Editorial Perspective: Perils and promise for child and adolescent sleep and associated psychopathology during the COVID-19 pandemic

The Relationship Between Epidemic Perception and Cyberbullying Behaviors of Chinese Adolescents During the COVID-19 Pandemic: Cross-Sectional Study

Background

In response to the COVID-19 outbreak, the government initiated measures for social distancing, leading to a gradual transition of adolescents' social interactions toward web-based platforms. Consequently, web-based behaviors, particularly cyberbullying, have become a prominent concern. Considering that adolescents experience more intense feelings, the widely increased negative emotions and strains perceived from the COVID-19 pandemic may end up engaging in cyberbullying behaviors. In addition, during the COVID-19 pandemic, adolescents experiencing insomnia and negative affect are more prone to diminished self-control, which is associated with cyberbullying behaviors.

Objective

This study aims to investigate the relationship between epidemic perception and cyberbullying behaviors, while also examining the serial mediating roles of insomnia and negative affect on the relationship between epidemic perception and cyberbullying behaviors.

Methods

This study presents a large-scale web-based survey conducted during the period of concentrated COVID-19 outbreaks, encompassing 20,000 Chinese adolescents. A total of 274 submitted questionnaires were discarded because of high levels of missing data or their answers were clearly fictitious or inconsistent. The final count of valid participants amounted to 19,726 (10,371 boys, age range: 12-18 years; mean 14.80, SD 1.63 years). The Perceptions of COVID-19 Scale, Negative Affect Scale, Insomnia Scale, and Cyberbullying Behavior Scale were used to assess participants' responses on the Questionnaire Star platform.

Results

The results show that epidemic perception is positively correlated with cyberbullying behaviors (r=0.13; P<.001), insomnia (r=0.19; P<.001), and negative affect (r=0.25; P<.001). Insomnia is positively correlated with negative affect (r=0.44; P<.001) and cyberbullying behaviors (r=0.30; P<.001). Negative affect is positively correlated with cyberbullying behaviors (r=0.25; P<.001). And insomnia and negative affect play independent mediating and serial mediating roles in epidemic perception and cyberbullying behaviors.

Conclusions

This study provides additional empirical evidence on the relationship between the perception of COVID-19 pandemic and cyberbullying in adolescents. In addition, the study offers recommendations for implementing interventions targeted at mitigating cyberbullying in adolescents during the COVID-19 pandemic.

Chronotype Differences and Symptom Network Dynamics of Post-Pandemic Sleep in Adolescents and Young Adults

Background: Social restrictions during the COVID-19 pandemic resulted in altered sleep patterns and mental health challenges, particularly among adolescents and young adults. Our objective was to examine the potential difference in insomnia prevalence and sleep patterns in this population between the first COVID-19 lockdown and the post-lockdown period, with a focus on chronotype. Additionally, we explored the network of sleep-related differences between these two periods. Methods: A total of 946 respondents participated in our online questionnaire. We performed mixed ANOVA, Ising network and Directed Acyclic Graph (DAG) analyses. Results: Respondents reported going to bed earlier, waking up earlier, sleeping less, and feeling less mentally tired than during the lockdown. The severity of insomnia symptoms did not change. The lethargic chronotype reported more insomnia symptoms, depressive feelings, and agitation than others. Mental fatigue was the central symptom in the Ising network and served as the parent node in the DAG. Conclusions: Post-lockdown, adolescents and young adults have shifted to earlier sleep and wake times with reduced overall sleep, and they experience fewer depressive feelings and less agitation, though insomnia symptoms remain unchanged. Participants who reported increased irritability or poorer sleep quality during confinement also reported similar or diminished attentional capacities compared to their usual levels.

The Double-Edged Sword of Online Learning for Ethnoracial Differences in Adolescent Mental Health During Late Period of the COVID-19 Pandemic in the United States: National Survey

BACKGROUND

Despite several theories suggesting online learning during the COVID-19 pandemic would aggravate ethnoracial disparities in mental health among adolescents, extant findings suggest no ethnoracial differences in mental health or that those from minoritized ethnoracial groups reported better mental health than their White counterparts.

OBJECTIVE

This study aimed to identify why findings from prior studies appear to not support that ethnoracial disparities in mental health were aggravated by testing 2 pathways. In pathway 1 pathway, online learning was associated with reporting fewer confidants, which in turn was associated with poorer mental health. In pathway 2, online learning was associated with reporting better sleep, which in turn was associated with better mental health.

METHODS

We analyzed survey data from a US sample (N=540) of 13- to 17-year-olds to estimate how school modality was associated with mental health via the 2 pathways. The sample was recruited from the AmeriSpeak Teen Panel during spring of 2021, with an oversample of Black and Latino respondents. Ethnoracial categories were Black, Latino, White, and other. Mental health was measured with the 4-item Patient Health Questionnaire, which assesses self-reported frequency of experiencing symptoms consistent with anxiety and depression. School modality was recorded as either fully online or with some in-person component (fully in-person or hybrid). We recorded self-reports of the number of confidants and quality of sleep. Covariates included additional demographics and access to high-speed internet. We estimated bivariate associations between ethnoracial group membership and both school modality and mental health. To test the pathways, we estimated a path model.

RESULTS

Black and Latino respondents were more likely to report being in fully online learning than their White counterparts (P<.001). Respondents in fully online learning reported fewer confidants than those with any in-person learning component (β=-.403; P=.001), and reporting fewer confidants was associated with an increased likelihood of reporting symptoms consistent with anxiety (β=-.121; P=.01) and depression (β=-.197; P<.001). Fully online learning respondents also reported fewer concerns of insufficient sleep than their in-person learning counterparts (β=-.162; P=.006), and reporting fewer concerns was associated with a decreased likelihood of reporting symptoms consistent with anxiety (β=.601; P<.001) and depression (β=.588; P<.001). Because of these countervailing pathways, the total effect of membership in a minoritized ethnoracial group on mental health was nonsignificant.

CONCLUSIONS

The findings compel more nuanced discussions about the consequences of online learning and theorizing about the pandemic's impact on minoritized ethnoracial groups. While online learning may be a detriment to social connections, it appears to benefit sleep. Interventions should foster social connections in online learning and improve sleep, such as implementing policies to enable later start times for classes. Future research should incorporate administrative data about school modality, rather than relying on self-reports.

Early life adversity and adolescent sleep problems during the COVID-19 pandemic

The COVID-19 pandemic resulted in a reorganization of adolescents' routines, especially their sleep schedules. Utilising 175 caregiver-adolescent dyads, the current study examined associations of biological (e.g., prenatal substance use), environmental (e.g., poverty), and relational (e.g., child maltreatment) subtypes of early life adversity (ELA) with various components of adolescents' sleep across the first year of the COVID-19 pandemic. Relational ELA explained unique variance in adolescents' sleep disturbances, but not other sleep components, following short- and longer-term exposure to the COVID-19 pandemic. However, the direction of this association switched such that relational ELA predicted decreased sleep disturbances during the initial phase of the U.S. COVID-19 pandemic in spring 2020 beyond pre-pandemic levels, but, over time, contributed to increased sleep disturbances beyond early-pandemic levels as the pandemic extended into the winter of 2020.

Course of child social-emotional and sleep symptoms, parental distress and pandemic-related stressors during COVID-19

Research on the longitudinal courses of child social-emotional symptoms and sleep during the COVID-19 pandemic within societies would be of key value for promoting child well-being in global crises. We characterized the course of children's social-emotional and sleep symptoms before and throughout the pandemic in a Finnish longitudinal cohort of 1825 5- to 9-year-old children (46% girls) with four follow-up points during the pandemic from up to 695 participants (spring 2020-summer 2021). Second, we examined the role of parental distress and COVID-related stressful events in child symptoms. Child total and behavioral symptoms increased in spring 2020 but decreased thereafter and remained stable throughout the rest of the follow-up. Sleep symptoms decreased in spring 2020 and remained stable thereafter. Parental distress was linked with higher child social-emotional and sleep symptoms. The cross-sectional associations between COVID-related stressors and child symptoms were partially mediated by parental distress. The findings propose that children can be protected from the long-term adverse influences of the pandemic, and parental well-being likely plays a mediating role between pandemic-related stressors and child well-being. Further research focusing on the societal and resilience factors underlying family and child responses to the pandemic is warranted.

Perceived Epidemic Impacts and Mental Symptom Trajectories in Adolescents Back to School After COVID-19 Restriction: A Longitudinal Latent Class Analysis

PURPOSE

This study aimed to assess the impacts of COVID-19 epidemic on various life aspects and identify the trajectories of common mental symptoms among adolescents back to school after COVID-19 restriction. Furthermore, potential predictors associated with those trajectories were investigated.

