The Protective Roles of Exercise and Maintenance of Daily Living Routines for Chinese Adolescents During the COVID-19 Quarantine Period

Physical activity on the mental health of children and adolescents during COVID-19 pandemic-induced school closures-A systematic review

PROPOSE

To review published Physical Activity (PA) on the Mental Health of Children and Adolescents aged 5 to 18 years during COVID-19 pandemic-induced school closures.

METHODS

From the database creation to April 2022, 10 databases are retrieved, with 4427 records filtered, 14 included in this research. The research takes Agency for Healthcare Research and Quality (AHRQ) evaluation standards.

RESULTS

The thesis selects 14 studies from 6 countries, involving 400009 children and adolescents. These studies happened during the lockdown of COVID-19 (from December 2019 to April 2021). During the lockdown of COVID-19, schools were closed, which was considered part of a more extensive lockdown. Schools were closed for 1 to 4 weeks. There were 10 high quality studies (71.4%) and 4 medium quality studies (28.6%). 4 studies report that the pandemic reduces the time of PA but increases the time of watching screen and sitting. 10 studies (71.4%) identify that PA is positive for the mental health, because it helps reduce mental symptoms to a certain extent, especially anxiety, depression, and emotional disorders. 5 studies show that PA may not improve the mental health of children and adolescents under 12 during the pandemic. 4 studies indicate that the influence of PA on mental health of children and adolescents is determined by the amount of activity, including the extent, intensity, frequency, and duration, etc.

CONCLUSIONS

In this narrative synthesis of reports from the class suspension period, reports that PA has a improve on the mental health of children and adolescents to a certain extent. it is found that PA may be helpful in reducing mental health symptoms of children and adolescents who are influenced by class suspension because of the COVID-19 pandemic. Therefore, stakeholders of the mental health of children and adolescents around the world should recommend PA because it is a practicable and beneficial way for long-term mental support.

The longitudinal impact of the COVID-19 pandemic on adolescents' internalizing symptoms, substance use, and digital media use

The present study examined the long-term effects of the COVID-19 pandemic on adolescent internalizing symptoms, substance use, and digital media use before and during the pandemic. A nationally representative longitudinal cohort of 3718 Israeli adolescents aged 12-16 at baseline completed measures of internalizing symptoms (anxiety, depression, and somatization), the prevalence of substance use (i.e., previous 30-day use of tobacco, alcohol, and cannabis), and average daily use of internet/television, video games, and social media. Social support and daily routines were assessed as potential protective factors for mental health. Data were collected in 10 public schools at four measurement points: before the Covid-19 outbreak (September 2019), after the first wave lockdown (May 2020), after the third wave lockdown (May 2021), and after the fifth wave of the pandemic (May 2022). Multi-level mixed models were used to analyze the longitudinal data. The results showed significant increases in internalizing symptoms, substance use (tobacco, alcohol, and cannabis), and daily screen time from the start of the study to the 33-month follow-up. Social support and daily routines moderated the increases in internalizing symptoms and digital media use. These findings highlight the need for public and educational mental health services to address the continuing impact of the pandemic on adolescents.

Lived experiences of adolescents with major depressive disorder during the COVID pandemic: A qualitative study from a tertiary care center

Objectives

Depression is a leading cause of global disease burden and morbidity among adolescents. Studies have reported higher rates of depression and anxiety secondary to the COVID pandemic and the psychosocial impact of social distancing measures. There is a paucity of literature on the subjective experiences of depressed adolescents in such pandemic circumstances. The objective of this study was to explore the lived experiences of adolescents with major depressive disorder (MDD) during the COVID pandemic, and the impact of the pandemic, and pandemic-related circumstances on adolescents' mental health and coping.

Materials and Methods

In-depth interviews with eight adolescents diagnosed with MDD were analyzed using interpretative phenomenological analysis.

Results

The analysis revealed three major themes; "The pandemic was arduous," "Negativity in family interactions," and "Effects on depression." Most adolescents coped using excessive screen time as a distraction, and their families perceived them as indolent.

Conclusion

The study found that adolescents' experience of depression during the pandemic was extremely overwhelming because, on the one hand, they had to deal with immediate COVID infection-related worries and were not able to adjust to the new routine, not able to concentrate during online classes while also dealing with greater interpersonal discord with their parents and limited social resources for coping. The findings expand the clinical understanding of adolescents' experience of depression during pandemic circumstances and would aid in better management planning.

Daily routine disruptions and psychiatric symptoms amid COVID-19: a systematic review and meta-analysis of data from 0.9 million individuals in 32 countries

BACKGROUND

There is currently a deficit of knowledge about how to define, quantify, and measure different aspects of daily routine disruptions amid large-scale disasters like COVID-19, and which psychiatric symptoms were more related to the disruptions. This study aims to conduct a systematic review and meta-analysis on the probable positive associations between daily routine disruptions and mental disorders amid the COVID-19 pandemic and factors that moderated the associations.

METHODS

PsycINFO, Web of Science, PubMed, and MEDLINE were systematically searched up to April 2023 (PROSPERO: CRD42023356846). Independent variables included regularity, change in frequency, and change in capability of different daily routines (i.e., physical activity, diet, sleep, social activities, leisure activities, work and studies, home activities, smoking, alcohol, combined multiple routines, unspecified generic routines). Dependent variables included symptoms and/or diagnoses of mental disorders (i.e., depression, anxiety, post-traumatic stress disorder, and general psychological distress).

RESULTS

Fifty-three eligible studies (51 independent samples, 910,503 respondents) were conducted in five continents. Daily routine disruptions were positively associated with depressive symptoms (r = 0.13, 95% CI = [0.06; 0.20], p < 0.001), anxiety symptoms (r = 0.12, 95% CI = [0.06; 0.17], p < 0.001), and general psychological distress (r = 0.09, 95% CI = [0.02; 0.16], p = 0.02). The routine-symptom associations were significant for physical activity, eating, sleep, and smoking (i.e., type), routines that were defined and assessed on regularity and change in capability (i.e., definition and assessment), and routines that were not internet-based. While the positive associations remained consistent across different sociodemographics, they were stronger in geo-temporal contexts with greater pandemic severity, lower governmental economic support, and when the routine-symptom link was examined prospectively.

CONCLUSIONS

This is one of the first meta-analytic evidence to show the positive association between daily routine disruptions and symptoms of mental disorders among large populations as COVID-19 dynamically unfolded across different geo-temporal contexts. Our findings highlight the priority of behavioral adjustment for enhancing population mental health in future large-scale disasters like COVID-19.

