Increase of depression among children and adolescents after the onset of the COVID-19 pandemic in Europe: a systematic review and meta-analysis

Changes and relevant factors in depressive and anxiety symptoms among Chinese adolescents after the "Double Reduction" policy: A repeated cross-sectional survey with a nested longitudinal subsample

BACKGROUND

The Chinese government has enacted the "Double Reduction" Policy, which aims to reduce students' academic burden and promote their mental health, but there is limited research examining the policy's impact on students' well-being. This study aims to evaluate changes in students' mental health problems before and after the "Double Reduction" Policy and explore relevant influential factors.

METHODS

A total of 101,976 elementary and junior high school students were recruited before the "Double Reduction" Policy, and 91,832 students were recruited one year later. Through data integration, a total of 36,637 students participated in both web-based surveys and provided complete data on all measures.

RESULTS

As a whole, we found that the prevalence of students' depression (12.1 % to 9.2 %) and anxiety (8.9 % to 6.2 %) tended to decline after the "Double Reduction" Policy. Attending private school, reduced homework, more extracurricular activities, more time with parents, reduced academic stress, and sleep duration ≥8 h/n were associated with the decrease in the likelihood of mental health problems in students. Female gender, negative life events, and negative impact of COVID-19 as risk factors for mental health.

CONCLUSIONS

These findings indicated that the "Double Reduction" Policy has improved the well-being of Chinese students. Reducing students' homework burden and alleviating their academic pressure are beneficial for their mental health. Increasing time for extracurricular activities and interaction with parents, as well as ensuring sufficient sleep for students, are also effective ways to prevent the onset and exacerbation of mental health symptoms in adolescents.

Who accessed STI testing in Britain during the COVID-19 pandemic and how: Findings from Natsal-COVID, a cross-sectional quasi-representative survey

BACKGROUND

During the COVID-19 pandemic, online sexual health service delivery increased across Britain. We investigated inequalities in STI testing access and methods of access during the first year of the pandemic.

METHODS

Natsal-COVID, an online-survey of people 18-59 years in Britain, explored sexual health experiences in the first year of the pandemic. We describe the socio-demographics of participants who used STI testing services and compare those who reported being "online service users", defined as using services with no direct clinician interactions (regardless of whether they also used other methods), with those who were exclusively "other service users", defined as face-to-face, telephone, or video calls.

RESULTS

246/6,064 participants (4.2%) reported STI testing between 03/2020-03/2021. Of those, 35.8% (95%CI 29.2-42.8) used online services. Online service users (compared to other service users) were more often white (74.9% (62.2-84.4) versus 68.5% (59.4-76.3)), less often had anxiety (39.0% (28.4-50.9) versus 57.2% (48.4-65.6)) and less often had disabilities (25.8% (16.8-37.4) versus 48.1% (39.4-56.9)). Among women (only), online users were more often in good health (91.4% (81.3-96.2) versus 69.3% (57.4-79.2)).

CONCLUSIONS

More than one third of STI testers used online services during this period. Differences exist in the characteristics of people accessing online versus other testing services. These data suggest that online services were more likely to be accessed by groups with typically lower risk of poor sexual health (white and in good health). Further investigation is needed, especially if online services are the only option offered, as differences in ability to access services could widen inequalities.

Impact of COVID-19 on referrals to paediatric liaison psychiatry at Children's Health Ireland at Crumlin as the pandemic moved to endemic status

BACKGROUND

Rates of acute mental health presentations in youth were increasing pre-pandemic internationally. Longitudinal studies following COVID-19 attest to ongoing deterioration in youth mental health, recognising adverse unintended consequences following public health restrictions.

AIMS

To examine whether the initial post-COVID-19 increase in mental health presentations persisted following the reclassification of COVID-19 to endemic status, accompanied by the removal of most restrictions.

METHOD

All referrals to paediatric liaison psychiatry (PLP) between January 2018 and December 2022 in a Dublin tertiary children's hospital were included in the study. An interrupted time series analysis with autoregressive integrated moving average models was conducted, examining referrals with respect to different phases of COVID-19 and application of public health restrictions.

RESULTS

Some 1385 referrals to PLP were received over the 5-year study. There was a significant decrease in PLP referrals immediately post-COVID-19, followed by a significant and sustained increase as the pandemic progressed and moved to endemic status. Public health restriction phases had a unique effect on those presenting with suicidal ideation, with a significant increase in the number of referrals. There was no effect of restrictions on other clinical profiles.

CONCLUSIONS

Increased referrals for youth with mental health difficulties, reported during the COVID-19 pandemic, persisted into the early endemic stage, after COVID-19 public health restrictions ceased. Specific impacts of restrictions on suicidal ideation referrals require further study. Investment in child and adolescent mental health services remains a priority, and future pandemic response strategies need to examine unintended consequences of any enforced public health measure.

Clarifying the Links between Perceived Stress and Depressiveness: a Longitudinal Study of COVID-19's Effects on Adolescents in Germany

Young people are navigating an increasingly uncertain and unstable social and economic environment, further complicated by COVID-19. Individual resources and vulnerabilities, such as mental health and sensitivity to stress, play a significant role in how well youth adapt to the career paths and living conditions altered by the pandemic, a dynamic that is not yet well understood. This study examined the role of COVID-19 on the intertwined relation between perceived stress and depressiveness (negative and positive affect) in adolescents, focusing on gender differences. Longitudinal data from 673 German adolescents (Mage = 16.8 years, SDage = 0.91; female = 59%) were collected in three waves, before (T1) and during the pandemic (T2, T3). Using Latent Change Score models, the bidirectional relation between perceived stress and depressiveness was analyzed, considering gender as a moderator. The results showed that adolescents who found their situation stressful were at risk of developing depressiveness at the outbreak of the pandemic and throughout its progression. As the pandemic progressed, an increase in positive affect was linked to heightened perceived stress. Gender-specific differences were particularly evident in the levels of perceived stress and depressiveness, with women being more vulnerable. This study highlights how vulnerabilities in stress perception affect adolescents' mental health, with gender-specific differences underscoring the need for tailored mental health measures.

Symptoms of Depression, Eating Disorders, and Binge Eating in Adolescents With Obesity: The Fast Track to Health Randomized Clinical Trial

Importance

Depression and eating disorders are heightened for adolescents with obesity. Clinical reviews alongside self-report questionnaires are important to ensure appropriate intervention.

Objective

To evaluate changes in self-report symptoms of depression, eating disorders, and binge eating in adolescents with obesity during the Fast Track to Health trial.

Design, Setting, and Participants

This was a randomized clinical trial conducted from 2018 to 2023. It was a multisite trial conducted at children's hospitals in Sydney, New South Wales, and Melbourne, Victoria, Australia, and included adolescents (13-17 years) with obesity (defined as adult equivalent body mass index ≥30; calculated as weight in kilograms divided by height in meters squared) and 1 or more related complications.

Interventions

Duration was 52 weeks including a very low energy diet for 4 weeks followed by intermittent energy restriction (IER) or continuous energy restriction (CER).