METHODS

This longitudinal study, with five data collection points and a total follow-up of 68.4 days, was conducted among 1,393 junior high school students (mean age: 13.8 years; male, 53.3%) shortly after school reopened during the first COVID-19 outbreak in China. Questions on sociodemographics and perceived COVID-19 epidemic impacts were completed at the baseline while the Patient Health Questionnaire, Generalized Anxiety Disorder Scale, and Insomnia Severity Index were measured throughout the study for depression, anxiety, and insomnia symptoms, respectively. Trajectories of mental symptoms were classified by longitudinal latent class analysis, and the associated predictive factors were identified with multinomial regression modelling.

RESULTS

Our study revealed high but steadily declining prevalence of depression, anxiety, and insomnia symptoms (p trend < .001). Five distinctive trajectories were identified for both depression and anxiety ("resistance," "low symptom," "recovery," "chronic dysfunction," and "delayed dysfunction") and three for insomnia ("resistance," "low symptom," and "chronic dysfunction"). Besides the significant association between the mental symptom trajectories and students' perceived COVID-19 impacts on study practice, family income, and family relationship, female gender, lower school grade, and higher body mass index were found to be predictive of high severity trajectories.

DISCUSSION

Our findings may help locate the most psychologically vulnerable adolescents during the epidemic and foster better implementation of targeted intervention.

Bedtime procrastination related to loneliness among Chinese university students during post-pandemic period: a moderated chain mediation model

BACKGROUND

This study examined the relationship between loneliness and bedtime procrastination among Chinese university students, the mediating effects of COVID-19 risk perception and self-regulatory fatigue, and connectedness to nature's protective role, post pandemic.

METHODS

We recruited 855 students to complete the Loneliness, Perceived Risk of COVID-19 Pandemic, Self-Regulatory Fatigue, Bedtime Procrastination, and Connectedness to Nature Scales. Data for descriptive statistics, correlation analysis, and moderated chain mediation effects were analyzed using SPSS 24.0 and process 3.5 macros.

RESULTS

Loneliness positively correlated with bedtime procrastination, COVID-19 risk perception mediated the impact of loneliness on bedtime procrastination, self-regulatory fatigue mediated the effect of loneliness on bedtime procrastination, and COVID-19 risk perception and self-regulatory fatigue mediated the effect between loneliness and bedtime procrastination. Furthermore, connectedness to nature mediated the impact of COVID-19 risk perception on self-regulatory fatigue.

CONCLUSIONS

The results indicate the effects and potential mechanisms of loneliness on bedtime procrastination after the relaxation of the pandemic prevention and control policy in China from the perspective of self-regulatory resources and provide insights into improving university students' sleep routine and mental health post pandemic.

Sleep Problems Before and During the COVID-19 Pandemic in Children with Autism Spectrum Disorder, Down Syndrome, and Typical Development

Sleep problems are common in children and adolescents, particularly those with Neurodevelopmental Disorders. With the changes in daily habits resulting from the COVID-19 pandemic, we have analyzed sleep characteristics, during social isolation, in Brazilian children and adolescents aged between 4 and 12 years with Autism Spectrum Disorder (N = 267), Down Syndrome (N = 74), and typical development (N = 312). The ASD group presented with worse indicators of sleep habits in the Children's Sleep Habits Questionnaire (CSHQ-BR) and fell asleep later during the pandemic. The entire group started fall asleep and waking up later during the pandemic - as well as waking up more often during the night. These results may contribute to parental guidance and sleep habit-related interventions during and after the COVID-19 pandemic.

Childhood sleep: physical, cognitive, and behavioral consequences and implications

BACKGROUND

Sleep problems in children have been increasingly recognized as a major public health issue. Previous research has extensively studied and presented many risk factors and potential mechanisms for children's sleep problems. In this paper, we aimed to identify and summarize the consequences and implications of child sleep problems.

DATA SOURCES

A comprehensive search for relevant English language full-text, peer-reviewed publications was performed focusing on pediatric sleep studies from prenatal to childhood and adolescence in a variety of indexes in PubMed, SCOPUS, and Psych Info published in the past two decades. Both relevant data-based articles and systematic reviews are included.

RESULTS

Many adverse consequences are associated with child sleep deficiency and other sleep problems, including physical outcomes (e.g., obesity), neurocognitive outcomes (e.g., memory and attention, intelligence, academic performance), and emotional and behavioral outcomes (e.g., internalizing/externalizing behaviors, behavioral disorders). Current prevention and intervention approaches to address childhood sleep problems include nutrition, exercise, cognitive-behavioral therapy for insomnia, aromatherapy, acupressure, and mindfulness. These interventions may be particularly important in the context of coronavirus disease 2019. Specific research and policy strategies can target the risk factors of child sleep as well as the efficacy and accessibility of treatments.

CONCLUSIONS

Given the increasing prevalence of child sleep problems, which have been shown to affect children's physical and neurobehavioral wellbeing, understanding the multi-aspect consequences and intervention programs for childhood sleep is important to inform future research direction as well as a public health practice for sleep screening and intervention, thus improving sleep-related child development and health.

[Attention deficit hyperactivity disorder in children and adolescents: lessons from the COVID-19 pandemic]

To limit the spread of the coronavirus infection COVID-19, which has received the status of a pandemic, a lockdown was temporarily introduced. In conditions of isolation, children and adolescents suffering from attention deficit hyperactivity disorder (ADHD) were faced with forced changes in their daily routine in the form of a transition to distance learning, a decrease in physical activity, an increase in time in front of TV screens/computer monitors/tablets, etc. The review provides current evidence on the associations between social restrictions caused by the COVID-19 pandemic and behavioral problems in children and adolescents with ADHD. The main factors that can influence the severity of the disease in children and adolescents are analyzed. Particular attention is paid to the role of parental behavior and its influence on the manifestations of ADHD in children in isolation. The results of numerous observations and online surveys of relatives and children suffering from ADHD have demonstrated a multidirectional trajectory of the disease depending on numerous factors, including relationships with parents and immediate family. Despite the end of the COVID-19 pandemic, the effects of isolation during critical periods of childhood have the potential to increase the burden of mental illness. Treatment of children and adolescents with ADHD during the COVID-19 pandemic should be pathogenetic, taking into account the main symptoms of the disease. When choosing pharmacotherapy, priority should be given to drugs with verified effectiveness and a reliable safety profile.

Sleep and Sleep Hygiene of Adolescents With and Without ADHD During COVID-19

OBJECTIVE

This study examined the effect of COVID-19 restrictions on the sleep and sleep hygiene of adolescents with ADHD and comorbid sleep problems and neurotypical adolescents (NT).

METHOD

Four groups (two ADHD and two NT) of in total 100 adolescents (50 ADHD and 50 NT) were included. One ADHD and NT group were tested during many COVID-19 restrictions, the other during few. MANCOVAs were implemented with ADHD diagnosis and level of COVID-19 restrictions as independent and sleep outcomes (subjective and objective total sleep time (TST) and sleep onset latency (SOL), sleep and sleep hygiene problems) as dependent variables.

RESULTS

Both groups had a shorter objective TST during the week during many COVID-19 restrictions. Furthermore, adolescents with ADHD had a shorter subjective SOL during the weekend when there were many COVID-19 restrictions, while the SOL of the NT group stayed the same.

CONCLUSION

COVID-19 restrictions are related to the sleep of adolescents with and without ADHD. However, causality and underlying mechanisms need further investigation.

Prevalence and influencing factors of sleep disturbance among medical students under the COVID-19 pandemic

BACKGROUND

Medical students may feel severe psychological stress during COVID-19, which might impair their ability to sleep. This research aimed to look at the risk factors for sleep disturbance and the prevalence of sleep disturbance among medical students.

METHODS

538 medical students in total were recruited for this research. Anxiety, depression, and sleep disturbance were assessed using the Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and Pittsburgh Sleep Quality Index (PSQI). To evaluate the possible risk variables, we computed descriptive statistics for each assessment item and ran univariate and logistic regression analyses.

RESULTS

Medical students had a 63.6% prevalence of sleep disturbance (n = 342). According to logistic regression, introverted students are 1.77 times more likely than extroverted students to have sleep disturbance (OR = 1.77, 95% CI 1.08-2.91). Medical students with depression had a 5.6-times higher risk of sleep disturbance than those without depression (OR = 5.60, 95% CI 3.43-9.15). Additionally, medical students with anxiety were 3.95 times more likely than those without anxiety to have sleep disturbance (OR = 3.95, 95% CI 2.04-7.64).

CONCLUSIONS

According to this research, the COVID-19 pandemic caused significant sleep disturbance among medical students. Additionally, among medical students, introversion, anxiety, and depression were risk factors for sleep disturbance.