Assessing the health, social, educational and economic impact of the COVID-19 pandemic on adolescents in low- and middle-income countries: a rapid review of the literature

COVID-19 has caused profound health, social, educational and economic devastation around the world, especially among the lives of adolescents in low- and middle-income countries. This paper looks at a wide array of outcomes impacting adolescents' daily lives including health (mental, physical, sexual and reproductive health, vaccine perceptions and overlap between these topics), social relationships (family and peer), education and socio-economic disparities. Both scientific and grey literature between December 2019 and February 2022 were sought from PubMed, Google Scholar and organisations conducting research among adolescents, and coded. A total of 89 articles were included, 73% of which were peer-reviewed; 37% of the articles were from WHO's Western Pacific region; 62% of the articles were cross-sectional; 75% were quantitative. Three major topics emerged in more than half the articles: mental health (72%), education (61%) and socio-economic ramifications (55%). However, there were regional differences in topics and many of them overlapped. The results indicate that, where there has been research, almost all findings have been linked to worse mental health during the pandemic. Overall, remote education was seen as a negative experience. The ramification of school closures on future aspirations, in particular early school leaving, highlights the importance of prioritising education during future pandemics based on the situation within the country. Gender and other disparities have made marginalised adolescents vulnerable to the economic ramifications of containment measures. Given the risks identified, there is a pressing need to put adolescents at the centre of establishing priorities for their health agenda for post-pandemic recovery.

Maternal involvement and adolescents' psychological and academic adjustment after COVID-19 return-to-school: A one-year longitudinal study

The current study examined the idea that maternal involvement during the COVID-19 school closure period could contribute to the development of adolescents' daily routines, which could ultimately associate with their psychological and academic adjustment after return-to-school. Data were collected from 520 Chinese adolescents (Mage  = 12.75 years, SDage  = 1.48 years) and their mothers during the COVID-19 school closure and one year after return-to-school. Results indicated that maternal involvement in both education and leisure activities predicted more consistent adolescents' daily routines during the school closure period and then contributed to their more consistent daily routines after return-to-school, resulting in less psychological maladjustment and better academic outcomes. Findings highlight the importance of maternal involvement and daily routines in the context of COVID-19.

Parenting and parent-child home practice during the COVID-19 pandemic: a case in central China

The current study aims to explore parents' perceptions of parenting and parent-child activities at home with children aged 3-6 during the pandemic in China. A parenting survey was conducted to investigate parental role, age, educational background, work productivity, and different parenting categories during the lockdown period. We also examined the experiences of young children's participation in extracurricular activities before and after the stay-at-home policy was implemented as well as their activities with parents during the lockdown period. The results showed that parents' work productivity affected their perceptions of well-being during the COVID-19 pandemic. Children spent less time on extracurricular activities during the lockdown period, but some particular activities increased in frequency, especially academic extracurricular activities.

Physical activity and mental health in children and youth during COVID-19: a systematic review and meta-analysis

BACKGROUND

The coronavirus disease (COVID-19) and universal mitigation strategies have fundamentally affected peoples' lives worldwide, particularly during the first two years of the pandemic. Reductions in physical activity (PA) and increased mental health (MH) problems among children and youth have been observed. This systematic review and meta-analysis investigated the relationship between physical activity (PA) and mental health (MH) among children and youth during the COVID-19 pandemic.

METHODS

Four electronic databases (EMBASE, PsycINFO, PubMed, and Web of Science) were systematically searched to identify studies that (1) examined the relationship between PA and MH among children and youth (aged 2-24 years old) and (2) were published in peer-reviewed journals in English between January 2020 and December 2021. Relationships between PA and two MH aspects (i.e., negative and positive psychological responses) among children and youth at different age ranges and those with disabilities or chronic conditions (DCC) were synthesized. Meta-analyses were also performed for eligible studies to determine the pooled effect size.

RESULTS

A total of 58 studies were eventually included for variable categorization, with 32 eligible for meta-analyses. Our synthesis results showed that greater PA participation was strongly related to lower negative psychological responses (i.e., anxiety, depression, stress, insomnia, fatigue, and mental health problems) and higher positive psychological responses (i.e., general well-being and vigor) in children and youth during COVID-19. The pattern and strength of relations between PA and MH outcomes varied across age ranges and health conditions, with preschoolers and those with DCC receiving less attention in the existing research. Meta-analysis results showed that the magnitude of associations of PA with negative (Fisher's z = - 0.198, p < 0.001) and positive (Fisher's z = 0.170, p < 0.001) psychological responses among children and youth was weak. These results were linked to age of participants, study quality, and reporting of PA-related information.

CONCLUSIONS

PA participation and MH among children and youth deteriorated during the COVID-19 pandemic and were closely associated with each other. For the post-COVID-19 era, additional research on age- and health condition-specific relationships between PA and MH outcomes from a comprehensive perspective is warranted. (Word count: 344 words).

Enhancing human resilience beyond COVID-19-related stress: public responses to multi-benefits of home gardening

The SARS-CoV-2 virus has caused a public health crisis globally. Against the backdrop of global resilience, studies have demonstrated the therapeutic value of home gardening as a measure to strengthen human health. However, there is a lack of comparative studies on its benefits across countries. Studies need to examine the role of home gardening in improving public health in various societies to understand and encourage this practice broadly and effectively. We chose Taiwan, Thailand, and Vietnam as case studies, which have suffered substantial pandemic impacts, with millions of infections and thousands of deaths. We explored and compared the perceptions of people on home gardening and its health benefits during the COVID-19 pandemic. We conducted online surveys in three countries between May 1 and September 30, 2022, with a total of 1172 participants. Data were collated on perceived pandemic stress, challenges and solutions in gardening, home gardening intentions, and mental and physical health benefits. In these countries, we found that perceived pandemic stress positively affects home gardening intentions, whereby the motivation of Vietnamese people is the highest. Challenges hinder gardening intentions, while the solutions only positively affect gardening intentions in Taiwan and Vietnam. Home gardening intentions positively affect mental and physical health, whereby there are higher mental health benefits in Taiwanese people than in Thai people. Our findings potentially support public health recovery and promote healthy lifestyles during the COVID-19 pandemic.

Subgroups of perceptions and related behaviors during the COVID-19 lockdown: experience of adolescents in the PARIS birth cohort

BACKGROUND

Adolescents may not all have reacted similarly to the COVID-19 lockdown. This study aimed to identify subgroups of perceptions in adolescents from the PARIS cohort during the first French lockdown, and to investigate whether adolescent behaviors differed according to these subgroups.

METHODS

Online questionnaires were sent to 1,549 PARIS adolescents aged 13-17 years who reported on possible infection with SARS-CoV-2, their perceptions, and behaviors during lockdown. Ascending hierarchical clustering was performed on the perception variables. Associations of behaviors with perception clusters were analyzed using multivariable multinomial logistic regression.

RESULTS

Three perception clusters were identified among 791 adolescents (response rate 51%). One cluster "happy" (39%) had good mental health and did not feel stressed during lockdown. Another cluster "unhappy" (19%) was mainly unhappy, felt stressed, suffered from overcrowded living conditions, and experienced deteriorating relationships with family members. A further cluster "intermediate" (42%) experienced moderate well-being and stress, felt more supported by family, and worried about the health of their relatives. Compared with the "happy" cluster, the unhappy adolescents were more affected by COVID-19, had difficulty doing school activities, spent more time on social networks and less time on video games, slept less, and reported a deterioration in their diet. Adolescents "intermediate" with moderate well-being were more often girls, spent more time on social networks, were more physically active, slept less, and more often reported eating fruit and vegetables and drinking alcohol.

CONCLUSIONS

Not all adolescents experienced lockdown in the same way. This study highlighted subgroups that differed in terms of well-being and health-related behaviors. These results should motivate public authorities to consider the benefit/risk ratio of implementing strict lockdowns by taking into account family disparities and inequities among adolescents.