Main Outcomes and Measures

Self-report symptoms of depression (Center for Epidemiologic Studies Depression Scale-Revised 10-Item Version for Adolescents [CESDR-10]; scores 0-30), eating disorders (Eating Disorder Examination Questionnaire [EDE-Q]; scores 0-6), and binge eating (Binge Eating Scale [BES]; scores 0-46) were assessed. Adolescents were screened for depression and eating disorders (weeks 0, 4, 16, and 52) and monitored for the onset of new symptoms of disordered eating during dietetic consults.

Results

Of 141 adolescents (median [IQR] age, 14.8 [12.9-17.9] years; 71 male [50.4%]) enrolled, median baseline EDE-Q score was 2.28 (IQR, 1.43-3.14), median baseline CESDR-10 score was 9.00 (IQR, 4.00-14.50), and median baseline BES score was 11.00 (IQR, 5.00-17.00). There were no differences between groups for change in CESDR-10 (mean difference at week 52, 0.75; 95% CI, -1.86 to 3.37), EDE-Q (mean difference at week 52, 0.02; 95% CI, -0.41 to 0.45), or BES (mean difference at week 52, -2.91; 95% CI, -5.87 to 0.05). The within-group reductions at week 4 were maintained at week 52, for CESDR-10 and EDE-Q, indicating reduced symptoms of depression and eating disorders. Within-group reductions on the BES were maintained in the IER group only. Seventeen adolescents (12.1%) required support or referral for depression and/or disordered eating, including 7 (5%; 5 IER, 2 CER) adolescents who experienced the onset or reemergence of symptoms during the intervention.

Conclusions and Relevance

Results suggest that many treatment-seeking adolescents with obesity self-reported symptoms of depression and eating disorders. Although symptoms reduced for most, some required additional support. Obesity treatment is an opportune time to screen and monitor for depression and disordered eating.

Trial Registration

Australian New Zealand Clinical Trials Registry: ACTRN12617001630303.

General practitioner referrals to a child and adolescent mental health service (CAMHS): pre and post COVID-19 pandemic

OBJECTIVES

To compare the characteristics of GP referrals to CAMHS prior to and over the entire pandemic.

METHODS

All accepted referrals to a Dublin-based CAMHS between January 1, 2019, and June 30, 2023, were examined. Referral letters were anonymised in batches, and information was extracted directly onto a designated proforma.

RESULTS

Before the pandemic (January 2019-February 2020), an average of 17.8 referrals were accepted per month, while during and after the pandemic (March 2020-June 2023), this rose to 18.7 accepted referrals per month. Increases were observed in the clinic's prioritisation of cases during the pandemic period (54.8% v. 41%, p < .001).Referrals post COVID-19 were older (13.1-13.64 years, p = .010) with a higher proportion of females (50.2% v. 62.1%, p < .001). Internalising disorders increased during the pandemic (68.7% v. 78.7%, p = .001), with self-harm referrals also being notably more frequent (18.5% v. 36.3%, p < .001). Referrals for anxiety (43.0% v. 78.2%, p = .004) and eating disorders (0% v.. 6.2%, p < .001) increased significantly. Referrals for psychosis (8.4% v. 4.8%, p = .032) and autism spectrum disorder (ASD) (26.5% v. 18.7%, p = .008) decreased after the onset of the pandemic.

CONCLUSIONS

Notable increases in referrals for anxiety, depression, self-harm, and eating disorders underscore the impact of the pandemic on youth mental health. Understanding these shifts is crucial for CAMHS to adapt resources and interventions effectively. Clinicians must remain vigilant in assessing and addressing the evolving mental health needs of youths in the post-COVID era, ensuring timely and appropriate interventions, and resources to mitigate long-term consequences.

Assessment of Children and Adolescents' Admissions to Pediatric Psychiatric Emergency Department

OBJECTIVE

Emergencies in child and adolescent psychiatry are prevalent, and pediatric psychiatric emergency departments play a crucial role in acute intervention during mental health-related crises. This retrospective cross-sectional study aimed to analyze the characteristics of children and adolescents who were admitted to a pediatric psychiatric emergency department.

METHOD

The data were collected from the records of 8803 patients (females 56.6%, Mage = 15.07 ± 2.6) admitted to our pediatric psychiatry emergency department between 2014 and 2021. Diagnoses were made using the International Statistical Classification of Diseases, 10th Revision. We used descriptive statistics to determine patient characteristics and conducted a regression analysis to compare the changes in the admissions numbers by the year.

RESULTS

It was found that depressive disorder was the highest psychiatric diagnosis, with a percentage of 21.4%. Depressive disorder, autism spectrum disorder, and obsessive-compulsive disorder have shown an increase over the years. In 2020, with the onset of the COVID-19 pandemic, psychiatric admissions reached their lowest level. The percentage of hospitalizations was 21.1% for the total of all years. No significant change was found in the total number of admissions, sex, and age.

CONCLUSIONS

The number of admissions for female adolescents who were diagnosed with depressive disorder to our pediatric psychiatry emergency department is shown to be high. The fact that these patients seek help more frequently should be taken into consideration during the planning of mental health services for outpatient and inpatient clinics as well as pediatric psychiatry emergency services.

The impact of the pandemic on psychophysical well-being and quality of learning in the growth of adolescents (aged 11-13): a systematic review of the literature with a PRISMA method

Introduction

This study examines the social impact and psychological effects of the COVID-19 pandemic on the growth of adolescents students, aged 11-13, on well-being and learning.

Methods

Said review, therefore, will consider all the report of scientific works published since 2020 on the following platforms: SCOPUS, PsycoInfo, and Web of Science. Specifically, the research has selected all studies concerning students aged 11-13. Furthermore, the authors have restricted the scope of the study to two fundamental aspects of the above-mentioned subjects, such as their physical and psychological well-being and didactic learning following the COVID-19 pandemic. The justification for choosing such themes lies in the fact that the SARS-CoV-2 pandemic and the ensuing measures adopted to curb its spread have had -and very likely will continue having- sizable repercussions in the life of each individual, especially in students considered, whose psychological and physical well-being has been considerably affected.

Results

In particular, during the peak of the pandemic and its subsequent phases, the various measures issued to limit contagion have completely compromised and disregarded the rights of children and youngsters. Suddenly, leisure, sport, play, relations, and socialization disappeared from their lives. Besides, in the early stages of the pandemic, remote teaching replaced face-to-face teaching, later to become an intermittent system in the red- and orange-labelled areas of the country. Consequently, such measures have severely limited opportunities for learning, growth, curiosity and creating relationships that are typical of both a school and outside environment. Concerning the well-being of the subjects considered, a review of the target literature indicates a wide range of psychological and physical disorders, such as malaise, eating and sleep disorders, addiction to games, internet, alcohol, and drugs. For what regards, instead, the realm of learning, most studies highlight a diminished school performance as the main implication of remote teaching. Furthermore, a remarkable number of studies reveals substantial social inequalities; specifically, students coming from middle class families have managed to maintain higher quality educational standards in a critical context such as the pandemic, while those students coming from socially disadvantaged families have had fewer learning opportunities both in terms of time and range of experiences (due to lack of electronic devices, Internet connectivity, homework, continuity of after-school activities). In summary, if the school system pre-COVID-19 already presented significant limitations in its ability to reduce existing social inequalities, school closures during lockdowns pose enormous challenges in developing effective policies to compensate learning losses and inequalities.

