What we have learnt about trauma, loss and grief for children in response to COVID-19

Mental health, sleep, and respiratory health after initiating elexacaftor/tezacaftor/ivacaftor treatment in children with cystic fibrosis

INTRODUCTION

Cystic fibrosis transmembrane conductance regulator (CFTR) modulator elexacaftor/tezacaftor/ivacaftor (ETI) significantly improves lung function but its effect on mental health and sleep remains poorly understood. We report on mental health, sleep, and respiratory health outcomes of adolescents with CF commenced on ETI therapy, and monitored the prevalence of neuropsychiatric issues through the coronavirus disease 2019 pandemic.

METHODS

We conducted a prospective longitudinal study of 31 adolescents (aged 10-18 years) from July 2021 to October 2022. Data collected include demographics, Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), Pediatric Daytime Sleepiness Scale (PDSS), Sleep Disturbance Scale for Children (SDSC) scores, and FEV1 percent predicted. Twenty of 31 adolescents had data before and after ETI initiation. Mean differences (MD) in mental health, sleep, and respiratory health pre- and post-ETI therapy commencement were estimated using paired t-tests. The prevalence and trajectories of anxiety, depression, and sleep disturbance were described between the ETI epochs, and over the pandemic period.

RESULTS

FEV1 improved following ETI therapy commencement (MD, 95% confidence interval [CI]: 7.1% (4.7%-9.6%) whereas PHQ-9, GAD-7, PDSS, and SDSC scores did not change significantly. Ten percent of participants developed new-onset anxiety/depression concerns and 10% developed new sleep concerns following ETI initiation.

CONCLUSION

This is the first prospective longitudinal study of mental health and sleep changes after ETI commencement in adolescents with CF. Although respiratory outcomes improved, ETI did not improve anxiety, depression or sleep.

Scoping review: longitudinal effects of the COVID-19 pandemic on child and adolescent mental health

The COVID-19 pandemic and associated containment measures have massively changed the daily lives of billions of children and adolescents worldwide. To investigate the global longitudinal effects on various mental health outcomes over a period of 1.5 years, we conducted a scoping review in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We included the peer-reviewed articles from PubMed, Web of Science, and APA PsycInfo that were published between December 2019 and December 2021, followed a longitudinal or repeated cross-sectional design, and quantitatively assessed with clinical questionnaires the effect of the COVID-19 pandemic or a related stressor on mental health indicators in community samples of children and adolescents.The results of our qualitative analysis of 69 studies indicate a general trend of less psychological well-being and more mental health problems, such as heightened stress, and depressive and anxiety symptoms during the pandemic. Data suggest that both protection measure intensity and infection dynamics were positively associated with severity of the psychopathology. The most reported influencing factors were age, gender, socio-economic status, previous state of mental and physical health, self-regulation abilities, parental mental health, parenting quality, family functioning, social support, isolation and loneliness, health-related worries, and consistent routines and structure. Our results demonstrate that children and adolescents worldwide have experienced more mental health problems due to the COVID-19 pandemic. They call for improved access to child and adolescent mental health care and prioritisation of child and adolescent welfare in political decision making.

Transforming Empathy-Based Stress to Compassion: Skillful Means to Preventing Teacher Burnout

Objectives

Teachers play a critical role in preparing our children and adolescents for a successful future. However, despite the large number of students impacted by trauma and adversity, teachers are often not well prepared to provide trauma-sensitive support. Furthermore, while working to support students exposed to trauma and adversity, teachers may experience empathy-based stress exacerbating already high levels of stress among them. This narrative review explores the issue of empathy-based stress within the context of the prosocial classroom model which proposes that teachers' social and emotional competence and well-being are key to their ability to create and maintain supportive learning environments critical to student academic and behavioral outcomes.

Methods

Recent findings in neuroscience and education research are applied to support teachers' development of these competencies.

Results

We propose that shifting from empathy-based stress to compassionate responding may be one such competency to help teachers' respond effectively to their students' needs while protecting their own wellbeing.

Conclusion

We review research that supports this proposition and explore implications for teacher professional learning, educational policy, and further research.

Addressing Social Context in Adverse Childhood Experience Screening Policy: Implications for Children With Special Health Care Needs

Adverse childhood experiences (ACEs) disproportionately affect children with special health care needs, especially racial and ethnic minority children whose ACEs may be less likely to be identified. As awareness and understanding of the health impacts of ACEs have increased, heightened by the COVID-19 pandemic, several areas of the United States have initiated policy efforts to screen for and address ACEs. However, these policies do not always include mechanisms to account for context-specific adversity or contemporary stressors in the lives of children. Stressors most significant in a child's life may include adversities beyond those included in common ACE screening instruments. ACE policy in California will be discussed relative to addressing the social context in ACEs screening. By taking a holistic view of ACEs and thinking beyond deriving ACE scores alone, clinicians can ensure that ACE-related policies are implemented with maximum benefit to diverse children with special health care needs.

Schooling upheaval during COVID-19: troubling consequences for students' return to school

Efforts to contain the COVID-19 virus resulted in various stay-at-home orders and school closures around the globe, causing unprecedented disruption to the lives of children and generating grave concern for their well-being. This study draws on phone interviews with 12 teachers and 6 school leaders from 13 government schools in New South Wales, Australia, to provide insight into how students fared on their return to school after the first wave of COVID-19 in 2020. The interviews highlighted negative consequences for many students including increased stress and anxiety and decreased engagement. This evidence suggests that even a comparatively short period of school closure can drive troubling changes in students' well-being and behaviour following their return to school. Given far more challenging conditions arising from the pandemic, both elsewhere in Australia and globally, we argue that attending to student well-being is as important as ensuring academic achievement and must be a key focus of policy makers and education systems moving forward.

Postvention as Prevention: Coping with Loss at School

Many Pre-K through grade 12 (PK-12) students have experienced traumatic events throughout the pandemic in a myriad of ways including the death of family members and peers, loss of social interaction and increased violence at home. The consequences can be traumatic and manifest themselves in fear, anxiety, anger, isolation, and loneliness. Too often this leads to depression, anxiety, grief, substance use disorders, post-traumatic stress disorder, suicidal ideation and even suicides. This study assesses the impact of an innovative virtual human role-play simulation that prepares PK-12 educators, administrators, and school staff to respond to a student death in the school community by creating communities of support to help manage traumatic loss. The simulation addresses crisis response planning, postvention plans, and provides learners with role-play practice in using evidence-based motivational interviewing communication strategies in conversations with students and colleagues after the occurrence of a death. The sample consisted of educators and staff who were recruited from geographically dispersed areas across the US between January 2021 through December 2021. Matched sample t-tests and ANOVAs were used to assess quantitative data, and a qualitative analysis software, MAXQDA, was used to assess open-ended response data. Results show statistically significant increases in school personnel's preparedness and self-efficacy to recognize signs of trauma in their students and colleagues, and to approach them to talk about concerns and, if necessary, make a referral to support services. Simulations such as this hold tremendous potential in teaching educators how address trauma due to a student death.