The impacts of physical activity on psychological and behavioral problems, and changes in physical activity, sleep and quality of life during the COVID-19 pandemic in preschoolers, children, and adolescents: A systematic review and meta-analysis

Background

The COVID-19 pandemic has greatly affected the level of physical activity (PA). However, little is known about its effect on health outcomes.

Methods

Articles without language restrictions published from the database inception through March 16, 2022, were retrieved using the CINAHL Complete, Cochrane Library, EMBASE, Medline, PubMed, and PsycINFO databases. High-quality articles assessing the effect of PA on psychological and behavioral problems. Additionally, PA, QoL, and/or sleep problems before and during the pandemic were included. Articles without data regarding PA or involving non-general populations were excluded. The PRISMA and MOOSE guidelines were followed. Data quality of the selected articles was assessed using the Newcastle-Ottawa Scale and GRADE approach. Data were pooled using a random-effects model and sensitivity analysis if heterogenicity was high (I 2 ≥ 50%). The relationship between PA and psychological and behavioral problems; and changes in PA, QoL, and sleeping patterns before and during the pandemic in preschoolers, children, and adolescents were investigated. A meta-analysis was conducted; odds ratios (ORs), mean differences (MD), and standardized MDs (SMDs) were calculated.

Results

Thirty-four articles involving 66,857 participants were included. The results showed an overall significant protective effect between PA and psychological and/or behavioral problems (OR = 0.677; 95% CI = 0.630, 0.728; p-value <0.001; I 2   = 59.79%). This relationship was also significant in the subgroup analysis of children (OR = 0.690; 95% CI = 0.632, 0.752; p-value <0.001; I 2   = 58.93%) and adolescents (OR = 0.650; 95% CI = 0.570, 0.741; p-value <0.001; I 2   = 60.85%); however, no data on the relationship in preschoolers were collected. In addition, the overall time spent on PA significantly decreased by 23.2 min per day during the COVID-19 pandemic (95% CI = -13.5, -32.9; p-value <0.001; I 2   = 99.82%). Moreover, the results showed an overall significant decrease in QoL (SMD = -0.894, 95% CI = -1.180, -0.609, p-value <0.001, I 2   = 96.64%). However, there was no significant difference in sleep duration during the COVID-19 pandemic (MD = 0.01 h per day, 95% CI = -0.027, 0.225; p-value = 0.125; I 2   = 98.48%).

Conclusion

During the pandemic, less PA was contributed to poor QoL and sleep quality. However, increases in PA are associated with reduced occurrences of psychological and behavioral problems. Implementing recovery plans to address the health effect of the pandemic is essential.

Generalized anxiety among Finnish youth from 2013 to 2021-Trend and the impact of COVID-19

BACKGROUND

Alarming levels of emotional symptoms among youth were reported during the COVID-19 pandemic. Studies assessing these figures against the pre-pandemic developments are rare. We examined the trend of generalized anxiety (GA) in adolescents in the 2010s and the effect of the COVID-19 pandemic against this trend.

METHODS

Data from the Finnish School Health Promotion study with 750,000 participants aged 13-20 between 2013 and 2021 was analyzed using GAD-7 to measure self-reported GA (cut-off ≥10). Inquiries were made about remote learning arrangements. Effects of time and COVID-19 were analyzed with logistic regression.

RESULTS

Among females, an increasing trend in GA between 2013 and 2019 was found (OR per year 1.05), and the prevalence increased from 15.5 % to 19.7 %. Among males, the trend was decreasing (OR = 0.98), with prevalence from 6.0 % to 5.5 %. Increase in GA from 2019 to 2021 was stronger in females (19.7 % to 30.2 %) than males (5.5 % to 7.8 %), while the effect of COVID-19 on GA was equally strong (OR = 1.59 vs. OR = 1.60) against the pre-pandemic trends. Remote learning was associated with elevated levels of GA, especially among those with unmet needs for learning support.

LIMITATIONS

The design of repeated cross-sectional surveys doesn't allow analyses of within individual changes.

CONCLUSIONS

Given the pre-pandemic trends of GA, the COVID-19 effect on it appeared equal in both sexes. The increasing pre-pandemic trend among adolescent females and the strong effect of COVID-19 on GA among both sexes warrants constant monitoring of mental health of the youth in the aftermath of the COVID-19 pandemic.

Effect of traditional Chinese medicine massage on physical and mental health of middle-aged and elderly women

This mixed-methods study examined the effects of traditional Chinese medicine massage on the physique, athletic performance, body composition, and perceived physical and mental health of 10 middle-aged and older women by using questionnaires and multiple measurement instruments. Microsoft Office and IBM SPSS 26.0 were used for the verification and calculation of results. Multivariate analysis was employed to analyze the data. Intermittent exercise significantly influenced the body composition, physical fitness, sports performance, and physical and mental health of female college students and improved their self-confidence, sleep quality, eating habits, weight, blood pressure, and sports performance, even when not accompanied with massage. However, although the rate of improvement was stable, intermittent exercise with traditional Chinese medicine massage yielded greater improvements in abdominal muscle strength and flexibility than intermittent exercise without traditional Chinese medicine massage. In terms of physical and mental health, headache, head pressure, back pain, and sense of loss were significantly alleviated (p < 0.01) in the traditional Chinese medicine massage group.

Anxiety during the COVID‐19 pandemic in prisoners who had high risks to suffer from mood disorders: A longitudinal study before and during the COVID‐19

We compared the anxiety levels in prisoners before and after the COVID-19 outbreak and analyzed the causes of the changes in anxiety. The first survey was conducted in October 2019 (T0), and the second was conducted in March 2020 (T1). Generalized anxiety disorder-7 (GAD-7), Patient Health Questionnaire-9, and Insomnia Severity Index scales were selected to assess the quality of emotion and sleep among prisoners (N = 803). Three subjective questions were asked to evaluate prisoners' personal feelings on the COVID-19. Paired Samples T-test, Binary, and Multivariate Logistic Stepwise Regression were used to analyze the data. GAD-7 scores decreased at T1 (p < 0.001). For the prisoners without anxiety at T0 (n = 480), GAD-7's mean value at T1 raised (p < 0.001), whereas the mean value decreased (p < 0.001) for the prisoners with anxiety at T0 (n = 323). For the prisoners without anxiety, shorter years of education (OR = 0.843), COVID-19 (OR = 4.936), severer depression at T1 (OR = 1.683), and severer insomnia at T1 (OR = 1.134) were associated with the new onset of anxiety. For the prisoners with anxiety, anxiety was alleviated in 71.2% and exacerbated in 10.5% at T1. For the alleviators, severer depression at T1 (OR = 0.667) and COVID-19 (OR = 0.258) were associated with anxiety unrelief; severer anxiety at T0 (OR = 1.343) was associated with anxiety alleviation. For the exacerbators, severer anxiety at T0 (OR = 0.517) was associated with anxiety unaggravation; severer depression at T1 (OR = 1.196), COVID-19 (OR = 22.882), and severer depression at T0 (OR = 1.181) were associated with anxiety exacerbation. At the outbreak of COVID-19, prisoners' anxiety was reduced. The main factor was the baseline anxiety levels. That may be related to prison management and the Downward Social Comparison.