Sleep and Inflammation during COVID-19 Virtual Learning in Adolescents with Overweight or Obesity

(1) Background: Adolescents present as a high-risk group for a range of adverse physical health outcomes during the pandemic, including sleep and C-reactive protein (CRP) levels. As adolescents with overweight or obesity (OWOB) present as an even higher risk group, the present study assessed relationships between sleep and CRP levels before and during COVID-19 in adolescents with OWOB. (2) Methods: Fourteen adolescents with OWOB participated in a pre-COVID1, pre-COVID2, and during-COVID-19 lab visit, measuring sleep and CRP levels. The sample size was limited by the number of participants who provided data before COVID-19 and who were enrolled in virtual school during the recruitment phase. However, our power analyses indicated needing a minimum of 10 participants to achieve adequate power. Pre-COVID1, pre-COVID2, and during-COVID-19 normative expected CRP levels were calculated based on age, sex, race, and body mass index percentile-matched data. Analyses compared pre-COVID1 and pre-COVID2 sleep with during-COVID-19 sleep, during-COVID-19 sleep and during-COVID-19 CRP levels, during-COVID-19 CRP levels with normative expected during-COVID-19 CRP levels, change in CRP levels from pre-COVID1 and pre-COVID2 to during-COVID-19 with normative expected CRP levels during those time periods, and change in CRP levels before COVID-19 with change in CRP levels during COVID-19. (3) Results. During COVID-19, participants experienced decreased sleep efficiency (p = 0.001), later wake time (p < 0.001), longer time in bed (p = 0.021), and onset latency (p = 0.004), compared to pre-COVID1, and decreased sleep efficiency (p = 0.002), longer onset latency (p = 0.006), and later wake time (p < 0.001) and bedtime (p = 0.016) compared with pre-COVID2. During-COVID-19 CRP levels were positively correlated with during-COVID-19 wake times (p = 0.01) and times in bed (p = 0.008). During-COVID-19 CRP levels were greater than normative expected CRP levels (p < 0.001). CRP levels increased more from pre-COVID1 and pre-COVID2 to during-COVID-19 than normative expected changes in CRP levels (p < 0.003). Changes in CRP levels before and during COVID-19 were not significantly different. (4) Conclusions. These findings highlight the consequential effects of COVID-19, including impairments in sleep, on adolescents with OWOB. CRP levels increased more (~5 mg/L) during COVID-19 than normative expected change.

The relationship between sleep quality and daytime dysfunction among college students in China during COVID-19: a cross-sectional study

Objective

College Students' sleep quality and daytime dysfunction have become worse since the COVID-19 outbreak, the purpose of this study was to explore the relationship between sleep quality and daytime dysfunction among college students during the COVID-19 (Corona Virus Disease 2019) period.

Methods

This research adopts the form of cluster random sampling of online questionnaires. From April 5 to 16 in 2022, questionnaires are distributed to college students in various universities in Fujian Province, China and the general information questionnaire and PSQI scale are used for investigation. SPSS26.0 was used to conduct an independent sample t-test and variance analysis on the data, multi-factorial analysis was performed using logistic regression analysis. The main outcome variables are the score of subjective sleep quality and daytime dysfunction.

Results

During the COVID-19 period, the average PSQI score of the tested college students was 6.17 ± 3.263, and the sleep disorder rate was 29.6%, the daytime dysfunction rate was 85%. Being female, study liberal art/science/ engineering, irritable (due to limited outdoor), prolong electronic entertainment time were associated with low sleep quality (p < 0.001), and the occurrence of daytime dysfunction was higher than other groups (p < 0.001). Logistics regression analysis showed that sleep quality and daytime dysfunction were associated with gender, profession, irritable (due to limited outdoor), and prolonged electronic entertainment time (p < 0.001).

Conclusion

During the COVID-19 epidemic, the sleep quality of college students was affected, and different degrees of daytime dysfunction have appeared, both are in worse condition than before the COVID-19 outbreak. Sleep quality may was inversely associated with daytime dysfunction.

Effects of the COVID-19 pandemic on mental health and sleep quality in the Chinese general populations during sporadic and outbreak periods

The different coronavirus disease 2019 (COVID-19) outbreak patterns may have different impact on the mental health, but there is no such report at present. This study was aimed to investigate general populations mental health and sleep quality during the sporadic and outbreak of COVID-19 in Tianjin of China. Two cross-sectional studies included 1090 participants during the COVID-19 sporadic period from 28th January to 28th February 2022 and 2036 participants during the COVID-19 outbreak period from 1st January to 1st February 2023. We used the propensity score matching method to match the 2 samples (sporadic and outbreak group) with a ratio of 1:1. Finally, 1087 participants were included in each group. The demographics, Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale-7, Connor-Davidson Resilience Scale, and Pittsburgh Sleep Quality Index were collected from all participants. There was a significant difference between the sporadic and outbreak groups for COVID-19-infected status, anxiety levels, sleep quality, and phycological resilience (all P < .05). Logistic regression analysis showed that female (P < .05) and depression status (P < .05) were the risk factors for the incidence rate of anxiety and poor sleep quality in sporadic group, and outbreak group, while phycological resilience were robust related to the sleep quality (P < .01). Poor sleep quality (P < .01) was related to the incidence of anxiety in sporadic group but not the outbreak group; anxiety levels (P < .01) were related to sleep quality in sporadic group but not the outbreak group. During the COVID-19 pandemic, general populations experienced high anxiety and poor sleep quality incidence rates, especially in the outbreak period. Different risk models for anxiety and sleep quality were found in the different outbreak patterns.

Cost-effectiveness and budget impact analysis of lisdexamfetamine versus methylphenidate for patients under 18 with attention-deficit/hyperactivity disorder in Iran

BACKGROUND

Lisdexamfetamine (LDX) and Methylphenidate (MPH) are stimulant agents that have been shown to provide significant benefits in the management of attention-deficit/hyperactivity disorder (ADHD) in patients.

AIM

This study aimed to assess the cost-effectiveness and the budget impact of LDX compared to MPH as the first-line treatment for ADHD.

METHODS

A one-year cost-effectiveness analysis (CEA) was conducted to compare the effects of LDX and MPH in reducing disease symptoms and patient costs and improving quality of life (QoL) from a social perspective. Clinical data were obtained using the EQ-5D questionnaire. In contrast, economic data were sourced from the official website of the Iranian Food and Drug Association (FDA), the national book of tariffs, and specific questionnaires designed to evaluate patients' direct and indirect costs. 197 patients were included in the study, including individuals who sought psychiatric evaluation at a hospital in Mashhad and those who obtained ADHD medications from governmental pharmacies. The cost-effectiveness of the study medicine was assessed using the decision tree method, and the results were presented as the Incremental Cost-Effectiveness Ratio (ICER). Deterministic Sensitivity Analysis (DSA) and Probabilistic Sensitivity Analysis (PSA) were performed to assess the robustness of the findings. Additionally, a Budget Impact Analysis (BIA) was conducted over five years, considering three different scenarios, to evaluate the financial implications of incorporating LDX into the national pharmaceutical system.

RESULTS

The ICER for LDX therapy compared to MPH was estimated at USD 264.28 (with an incremental cost of USD 54.9, incremental effectiveness of 0.208, and Quality-Adjusted Life Years (QALYs) gained of 0.765). The PSA indicated a 0.994% probability of LDX being cost-effective, considering a threshold of USD 2450 per QALY. Furthermore, the DSA revealed that the acquisition cost of LDX influenced the model's sensitivity. The BIA demonstrated that incorporating LDX into Iran's healthcare system would result in a financial burden of approximately $368,566 in the first year, representing an additional cost of $11,154 compared to the non-availability of this medicine and the use of previous medications. It is projected that by 2027, the financial burden of treating ADHD with LDX will reach approximately USD 443,879 over five years, amounting to an increase of $71,154 compared to the absence of this medicine.

CONCLUSION

From a social perspective, the inclusion of LDX in the treatment regimen for ADHD is associated with higher costs and an increased financial burden. However, based on our analysis, LDX appears to be a cost-effective choice for managing ADHD in Iran when compared to MPH.

COVID-19 effects on diet, sleep, and physical activity among mid- to late-adolescents residing in the deep south in the United States

PURPOSE

This study investigated the differential impact of COVID-19 on United States (US) adolescents' physical health as a function of sociodemographic factors over 18 months. It was hypothesized that the impact of COVID-19 and its mitigation efforts on physical health factors would vary by sociodemographic factors.

DESIGN AND METHODS

Data were drawn from a longitudinal study in which participants (ages 16 or 18) self-reported sleep, diet, and physical activity over 18months. Participants were enrolled between 2018 and 2022. Participants (n = 190, 73% Black/African American, 53% female) provided 1330 reports over 194 weeks (93 weeks before and 101 weeks after COVID-19 restrictions implementation).

