The impact of gender differences, school adjustment, social interactions, and social activities on emotional and behavioral reactions to the COVID-19 pandemic among Japanese school children

Post-Pandemic Evolution of Suicide Risk in Children and Adolescents Attending a General Hospital Accident and Emergency Department

BACKGROUND

Lockdowns and other health protective measures, such as social distancing, imposed during the COVID-19 pandemic nurtured unprecedented levels of stress and social isolation around the world. This scenario triggered an increase in suicide thoughts and self-harm behaviours among children and young people. However, the longer-term impact of the pandemic on children's and adolescents' mental health, especially with regard to self-harm, is still to be fully discovered.

METHODS

We carried out a retrospective study where we collected data related to suicide ideation and self-harm behaviours in all patients aged under 18 that required on-call psychiatric services at the General Hospital Accident and Emergency (A&E) department in Salamanca, Spain, during 2019 (pre-pandemic) and in both 2021 and 2022 to capture possible variation at different time points during the post-pandemic period.

RESULTS

A total of 316 patients aged under 18 were seen by on-call psychiatric services at the A&E department during the three time periods: 78 in 2019, 98 in 2021 and 140 in 2022. The mean age was 15.12 (SD 2.25) and females represented more than twice the number of males each year. More than half of all patients assessed during 2022 disclosed suicide thoughts, whilst in 2019, it was near 25%. This increase in suicide ideation rates was more marked among females (X2 = 15.127; p = 0.001), those aged over 15 (X2 = 16.437; p < 0.001) and/or those with a previous history of mental health problems (X2 = 17.823; p < 0.001). We identified an increase in the proportion of males with suicide ideas, especially between 2021 and 2022 (X2 = 8.396; p = 0.015).

CONCLUSIONS

Our study suggests that children's and adolescents' demand for urgent mental healthcare and their clinical presentations in A&E departments with suicide thoughts and/or self-injuries do not seem to be declining after the pandemic but increasing over time. More research is warranted to understand possible factors involved in this sustained upward trend.

Preschool Emotional Problems in the Post-Pandemic Era between Parental Risk and Protective Factors

The psychosocial adaptation of children born or experiencing their early years during the COVID-19 pandemic remains uncertain. In order to implement prevention strategies, it is, therefore, a priority to deeply analyze children's mental health in this post-pandemic phase and to identify family risk and protective factors. Indeed, recent studies reveal that children's emotional distress increased with the COVID-19 pandemic, especially in situations of high parental stress. The study investigates associations between some parental characteristics (coping strategies, parental burnout, resilience, perception of social support, and promotion of children's social-emotional competence) and children's emotional symptoms, considering gender differences. A total of 358 parents of children aged 2 to 6 years participated in this study. Regression analyses show that parental burnout is a predictor of emotional symptoms; moreover, for females, higher levels of emotional symptoms are associated with parental maladaptive coping strategies, whereas for males, the parent's ability to promote children's emotional competence is a protective factor. Results emphasize the importance of supporting parental well-being as a critical factor in shielding children from the repercussions of adverse situations.

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.

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

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

Safety, tolerability and immunogenicity of Biological E's CORBEVAX™ vaccine in children and adolescents: A prospective, randomised, double-blind, placebo controlled, phase-2/3 study

BACKGROUND

After establishing safety and immunogenicity of Biological-E's CORBEVAX™ vaccine in adult population (18-80 years) in Phase 1-3 studies, vaccine is further tested in children and adolescents in this study.

METHODS

This is a phase-2/3 prospective, randomised, double-blind, placebo-controlled study evaluating safety, reactogenicity, tolerability and immunogenicity of CORBEVAX™ vaccine in children and adolescents of either gender between <18 to ≥12 years of age in Phase-2 and <18 to ≥5 years of age in Phase-Phase-2/Phase-3 with placebo as a control. This study has two age sub-groups; subgroup-1 with subjects <18 to ≥12 years of age and subgroup-2 with subjects <12 to ≥5 years of age. In both sub groups, eligible subjects (SARS-CoV-2 RT-PCR negative and seronegative at baseline) were randomized to receive either CORBEVAX™ vaccine or Placebo in 3:1 ratio.

FINDINGS

The safety profile of CORBEVAX™ vaccine in both pediatric cohorts was comparable to the placebo-control group. Majority of reported adverse events (AEs) were mild in nature. No severe or serious-AEs, medically attended AEs (MAAEs) or AEs of special interest (AESI) were reported during the study period and all reported AEs resolved without any sequelae. In both pediatric age groups, CORBEVAX™ vaccinated subjects showed significant improvement in humoral immune-responses in terms of anti-RBD-IgG concentrations, anti-RBD-IgG1 titers, neutralizing-antibody (nAb)-titers against Ancestral-Wuhan and Delta-strains. Significantly high interferon-gamma immune- response (cellular) was elicited by CORBEVAX™ vaccinated subjects with minimal effect on IL-4 cytokine secretion.

INTERPRETATIONS

The safety profile of CORBEVAX™ vaccine in <18 to ≥5 years' children and adolescents was found to be safe and tolerable. Significant increase in anti-RBD-IgG and nAb-titers and IFN-gamma immune-responses were observed post-vaccination in both pediatric age sub-groups. The nAb titers observed in both the pediatric age cohorts were non-inferior to the adult cohort (BECT069 study) in terms of ratio of the GMT's of both the cohorts. This study shows that CORBEVAX™ vaccine is highly immunogenic and can be safely administered to pediatric population as young as 5 years old. The study was prospectively registered with clinical trial registry of India- CTRI/2021/10/037066.