Impact of the COVID-19 pandemic on children and adolescents: determinants and association with quality of life and mental health-a cross-sectional study

BACKGROUND

The medium-term impact of the COVID-19 pandemic on the wellbeing of children and adolescents remains unclear. More than 2 years into the pandemic, we aimed to quantify the frequency and determinants of having been severely impacted by the COVID-19 pandemic and estimate its impact on health-related quality of life (HRQoL) and mental health.

METHODS

Data was drawn from a population-based cohort of children and adolescents, recruited between December 2021 and June 2022, in Geneva, Switzerland. The Coronavirus impact scale was used to assess the multidimensional impact of the pandemic on children through parent's report. A score higher than one standard deviation above the mean was deemed a severe impact. Parents additionally reported about their offspring HRQoL and mental health with validated scales. Determinants of having been severely impacted were assessed with logistic models, as were the associations between having experienced a severe impact and poor HRQoL or mental health.

RESULTS

Out of 2101 participants aged 2-17, 12.7% had experienced a severe pandemic impact. Having a lasting health condition, a pandemic-related worsening of lifestyle habits or an unfavorable family environment were associated with having been severely impacted by the pandemic, while a previous anti-SARS-CoV-2 infection was not. Participants who had experienced a severe pandemic impact were more likely to present poor HRQoL (aOR = 3.1; 95% CI 2.3-4.4) and poor mental health (aOR = 3.9; 95% CI 2.5-6.2).

CONCLUSION

The COVID-19 pandemic may have persistent consequences on the wellbeing of children and adolescents, especially among those with health and family vulnerabilities.

School-Age Child Routines: Adaptation and Validation Studies of the Portuguese Version of the Child Routines Questionnaire

Child routines have been recognized as positive contributors to children's development. However, in Portugal there is still a lack of instruments available to assess school-age child routines. The purpose of this study was to present the translation, adaptation, and validation studies of the Portuguese version of the Child Routines Questionnaire (CRQ), a parent self-report measure developed to assess school-age child routines. A total of 460 parents of children aged between 6 and 12 years-old participated in the study. Two studies were conducted to define the CRQ-PT factor structure. In Study 1 (n = 204 children from 6 to 12 years-old), findings from the exploratory factor analysis provided evidence for a four-factor structure (for 32 items), which explained 43.53% of the total variance. In Study 2 (n = 256 children from 6 to 9 years-old), results from confirmatory factor analysis showed good model fit indices (CFI = 0.84, RMSEA = 0.06). The total scale of the CRQ-PT (α = 0.89) and its subscales showed good internal consistency. Further evidence of construct validity was shown by weak to moderate correlations with measures of parental sense of competence and family mealtime routines. Relevant contributions of the study are underscored, namely the availability and usefulness of a reliable and valid assessment tool to evaluate the routines of Portuguese school-age children for clinical practice and research purposes.

Relations between maternal panic over COVID-19 and children's depressive symptoms: the moderating role of children's daily routines

The sudden outbreak of COVID-19 and consequent quarantine policies have substantially altered family lives worldwide. Potential associations between parental negative emotional expressions towards the pandemic, family factors, and child psychological adjustment remain under-explored. Accordingly, the goal of the present study was to examine the relation between maternal panic over COVID-19 and children's depressive symptoms, with a focus on the potential moderating role of children's daily routines during a period of strict quarantine. Participants were N = 1,589 children (M age = 13.13 years, SD = 1.54; 50.7% girls) and their mothers, from Zhengzhou, Henan Province, in Mainland China. Data were collected in April of 2020, when school closure policies were in effect. Mothers reported their panic over COVID-19 and children reported their depressive symptoms and daily routines during the quarantine period. Overall, results indicated a significant positive association between maternal panic over COVID-19 and child depressive symptoms. However, maintaining regular daily routines was found to be a significant moderator of this association, with higher levels of daily routines attenuating the link between maternal panic reactions and child psychological distress (i.e., buffering effect). The results highlight the protective role of regular daily routines in promoting psychological adjustment among Chinese children during the COVID-19 pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-04129-0.

Pediatric emergency care admissions for somatic symptom disorders during the COVID-19 pandemic

During the COVID-19 pandemic, children and adolescents with psychiatric disorders experienced an exacerbation of their symptoms with more access to the emergency department (ED). However, little is known about the experience of somatic symptom disorders (SSDs) during the COVID-19 pandemic in children. Therefore, we aimed to compare the rates of pediatric ED admissions for SSDs before and during the COVID-19 pandemic and to understand whether the relative risk of ED admissions for SSDs changed between the two periods. We retrospectively enrolled all children between 4 and 14 years admitted for SSDs in the pediatric ED of Santobono-Pausilipon Hospital, Naples, Italy, from March 11th, 2020, to March 11th, 2021 (pandemic period), and in the same time period of the previous year (pre-pandemic period). We identified 205/95,743 (0,21%) children with SSDs presenting in ED in the pre-pandemic year and 160/40,165 (0,39%) in the pandemic year (p < 0.05). Considering the accesses for age, we observed a relative decrease of the accesses for SSDs over 12 years old (IRR 0,59; CI 0,39-0,88), while we found no differences under 12 years old (IRR 0,87; CI 0,68-1,10).   Conclusion: In this study, we found that despite the massive decrease in pediatric admissions due to the COVID-19 pandemic, somatic symptom disorders' admissions to the pediatric ED increased, suggesting an impact of the pandemic also on pediatric psychiatric disorders. What is Known: • During the COVID -19 pandemic, children and adolescents with a psychiatric disorder experienced exacerbation of their symptoms with more accesses in Emergency Department. What is New: • We found that despite the massive decrease of the pediatric admissions due to the COVID-19 pandemic, somatic symptom disorders admissions in healthy children to the pediatric Emergency Department increased ,suggesting an impact of the pandemic also on the pediatric psychiatric disorders.

Youth physical activity and the COVID-19 pandemic: A systematic review

•

Numerous studies examined youth physical activity (PA) during the COVID-19 pandemic.

•

Overall decreases in youth PA were seen during the first 1.5 years of the pandemic.

•

There were differences in PA by sub-populations (e.g., age, sex/gender)

•

There were also differences in PA by location/type (e.g., outdoor, play)

•

Programming and policy should focus on evolving PA promotion for youth.

The purpose of the systematic review was to identify, evaluate, and synthesize evidence from available published literature examining the impact of the coronavirus disease 2019 (COVID-19) pandemic on youth physical activity (PA). A systematic review of the literature was conducted for years 2020–2021. Published articles were searched in eight databases. Inclusion criteria included: availability of full-text, written in English language, and reported quantitative or qualitative results of original or secondary data on PA and COVID-19 related factors among youth (ages 5–17 years). A standard quality assessment tool assessed risk of bias and quality of included articles. The search retrieved 2,899 articles with 51 articles ultimately meeting inclusion criteria. The majority of articles (65 %) investigated change in PA from before to during the pandemic. Most evidence indicated an overall decrease in youth PA levels during the pandemic with differences observed among sub-populations (e.g., age, sex or gender), type, and location. Findings suggest pandemic-related closures hindered PA participation due to a high reliance on school- and sport-based PA. Programmatic strategies (e.g., activity breaks, active curriculum, free online activities/lessons) should include aligning intervention measures and geared towards evolving and ongoing PA promotion based on the latest findings.