Discussion

Therefore, based on the results shown, the necessity arises of an emergency plan with social and educational objectives to restore those social, emotional, and cognitive abilities that are compromised. In general, it is the responsibility of countries and governments to guarantee the right to education in these difficult times, while avoiding any type of inequalities and establishing a digital learning system, that allows to face situations such as those generated by the Coronavirus, thus preventing those situations of serious anxiety and stress that have affected most subjects.

[Social situation, health, and health behavior of children and adolescents in one-parent households at the end of the COVID-19 pandemic: Results of the KIDA study 2022-2023]

INTRODUCTION

During the COVID-19 pandemic, single parents and their children were particularly exposed to stress due to the containment measures and to limited resources. We analyzed differences in the social and health situation of children and adolescents in one-parent households and two-parent households at the end of the pandemic.

METHODS

The analysis is based on data from the KIDA study, in which parents of 3‑ to 15-year-old children as well as 16- to 17-year-old adolescents were surveyed in 2022/2023 (telephone: n = 6992; online: n = 2896). Prevalences stratified by family type were calculated for the indicators psychosocial stress, social support, health, and health behavior. Poisson regressions were adjusted for gender, age, level of education, and household income.

RESULTS

Children and adolescents from one-parent households are more likely to be burdened by financial restrictions, family conflicts, and poor living conditions and receive less school support than peers from two-parent households. They are more likely to have impairments in health as well as increased healthcare needs, and they use psychosocial services more frequently. Furthermore, they are less likely to be active in sports clubs, but they take part in sporting activities at schools as often as minors from two-parent households. The differences are also evident when controlling for income and education.

DISCUSSION

Children and adolescents from one-parent households can be reached well through exercise programs in a school setting. Low-threshold offers in daycare centers, schools, and the community should therefore be further expanded. Furthermore, interventions are needed to improve the socioeconomic situation of single parents and their children.

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.

Validation and psychometric evaluation of the Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS) among Czech adolescents using Item Response Theory

BACKGROUND

The topic of adolescent mental health is currently a subject of much debate due to the increasing prevalence of mental health problems among this age group. Therefore, it is crucial to have high-quality and validated mental well-being measurement tools. While such tools do exist, they are often not tailored specifically to adolescents and are not available in Czech language. The aim of this study is to validate and test the Czech version of the Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS) on a large sample of Czech adolescents aged 15 to 18 years.

METHODS

The analysis is based on data from the first wave of the Czech Education Panel Survey (CZEPS) and was mainly conducted using Item Response Theory (IRT), which is the most appropriate method for this type of analysis. Specifically, the Graded Response Model (GRM) was applied to the data. This comprehensive validation study also included reliability and three types of validity (construct, convergent and criterion) testing.

RESULTS

The study found that the Czech version of the SWEMWBS for adolescents aged 15 to 18 years (N = 22,498) has good quality and psychometric properties. The data was analysed using the GRM model as it met the assumptions for the use of IRT. The estimated parameter values by GRM demonstrated good discriminant and informative power for all items, except for item 7, which showed poorer results compared to the others. However, excluding it from the scale would not enhance the overall quality of the scale. The five-category response scale functions effectively. Additionally, the results demonstrated high reliability, and all types of validity tested were also confirmed.

CONCLUSIONS

The Czech version of the SWEMWBS for adolescents has been validated as a psychometrically sound, reliable and valid instrument for measuring mental well-being. It can therefore be used with confidence in future studies.

Youth mental health care use during the COVID-19 pandemic in Alberta, Canada: an interrupted time series, population-based study

BACKGROUND

During the COVID-19 pandemic, youth had rising mental health needs and changes in service accessibility. Our study investigated changes in use of mental health care services for Canadian youth in Alberta before and during the COVID-19 pandemic. We also investigated how youth utilization patterns differed for subgroups based on social factors (i.e., age, gender, socioeconomic status, and geography) previously associated with health care access.

METHODS

We used cross-sectional population-based data from Alberta, Canada to understand youth (15-24 year) mental health care use from 2018/19 to 2021/22. We performed interrupted time series design, segmented regression modeling on type of mental health care use (i.e., general physician, psychiatrist, emergency room, and hospitalization) and diagnosis-related use. We also investigated the characteristics of youth who utilized mental health care services and stratified diagnosis-related use patterns by youth subgroups.

RESULTS

The proportion of youth using mental health care significantly increased from 15.6% in 2018/19 to 18.8% in 2021/22. Mental health care use showed an immediate drop in April 2020 when the COVID-19 pandemic was declared and public health protections were instituted, followed by a steady rise during the next 2 years. An increase was significant for general physician and psychiatrist visits. Most individual diagnoses included in this study showed significant increasing trends during the pandemic (i.e., anxiety, adjustment, ADHD, schizophrenia, and self-harm), with substance use showing an overall decrease. Mortality rates greatly increased for youth being seen for mental health reasons from 71 per 100,000 youth in 2018/19 to 163 per 100,000 in 2021/22. In addition, there were clear shifts over time in the characteristics of youth using mental health care services. Specifically, there was increased utilization for women/girls compared to men/boys and for youth from wealthier neighborhoods. Increases over time in the utilization of services for self-harm were limited to younger youth (15-16 year).

CONCLUSIONS

The study provides evidence of shifts in mental health care use during the COVID-19 pandemic. Findings can be used to plan for ongoing mental health needs of youth, future pandemic responses, and other public health emergencies.

It doesn't matter if I feel obliged as long as I enjoy it: The associations between organized leisure-time activities and adolescents' mental health and wellbeing

INTRODUCTION

There is a consensus that adolescents' participation in organized leisure-time activities (OLTAs) is pro-developmental and beneficial for youth mental health. While enjoyment in OLTA is commonly regarded as positive, the role of obligation in the context of adolescents' OLTA has been scarcely researched. The present study investigated how these theoretically contradictory experiences (enjoyment and/or obligation) in OLTA participation relate to adolescents' wellbeing and incidence of psychological complaints accounting for their possible co-occurrence.

METHODS

A nationally representative sample of 14,128 eleven-fifteen-year-old adolescents (49.7% girls) drawn from the Czech 2021/2022 Health Behaviour in School-aged Children cross-sectional study was used. A series of multivariate regression analyses assessed how perceptions of obligation and enjoyment in OLTA related to wellbeing and occurrence of psychological complaints. A person-centered approach derived groups of respondents on the basis of their perceptions of obligation and enjoyment.