RESULTS

Physical health outcomes moderated by demographic factors were measured and assessed over 18 months. Multilevel models and general estimated equations estimated the impact of COVID-19 restrictions on participants' health outcomes. Sleep and physical activity worsened after COVID-19 regardless of moderating factors, but some specific outcomes varied across subgroups.

CONCLUSIONS

This study diversifies the literature on the impact of COVID-19 and its mitigation measures on adolescents' social health. Further, it is based in the US's Deep South, largely populated by those identifying as Black/African American or of low socioeconomic status. Both subgroups are underrepresented in US-based health outcomes research. COVID-19 directly and indirectly impacted adolescents' physical health.

PRACTICE IMPLICATIONS

Understanding if and how COVID-19 impacted adolescents' health will inform nursing practice to adapt to and overcome adverse sequelae to promote positive patient health outcomes.

Ecological-Systems Contributors to Internalizing Symptoms in a US Sample of Adolescents During the COVID-19 Pandemic

OBJECTIVE

Internalizing problems are common in adolescence and increased substantially during the COVID-19 pandemic. Although rates of anxiety and depression have since improved, the general increase in the prevalence of mental health problems and disruptions to mental health services during the COVID-19 pandemic has resulted in huge gaps in care. Although research has primarily focused on proximal correlates of internalizing problems, a growing literature suggests that factors outside youths' immediate microsystems are equally crucial for their mental well-being. Thus, it is important to investigate multisystemic correlates of internalizing problems to inform individual and community-based interventions to address the current mental health burden.

METHOD

Leveraging secondary data from a nationally diverse U.S. sample of 2,954 adolescents (ages 13-16), we examined the associations between factors at multiple levels of youths' ecologies - spanning indicators of threat and deprivation - and their depression and anxiety symptoms during the COVID-19 pandemic. Furthermore, in follow-up exploratory analyses, we examined if these associations differed by adolescents' racial/ethnic groups.

RESULTS

Consistent with socioecological models, we found that indicators of threat and deprivation in the adolescents' immediate home and more distal neighborhood environments were associated with depression and anxiety symptoms. The patterns of associations were similar across racial/ethnic groups in multigroup structural equation models. Additionally, we found that mean levels of internalizing symptoms and socioecological predictors significantly differed across racial/ethnic groups.

CONCLUSION

These findings have important implications for understanding multi-level contributors to adolescent mental health, which may inform research, practice, and policy.

Comparison of Korean School Students' Safety Accident Rates before and after COVID-19

The COVID-19 pandemic has significantly affected various aspects of education, including the occurrence of injuries among Korean students. This study aims to analyze and compare injury rates in elementary, middle, and high schools before and after the pandemic and identify the associated factors. A non-experimental quantitative dataset compiled from the Korea School Safety Association's annual reports (2018-2022) was utilized. The data included information on school safety accidents among Korean children and adolescents during the COVID-19 pandemic. The dataset was analyzed based on factors such as time, location, type of accident, and injured body part. The findings revealed a decline in accidents during the early phase of the pandemic, followed by an increase after schools reopened. There were notable variations in the accidents in specific locations, types, and body parts affected during the pandemic, compared with the pre-pandemic period. This study highlights the importance of continuous monitoring, implementation of safety measures, and prioritization of physical activity programs and safety education to ensure a safe learning environment. Further research is recommended to track and address evolving school accidents in response to the pandemic and its aftermath.

[A review of research on psychological and behavioral problems in children with autism spectrum disorder during the coronavirus disease 2019 epidemic]

Since December 2019, coronavirus disease 2019 (COVID-19) has been rapidly spreading worldwide and affecting the physical and mental health of the general population. It may have even more serious potential harm to children with autism spectrum disorder (ASD). This paper provides a literature review on the psychological and behavioral problems experienced by children with ASD during the COVID-19 epidemic, as well as the factors influencing these issues. The findings of this review can serve as a basis for clinical research on ASD children.

Prevalence and associated factors of depressive and anxiety symptoms among Chinese secondary school students

BACKGROUND

Depressive and anxiety symptoms affect about one-fourth of Chinese secondary school students. However, the prevalence and correlates of mental distress among secondary school students from Western China remain largely unexplored. This study aimed to examine the prevalence and associations of depressive and anxiety symptoms with demographic, family, school, life, and behavior factors in a large, representative sample of secondary school students in Zigong, a city in Western China.

METHODS

Secondary school students were recruited using cluster sampling. The 9-item Patient Health Questionnaire, the 7-item Generalized Anxiety Disorder Questionnaire, Multidimensional Peer-Victimization Scale, the Pittsburgh Sleep Quality Index, and Nine-Item Internet Gaming Disorder Scale-Short Form were used. Descriptive statistic was used to describe the sociodemographic characteristics of participants. The clustering effect was adjusted by the "survey" package of R to calculate weighted prevalence. Univariate and multivariate logistic regression were used to explore associated factors of depression and anxiety, respectively.

RESULTS

A total of 63,205 participants were involved, in which the weighted prevalence of depression in all subjects was 23.0% (95% CI: 19.6- 27.0%), and the weighted prevalence of anxiety was 13.9% (95% CI: 11.2- 17.0%). Logistic regression results showed girls, being single-child, non-nuclear family, peer bullying, sleep disturbance, and internet gaming disorder symptoms were positively associated with depressive and anxiety symptoms.

CONCLUSION

Depressive and anxiety symptoms were prevalent among secondary school students in Western China. Our results can guide policy strategies for the assessment, prevention, and intervention of psychological status among Chinese secondary school students.

The impact of the COVID-19 pandemic on adolescent sleep behavior

Restorative sleep is a fundamental component of adolescent wellbeing, and the COVID-19 pandemic presented both challenges and opportunities for adolescents' sleep. In this review, we synthesize emergent themes from the growing scientific evidence for the impact of the pandemic on adolescent sleep behavior across different stages of the pandemic and in different locations around the world. We also highlight the ways in which COVID-19 shaped sleep patterns among college students-a subgroup of adolescents transitioning to emerging adulthood that were particularly impacted by the shift to remote learning. Finally, we discuss variations in the impact according to several potential moderating factors in adolescents' lives and point to areas that require additional longitudinal research.

The impact of the COVID-19 pandemic on sleep in children with Tourette syndrome in Ireland and the United Kingdom

STUDY OBJECTIVES

The aim of this mixed-methods study was to gain an insight through qualitative and quantitative means into the impact of the coronavirus disease 2019 (COVID-19) pandemic on children with and without Tourette syndrome (TS).

METHODS

Parents/guardians of children and adolescents with TS (n = 95; mean age = 11.2 years, standard deviation = 2.68 years) and typically developing controls (n = 86; mean age = 10.7 years, standard deviation = 2.8 years) in the United Kingdom and Ireland completed an online questionnaire examining sleep, with open-ended questions pertaining to their perceived impact of COVID-19 on the sleep of their children. Nine items from the Sleep Disturbance Scale for Children were used to supplement qualitative data.

RESULTS

A negative impact of the pandemic on the sleep of both groups was observed, including exacerbated tics, sleep deprivation, and anxiety, with particular disruption for children with TS. Parents of children with TS reported poorer sleep patterns than parents of typically developing children on the Sleep Disturbance Scale for Children. Analyses showed that group and age predicted 43.8% of variance in sleep duration: F (4, 176) = 34.2, P < .001.

CONCLUSIONS

Findings suggest that sleep patterns of children with TS may be more impacted by the pandemic than the average child. Given that there are generally more sleep issues reported in children with TS, further research is warranted in relation to the sleep health of children with TS in a postpandemic era. By identifying sleep issues potentially persisting after COVID-19, the true impact of the pandemic on the sleep of children and adolescents with Tourette syndrome may be ascertained.

CITATION

Colreavy E, Keenan L, Downes M. The impact of the COVID-19 pandemic on sleep in children with Tourette syndrome in Ireland and the United Kingdom. J Clin Sleep Med. 2023;19(8):1485-1493.

Associations of active and passive smartphone use with measures of youth mental health during the COVID-19 pandemic

Smartphone use provides a significant amount of screen-time for youth, and there have been growing concerns regarding its impact on their mental health. While time spent in a passive manner on the device is frequently considered deleterious, more active engagement with the phone might be protective for mental health. Recent developments in mobile sensing technology provide a unique opportunity to examine behaviour in a naturalistic manner. The present study sought to investigate, in a sample of 451 individuals (mean age 20.97 years old, 83% female), whether the amount of time spent on the device, an indicator of passive smartphone use, would be associated with worse mental health in youth and whether an active form of smartphone use, namely frequent checking of the device, would be associated with better outcomes. The findings highlight that overall time spent on the smartphone was associated with more pronounced internalizing and externalizing symptoms in youth, while the number of unlocks was associated with fewer internalizing symptoms. For externalizing symptoms, there was also a significant interaction between the two types of smartphone use observed. Using objective measures, our results suggest interventions targeting passive smartphone use may contribute to improving the mental health of youth.