Resilience and Wellbeing Strategies for Pandemic Fatigue in Times of Covid-19

The COVID-19 pandemic is truly one of the greatest collective health crises in history which have altered our life and living. For years, people have felt fatigued from following public health directives such as social distancing, wearing masks, washing hands frequently, and working or studying remotely without in-person interactions. In this paper, we explore strategies for resilience and wellbeing which can mitigate pandemic-caused stress and behavioural fatigue. We start with individual level strategies including reworking stress appraisals, the importance of psychological flexibility, reducing loneliness through adaptive online platform use, optimizing familial relationships when living in close quarters for a prolonged period, reducing symptoms of burnout and using adaptive distractions, using specific evidence-based resilience strategies. We discuss specific considerations which tap on our shared identities and shared responsibilities which can enhance a sense of community, especially for individuals from marginalized backgrounds and how suicide risks can be minimized.

Perceived stress of adolescents during the COVID-19 lockdown: Bayesian multilevel modeling of the Czech HBSC lockdown survey

Objective

Long-term isolation, including lockdowns and quarantines, may have a distressing effect on anyone experiencing it. Adolescent brain architecture is very sensitive to environmental adversities, and the mental health development of adolescents may be particularly vulnerable during the pandemic era. In order to better understand the triggers for perceived adolescent stress (PSS) during the COVID-19 lockdown, the present study aimed to assess the effects of social well-being and changes in time use during the lockdown, as well as the family COVID experience of adolescents.

Methods

The sample for this study comprised n = 3,440 adolescents (54.2% girls; mean age = 13.5 ± 1.6 years). Bayesian correlations between PSS, health and well-being variables were assessed. PSS was then modeled as an outcome variable in a series of nested Bayesian multilevel regression models.

Results

The negative impact of the COVID-19 lockdown was more apparent in girls. PSS was moderately correlated with adolescent health and well-being. The strongest predictor of higher level of PSS was frequent feeling of loneliness. On the contrary, lower level of PSS was most associated with having someone to talk to.

Conclusion

Long-term social isolation of adolescents could be harmful to their mental health. Psychological coping strategies to prevent the consequences of social isolation and development of mental health problems should be promoted on the individual, family, and even community level.

Trajectories of mental health status during the early phase pandemic in China: A longitudinal study on adolescents living in the community with confirmed cases

Sufficient research reports that individuals living in the community with confirmed COVID-19 cases are more likely to exhibit poor mental health condition. However, little is known about the longitudinal trajectories of mental health status among these people who are exposed to increased risk of contracting COVID-19. Using a 3-wave longitudinal survey between February and June 2020, data has been collected from 2,352 adolescents living in the community with confirmed cases. Depressive/anxiety symptoms, soc-demographic, and other psychological factors of interest (e.g., social support) were measured. Using latent growth mixture modeling, we identified two subgroups (Resistance vs. Dysfunction) of adolescents based on their depressive and anxiety symptoms. More social support and positive coping are identified as protective factors for mental health, whereas higher level of negative coping predicts unfavorable outcomes. These findings suggested that adolescents living in the community with confirmed cases of COVID-19 are a group to which researchers should pay more attention when studying the impacts of quarantine on mental health. It is also crucial to emphasize the role of social support and positive coping in planning psychological interventions for adolescents.

Have the COVID-19 pandemic and lockdown affected children's mental health in the long term? A repeated cross-sectional study

OBJECTIVE

The study aimed to evaluate the impact of the COVID-19 pandemic on levels of anxiety and depressive symptoms in children and adolescents.

DESIGN

Cross-sectional surveys were carried out on the mental health of children; one survey was conducted before the COVID-19 pandemic and one into the pandemic, 15 months after the school closures and implementation of lockdown and social distancing. Demographic data and COVID-19 pandemic-related data were collected from specific parent-report and self-report questionnaires.

PARTICIPANTS

Participants included children and adolescents between ages 6 and 16 years, attending a tertiary care hospital without any diagnosed major psychiatric or chronic disorder.

ANALYSIS

Data were collected at two points (before the COVID-19 pandemic and during it) and compared. Levels of anxiety and depressive symptoms were compared and tested for statistically significant differences between these two points using appropriate statistical tests. Regression models were constructed to predict the factors affecting increased anxiety levels and depressive symptoms in the COVID-19 period.

RESULTS

832 and 1255 children/adolescents were included in the study during the pre-COVID-19 and COVID-19 times, respectively. The median age of the participants was 10 years (IQR=4 years). The median (IQR) Spence Children's Anxiety Scale score was 24 (12) at the pre-COVID-19 point and 31 (13) during the COVID-19 pandemic (p<0.001, r=-0.27). 11% and 16% of children reported being depressed at these two-time points, respectively (p=0.004, φ_c=-0.063). Regression analysis showed that many factors, including the duration of smartphone use, female gender and only child status, were associated with increased anxiety or depression levels.

CONCLUSION

A large proportion of children had elevated anxiety and depressive symptoms during the pandemic relative to before the pandemic, suggesting a need for measures to engage children in healthy habits to protect children's mental health and continuous monitoring of children during such scenarios.

Stress-related psychopathology during the COVID-19 pandemic

The COVID-19 pandemic has introduced widespread societal changes that have required ongoing adaptation. Unsurprisingly, stress-related psychopathology has increased during the pandemic, in both children and adults. We review these patterns through the lens of several leading conceptual models of the link between stress and psychopathology. Some of these models focus on characteristics of environmental stressors-including cumulative risk, specific stressor types, and stress sensitization approaches. Understanding the specific aspects of environmental stressors that are most likely to lead to psychopathology can shed light on who may be in most need of clinical intervention. Other models center on factors that can buffer against the onset of psychopathology following stress and the mechanisms through which stressors contribute to emergent psychopathology. These models highlight specific psychosocial processes that may be most usefully targeted by interventions to reduce stress-related psychopathology. We review evidence for each of these stress models in the context of other widescale community-level disruptions, like natural disasters and terrorist attacks, alongside emerging evidence for these stress pathways from the COVID-19 pandemic. We discuss clinical implications for developing interventions to reduce stress-related psychopathology during the pandemic, with a focus on brief, digital interventions that may be more accessible than traditional clinical services.

Relationship between Lifestyle and Self-Reported Smartphone Addiction in adolescents in the COVID-19 pandemic: A mixed-methods study

OBJECTIVES

1) To verify the association between Lifestyle and Self-Reported Smartphone Addiction in adolescents; and 2) to analyze the adolescents' perception of this relationship in the context of the COVID-19 pandemic.

METHOD

A mixed-methods research study with a sequential and explanatory design, developed with Brazilian adolescents aged between 15 and 18 years old. In the first phase, a quantitative, observational and cross-sectional study was carried out with 479 participants and, in the second, a qualitative approach of an exploratory and descriptive nature, with 16 participants.