RESULTS

Regression analyses, controlled for sociodemographic and family environment factors, and dimensions of OLTA participation, indicated that adolescents enjoying their OLTA displayed more favourable mental wellbeing reports. In contrast, perceptions of obligation were only weakly associated with more frequent psychological complaints and not at all with wellbeing, unless adolescents also reported the lack of enjoyment.

CONCLUSIONS

Enjoyment in OLTA plays a pivotal role in the association between OLTA participation and mental health, whereas the role of obligation is far less pronounced. In fact, if adolescents do not enjoy their participation, but feel obliged to participate, their self-assessed mental wellbeing is comparable to their peers not participating in OLTA at all.

A longitudinal study of child adjustment during the COVID-19 pandemic: the protective role of the parent-child relationship in middle childhood

This longitudinal study assessed how parent-child relationship quality during the first COVID-19 lockdown was related to changes in internalizing, externalizing, and sleep problems during the first months of the pandemic: during lockdown, partial deconfinement, and total deconfinement. Participants included 167 children (9-12 year) and their parents recruited in the province of Quebec, Canada. Child behavior problems decreased between lockdown and the two deconfinement assessments, but more sleep and behavior problems were associated with lower levels of relationship quality (more conflict, less closeness, and more insecure attachment). Significant interaction effects showed that changes in externalizing and sleep problems varied as a function of parent-child relationship. Results support the critical importance of the parent-child relationship with regard to child adjustment in middle childhood in times of crisis such as a pandemic. They also highlight resilience in children aged 9 to 12, with a decrease in problems over time.

Italian university students' future time perspective and well-being during the COVID-19 pandemic

Introduction

During the COVID-19 pandemic, young adults worldwide showed signs of distress as they were affected in their specific developmental tasks, including the construction of personal and professional futures.

Methods

The present study aimed to assess the situational future time perspective of Italian university students during the second pandemic wave, as measured by an ad hoc constructed instrument, to explore its interaction with some dispositional traits relevant in future construction, such as optimism, sense of life, aggression, and dispositional future time perspective, and to test their effect on psychological well-being. The total sample consisted of 389 subjects (18-35 years, M = 23.5, SD = 4.4).

Results and discussion

The results indicated that the pandemic experience, assessed by surveying specific indicators, negatively affected the future time perspective of students, particularly those dispositionally optimistic and convinced that life has meaning. However, awareness of the negative impact that the pandemic brought to the vision of the future seems to have dampened the levels of depression and stress, while anxiety was found to be related only to dispositional traits. The results also suggested the need for educational and economic policies that help young adults develop confidence in the future and in their ability to build it.

Parental Mental Health, Gender, and Lifestyle Effects on Post-Pandemic Child and Adolescent Psychosocial Problems: A Cross-Sectional Survey in Northern Italy

BACKGROUND

The exacerbation of psychosocial problems among children and adolescents during the coronavirus disease 2019 (COVID-19) pandemic necessitates an assessment of the long-term mental health impact of pandemic interventions. Focusing on both pandemic-related factors and demographic variables, such as gender and daily habits, an analysis was conducted to understand how these elements continue to affect young populations in the post-pandemic era.

METHODS

In April 2023, a comprehensive online survey was administered to families in South Tyrol, Italy, with children aged 7-19 years, to ensure age and gender representation. The survey included parent ratings and adolescent (11-19 years) self-reports using standardized instruments to measure the symptoms of mental health problems (Strengths and Difficulties Questionnaire, SDQ), anxiety (Screen for Child Anxiety Related Emotional Disorders, SCARED), and depression (Patient Health Questionnaire-2, PHQ-2). Statistical analyses included descriptive statistics, chi-square tests, and unadjusted odds ratios (ORs).

RESULTS

Of the 4525 valid responses, 1831 were self-reported by adolescents. Notable gender differences in mental health outcomes were identified, along with significant demographic predictors, such as age, single parenthood, parental mental health problems, and immigrant background. Negative effects were associated with reduced family climate and increased screen time, whereas physical activity showed beneficial effects. Proxy reports overestimated adolescents' mental health problems, whereas self-reports tended to underestimate them.

CONCLUSIONS

Persistent mental health problems and gender disparities highlight the need for a public health approach. This should include accessible support services, resilience building, targeted support for vulnerable families and gender-specific interventions.

Anxiety among children a year after the onset of the COVID-19 pandemic: a Brazilian cross-sectional online survey

Aim

This study seeks to build upon a prior investigation into the impact of the COVID-19 pandemic and to evaluate the prevalence of anxiety among Brazilian children, along with its associated factors, one year after the commencement of the pandemic.

Design

A cross-sectional study.

Methods

A survey was conducted from April–May 2021 in Brazil. Children aged 6–12 and their guardians from five Brazilian regions were included. The Children’s Anxiety Questionnaire (CAQ; scores 4–12) and Numerical Rating Scale (NRS; scores 0–10) were used to measure anxiety.

Results

Of the 906 children, 53.3% were girls (average age = 8.79 ± 2.05 years). Mothers responded for 87.1% of the children, and 70.9% were from the Southeast region. Based on a CAQ score of ≥9 and an NRS score of ≥8, the anxiety prevalence was 24.9 and 34.9%, respectively. Using logistic regression, a CAQ ≥9 score was associated with older children and children with chronic disease or disability. An NRS score of ≥8 was associated with reduced family income during the pandemic, the person caring for the children, and with children with chronic disease or disability.

Conclusion

These findings suggest the need to implement public health actions aimed at children with chronic diseases and disabilities and their parents to guide them regarding the warning signs and negative emotions. This study contributes to characterizing the evolution of the pandemic in Brazil and provides a basis for comparison with the literature from other countries.

Caregiver and Child Mental Health During 3 Years of the COVID-19 Pandemic

BACKGROUND AND OBJECTIVES

Coronavirus disease 2019 (COVID-19) lockdowns (stay-at-home orders) had significant mental health consequences in 2020 to 2021 for caregivers and children. Little is known about "postlockdown" periods in 2022 to 2023. We investigated the mental health experiences of Australian families throughout the 3 years of the COVID-19 pandemic (2020-2023), by demographic characteristics and lockdown length.

METHODS

A total N = 12 408 caregivers (N = 20 339 children, aged 0-17 years) completed Australia's only representative, repeated, cross-sectional, National Child Health Poll across 6 waves (June 2020-April 2023). Caregivers reported mental health for themselves (Kessler-6, poor versus not) and each child (self-rated mental health, poor/fair versus good/very good/excellent), and perceived impacts of the pandemic on own/child mental health (negative versus none/positive). Binary logistic models were fitted to predict marginal probabilities of each mental health measure by state/territory group (proxy for lockdown length), over time, adjusted for potential demographic confounders.

RESULTS

Poor caregiver Kessler-6 was similar between genders but more common for sole caregivers, and those with a home language other than English and lower education. Poor/fair child self-rated mental health was similar between genders and increased with child age. Perceived negative impacts were more common for females and socially advantaged caregivers. Overall, negative mental health experiences increased with lockdown length, peaking with the height of lockdown in July 2021, before declining.