A National Survey of U.S. Adolescent Sleep Duration, Timing, and Social Jetlag During the COVID-19 Pandemic

OBJECTIVES

To assess changes in duration, timing, and social jetlag in adolescent sleep during the COVID-19 pandemic and evaluate the impact of mood, physical activity, and social interactions on sleep.

STUDY DESIGN

An online survey queried adolescents' sleep before (through retrospective report) and during the initial phase of COVID-19 in May 2020. Adolescents (N = 3,494), 13-19 years old, in the United States (U.S.) answered questions about their current and retrospective (prior to COVID-19) sleep, chronotype, mood, and physical and social activities. Linear regression models were fit for time in bed, reported bed and wake times, and social jetlag during COVID-19, accounting for pre-COVID-19 values.

RESULTS

Total reported time in bed (a proxy for sleep duration) increased on weekdays by an average of 1.3 ± 1.8 hours (p < .001) during COVID-19, compared to retrospective report of time in bed prior to COVID-19. During COVID-19, 81.3% of adolescents reported spending 8 hours or more in bed on weekdays compared to only 53.5% prior to COVID-19. On weekdays, bedtimes were delayed on average by 2.5 hours and wake times by 3.8 hours during COVID-19 compared to prior to COVID-19. On weekends, bedtimes were delayed on average by 1.6 hours and waketimes by 1.5 hours (all p's < 0.001). Social jetlag of >2 hours decreased to 6.3% during COVID-19 compared to 52.1% prior to COVID-19. Anxiety and depression symptoms and a decline in physical activity during COVID-19 were associated with delayed bed and wake times during COVID-19.

CONCLUSIONS

During COVID-19, adolescents reported spending more time in bed, with most adolescents reporting 8 hours of sleep opportunity and more consistent sleep schedules. As schools return to in-person learning, additional research should examine how sleep schedules may change due to school start times and what lessons can be learned from changes that occurred during COVID-19 that promote favorable adolescent sleep.

Screen exposure and sleep: How the COVID-19 pandemic influenced children and adolescents - A questionnaire-based study

BACKGROUND

COVID-19 pandemic has drastically increased the exposure to electronic devices in children, influencing their lifestyle and their sleep. This study was conducted to explore the relationship between the augmented screen exposure and sleep habits in children during and after the pandemic.

METHODS

Using the "Google Forms" tool, we created an online questionnaire addressed to parents of children and adolescents aged 2-18 years. We explored the use of screens before and during/after the lockdown and assessed the presence of sleep disturbances through the Sleep Disturbance Scale for Children (SDSC), referring to the period before and during/after COVID-19 pandemic.

RESULTS

We collected 1084 valid questionnaires (median age 8.5 ± 4.1 years). We observed a significant increase in screens exposure for school (72%) and for leisure (49.7%) during the pandemic. We reported an increased sleep disturbances prevalence from 22.1% before the pandemic to 33.9% during the outbreak (p < 0.001). Even before the pandemic, the highest risks for sleep disorders were related to daily screen time for school reasons (OR 1.65, p < 0.001) and total screen time after 6 p.m. (OR 1.59, p < 0.001). The augmented exposure to screens for any reasons during the pandemic was significantly related to an increase of sleep disorders, especially regarding the increased exposure after 6 p.m. (OR 1.67, p < 0.001).

CONCLUSIONS

The augmented use of electronic devices was recognized to be a significant predisposing factor in increasing the rate of sleep disorders during and after the pandemic, thus sleep hygiene recommendations should be highlighted to improve sleep habits.

Determining the relationship between sleep disturbances in children and parental stress during COVID-19 pandemic

This study aimed to determine the relationship between child sleep disturbances and parental stress during the COVID-19 pandemic. This cross-sectional web-based study was conducted between February and April 2021 among 409 parents residing in Turkey who had children between the ages of 6 and 16 years. Data were collected online using the Sleep Disturbance Scale for Children (SDSC) and the Parental Stress Scale (PSS). In the study, there was a significant relationship found between the mean scores of the SDSC and PSS (r = 0.499, p < 0.001). In the multiple regression analysis, family type, socioeconomic status, occupation, the presence of sleep problems in the child before the pandemic, and the total score of the PSS significantly affected the total score of the SDSC. The presence of sleep problems in the child before the pandemic was significantly associated with the total score of the PSS (p < 0.05). Approximately 3.9% of the children had sleep disturbances (at scores over 70 points) during the COVID-19 pandemic. In conclusion, as the stress levels of parents increase, the rate of sleep disturbances in their children increases, and many demographic characteristics are associated with the occurrence of sleep disturbances in their children. It is important that parents do not reflect on their stress related to the pandemic and that their children maintain a normal sleep pattern whenever possible. School nurses should educate children and their parents about the importance of enough sleep and factors that contribute to inadequate sleep among children during the COVID-19 pandemic.

The impact of COVID-19 on sleep for autistic children: A systematic review

Background

Up to 80% of children with autism experience behavioural sleep problems, predominantly relating to bedtime resistance, sleep anxiety, sleep dysregulation, and shorter duration, which are associated with increased autistic symptom expression and emotional and behavioural difficulties. Researchers predicted the COVID-19 pandemic would worsen sleep and behavioural difficulties for autistic children, due to their need for routine and certainty. This systematic review is the first to focus on delineating the role of sleep disturbance in exacerbating autistic symptoms and internalising and externalising behaviours during the pandemic.

Method

In this PROSPERO registered systematic review, we aggregated and synthesised findings from empirical studies from 2020 onwards that included children with autism and examined sleep outcomes, using narrative and framework synthesis due to the variety of methods and designs employed. We identified additional relevant themes through inductive thematic analysis.

Results

Seventy-one studies met the search criteria, and we selected seventeen for review following screening and quality assessment. These studies reported mixed findings; with strongest support for worsening of sleep problems typically experienced by autistic children, including difficulties with sleep regulation and shorter sleep duration. Further, sleep problems were associated with increased expression of autistic characteristics.

Conclusions

Preliminary findings of worsening sleep and increased autistic characteristics for autistic children throughout the COVID-19 pandemic highlight the need for ongoing, accessible and flexible service provision during exposure to environmental stressors. We propose that behavioural sleep interventions are well suited to telehealth adaptation and play an important role in supporting families when in-person treatment for sleep problems is not possible.

Loneliness, affective disorders, suicidal ideation, and the use of psychoactive substances in a sample of adolescents during the COVID-19 pandemic: A cross-sectional study

PROBLEM

The global coronavirus (COVID-19) pandemic has been challenging for adolescents. Indeed, with the closure of schools and social centers and reduction of extracurricular activities, increased social isolation has compounded difficulties in and with school performance, loneliness, and social networking. Increased risk of mental health problems, substance abuse, affective disorders, suicidal ideation, and suicide has been reported in adolescents.

METHODS

This cross-sectional study assesses the association between loneliness, depression, anxiety, suicidal ideation, the use of social networks, and school achievement in a sample of Italian adolescents during the COVID-19 pandemic. This study also explores emotional dysregulation through the association between affective disorders (depression and anxiety), substance use, and social networks. The sample comprises adolescents in the first and second grades of high school during the pandemic; participants received an email explaining the purpose of the e-research. Data were collected using the Strengths and Difficulties Questionnaire, the Achenbach System of Empirically Based Assessment, and the Loneliness Scale.

FINDINGS

A total of 505 adolescents completed the web survey. Data revealed that students experienced difficulties with loneliness, problems with school achievement, and extracurricular activities. The mean scores for depression and anxiety were close to the borderline range. A total of 14.3% of adolescents intentionally harmed themselves or attempted suicide.

CONCLUSIONS

This study raises concerns about the impacts of the pandemic on adolescents that require the attention of adult reference figures who deal with adolescents, such as parents, teachers, and healthcare professionals. Results indicate the necessity of providing early interventions aimed at the prevention of psychopathologies and the promotion of adolescent mental health due to the pandemic.

Sleep and emotionality in adolescents with anorexia nervosa during the Covid-19 pandemic

PURPOSE

The recent Covid-19 pandemic and its lockdown measures raised concerns about people's mental health, leading to an increased interest in identifying vulnerable groups especially at risk for mental distress. This cross-sectional study investigated the impact of this unprecedented situation on sleeping patterns and emotionality in adolescents with anorexia nervosa (AN).

METHODS

Variations in sleeping patterns and emotionality of two groups of adolescents with AN, assessed before (N = 50) and during (N = 51) the Covid-19 lockdown were analysed. We further investigated these variations over time, considering the two lockdown periods in France.