RESULTS

An association was verified between Lifestyle and Self-Reported Smartphone Addiction by adolescents (p < 0.01), with a large size effect (d=0.98). All the domains related to lifestyle were associated with Self-Reported Smartphone Addiction, with greater effects evidenced in the following aspects: high effect for sleep, seat belt, stress and safe sex (d=0.85); and moderate effect for insight (d=0.74) and career (d=0.71). Subsequently, the qualitative analysis resulted in a category that describes how the adolescents understand this relationship in the face of the COVID-19 pandemic.

CONCLUSION

More problematic lifestyles were evidenced among the adolescents classified as dependent. In addition to that, it was understood that the COVID-19 pandemic exerted a considerable impact on the lifestyle and behavior established by the adolescents with their smartphones.

IMPLICATIONS FOR THE PRACTICE

Nurses and other health professionals are essential in the promotion of healthy lifestyles and adaptive behavior in smartphone use, especially in the face of this pandemic scenario and, thus, mitigating the harms to the adolescents' health.

Implementation of online classes during national school closure due to COVID-19 and mental health symptoms of adolescents: A cross-sectional survey of 5000 students

Aim

Online classes were implemented in numerous schools during the school closure due to COVID-19. The present study examined the relationship between online classes during national school closure and mental health symptoms after the reopening of schools.

Methods

We conducted a cross-sectional survey from October 1 to November 7, 2020 using an anonymous self-reported questionnaire to evaluate 21 junior and senior high schools in the Saitama prefecture of Japan. Out of the 5538 students who were recruited, 5000 agreed to participate. The relationship between the implementation of online classes and mental health symptoms (emotional symptoms, psychotic experience [PE], and smartphone addiction) was evaluated using mixed-effect logistic regression models, while controlling for individual and class-level covariates (e.g., gender, grades).

Results

Implementation of online classes was reported by 78.2% of classroom teachers, and it was associated with lower rates of emotional symptoms (OR = 0.79, 95% CI = 0.63-0.99, p = 0.040) and smartphone addiction (OR = 0.79, 95% CI = 0.65-0.96, p = 0.020), but not related to PE (OR = 0.91, 95% CI = 0.61-1.36, p = 0.637).

Conclusions

Implementing online classes during the national school closure might have had a potential protective effect for adolescents' mental health symptoms (especially emotional symptoms and smartphone addiction) after the reopening of schools during the ongoing COVID-19 pandemic.

Swedish Pupils' Perspectives on Emergency Remote Teaching during COVID-19 - A Qualitative Study

Due to the COVID-19 pandemic, schools in many countries were forced to stop face-to-face teaching and switch to emergency remote teaching (ERT). The aim of this study, based on semi-structured interviews with upper secondary-school pupils in Stockholm, was to explore how Swedish pupils perceive their ERT and to understand their preconditions for learning. We found variations among pupils with regard to how they perceived their new morning routine, the increased flexibility in structuring their day, the flexibility to choose their workplace at home, and the decreased control by their teachers. While some perceived the increased flexibility as challenging, others appraised it as a possibility to be more independent. With regard to their classmates, all participants perceived difficulties learning from each other in ERT. Identified difficulties involved comparing one's performance to that of classmates, having deep discussions, encouraging each other, and organizing themselves in a group. The results are discussed in relation to previous studies, and are interpreted through the lenses of the Designs for Learning Theory.

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.

Routines and Meaning in Life: Does Activity Content or Context Matter?

People feel that their lives are more meaningful while engaging in behaviors more closely aligned with their routines. Does the behavioral content of these routines and the contextual factors surrounding their enactment matter for this relationship? In two experience sampling studies (N = 93, 1,512 episodes; N = 97, 1,629 episodes), we test whether the relationship between routines and meaning in life (MIL) depends on the content of the activities. We found that the degree to which one's current activity is a routine positively related to momentary MIL beyond other meaningful features (e.g., relationships, goals, prosociality) of that activity. We conducted Study 2 in the context of mass routine disruptions of the COVID-19 pandemic. We found even stronger relationships between routine enactment and concurrent MIL in this context which held controlling for factors, including perceived chaos, mood, and anxiety. These findings suggest that routines uniquely relate to MIL, beyond the meaningfulness of their content and across contexts.

Longitudinal trajectories of depression and anxiety among adolescents during COVID-19 lockdown in China

BACKGROUND

This study examines the patterns and predictors of depression and anxiety trajectories among adolescents during COVID-19 lockdown in China.

METHODS

A total of 35,516 college students were followed from the pandemic outbreak period, initial remission period, and control period. Participants completed the Patient Heath Questionnaire, Generalized Anxiety Disorder Scale, Perceived Social Support Scale, the Simplified Coping Style Questionnaire, and APGAR-family scale. Distinct patterns of depression and anxiety trajectories were established through grouping participants based on time-varying changes of the cut-off score. Multivariate logistic regressions were used to examine predictors for trajectory membership.

RESULTS

Depression and anxiety prevalence during the COVID-19 outbreak were 21.3% and 11.5% respectively, and symptoms worsened as the lockdown time increased. Five depression/anxiety trajectories were observed: resistance, recovery, relapsing/remitting, delayed-dysfunction and chronic-dysfunction. Gender, academic year, residence location, history of mental health, and COVID-19 community exposure were significant predictors of distinct trajectories for depression or anxiety. Less social support or positive coping, more negative coping, and poorer family function were also risk predictors for not developing delayed or chronic dysfunction.

CONCLUSIONS

Although most adolescents remain euthymic or recover over time, some adolescents, especially those with the risk factors noted above, exhibit delayed or chronic symptoms. Thus, the need for individualized intervention with these adolescents is indicated.

A Study on the Effects of Chinese Massage on Physical and Mental Health in Participants Based Smart Healthcare

The purpose of this study is to understand the influence of the effect of the smart Chinese massage appliance on the participants' sports performance and physical and mental health after intermittent exercises. The study was performed by a mixed-study method. First, the experimental research method was used to design an experimental procedure and specifications such as data collection scope. Next, the quantitative research was carried out, using SPSS 26.0 statistical software to analyze data from the questionnaire. Then, the qualitative research was carried out by interviewing experts and respondents and obtaining their opinions. Finally, all the data were collated and analyzed using the multidimensional review method. Findings. Chinese massage significantly improved the physical fitness, exercise performance, body composition, and physical and mental health status of high-strength cyclic exercise participants. High-strength exercises can improve the physical and mental health of men. Medium-strength exercises could improve current conditions for women. Oxygen intake remained peaked for 8 sessions for men and increased after 30 sessions for women. Both groups required a 1-2-week adaptation period but had different exercise performance periods. After the experiment, head and back pain, as well as stress and negative emotions, was improved. The high intensity of the exercises relieved fear, headache or head stress, overeating, and other problems.

Exploring the impact of COVID-19 on the movement behaviors of children and youth: A scoping review of evidence after the first year

PURPOSE

The objective of this scoping review was to summarize systematically the available literature investigating the relationships between the coronavirus disease 2019 (COVID-19) pandemic and movement behaviors (physical activity, sedentary behavior, and sleep) of school-aged children (aged 5-11 years) and youth (aged 12-17 years) in the first year of the COVID-19 outbreak.

