Commentary: The impact of Covid-19 on psychopathology in children and young people worldwide - reflections on Newlove-Delgado et al. (2023)

Changes in child and adolescent mental health across the COVID-19 pandemic (2018-2023): Insights from general population and clinical samples in the Netherlands

Background

The COVID-19 pandemic negatively affected child and adolescent mental health and at the end of the pandemic (April 2022) child mental health had not returned to pre-pandemic levels. We investigated whether this observed increase in mental health problems has continued, halted, or reversed after the end of the pandemic in children from the general population and in children in psychiatric care.

Methods

We collected parent-reported and child-reported data at two additional post-pandemic time points (November/December 2022 and March/April 2023) in children (8-18 years) from two general population samples (N = 818-1056 per measurement) and one clinical sample receiving psychiatric care (N = 320-370) and compared these with data from before the pandemic. We collected parent-reported data on internalizing and externalizing problems with the Brief Problem Monitor and self-reported data on Anxiety, Depressive symptoms, Sleep-related impairments, Anger, Global health, and Peer relations with the Patient-Reported Outcomes Measurement Information System (PROMIS®).

Results

In the general population, parents reported no changes in externalizing problems but did report higher internalizing problems post-pandemic than pre-pandemic (p < 0.001). Children also reported increased mental health problems post-pandemic, especially in anxiety and depression, to a lesser extent in sleep-related impairment and global health, and least in anger (all ps < 0.01). In the clinical sample, parents reported higher internalizing (p < 0.001), but not externalizing problems post-pandemic compared to the start of the pandemic. Children reported greatest increases in problems in anxiety, depression, and global health, to a lesser extent on sleep-related impairment, and least on anger (all ps < 0.05).

Conclusions

Child mental health problems in the general population are substantially higher post-pandemic compared to pre-pandemic measurements. In children in psychiatric care mental health problems have increased during the pandemic and are substantially higher post-pandemic than at the start of the pandemic. Longitudinal and comparative studies are needed to assess what the most important drivers of these changes are.

The effect of dispositional resilience on the relationship between professional quality of life and psychological distress factors of nurses during the pandemic: A three-wave longitudinal study

BACKGROUND

COVID-19 overwhelmed all healthcare workers, especially nurses, who worked tirelessly in patient care in extremely stressful situations. Italy, with its hospital overcrowding and staff shortages, exacerbated these negative consequences.

DESIGN

A three-wave prospective longitudinal-design was adopted to use validated scales to examine the trend of stress, anxiety, depression and resilience on the professional quality of life of nurses who worked during the pandemic. During an 8-month period, a sample of 411 individuals was recruited and surveyed three times.

RESULTS

Resilience showed an increasing positive trend from the first to the third wave, increasing its effects on the outcomes and demonstrating its important protective role. The compassion fatigue showed progressively higher scores in the three waves, indicating greater workload perception and greater difficulty in managing the patients' perceived stress. Burnout increased in the first compared to second waves but decreased significantly in the third wave, due to the effect of resilience on burnout that was significantly stronger in the third wave.

CONCLUSION

Our findings align with the literature about the role of resilience and emphasize the importance of investing in strategies aimed at developing resilience in healthcare workers and providing prevention and assistance to them in terms of job demands and unsustainable stressors.

Mental health during the COVID-19 pandemic in children and adolescents with ADHD: A systematic review of controlled longitudinal cohort studies

Prior studies reported mixed effects of the COVID-19 pandemic on the mental health of children and adolescents with ADHD, but they were mainly cross-sectional and without controls. To clarify the impact, we searched Web of Science, EMBASE, Medline, and PsychINFO until 18/11/2023 and conducted a systematic review of controlled longitudinal cohort studies (Prospero: CRD42022308166). The Newcastle-Ottawa scale was used to assess quality. We identified 6 studies. Worsening of mental health symptoms was more evident in ADHD or control group according to symptom considered and context. However, those with ADHD had more persistent elevated symptoms and remained an at-risk population. Sleep problems deteriorated more significantly in those with ADHD. Lower pre-COVID emotion regulation skills and greater rumination were associated with worse mental health outcomes, and longer screen time with poorer sleep. Quality was rated as low in most studies, mainly due to self-report outcome measures and no information on attrition rates. Despite these limitations, results suggest a predominantly negative impact on youths with ADHD and may guide clinical practice and policy.

Long-term central nervous system (CNS) consequences of COVID-19 in children

INTRODUCTION

Neurological/neuropsychiatric symptoms are commonly reported by children/young people with long COVID, especially headache, fatigue, cognitive deficits, anosmia and ageusia, dizziness, mood symptoms, and sleep problems. However, reported prevalence estimates are highly variable due to study heterogeneity and often small sample size; most studies only considered short-term follow-ups; and, apart from mood and sleep problems, neuropsychiatric conditions have received less attention. Considering the potential debilitating effects of neurological/neuropsychiatric conditions, a comprehensive review of the topic is timely, and needed to support clinical recognition as well as to set the direction for future research.

AREAS COVERED

The authors discuss neurological/neuropsychiatric manifestations of long COVID in pediatric populations, with a focus on prevalence, associated demographic characteristics, and potential pathogenetic mechanisms.

EXPERT OPINION

Children/young people may develop persistent neurological/neuropsychiatric symptoms following acute SARS-CoV-2 infection, which may affect daily functioning and well-being. Studies in larger samples with longer follow-ups are needed to clarify prevalence and symptom duration; as well as less investigated risk factors, including genetic predisposition, ethnicity, and comorbidities. Controlled studies may help separate infection-related direct effects from pandemic-related psychosocial stressors. Clarifying pathogenetic mechanisms is paramount to develop more targeted and effective treatments; whilst screening programs and psychoeducation may enhance early recognition.

Editorial: Unsettling 'settled' science - the importance of questioning received wisdom about the causes of mental health and neuro-developmental conditions

The papers included in this year's Annual Research Review represent a heterogenous mix of concerns, zooming out, in some cases, to summarize the state of the science for a particular condition or developmental process and zooming in, in other cases, to identify effects of specific (and timely) risk factors for child and adolescent mental health. These papers highlight where the field has made significant strides in advancing our understanding of etiology or mechanisms of change or stability and they highlight how much is left to learn about the causes of psychopathology and the conditions under which developmental trajectories are maintained or disrupted.