RESULTS

Adolescents self-reported significantly more sleep difficulties and lower rates of positive emotions during lockdown, compared to those evaluated before it. Furthermore, present findings overall suggest that as the lockdown progresses, adolescents with AN show an increased deterioration of sleep quality, as indicated by greater insomnia severity levels. They also show a significant decrease in the subjective experience of positive emotionality, in particular in feelings of tenderness.

CONCLUSIONS

These sleep and emotionality alterations may have amplified the severity and the incidence of AN in adolescents during the Covid-19 pandemic. These features may therefore represent therapeutic targets to optimise care of adolescents with AN. This is particularly urgent, considering kinetics of the deterioration. Tools such as those provided by cognitive behavioural therapy for insomnia and by the positive psychology framework seem appropriate to guide clinicians in this context.

LEVEL OF EVIDENCE

Level V, descriptive study (evaluation data retrospectively studied).

Parental survey of the sleep patterns and screen time in US school children during the first 6 months of the COVID-19 pandemic

BACKGROUND

This study compared sleep duration, screen exposure and sleep quality in school-aged children before COVID-19 to that during school closures and again when schools re-opened in fall 2020.

METHODS

Cross-sectional anonymous, online survey of parents of children 5-13 years old. Questions elicited information about sleep timing and quality, screen time, and schooling at three distinct periods: before the pandemic, when schools first closed and then re-opened in the fall.

RESULTS

Respondents described 101 children who were an average of 8.5 years old and 51% male. In lockdown, children slept 25 min more (95%CI 00:13-00:38) due to later wake times (75 min, 95% CI 0:57-1:34) with later bedtimes (29 min, 95%CI 0:00-0:58). When schools re-opened, sleep duration returned to pre-pandemic levels, but sleep onset and offset times remained later. Despite more sleep, sleep quality and habits (e.g. bedtime refusal) worsened during lockdown and did not normalize in fall 2020. During lockdown, screen time increased in 65% of all children, and 96% of those in private schools. When schools reopened, 78% of children in hybrid/virtual learning had more than 4 h of screen exposure daily. Less screen time was associated with twofold higher odds of better sleep (OR 2.66, 95%CI 1.15-6.14).

CONCLUSIONS

Although school-aged children had more total sleep when schools were closed, sleep quality and habits worsened. Upon return to school, sleep times and quality did not normalize and were linked to screen time.

Daily and average associations of physical activity, social media use, and sleep among adolescent girls during the COVID-19 pandemic

Adolescents' daily lives have been disrupted during the Coronavirus disease 2019 (COVID-19) pandemic. It remains unclear how changes in adolescents' daily physical and social behaviours affect their sleep. The present study examined the daily and average effects of physical activity and social media use (i.e., video chatting, texting, and social networking sites) on adolescent girls' sleep during the COVID-19 pandemic. Adolescent girls aged 12-17 years (N = 93; 69% White) from a larger longitudinal study completed a 10-day daily diary protocol during state-mandated stay-at-home orders. Girls reported on daily sleep (duration, timing, quality), physical activity, and social media use during COVID-19. Multilevel modelling was used to examine the within- and between-person effects of physical activity and social media on sleep duration, timing, and quality during the 10-day period. Between-person associations indicate that youth with greater social media use (texting, video chatting, and social networking) and less physical activity had later sleep timing across the 10-day study period. Only video chatting was associated with shorter sleep duration. There were no within-person effects of physical activity or social media activities on sleep outcomes. Findings indicate that physical activity and social media use may impact later adolescent sleep timing during the COVID-19 pandemic. It will be critical for research to examine the potential long-term costs of delayed sleep timing, and whether targeting specific youth behaviours associated with sleep and circadian disruption improve mental and physical health during the COVID-19 pandemic and beyond.

Impact of COVID-19 pandemic on sleep of undergraduate students: A systematic literature review

The 2019 coronavirus pandemic forced the shift to distance education aggravating mental and physical vulnerabilities of undergraduate students, including sleep. This review aims to describe sleep problem rates and prevalence, sleep pattern disruption, sleep duration, sleep quality, insomnia symptoms, psychological and socio-economic factors affecting sleep of undergraduates in 22 countries. A systematic search for articles published from 2020 to 2021 using 'COVID-19,' 'Coronavirus,' 'Pandemic,' 'Sleep,' 'Mental Health,' and 'Students' from PubMed, Scopus, and Cochrane yielded 2550 articles, where 72 were included. Selection criteria were: English full-text available articles, undergraduates and not postgraduates, reported sleep outcomes, and participants not from allied health courses. Risk of bias was assessed using various Joanna Briggs Institute checklists and outcomes were descriptively synthesized. Prevalence of sleep problems was notable, while longitudinal studies showed increased rates. There was significantly increased sleep duration, and sleep pattern disruption during lockdowns. Several psychological, behavioural, environmental, demographic, and socio-economic factors were found to be associated with sleep changes. These highlight the pandemic's impact on sleep of undergraduate students and reveal opportunities for institutions to intervene with policies and programs to promote the well-being of undergraduates. Limitations include recall bias and underrepresentation of other countries. This study is self-funded with registration number RGAO-2021-0071.

Understanding the Need for Sleep to Improve Cognition

The restorative function of sleep is shaped by its duration, timing, continuity, subjective quality, and efficiency. Current sleep recommendations specify only nocturnal duration and have been largely derived from sleep self-reports that can be imprecise and miss relevant details. Sleep duration, preferred timing, and ability to withstand sleep deprivation are heritable traits whose expression may change with age and affect the optimal sleep prescription for an individual. Prevailing societal norms and circumstances related to work and relationships interact to influence sleep opportunity and quality. The value of allocating time for sleep is revealed by the impact of its restriction on behavior, functional brain imaging, sleep macrostructure, and late-life cognition. Augmentation of sleep slow oscillations and spindles have been proposed for enhancing sleep quality, but they inconsistently achieve their goal. Crafting bespoke sleep recommendations could benefit from large-scale, longitudinal collection of objective sleep data integrated with behavioral and self-reported data.

Changes in Sleep Satisfaction of Korean Adolescents in the Pre- and Post-COVID-19 Eras and Its Effects on Health Behaviors

Adolescence is a crucial period for cognitive and psychological development and physical maturation. During this period, hormonally influenced circadian rhythms lead to reduced hours of sleep, and it is important to determine whether sleep quality is sufficient for fatigue relief. Non-face-to-face classes during coronavirus disease-2019 (COVID-19) potentially affected adolescents' sleep quality, psychological state, amount of physical activity, smoking, alcohol consumption, and internet (smartphone) use. We investigated the effects of the COVID-19 situation on adolescents' sleep satisfaction and its relation to the aforementioned factors. Data of 109,281 adolescents collected via an online survey, conducted from 3 June 2019 to 12 July 2019 and from 3 August 2020 to 13 November 2020, were analyzed. Health status comparison between the satisfactory and unsatisfactory sleep groups yielded significant results (odds ratio [OR] = 1.10, confidence interval [CI] = 1.04-1.17) for 2020. In both groups, perceived health was worse in 2019 than in 2020 (OR = 2.72, CI = 2.53-2.92). During COVID-19, non-face-to-face classes increased adolescents' sleep satisfaction. Their psychological state improved, while amount of physical activity (muscle-strengthening exercises), average weight, and internet (smartphone) use increased. Smoking and alcohol consumption decreased.

Clinical and psychological status analysis of children and parents infected with familial aggregation omicron variant in Shanghai in parent-child ward

Aims

To analyze the clinical characteristics, treatment outcomes and sleep psychological problems of children and parents infected with familial aggregation Omicron variants under a parent-child ward treatment mode to provide a theoretical reference for the diagnosis and comprehensive treatment of Omicron variant strains.

Methods

The clinical data of 225 children and 230 adult family members admitted were retrospectively collected and analyzed to investigate their clinical characteristics and response to treatments.

Results

The proportion of infected adults and children was the same, and the proportion of children with mild disease was higher than that of adults, but the clinical symptoms were milder. The clinical symptoms of fever, nausea, vomiting and wheezing in children were significantly higher than in adults (P < 0.05). In addition, dry pharynx, pharynx itching and pharyngeal pain were lower than in adults (P < 0.05). The time of turning negative in the moderate group was longer than in the mild group, and the time of turning negative in the unvaccinated group was higher than in the vaccinated group (P < 0.05). The Cycle Threshold Value (Ct value) of Open Reading Frame 1ab (ORF1ab) and Nucleocapsid protein (N) gene of children were higher adults. The increase in the rate of Ct value of ORF1ab and N gene in adults treated with Traditional Chinese Medicine (TCM) was significantly higher than in those who underwent symptomatic treatment (P < 0.01). Based on the Children's Sleep Habits Questionnaire (CSHQ)score, we found varying levels of sleep problems in sleeping habits, latency and anxiety, night awakenings and abnormal sleep at all ages (P < 0.05). In the adult group, those with Self-Rating Scale of Sleep (SRSS) scores ≥3 accounted for more than 50% of adults with insomnia, sleep deprivation, sleep instability and early awakening. The proportion of adults with anxiety and depression was 21.3% and 16.4%.