METHODS

Searches for published literature were conducted across 6 databases on 2 separate search dates (November 25, 2020, and January 27, 2021). Results were screened and extracted by 2 reviewers (DCP and KR) independently, using Covidence. Basic numeric analysis and content analysis were undertaken to present thematically the findings of included studies according to the associated impact on each movement behavior.

RESULTS

A total of 1486 records were extracted from database searches; of those, 150 met inclusion criteria and were included for analysis. Of 150 articles, 110 were empirical studies examining physical activity (n = 77), sedentary behavior/screen time (n = 58), and sleep (n = 55). Results consistently reported declines in physical-activity time, increases in screen time and total sedentary behavior, shifts to later bed and wake times, and increases in sleep duration. The reported impacts on movement behaviors were greater for youth than for children.

CONCLUSION

The COVID-19 pandemic is related to changes in the quantity and nature of physical activity, sedentary behavior, and sleep among children and youth. There is an urgent need for policy makers, practitioners, and researchers to develop solutions for attenuating adverse changes in physical activity and screen time among children and youth.

Coping with COVID-19: Longitudinal Impact of the Pandemic on Adjustment and Links with Coping for Adolescents with and without ADHD

Understanding factors that foster resilience and buffer against the negative psychological impact of COVID-19 is critical to inform efforts to promote adjustment, reduce risk, and improve care, particularly for adolescents with neurodevelopmental disorders. This prospective longitudinal study addresses this gap by investigating the impact of the COVID-19 pandemic on adolescents’ mental health and substance use, and by assessing specific positive coping strategies among adolescents with and without attention-deficit/hyperactivity disorder (ADHD). Using multi-group autoregressive cross-lagged path models, the present study explored the reciprocal influence of positive coping behaviors on multiple adjustment outcomes including mental health symptoms, substance use, stress, and worry. Participants included 238 adolescents (132 male participants; ages 15–17; 118 with ADHD). Parents provided ratings of adolescent routines, and adolescents provided ratings of coping behaviors and psychological adjustment in spring (May/June), summer (July/August), and fall (October/November) 2020. All models included the effects of adjustment at the prior timepoint as well as relevant covariates including adolescent race, ethnicity, sex, medication status, and family income. Adolescents with ADHD were at greater risk for experiencing increases in mental health symptoms and substance use throughout the pandemic, relative to adolescents without ADHD. The use of positive coping strategies and adolescent routines buffered against increases in substance use and mental health problems for adolescents with ADHD. These findings have important clinical and public policy relevance for parents, schools, and employers who may aim to prioritize keeping schedules as consistent as possible to promote healthy adjustment.

The Impact of the COVID-19 Pandemic and Societal Infection Control Measures on Children and Adolescents' Mental Health: A Scoping Review

Background: The COVID-19 pandemic is primarily a crisis that affects people's physical health. However, it is well-known from previous epidemics and pandemics that there are other indirect negative impacts on mental health, among others. The purpose of this scoping review was to explore and summarise primary empirical research evidence on how the COVID-19 pandemic and societal infection control measures have impacted children and adolescents' mental health. Methods: A literature search was conducted in five scientific databases: PubMed, APA PsycINFO, Web of Science, CINHAL, and Social Science Premium Collection. The search string was designed using the Population (0-18 years), Exposure (COVID-19), Outcomes (mental health) framework. Mental health was defined broadly, covering mental well-being to mental disorders and psychiatric conditions. Results: Fifty-nine studies were included in the scoping review. Of these, 44 were cross-sectional and 15 were longitudinal studies. Most studies reported negative impact of the COVID-19 pandemic on child and adolescent mental health outcomes, yet the evidence was mixed. This was also the case for studies investigating societal control measures. Strong resilience, positive emotion regulation, physical activity, parental self-efficacy, family functioning and emotional regulation, and social support were reported as protective factors. On the contrary, emotional reactivity and experiential avoidance, exposure to excessive information, COVID-19 school concerns, presence of COVID-19 cases in the community, parental mental health problems, and high internet, social media and video game use were all identified as potentially harmful factors. Conclusions: Due to the methodological heterogeneity of the studies and geographical variation, it is challenging to draw definitive conclusions about the real impact of the COVID-19 pandemic on the mental health of children and adolescents. However, the existing body of research gives some insight to how parents, clinicians and policy makers can take action to mitigate the effects of COVID-19 and control measures. Interventions to promote physical activity and reduce screen time among children and adolescents are recommended, as well as parenting support programs.

The impact of COVID-19 lockdown on child and adolescent mental health: systematic review

COVID-19 was declared a pandemic in March 2020, resulting in many countries worldwide calling for lockdowns. This study aimed to review the existing literature on the effects of the lockdown measures established as a response to the COVID-19 pandemic on the mental health of children and adolescents. Embase, Ovid, Global Health, PsycINFO, Web of Science, and pre-print databases were searched in this PRISMA-compliant systematic review (PROSPERO: CRD42021225604). We included individual studies reporting on a wide range of mental health outcomes, including risk and protective factors, conducted in children and adolescents (aged ≤ 19 years), exposed to COVID-19 lockdown. Data extraction and quality appraisal were conducted by independent researchers, and results were synthesised by core themes. 61 articles with 54,999 children and adolescents were included (mean age = 11.3 years, 49.7% female). Anxiety symptoms and depression symptoms were common in the included studies and ranged 1.8-49.5% and 2.2-63.8%, respectively. Irritability (range = 16.7-73.2%) and anger (range = 30.0-51.3%), were also frequently reported by children and adolescents. Special needs and the presence of mental disorders before the lockdown, alongside excessive media exposure, were significant risk factors for anxiety. Parent-child communication was protective for anxiety and depression. The COVID-19 lockdown has resulted in psychological distress and highlighted vulnerable groups such as those with previous or current mental health difficulties. Supporting the mental health needs of children and adolescents at risk is key. Clinical guidelines to alleviate the negative effects of COVID-19 lockdown and public health strategies to support this population need to be developed.

"My Life during the Lockdown": Emotional Experiences of European Adolescents during the COVID-19 Crisis

This study investigates, using an online self-report questionnaire, adolescents' emotional reactions during the lockdown in a sample of 2105 secondary school students (aged 14-19) in Italy, Romania, and Croatia. We used a self-reported online questionnaire (answers on a 5-point scale or binary), composed of 73 questions investigating the opinions, feelings, and emotions of teenagers, along with sociodemographic information and measures of the exposure to lockdown. The survey was conducted online through a web platform in Italy (between 27 April and 15 June 2020), Romania, and Croatia (3 June and 2 July 2020). Students aged >14 years, living in a small flat, and not spending time outside were more likely to report anger, sadness, boredom/emptiness, and anxiety. Boys were significantly less likely than girls to report all measured emotional reactions. Those who lost someone from COVID-19 were more than twice as likely to experience anger compared to those who did not. Our findings may help identifying adolescents more likely to report negative emotional reactions during the COVID-19 pandemic and inform public health strategies for improving mental health among adolescents during/after the COVID-19 crisis.