CONCLUSIONS

Negative mental health experiences of Australian caregivers and children decreased during postlockdown periods of 2022-2023; however, social gradients persisted. These data can inform more precise mental health policies that enable better use of limited mental health infrastructure.

An integrative literature review of birth cohort and time period trends in adolescent depression in the United States

PURPOSE

The aim of this literature review is to examine evidence of time trends and birth cohort effects in depressive disorders and symptoms among US adolescents in peer-reviewed articles from January 2004 to April 2022.

METHODS

We conducted an integrative systematic literature review. Three reviewers participated at different stages of article review. Of the 2234 articles identified in three databases (Pubmed, ProQuest Central, Ebscohost), 10 met inclusion criteria (i.e., adolescent aged United States populations, included information about birth cohort and survey year, focused on depressive symptoms/disorders).

RESULTS

All 10 articles observed increases in depressive symptoms and disorders in adolescents across recent survey years with increases observed between 1991 and 2020. Of the 3 articles that assessed birth cohort trends, birth cohort trends were less prominent than time period trends. Proposed explanations for increases included social media, economic-related reasons, changes in mental health screening and diagnosis, declining mental health stigma, increased treatment, and, in more recent years, the COVID-19 pandemic.

CONCLUSIONS

Multiple cross-sectional surveys and cohort studies documented rising prevalence of depressive symptoms and disorder among adolescents from 1991 to 2020. Mechanisms driving this increase are still unknown. Research to identify these mechanisms is needed to inform depression screening and intervention efforts for adolescents.

Associations of evening-type and insomnia symptoms with depressive symptoms among youths

BACKGROUND

Evening-type and insomnia symptoms are significantly related to each other and independently associated with depressive symptoms, yet few studies have examined the potential interaction between these two conditions. Therefore, we aimed to examine the associations of evening-type and insomnia symptoms with depressive symptoms among Chinese youths, with a specific focus on the joint effects of the two conditions on depressive symptoms.

METHODS

Participants aged between 12 and 25 were invited to participate in an online survey from December 15, 2022, to May 26, 2023. Multivariate logistic regression models and additive interaction models were used to examine the independent and joint effects of chronotypes and insomnia symptoms on depressive symptoms, respectively.

RESULTS

Of the 6145 eligible youths, the prevalence of evening-type and insomnia symptoms were 24.9 % and 29.6 %, respectively. Both evening-type (adjusted OR, [AdjOR]: 3.21, 95 % CI: 2.80-3.67) and insomnia symptoms (AdjOR: 10.53, 95 % CI: 9.14-12.12) were associated with an increased risk of depressive symptoms. In addition, the additive interaction models showed that there is an enhanced risk of depression related to interaction between evening-type and insomnia symptoms (relative excess risk due to interaction, [RERI]: 11.66, 95 % CI: 7.21-16.11).

CONCLUSIONS

The present study provided additional evidence demonstrating the presence of interaction between evening-type and insomnia symptoms, which can lead to a higher risk of depressive symptoms. Our findings argue the need for addressing both sleep and circadian factors in the management of depressive symptoms in young people.

Assessing the impact of physical activity on reducing depressive symptoms: a rapid review

CONTEXT

The prevalence of depression among teenagers is a significant issue worldwide, which calls for a thorough investigation of non-drug treatments. This expedited evaluation examines 24 specifically chosen studies to clarify the correlation between physical activity depression symptoms in teenagers, undertaken following PRISMA principles.

METHODS

A wide range of research methods, including longitudinal studies, surveys, and cross-sectional analyses, were used in different nations to understand the intricate relationship between physical activity, sedentary behaviours, and depression symptoms. The data-gathering methods included standardised questionnaires, accelerometer measurements, and self-report instruments.

FINDINGS

The review highlights the crucial significance of engaging in physical activity to alleviate depression symptoms. Improved self-esteem consistently acts as a crucial intermediary between participation in physical activity and decreased rates of depression. Engaging in physical activity is a safeguard, particularly for individuals with restricted access to physical activity. In contrast, a sedentary lifestyle greatly increases the probability of developing moderate to severe symptoms of depression. Gender differences are apparent, with females being disproportionately impacted by depression. There are strong connections between engaging in physical activity and reducing symptoms of depression, which can be observed in various situations, such as participating in team sports or engaging in leisure activities.

CONCLUSION

This study provides insight into the potential of physical activity as a non-pharmacological approach to address adolescent depression. This highlights the significant impact of physical activity, which has important implications for public health programs aimed at improving the mental well-being of adolescents by promoting physical activity. It is crucial to do additional research that considers gender-specific variations and various physical activity circumstances to enhance our comprehension of this important matter.

Sex Differences in Adolescent Depression Trajectory Before and Into the Second Year of COVID-19 Pandemic

OBJECTIVE

Evidence on the impact of the COVID-19 pandemic on adolescent mental health is mixed and does not disentangle natural age-related changes. We compared depressive symptoms among 16-year-olds surveyed, at a fourth wave, before or during the pandemic, while accounting for expected trajectories of within-person change based on 3 prior waves.

METHOD

In this longitudinal cohort of 3,171 adolescents in Tokyo, Japan, adolescents were grouped based on their age 16 survey timing: pre-pandemic (February 2019 to February 2020) and during-pandemic (March 2020 to September 2021). Depressive symptoms were self-reported using the Short Mood and Feelings Questionnaire. Mixed-effect models were fitted to assess group differences while controlling for previous trends. Variations by sex, household income, and pandemic phase (early, late first-year, and second-year) were examined.

RESULTS

Of 2,034 eligible adolescents, 960 (455 girls) were assessed before and 1,074 (515 girls) during the pandemic. Overall, depressive symptoms increased by 0.80 points (95% CI 0.28-1.31, 0.15 SD of the population average). This increase varied by sex and pandemic phase. For boys the increase emerged in the late first-year phase and enlarged in the second-year phase (mean difference from pre-pandemic: 1.69, 0.14-3.24), whereas for girls it decreased in the early school-closure phase (mean difference: -1.98, -3.54 to -0.41) and returned to the pre-pandemic level thereafter, with no additional increases during the pandemic.

CONCLUSION

Into the second year of the COVID-19 pandemic, depressive symptoms of 16-year-olds worsened above the expected age-related change only in boys. Continuous monitoring and preventive approaches for adolescents at the population level are warranted.

DIVERSITY & INCLUSION STATEMENT

We worked to ensure that the study questionnaires were prepared in an inclusive way. We worked to ensure sex and gender balance in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote sex and gender balance in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

[How can we ensure the future care for children and adolescents with mental disorders?]

The interdisciplinary care of children and adolescents with mental disorders requires services from various German codes of social law and-within the medical care system-enclosing inpatient and outpatient services. The increasing demand, the increase in severity of disorders, and the general shortage of staff in social services put pressure on the structures of the interdisciplinary service networks resulting in long waiting periods, long distances, and regionally insufficient care. The medical field of child and adolescent psychiatry and psychotherapy (CAPP) plays the central and coordinating role within the cooperative care for children and adolescents with mental disorders. The CAPP is in clear need of reforms; however, these are markedly different from the reform needs of the German somatic medical care system and differ substantially from those of the (adult) psychiatry, psychotherapy, and psychosomatics disciplines. This discussion paper describes the reform requirements, the specifics of the CAPP structures, and suggestions to overcome sectors of service provision, enhance networking, intensify telemedicine, and develop evidence-based prevention and early recognition of child mental disorders.