Conclusion

Infections in children and adults during this pandemic were mainly associated with familial aggregation infections, and their clinical symptoms were mainly located in the upper respiratory tract. With comprehensive treatment, children became negative faster, vaccination led to faster recovery, and although some patients experienced sleeping and psychological issues, all patients had good prognoses following comprehensive diagnosis under a parent-child ward treatment mode.

Self-reported changes in sleep patterns and behavior in children and adolescents during COVID-19

The COVID-19 pandemic and lockdowns worldwide forced children and adolescents to change and adapt their lives to an unprecedented situation. Using an online survey, we investigated whether they showed changes in sleep quality and other related factors due to this event. Between February 21st, 2021 and April 19th, 2021, a total of 2,290 Austrian children and adolescents (6-18 years) reported their sleep habits and quality of sleep as well as physical activity, daylight exposure and usage of media devices during and, retrospectively, before the pandemic. Results showed an overall delay of sleep and wake times. Almost twice as many respondents reported having sleeping problems during the pandemic as compared to before, with insomnia, nightmares and daytime sleepiness being the most prevalent problems. Furthermore, sleeping problems and poor quality of sleep correlated positively with COVID-19 related anxiety. Lastly, results showed a change from regular to irregular bedtimes during COVID-19, higher napping rates, a strong to very strong decrease in physical activity and daylight exposure, as well as a high to very high increase in media consumption. We conclude that the increase in sleeping problems in children and adolescent during COVID-19 is concerning. Thus, health promoting measures and programs should be implemented and enforced.

Sleeping Sound Autism Spectrum Disorder (ASD): a randomised controlled trial of a brief behavioural sleep intervention in primary school-aged autistic children

BACKGROUND

Behavioural sleep problems are common in children with autism spectrum disorder (ASD); however, evidence for the efficacy of behavioural sleep interventions is limited. This study examined the efficacy of a brief behavioural sleep intervention in autistic children. It was hypothesised that the intervention would reduce overall child sleep problems (primary outcome), in addition to improvements in children's social, emotional, cognitive, academic functioning, and quality of life, and parent/caregivers' stress, quality of life, and mental health (secondary outcomes).

METHODS

A randomised controlled trial was conducted with participants randomised via a computer-generated sequence to the sleeping sound intervention (n = 123) or treatment as usual (n = 122) group. Participants comprised 245 children with an ASD diagnosis. Inclusion criteria were as follows: confirmation of DSM IV or DSM-5 diagnosis of ASD, participants aged between 5 and 13 years and parent/caregiver report of moderate-severe sleep problems. Exclusion criteria were as follows: parent/caregiver intellectual disability or lacking sufficient English to complete questionnaires; and child participant with co-occurring medical conditions known to impact sleep. The intervention group received the sleeping sound intervention (2 × 50-min face-to-face sessions plus follow-up phone call) by a trained clinician.

RESULTS

Change in children's sleep problems was measured by the Children's Sleep Habits Questionnaire (CSHQ) at 3 months post randomisation. Parents/caregivers of children in the intervention group reported a reduction in child sleep problems at 3 months post randomisation (effect size: E.S -0.7). There were also small effects in a number of child (internalising symptoms, emotional behavioural disturbance and quality of life) and parent/caregiver (mental health, parenting stress and quality of life) outcomes; however, these did not remain significant when controlling for multiple comparisons.

CONCLUSIONS

The sleeping sound ASD intervention is an efficacious and practical way to reduce sleep problems for autistic children. This brief behavioural intervention has the potential to be embedded easily into the Australian healthcare system.

The Trap of the COVID-19 Pandemic: Italian Adolescents Fare Well at First, Maybe Thanks to Protective Trait Expression

Abundant research indicates that the COVID-19 pandemic has been negatively affecting mental health in adolescence. Few works, however, benefit from data from the same sample before and after the onset of the pandemic. The present longitudinal study involved a non-clinical group of 136 Italian adolescents (Mage = 16.3 years ± 1.08, 67% girls) to investigate their psychological response to the first lockdown and explore the role of a protective trait (i.e., Positivity) in moderating the effect of Intolerance of Uncertainty (IU) on internalizing symptoms before and during the COVID-19 outbreak. Participants completed self-report questionnaires assessing psychopathological symptoms, psychological well-being, IU, and Positivity on three separate occasions: October 2019 (T1), January 2020 (T2), and April 2020 (T3). The results showed that internalizing and externalizing symptoms as well as psychological well-being did not vary significantly over time. Positivity was found to significantly moderate the relationship between IU and internalizing symptoms at T3 (i.e., during the COVID-19 lockdown) only. Overall, our findings suggest that the teenagers' good adjustment to the initial phase of the pandemic might have been associated with the enhanced weight of the Positivity trait, which may have encouraged a positive attitude towards self, life, and the future.

Emotional impact on children during home confinement in Spain

Introduction

The COVID-19 pandemic has brought about important changes. On March 14, 2020, a strict home confinement was decreed in Spain. Children did not attend school and were not allowed to leave their homes. The aim of this study was to determine the emotional state of these children, as well as associated factors.

Material and methods

A cross-sectional descriptive study was conducted using an online questionnaire sent by cell phone. This survey includes sociodemographic items and questions concerning the emotional impact of the lockdown. With the questions on emotions, two categories of emotional state were established with the variables fear, irritability, sadness and somatization: those who were less or more emotionally affected. A multivariate logistic model was used to estimate the associations between the variables.

Results

A total of 3,890 responses were obtained. The mean age of the children was 6.78 years (range 0 to 16). A score indicating poor emotional state was reported by 40.12%. The multivariate logistic model for poor emotional state was directly associated with having less appetite, sleep disturbances, and with parents' beliefs that their child will have difficulties returning to normal life after lockdown. A better emotional state was associated with being an only child, access to outdoor spaces at home, having pets, and parents informing their children about the pandemic using creative explanations.

Conclusions

During strict home confinement, a considerable emotional impact was observed in children as described by their parents. Specific elements were associated with a better or poorer emotional state.

COVID-19 pandemic-related aspects and predictors of emotional and behavioural symptoms in youth with pre-existing mental health conditions: results from Georgia, Lithuania, Romania, Serbia, and Turkey

OBJECTIVE

This study evaluated levels of and predictors of emotional and behavioral symptoms in youth with pre-existing mental health conditions over the early phase of the COVID-19 pandemic in 2020 across Georgia, Lithuania, Romania, Serbia, and Turkey.

METHODS

The study included 421 children and adolescents aged 5 - 18 years with pre-existing mental health conditions and corresponding ongoing treatments. We used a parent- and/or child-report, which taps into a broad range of mental health symptoms and contextual factors thought to be particularly pertinent during periods of social restrictions. Data were collected simultaneously across the countries from May 2020 to August 2020.

RESULTS

According to parents, 121 (33.1%) children had deteriorations in the overall quality of mental health over the COVID-19, 156 (43.1%) deteriorations in the quantity of mental health care received, while 82 (25.1%) mental health care received did not meet the needs. For 121 (49.8%) of children, there was worsening in the main presenting psychiatric symptom compared to January 2020, while for 64 (26.3%) there was some improvement. In total, 128 (43.9%) children reported worsened emotional and 118 (40.6%) behavioral symptoms. The COVID-related worry, parental emotional difficulties, and parent-child relationships emerged as the most relevant predictors for higher levels of emotional and behavioral difficulties.

CONCLUSIONS

This study found that the COVID-19 pandemic has considerably changed the daily lives of some children with pre-existing mental health conditions, where almost every second child had deteriorations in overall mental health or worsening of psychiatric symptoms.

Treatment of Attention Deficit - Hyperactivity Disorder in a Pediatric Patient with COVID-19

It is unknown that the novel Coronavirus (COVID 19), which emerged for the first time in December 2019 and spread all over the world, have affected how many children symptomatically or asymptomatically. The uncertainty of the treatment algorithm of pandemic factor and rapidly developing pandemic process created a chaotic environment in whole world. Children and adolescents have been adversely affected by this chaotic environment. Studies examining the effects of this period on the mental health of children and adolescents are scarce. It has been suggested that individuals with psychiatric disorders such as attention deficit-hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) adapted more difficultly and were affected more negatively than other individuals. In this study, we present a patient with ADHD and oppositional defiant disorder (ODD) who was using short-acting methylphenidate (IRIS-MPH) for treatment, had no worsening or any adverse side effects and was treated carefully for COVID 19 infection. However, further studies are required to evaluate the safety of IRIS-MPH and other psychotropic agents in patients with COVID 19.

