive familial relationships, and social support were associated with better mental health outcomes.

CONCLUSIONS

This review highlights the urgent need for practitioners and policymakers to attend to and collaborate with children and adolescents, especially those in higher risk subgroups, to mitigate short- and long-term pandemic-associated mental health effects.

Internalizing symptoms and family functioning predict adolescent depressive symptoms during COVID-19: A longitudinal study in a community sample

BACKGROUND

The COVID-19 pandemic and lockdown pose a threat for adolescents' mental health, especially for those with an earlier vulnerability. Accordingly, these adolescents may need increased support from family and friends. This study investigated whether family functioning and peer connectedness protects adolescents with earlier internalizing or externalizing symptoms from increased depressive symptoms during the first Dutch COVID-19 lockdown in a low-risk community sample.

METHODS

This sample comprised 115 adolescents (Mage = 13.06; 44% girls) and their parents (N = 111) and is part of an ongoing prospective study on child development. Internalizing and externalizing symptoms were self-reported a year before the COVID-19 lockdown. In an online survey during the first Dutch lockdown (April-May 2020), adolescents reported depressive symptoms and perceived peer connectedness, and parents reported family functioning.

RESULTS

Twenty-four percent of adolescents reported clinically relevant symptoms of depression during the first COVID-19 lockdown. Depressive symptoms were significantly predicted by earlier internalizing, but not externalizing symptoms. Furthermore, higher quality of family functioning, but not peer connectedness, predicted fewer adolescent depressive symptoms. Family functioning and peer connectedness did not moderate the link between pre-existing internalizing symptoms and later depressive symptoms.

CONCLUSIONS

In a low-risk community sample, one-in-four adolescents reported clinically relevant depressive symptoms at the first COVID-19 lockdown. Higher earlier internalizing symptoms and lower quality of family functioning increased risks. These results indicate that even in low-risk samples, a substantial group of adolescents and their families are vulnerable during times of crisis.

Exploring the Associations between Single-Child Status and Childhood High Blood Pressure and the Mediation Effect of Lifestyle Behaviors

Background: This study aimed to assess the association between single-child status and childhood high blood pressure (HBP) and to explore the role of lifestyle behaviors in this relationship. Methods: This study used data from a cross-sectional survey of 50,691 children aged 7~18 years in China. Linear and logistic regression models were used to assess the relationship between single-child status and HBP, and interactions between single-child status and lifestyle behaviors were also evaluated. Mediation analysis was conducted to detect the mediation effect of lifestyle behaviors. Results: Of the participants enrolled, 67.2% were single children and 49.4% were girls. Non-single children were associated with a greater risk of HBP, especially in girls (OR = 1.11, 95%CI: 1.03~1.19). Meat consumption and sedentary behavior mediated 58.9% of the association between single-child status and HBP (p < 0.01). When stratified by sleeping duration, non-single girls of insufficient sleep and hypersomnia showed a higher risk of HBP (p < 0.05) than single-child peers, but not in those with adequate sleep. Conclusion: Findings suggest that non-single children had an increased risk of HBP, and keeping healthy lifestyle behaviors could help to mitigate the adverse impact in non-single children.

Anxiety in Chinese Patients With Cleft Lip and/or Palate: A Preliminary Study

OBJECTIVES

To preliminarily analyze factors that affected the prevalence of anxiety in Chinese patients with cleft lip and/or palate (CL/P).

METHODS

The Generalized Anxiety Disorder Scale (GAD-7) was used to screen anxiety in Chinese CL/P patients. Non-CL/P individuals were also included as the control group. Sociodemographic and clinical data consisting of diagnosis, gender, only child or not, monthly household income, and current family location were collected to analyze possible factors that could affect the anxiety of this patient population.

RESULTS

One hundred forty-two and 78 valid questionnaires were collected from the study and control groups, respectively. The mean GAD-7 score of the study group (3.092 ± 3.381) was significantly lower than the control (3.987 ± 2.505). Moreover, the proportion of patients presenting with moderate-severe anxiety was larger in the study group than in the control group (6.6 vs. 0.0%). Statistically significant differences in GAD-7 scores were observed between the study and control groups when the patient was the only child, living in an urban area, or the monthly household income was between 1,000 and 5,000 yuan.

CONCLUSION

Although the severity of anxiety in Chinese CL/P patients was not severer than those without CL/P, there was a relatively high incidence of moderate-severe anxiety in CL/P patients, while the only child, current family location and the monthly household income played significant roles in affecting anxiety psychology.

"Coronavirus Changed the Rules on Everything": Parent Perspectives on How the COVID-19 Pandemic Influenced Family Routines, Relationships and Technology Use in Families with Infants

This study explores how the first wave of the COVID-19 pandemic influenced family routines, relationships and technology use (smartphones and tablet computers) among families with infants. Infancy is known to be an important period for attachment security and future child development, and a time of being susceptible to changes within and outside of the family unit. A qualitative design using convenience sampling was employed. A total of 30 mothers in Perth, Western Australia participated in semi-structured interviews by audio or video call. All mothers were parents of infants aged 9 to 15 months old. Interviews were audio-recorded and transcribed, and data were analysed using thematic analysis to code and identify themes in an inductive manner. Families described staying home and stopping all external activities. Three themes relating to family interactions and wellbeing were found: enhanced family relationships; prompted reflection on family schedules; and increased parental stress. Two themes related to family device use were found: enabled connections to be maintained; and source of disrupted interactions within the family unit. Overall, participants described more advantages than downsides of device use during COVID-19. Findings will be of value in providing useful information for families, health professionals and government advisors for use during future pandemic-related restrictions.

Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19: A Meta-analysis

Importance

Emerging research suggests that the global prevalence of child and adolescent mental illness has increased considerably during COVID-19. However, substantial variability in prevalence rates have been reported across the literature.

Objective

To ascertain more precise estimates of the global prevalence of child and adolescent clinically elevated depression and anxiety symptoms during COVID-19; to compare these rates with prepandemic estimates; and to examine whether demographic (eg, age, sex), geographical (ie, global region), or methodological (eg, pandemic data collection time point, informant of mental illness, study quality) factors explained variation in prevalence rates across studies.

Data Sources

Four databases were searched (PsycInfo, Embase, MEDLINE, and Cochrane Central Register of Controlled Trials) from January 1, 2020, to February 16, 2021, and unpublished studies were searched in PsycArXiv on March 8, 2021, for studies reporting on child/adolescent depression and anxiety symptoms. The search strategy combined search terms from 3 themes: (1) mental illness (including depression and anxiety), (2) COVID-19, and (3) children and adolescents (age ≤18 years). For PsycArXiv, the key terms COVID-19, mental health, and child/adolescent were used.

Study Selection

Studies were included if they were published in English, had quantitative data, and reported prevalence of clinically elevated depression or anxiety in youth (age ≤18 years).

Data Extraction and Synthesis

A total of 3094 nonduplicate titles/abstracts were retrieved, and 136 full-text articles were reviewed. Data were analyzed from March 8 to 22, 2021.

Main Outcomes and Measures

Prevalence rates of clinically elevated depression and anxiety symptoms in youth.

Results

Random-effect meta-analyses were conducted. Twenty-nine studies including 80 879 participants met full inclusion criteria. Pooled prevalence estimates of clinically elevated depression and anxiety symptoms were 25.2% (95% CI, 21.2%-29.7%) and 20.5% (95% CI, 17.2%-24.4%), respectively. Moderator analyses revealed that the prevalence of clinically elevated depression and anxiety symptoms were higher in studies collected later in the pandemic and in girls. Depression symptoms were higher in older children.

Conclusions and Relevance

Pooled estimates obtained in the first year of the COVID-19 pandemic suggest that 1 in 4 youth globally are experiencing clinically elevated depression symptoms, while 1 in 5 youth are experiencing clinically elevated anxiety symptoms. These pooled estimates, which increased over time, are double of prepandemic estimates. An influx of mental health care utilization is expected, and allocation of resources to address child and adolescent mental health concerns are essential.

Investigating the effects of COVID-19 lockdown on Italian children and adolescents with and without neurodevelopmental disorders: a cross-sectional study

We conducted a cross-sectional study to compare the impact of social distancing and lifestyle changes that occurred during Corona Virus Disease 2019 (COVID-19) lockdown on children and adolescents with and without Neurodevelopmental Disorders (NDDs). An online questionnaire was administered in order to investigate the effects of NDD condition, socio-demographic status, familiar/home environment and COVID-19 exposure on their lives during a two months period of social isolation. We used logistic regression, focusing on five endpoints (remote learning, lifestyle, stress/anxiety, sociality, scolding) to define the extent of these effects. Most questions were paired up to parents and children, to verify the occurrence of agreement. 8305 questionnaires were analyzed, 1362 of which completed by NDDs and 6943 by controls. Results showed that the presence of a NDD, compared to controls, had a significant impact on: Remote Learning (i.e. subjects with NDDs experienced more difficulties in attending online classes and studying), Sociality (i.e. subjects with NDDs missed their schoolmates less), Scolding (i.e. subjects with NDDs were scolded more often) and Anxiety (i.e. subjects with NDDs were perceived by their parents as more anxious). Substantial agreement between parents and children arose from questions concerning Remote learning, Lifestyle and Scolding. The current study actually points out that having a NDD gives account for a stronger influence on school performance and on behavioral and psychological aspects, during a two months lockdown. Such results may provide useful information to governments and school authorities on how carrying through supportive strategies for youth affected by NDDs.

The Intersection Between Childhood Trauma, the COVID-19 Pandemic, and Trauma-related and Psychotic Symptoms in People With Psychotic Disorders

Introduction

People with psychotic disorders may be disproportionately affected by the traumatic effects of the COVID-19 pandemic. Childhood trauma, which also increases vulnerability to subsequent stressors, is common in individuals with psychosis. In this study, we investigated the intersection of the pandemic, childhood trauma, and psychotic and trauma-related symptoms in individuals with psychotic disorders.

Methods

We administered a cross-sectional survey to 151 participants [47 schizophrenia (SZ), 53 psychotic bipolar disorder (BP)], 51 healthy control (HC)] during the COVID-19 pandemic. Participants were asked about exposure to the pandemic’s impacts, childhood trauma, and post-traumatic stress, dissociative, and psychotic symptoms.

Results

BP reported greater negative impacts to emotional health than SZ and HC and to non-COVID physical health than HC. SZ reported less impact on work and employment during the pandemic. There were no other group differences in pandemic-related adversities. We also found that cumulative exposure to the pandemic’s negative impacts was significantly associated with PTSD symptoms but not psychotic or dissociative symptoms. Moreover, the number of adversities an individual experienced during the pandemic was strongly associated with the cumulative number of traumatic experiences they had in childhood.

Discussion

Our results suggest that having a psychotic disorder does not, in and of itself, increase susceptibility to the pandemic’s negative impacts. Instead, we provide evidence of a graded relationship between cumulative exposure to the pandemic’s negative impacts and PTSD symptom severity, as well as a graded relationship between cumulative childhood traumatic experiences and the number pandemic adversities, across diagnoses.