Self-concept mediates the relationships between childhood traumatic experiences and adolescent depression in both clinical and community samples

BACKGROUND

Childhood trauma is a pivotal risk factor for adolescent depression. While the association between childhood trauma and depression is well-established, the mediating role of self-concept has not been acknowledged. Specifically, limited attention has been paid to how childhood maltreatment impacts adolescent depression through physical and social self-concept, both in clinical and community samples. This study aims to investigate how distinct and cumulative childhood trauma affects adolescent depression, as well as the potential mediating role of self-concept in their relationships.

METHODS

We recruited 227 depressed adolescents (dataset 1, 45 males, age = 15.34 ± 1.96) and 574 community adolescents (dataset 2, 107 males, age = 16.79 ± 0.65). Each participant was assessed on five subtypes of childhood trauma severity, cumulative trauma index, physical and social self-concept, and depression. Mediation models were tested separately in the clinical and community samples.

RESULTS

Clinically depressed adolescents experienced a higher level of trauma severity, a greater number of trauma subtypes, and had lower levels of physical and social self-concept compared to community adolescents. Analyses on childhood trauma severity and cumulative trauma index jointly indicated that physical and social self-concept played mediation roles in the relationships between childhood trauma experiences and depression. Moreover, the mediating effects of self-concept were stronger in depressed adolescents when compared to community samples.

CONCLUSIONS

Our findings suggest that physical and social self-concept play mediating roles in the pathway linking childhood trauma and adolescent depression, particularly in clinically depressed individuals.

The impact of COVID-19 on young people's mental health, wellbeing and routine from a European perspective: A co-produced qualitative systematic review

BACKGROUND

The impact of the Covid-19 pandemic on young people's (YP) mental health has been mixed. Systematic reviews to date have focused predominantly on quantitative studies and lacked involvement from YP with lived experience of mental health difficulties. Therefore, our primary aim was to conduct a qualitative systematic review to examine the perceived impact of the Covid-19 pandemic on YP's (aged 10-24) mental health and wellbeing across Europe.

METHODS AND FINDINGS

We searched MEDLINE, PsycINFO, Embase, Web of Science, MEDRXIV, OSF preprints, Google, and voluntary sector websites for studies published from 1st January 2020 to 15th November 2022. European studies were included if they reported qualitative data that could be extracted on YP's (aged 10-24) own perspectives of their experiences of Covid-19 and related disruptions to their mental health and wellbeing. Screening, data extraction and appraisal was conducted independently in duplicate by researchers and YP with lived experience of mental health difficulties (co-researchers). Confidence was assessed using the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) approach. We co-produced an adapted narrative thematic synthesis with co-researchers. This study is registered with PROSPERO, CRD42021251578. We found 82 publications and included 77 unique studies in our narrative synthesis. Most studies were from the UK (n = 50; 65%); and generated data during the first Covid-19 wave (March-May 2020; n = 33; 43%). Across the 79,491 participants, views, and experiences of YP minoritised by ethnicity and sexual orientation, and from marginalised or vulnerable YP were limited. Five synthesised themes were identified: negative impact of pandemic information and restrictions on wellbeing; education and learning on wellbeing; social connection to prevent loneliness and disconnection; emotional, lifestyle and behavioural changes; and mental health support. YP's mental health and wellbeing across Europe were reported to have fluctuated during the pandemic. Challenges were similar but coping strategies to manage the impact of these challenges on mental health varied across person, study, and country. Short-term impacts were related to the consequences of changing restrictions on social connection, day-to-day lifestyle, and education set-up. However, YP identified potential issues in these areas going forward, and therefore stressed the importance of ongoing long-term support in education, learning and mental health post-Covid-19.

CONCLUSIONS

Our findings map onto the complex picture seen from quantitative systematic reviews regarding the impact of Covid-19 on YP's mental health. The comparatively little qualitative data found in our review means there is an urgent need for more high-quality qualitative research outside of the UK and/or about the experiences of minoritised groups to ensure all voices are heard and everyone is getting the support they need following the pandemic. YP's voices need to be prioritised in decision-making processes on education, self-care strategies, and mental health and wellbeing, to drive impactful, meaningful policy changes in anticipation of a future systemic crisis.

Evidence linking COVID-19 and the health/well-being of children and adolescents: an umbrella review

BACKGROUND

Experiences during childhood and adolescence have enduring impacts on physical and mental well-being, overall quality of life, and socioeconomic status throughout one's lifetime. This underscores the importance of prioritizing the health of children and adolescents to establish an impactful healthcare system that benefits both individuals and society. It is crucial for healthcare providers and policymakers to examine the relationship between COVID-19 and the health of children and adolescents, as this understanding will guide the creation of interventions and policies for the long-term management of the virus.

METHODS

In this umbrella review (PROSPERO ID: CRD42023401106), systematic reviews were identified from the Cochrane Database of Systematic Reviews; EMBASE (OvidSP); and MEDLINE (OvidSP) from December 2019 to February 2023. Pairwise and single-arm meta-analyses were extracted from the included systematic reviews. The methodological quality appraisal was completed using the AMSTAR-2 tool. Single-arm meta-analyses were re-presented under six domains associated with COVID-19 condition. Pairwise meta-analyses were classified into five domains according to the evidence classification criteria. Rosenberg's FSN was calculated for both binary and continuous measures.

RESULTS

We identified 1551 single-arm and 301 pairwise meta-analyses from 124 systematic reviews that met our predefined criteria for inclusion. The focus of the meta-analytical evidence was predominantly on the physical outcomes of COVID-19, encompassing both single-arm and pairwise study designs. However, the quality of evidence and methodological rigor were suboptimal. Based on the evidence gathered from single-arm meta-analyses, we constructed an illustrative representation of the disease severity, clinical manifestations, laboratory and radiological findings, treatments, and outcomes from 2020 to 2022. Additionally, we discovered 17 instances of strong or highly suggestive pairwise meta-analytical evidence concerning long-COVID, pediatric comorbidity, COVID-19 vaccines, mental health, and depression.

CONCLUSIONS

The findings of our study advocate for the implementation of surveillance systems to track health consequences associated with COVID-19 and the establishment of multidisciplinary collaborative rehabilitation programs for affected younger populations. In future research endeavors, it is important to prioritize the investigation of non-physical outcomes to bridge the gap between research findings and clinical application in this field.

Effects of exercise therapy on anxiety and depression in patients with COVID-19: a systematic review and meta-analysis

Objective

With increasing rates of anxiety and depression during COVID-19, exercise treatment has drawn attention for its effects on COVID-19 patients with anxiety and depression. This study set out to assess the impact of exercise therapy on COVID-19 patients' anxiety and depression.