The year 2021 in COVID-19 pandemic in children

In this article, the developments in the field of COVID-19 pandemic published in the Italian Journal of Pediatrics in 2021 are reflected. We describe progresses in SARS-CoV-2 transmission route, clinical presentation, diagnosis, treatment, and access to health care facilities in children. They led to substantial changes in the clinical approach.

Smartphone Usage and Sleep Quality in Korean Middle School Students During the COVID-19 Pandemic

OBJECTIVE

This study evaluated the quality of sleep and smartphone addiction in Korean adolescents during the coronavirus disease 19 pandemic and analyzed their effects on perceived quality of life.

METHODS

An online survey system provided by the Gwangmyeong City Health Center located in Gyeonggi-do, Korea, was completed by 1,678 local middle school students from April 1 to June 30, 2021. We measured quality of life using the KIDSCREEN-27 health-related quality of life questionnaire, quality of sleep using the Korean version of the Pittsburgh Sleep Quality Index, and smartphone addiction using the Smartphone Addiction Self-Diagnosis Scale. Bed times, wake times, and total sleep hours were also recorded.

RESULTS

Sleep quality and quantity were directly associated with smartphone addiction. The results indicated that lower quality of life was associated with lower sleep quality, delayed onset of sleep, shorter total sleep time, and higher smartphone addiction. Female students reported lower quality of life, lower sleep quality, delayed sleep phases, shorter total sleep hours, and higher smartphone addiction scores than did male students.

CONCLUSION

Our results suggest that adolescents' quality of life is threatened by poor sleep, which in turn could be due to unhealthy smartphone usage. Girls were more heavily affected by this trend than were boys. Preparations to intervene for further mental health issues that might follow are necessary.

Association between Sleep Quality and Depression Symptoms in Chinese College Students during the COVID-19 Lockdown Period

Background: The outbreak of COVID-19 has seriously threatened the health of people around the world. To prevent the spread of the epidemic, Chinese universities have implemented closed management of campuses. The implementation of restrictive measures has gradually caused changes in the quality of sleep and the psychological state of college students. In addition, college students are faced with the dual pressure of employment and study, and the psychological pressure is huge. Therefore, it is necessary to investigate sleep and depressive symptoms among college students. Methods: Using the method of stratified cluster sampling, 6695 college students were selected from three universities in Jiangxi, Anhui, and Xinjiang provinces from April to May 2022. The Chinese version of the Pittsburgh sleep quality index (PSQI) and the self-rating depression scale (SDS) were used for the survey. Hierarchical logistic regression analysis was used to analyze the relationship between the PSQI and the SDS. Results: Overall, during the outbreak of COVID-19, 69.0% of males and 73.5% of females had poor sleep quality among Chinese college students and the detection rate of depressive symptoms was 43.6% for males and 47.8% for females, respectively. Taking students with good sleep quality as references, after controlling for covariates, hierarchical logistic regression shows that Chinese college students with poor sleep quality have a higher OR value (OR = 12.0, 95%CI: 10.2~14.1, p < 0.001), especially in males (OR = 43.8, 95%CI:30.2~63.6, p < 0.001). For both males and females, the OR value of college students with the following characteristics was higher: rural college students (males, OR = 50.32, 95%CI: 32.50−77.93; females, OR = 8.03, 95%CI: 6.45−9.99), overweight college students (males, OR = 62.17, 95%CI: 19.47−198.53; females, OR = 16.67, 95%CI: 6.48−42.88), and college students drinking sugar-sweetened beverages (males, OR = 59.00, 95%CI: 36.96−94.18; females, OR = 8.16, 95%CI: 6.63−10.05) (p < 0.001). Conclusions: Poor sleep quality is associated with depressive symptoms among Chinese college students, especially college males. Our research suggests that it is necessary to consider the improvement of sleep quality and depressive symptoms among college students during the COVID-19 epidemic.

Health Problems of Students during Distance Learning in Central and Eastern Europe: A Cross-Sectional Study of Poland and Ukraine

The COVID-19 pandemic has significantly disrupted the functioning of society. Issues of deteriorating health were among the main problems resulting from restrictions such as self-isolation, social distancing, and remote education. The aim of this research was to attempt to probe the psychophysical condition of students after more than a year of remote education. The survey method (CAPI) was used to collect the data on a representative sample of 1000 students in Poland and 1022 in Ukraine. The research sample was selected in a randomly stratified manner, taking into account such characteristics as: gender, age, and place of residence. The results of the research showed that 44% of Polish and 50% of Ukrainian students experienced health problems. The burden of remote education mainly contributed to the reduction of physical fitness. Young Poles more often paid attention to the deterioration of mental well-being, and Ukrainians to the deterioration of their physical condition. Based on the conducted analyses, it was also established that health problems appeared more often among the females, students with lower social support and with lower trust levels. The main risk factors were Internet addiction, secondary effects of the pandemic, and negative remote education experiences. Research has shown that remote education and problems that arise in students' households during the pandemic may have significantly contributed to the deterioration of their psychophysical condition.

Negative perfectionism and sleep quality in Chinese international students under COVID-19 epidemic: A moderated mediation

Objective

This study used a moderated mediation model to test the mediating effect of anxiety on the relationship between negative perfectionism and sleep quality and the moderating effect of COVID-19 epidemic risk perception during the COVID-19 pandemic in Chinese international students.

Materials and methods

A sample of 239 Chinese international students from the south of China, was surveyed with the Negative and Positive Perfectionism Scale, the Pittsburgh Sleep Quality Index, the General Anxiety Disorder Scale, and the COVID-19 Epidemic Risk Perception Inventory. Version 23.0 of SPSS and version 3.4 of PROCESS were used to perform the correlation analyses, mediation analysis, and moderated mediation analysis.

Results

(1) Negative perfectionism was significantly correlated with anxiety (r = 0.371, p < 0.01) and poor sleep quality (r = 0.291, p < 0.01). Anxiety was significantly correlated with poor sleep quality (r = 0.594, p < 0.01). (2) The mediating effect test showed that anxiety had a mediating effect between negative perfectionism and poor sleep quality (β = 0.157, p < 0.01). (3) Epidemic risk perception moderated the mediating effect of anxiety between negative perfectionism and poor sleep quality (β = 0.070, p < 0.01).

Conclusion

Negative perfectionism affected sleep quality indirectly through anxiety. In particular, COVID-19 epidemic risk perception moderated the relationship between anxiety and sleep quality, such that the association was stronger when the COVID-19 epidemic risk perception was high. These results provide a more comprehensive understanding of the negative link between negative perfectionism and poor sleep quality.

Sleep and Mental Health Among Adolescents During the COVID-19 Pandemic

OBJECTIVE

This study aimed to investigate the association of sleep with mental health among Korean adolescents during the coronavirus disease (COVID-19) pandemic.

METHODS

Using data from the 16th Korea Youth Risk Behavior Web-Based Survey (2020) of 46,475 adolescents, we examined sleep duration and satisfaction and examined mental health for depressive symptoms, anxiety, and suicidal ideation. The data were analyzed using complex sample descriptive statistics and a multiple logistic regression model.

RESULTS

In 2020, the average sleep duration was 6.3 hours, and the sleep satisfaction rate was 30.8%. Depressive symptom and suicidal ideation rates were 24.2 and 10.3, respectively. These values are slightly better than those previously reported, before COVID-19. However, poor sleep was still associated with mental health. The likelihood of mental health problems was higher among those who slept for six hours or less than for those who slept for eight hours or more (p<0.05). Additionally, the results showed that the lower the sleep satisfaction, the higher the likelihood of mental health problems (p<0.05).

CONCLUSION

Even after the COVID-19 outbreak, poor sleep associated with mental health problems remained as high as before the outbreak of COVID-19.

The impact of the COVID-19 pandemic on the mental health of children with psychiatric diagnoses - multidimensional CCPCA Model

BACKGROUND

The study aimed to assess the severity of symptoms of anxiety and depression in children with previously diagnosed psychiatric disorders during the COVID-19 pandemic in Poland.

METHODS

Online questionnaires were used to investigate three groups of subjects: patients with a psychiatric diagnosis, primary school pupils, and children from children's homes. A total of 167 children with their parents or guardians participated in the study. In addition to basic statistics, a multidimensional Centroid Class Principal Component Analysis (CCPCA) model was used.

RESULTS

It was found that the strongest fear of the coronavirus was experienced by children from children's homes, while the most severe depressive symptoms and state anxiety were observed among patients diagnosed with psychiatric disorders. Parental care by assisting with school education and lack of close contact with other people (less than two metres) at parents/guardians' work had the most potent protective effect in reducing the fear of COVID-19.

CONCLUSIONS

There is a need for further research in children and adolescents to develop effective strategies for protecting their mental well-being when faced with social isolation or disease.