"Trying My Best": Sexual Minority Adolescents' Self-Care During the COVID-19 Pandemic

PURPOSE

The COVID-19 pandemic has resulted in major life disruptions for sexual minority adolescents (SMAs), who already face and cope with pervasive and disproportionate rates of social, behavioral, and mental health challenges. Current research suggests that SMAs are struggling with COVID-19-related shelter in place orders navigating family proximity and dynamics and experiencing isolation from SMA-specific supports. Given identified challenges that may exacerbate known mental health disparities in SMAs, this work explores self-care practices among SMAs during the COVID-19 pandemic.

METHODS

The present study uses data from open-ended questions to understand SMA experiences of self-care within a nationwide sample of SMAs (N = 770; M = 17.48 years, SD = 1.00) who are part of an ongoing prospective study. Data were collected via online questionnaire between May 13 and 31, 2020. Thematic analysis guided data exploration.

RESULTS

Thematic analysis revealed five self-care practices among SMAs: (1) relationships, (2) routines, (3) body and mind, (4) rest and reset, and (5) tuning out. SMAs engaged in many positive coping strategies (i.e., exercise, establishing routine) and often linked these activities to positive well-being. Other SMAs engaged in activities to distract or disengage from stressors (i.e., excessive TV and alcohol and drug use).

CONCLUSIONS

These findings highlight the resiliency of SMAs during the current pandemic, opportunities for providers to emphasize adaptive coping skills with youths, and the need for more research on adolescent self-care practices.

Knowledge, Attitudes, and Practices of Urban Residents Toward COVID-19 in Shaanxi During the Post-lockdown Period

Background: The coronavirus disease 2019 (COVID-19) pandemic in China is essentially under control. Under global scrutiny, China has started reviving the social, cultural, and working lives of its inhabitants. However, localized outbreaks of COVID-19 are occurring, indicating that the country still needs to follow disease prevention and control measures. Previous studies have assessed the knowledge, attitudes, and behaviors of the general public in China regarding COVID-19 during the pandemic. However, little is known about knowledge, attitudes, and practices (KAP) of Chinese residents regarding COVID-19 after periods of lockdown. Therefore, this study was conducted to identify the KAP and other factors among the residents of Shaanxi Province during the post-lockdown period. Methods: A cross-sectional, network questionnaire survey was conducted in Shaanxi Province from October 1-30, 2020. A total of 1,175 urban residents were interviewed via Wen Juan Xing, an online questionnaire tool. A self-developed online KAP COVID-19 questionnaire was developed in this study. The questionnaire consisted of four parts: general information, knowledge, attitude, and practice. Descriptive statistics and binomial logistic regression analysis were used in the statistical analysis. Results: The majority of the participants were knowledgeable about COVID-19. They had optimistic attitudes and behaved appropriately toward COVID-19. Education was an associated factor for the knowledge of residents and the knowledge of COVID-19 was high among people with high academic qualifications. Attitudes were more positive in residents who lived with elderly people, women, and children. The score of practice was higher in residents with positive attitudes and high academic qualifications. There was a positive correlation between age and practice. Conclusion: We found that the KAP of residents in Shaanxi was at a relatively high level during the post-lockdown period. Although the lockdown was lifted, the epidemic is not over. Thus, it is necessary to develop targeted health education programs for residents with different demographic characteristics in Shaanxi.

Effects of Sports Massage on the Physiological and Mental Health of College Students Participating in a 7-Week Intermittent Exercises Program

The purpose of the research is to analyze the improvement in the physical and mental health of college students after intermittent exercises are performed by massage. The present study employed a mixed research method. An experimental study was conducted to analyze the current status of the volunteers’ sports performance and body composition, and then a questionnaire was designed for the subjects’ physical and mental health. The data were then analyzed using SPSS 26.0 software for statistical analysis such as t-test and ANOVA. The subjects were then interviewed to collect their opinions on the study results, and finally, the results were explored by multivariate analysis. The study found that intermittent exercise can help university students develop physical fitness and performance, improve body composition, and regulate physical and mental health. The combination of intermittent exercise with sports massages further enhanced the performance of sit-ups and standing long jump, improve blood pressure, BMI, and self-confidence, as well as reducing suicidal tendencies (experimental group > control group). However, intermittent exercise participants still experienced fatigue, headache, emotional loss, and fear of depression, and the addition of sports massage did not significantly improve flexibility and cardiorespiratory endurance (control group > experimental group).

The Impact of Positive Youth Development Attributes on Posttraumatic Stress Disorder Symptoms Among Chinese Adolescents Under COVID-19

PURPOSE

This study examined the prevalence of posttraumatic stress disorder (PTSD) symptoms among adolescents in mainland China under COVID-19. The direct effects of the perceived threat of COVID-19 and positive youth development (PYD) qualities, as well as the moderating effect of PYD qualities on PTSD symptoms, were studied.

METHODS

Five schools in Chengdu, Sichuan, China, participated in this study. Two waves of data were collected before school lockdown (Wave 1, between December 2019 and January 2020) and after school resumption (Wave 2, between June 2020 and July 2020), respectively. A total of 4,981 adolescents aged above 11 years (Mean age = 13.15, SD = 1.32 at Wave 1, 51.5% girls) completed questionnaires at both waves. Students responded to measures of PYD qualities at both waves and perceived threat and PTSD symptoms at Wave 2.

RESULTS

A total of 517 adolescents (10.4%) could be regarded as having PTSD. Results indicated significant unique main effects of perceived threat (β = .13, p < .001) and Wave 1 PYD qualities (β = -.16, p < .001) on PTSD symptoms. Besides, results showed a significant moderating effect of PYD qualities in mitigating the negative impact of perceived threat on PTSD symptoms.

CONCLUSIONS

This study revealed the protective effect of PYD attributes in reducing the negative influence of traumatic situations such as COVID-19 on adolescent mental health. Results underscore the importance of promoting PYD qualities in adolescents in mainland China via effective PYD programs.

Adolescent Vision Health During the Outbreak of COVID-19: Association Between Digital Screen Use and Myopia Progression

The coronavirus (COVID-19) pandemic has impacted education systems globally, making digital devices common arrangements for adolescent learning. However, vision consequences of such behavioral changes are not well-understood. This study investigates the association between duration of daily digital screen engagement and myopic progression among 3,831 Chinese adolescents during the COVID-19 pandemic. Study subjects report an average of 2.70 (SD = 1.77), 3.88 (SD = 2.23), 3.58 (SD = 2.30), and 3.42 (SD = 2.49) hours of television, computer, and smartphone for digital learning use at home, respectively. Researchers analyzed the association between digital screen use and myopic symptoms using statistical tools, and find that every 1 h increase in daily digital screen use is associated with 1.26 OR [Odds Ratio] (95% CI [Confidence Interval: 1.21-1.31, p < 0.001]) higher risks of myopic progression. Using computers (OR = 1.813, 95% CI = 1.05-3.12, p = 0.032) and using smartphones (OR = 2.02, 95% CI = 1.19-3.43, p = 0.009) are shown to be associated with higher risks of myopic progression than television use. Results from additional sensitivity tests that included inverse probability weights which accounted for heterogeneous user profile across different device type categories confirm that these findings are robust. In conclusion, this study finds that daily digital screen use is positively associated with prevalence of myopic progression and holds serious vision health implications for adolescents.