Methods

PubMed, EMBASE, Web of Science and Cochrane Library were used to search articles about exercise therapy as a means of treating anxiety and depression in COVID-19 patients from inception to April 30, 2023. The risk of bias was assessed by the Cochrane Collaboration bias risk tool. Data were pooled with the random effects model. RevMan version 5.4 was used for the statistical analyses. This work was registered in the PROSPERO database (registration number: CRD42023406439).

Selection criteria

Randomized clinical trials (RCTs) of COVID-19 patients with anxiety and depression were included to assess the impact of physical exercise on COVID-19 patients with anxiety and depression.

Results

6 studies including a total of 461 COVID-19 patients were analyzed in this meta-analysis. Overall, the meta-analysis showed that compared with the control group, exercise could significantly improve anxiety (SMD = -0.76; 95%CI: -0.96, -0.55; p < 0.00001), depression level (SMD = -0.39; 95%CI: -0.70, -0.09; p = 0.01), the PHQ-9 score (MD = -1.82; 95%CI: -2.93, -0.71; p = 0.001) and the sleep quality (SMD = -0.73; 95%CI: -1.32, -0.14; p = 0.01) in COVID-19 patients.

Conclusion

The research provided evidence that exercise therapy is able to help COVID-19 patients experience less anxiety and depression and have better-quality sleep.

Systematic review registration

CRD42023406439.

Genetics, epigenetics, and neurobiology of childhood-onset depression: an umbrella review

Depression is a serious and persistent psychiatric disorder that commonly first manifests during childhood. Depression that starts in childhood is increasing in frequency, likely due both to evolutionary trends and to increased recognition of the disorder. In this umbrella review, we systematically searched the extant literature for genetic, epigenetic, and neurobiological factors that contribute to a childhood onset of depression. We searched PubMed, EMBASE, OVID/PsychInfo, and Google Scholar with the following inclusion criteria: (1) systematic review or meta-analysis from a peer-reviewed journal; (2) inclusion of a measure assessing early age of onset of depression; and (3) assessment of neurobiological, genetic, environmental, and epigenetic predictors of early onset depression. Findings from 89 systematic reviews of moderate to high quality suggest that childhood-onset depressive disorders have neurobiological, genetic, environmental, and epigenetic roots consistent with a diathesis-stress theory of depression. This review identified key putative markers that may be targeted for personalized clinical decision-making and provide important insights concerning candidate mechanisms that might underpin the early onset of depression.

The relationship between cognitive and affective control and adolescent mental health

Background

Cognitive control problems have been implicated in the etiology and maintenance of mental health problems, including depression, in adults. Studies in adolescents have been more equivocal, with some showing changes in cognitive control in adolescents with mental health problems, whereas others fail to show an association. This study examines whether adolescent mental health is associated with affective control, the application of cognitive control in affective contexts, which shows more protracted development than cognitive control.

Methods

The present study investigated the association of cognitive and affective control with depressive symptomatology and self-reported diagnostic history of mental health problems in adolescents. The study included 1929 participants (M age = 13.89) from the Future Proofing Study (N = 6,388, 11-16 years), who completed affective (incl., affective stimuli) and/or cognitive (incl., neutral stimuli) versions of a working memory (backward digit-span) and/or shifting (card-sorting) task at least once within 3 weeks of assessing mental health.

Results

Poorer working memory was associated with greater depressive symptomatology in adolescents (β = -0.06, p = .004), similarly across cognitive and affective control conditions (β = -0.02, p = .269). Adolescents with self-reported diagnostic history of mental health problems had significantly poorer shifting ability in affective compared to cognitive control conditions (b = 0.05, p = .010), whereas for adolescents with no self-reported diagnoses, shifting ability did not differ between conditions (b = -0.00, p = .649).

Conclusions

The present analyses suggest that working memory difficulties, in particular, may be associated with the experience of current depressed mood in adolescents. Problems with affective shifting may be implicated in a range of mental health problems in adolescents. Given the ubiquitous need for efficient cognitive functioning in daily life, enhancing cognitive and affective control in adolescents may be a promising means of improving functioning across a range of domains, including affective functioning, and by extension, adolescent mental health.

Fertility Declines Near the End of the COVID-19 Pandemic: Evidence of the 2022 Birth Declines in Germany and Sweden

Following the onset of the COVID-19 pandemic, many countries faced short-term fertility declines in 2020-2021, a development which did not materialize in the majority of German-speaking and Nordic countries. However, more recent birth statistics show a steep fertility decline in 2022. We aim to provide empirical evidence on the unexpected birth decline in 2022 in Germany and Sweden. We rely on monthly birth statistics and present seasonally adjusted monthly Total Fertility Rates (TFR) for Germany and Sweden. We relate the nine-month lagged fertility rates to contextual developments regarding COVID-19. The seasonally adjusted monthly TFR of Germany dropped from 1.5-1.6 in 2021 to 1.4 in early 2022 and again in autumn 2022, a decline of about 10% in several months. In Sweden, the corresponding TFR dropped from about 1.7 in 2021 to 1.5-1.6 in 2022, a decline of almost 10%. There is no association of the fertility trends with changes in unemployment, infection rates, or COVID-19 deaths, but a strong association with the onset of vaccination programmes and the weakening of pandemic-related restrictions. The fertility decline in 2022 in Germany and Sweden is remarkable. Common explanations of fertility change during the pandemic do not apply. The association between the onset of mass vaccinations and subsequent fertility decline indicates that women adjusted their behaviour to get vaccinated before becoming pregnant. Fertility decreased as societies were opening up with more normalized life conditions. We provide novel information on fertility declines and the COVID-19-fertility nexus during and in the immediate aftermath of the pandemic.

Evaluation of a web-based information platform on youth depression and mental health in parents of adolescents with a history of depression

Research shows the important role of parents' mental health literacy in detecting depressive symptoms and supporting their children to seek professional help. Improving mental health literacy in parents has recently gained even greater importance due to the negative impact of the COVID-19 pandemic on children and adolescents' mental health. The aim of the present experimental pre-post-follow-up study was to examine knowledge change after the reception of contents from an innovative web-based platform ( www.ich-bin-alles.de/eltern ) containing evidence-based information on youth depression and mental health in parents of adolescents with a history of depression. A second aim was to assess evaluation of the layout and the acceptance of the platform. N = 33 parents of adolescents with a history of depression (either current or remitted depression) were presented different content domains of the website. Participants' knowledge about depression was assessed at pre- and post-intervention, and at a four week follow-up. Moreover, parents evaluated the acceptance and the layout of the website. The trial was preregistered at clinicaltrials.gov (NCT05335564). The results showed a significant increase in total knowledge from pre to post, which remained stable over the course of four weeks. Explorative analyses showed that sociodemographic variables did not influence the extent of knowledge gain. Acceptance rates were high and evaluations of the website's layout were positive. The findings show that the web-based information portal is a promising and appealing means to increase parental knowledge on youth depression. Low-threshold psychoeducational approaches like websites are particularly relevant in times of crisis and increased prevalence rates of depressive symptoms and disorders (ehealth). These results are an important basis for future studies as well as approaches that aim to impart knowledge about mental disorders like youth depression via web-based means. Furthermore, they bear implications for policy decisions concerning mental health education and campaigns.

Mental health and quality of life in children and adolescents during the COVID-19 pandemic: a systematic review of longitudinal studies

Background

The COVID-19 pandemic has significantly impacted the mental health of children and families, i.e., due to measures like social distancing and remote schooling. While previous research has shown negative effects on mental health and health-related quality of life (HRQoL), most studies have focused on pre-post comparisons in the early pandemic stages. This systematic review aims to examine longitudinal studies to understand the long-term impacts of the pandemic on children and adolescents.

Methods

This systematic review adhered to the PRISMA guidelines and was preregistered in the international prospective register of systematic reviews (Record ID: CRD42022336930). We systematically searched PubMed/MEDLINE, Web of Science, PsycINFO, PSYNDEX, and the WHO-COVID-19 database and included studies published up to August 30, 2022. Based on pre-defined eligibility criteria, longitudinal and prospective studies that assessed the mental health or quality of life of children or adolescents (0-19 years) in the general population over a longer time span (at two or more measurement points) during the COVID-19 pandemic were included in the review. The methodological quality of the included studies was assessed using an adapted version of the Effective Public Health Practice Project (EPHPP) checklist. Narrative data synthesis was used to summarize the findings.

Results

A total of 5,099 results were obtained from literature searches, with 4,935 excluded during title/abstract screening. After reviewing 163 full-text articles, 24 publications were included in the review. Sample sizes ranged between n = 86 and n = 34,038. The length of the investigated time periods and the number of assessment points, as well as outcomes, varied. The majority of studies were of moderate methodological quality. Mental health outcomes were more frequently studied compared to measures of HRQoL. The findings from these studies mostly suggest that children and adolescents experienced heightened mental health problems, specifically internalizing symptoms like anxiety and depression. Further, there was a decline in their overall HRQoL over the course of the COVID-19 pandemic that did not necessarily subside when lockdowns ended.

Conclusion

It is crucial to continue monitoring the mental health and well-being of children and adolescents following the pandemic to identify groups at risks and plan interventions. This should ideally be conducted by large systematic studies, using validated instruments, and encompassing representative samples to obtain reliable and comprehensive insights with the aim of improving youth mental health care.

Prevalence of depression, anxiety in China during the COVID-19 pandemic: an updated systematic review and meta-analysis

Background

Mental health risks associated with the aftermath of the COVID-19 pandemic are often overlooked by the public. The aim of this study was to investigate the effects of the COVID-19 pandemic on depression and anxiety disorders in China.

Methods

Studies were analyzed and extracted in accordance with the PRISMA 2020 flowchart. The studies were screened and extracted using electronic databases including PubMed, Web of Science, Embase, Cochrane Library, and ClinicalTrials.gov according to the predefined eligibility criteria. The Cochrane Review Manager software 5.3.1 was used for data analysis and the risk of bias assessment.

Results

As of 2023, a total of 9,212,751 Chinese have been diagnosed with COVID-19 infection. A total of 913,036 participants in 44 studies were selected following the eligibility criteria, the statistical information of which was collected for meta-analysis. The pooled prevalence of depression and anxiety were 0.31 (95% CI: 0.28, 0.35; I2 = 100.0%, p < 0.001) and 0.29 (95% CI: 0.23, 0.36; I2 = 100.0%, p < 0.001), respectively. After performing a subgroup analysis, the prevalence of depression among women, healthcare workers, students, and adolescents was 0.31 (95% CI: 0.22, 0.41), 0.33 (95% CI: 0.26, 0.44), 0.32 (95% CI: 0.26, 0.39), and 0.37 (95% CI: 0.31, 0.44), respectively.

Conclusion

The prevalence of depression and anxiety among the Chinese was overall high. Monitoring and surveillance of the mental health status of the population during crises such as sudden global pandemics are imperative.

Systematic review registration

https://clinicaltrials.gov/, identifier [CRD42023402190].

How the COVID-19 pandemic and related school closures reduce physical activity among children and adolescents in the WHO European Region: a systematic review and meta-analysis

BACKGROUND

Emerging research suggests that physical activity among children and adolescents decreased during the COVID-19 pandemic. However, a differentiated overview of European youth is lacking. In particular, no systematic analysis has been conducted to date on the impact of heterogeneous pandemic restrictions and school closures within European countries, and with regard to potentially vulnerable groups.

METHODS

We searched seven databases and included studies for children and adolescents (≤ 19 years) of the WHO European Region that compared physical activity during the COVID-19 pandemic with a pre-pandemic baseline using validated measurement instruments. We used the Oxford Stringency Index and School Closure Index as indicators of restriction stringency. Screening for eligibility, data extraction, assessment of the study risk of bias (using the 'Risk of Bias in Non-randomized Studies - of Exposure' [ROBINS-E]) and certainty grading of evidence (using the GRADE approach), were all done in duplicate. Unpublished data was requested from study authors. Data were pooled in random effects models. An a priori protocol was published, reporting is carried out in accordance with the 'Preferred Reporting Items for Systematic Review and Meta-Analyses' (PRISMA) statement.

RESULTS

Of 14,897 non-duplicate records, 26 publications (n = 15,038 pre-pandemic, n = 13,041 during pandemic) met full inclusion criteria. Comparison before and during the COVID-19 pandemic revealed a significant reduction in total physical activity (standardized mean difference [SMD], -0.57 [95%CI, -0.95; -0.20]) and moderate-to-vigorous physical activity (SMD, -0.43 [95% CI, -0.75; -0.10]), corresponding to a decrease of 12 min per day (a 20% reduction of the WHO recommendation). A decrease in sporting activity was also recorded. Subgroup analyses suggested that middle childhood (aged 8-12) and adolescents were particularly affected by the decline. School closures were associated with a reduction in physical activity. The certainty of evidence for all outcomes was low.

CONCLUSIONS

A sharp decline in all forms of physical activity was recorded among European children and adolescents during the COVID-19 pandemic. This decline was higher during periods of school closure and mainly affected younger schoolchildren and adolescents. Immediate action by policy-makers and practitioners, as well as evidence-based public health strategies, are imperative in reversing this trend.

TRIAL REGISTRATION

PROSPERO: CRD42023395871.

Cross-sectional analysis reveals COVID-19 pandemic community lockdown was linked to dysregulated cortisol and salivary alpha amylase in children

The COVID-19 pandemic altered everyday life starting in March 2020. These alterations extended to the lives of children as their normal routines were disrupted by community lockdowns, online learning, limited in-person social contact, increased screen time, and reduced physical activity. Considerable research has investigated the physical health impact of COVID-19 infection, but far fewer studies have investigated the physiological impact of stressful pandemic-related changes to daily life, especially in children. The purpose of this study was to leverage an ongoing clinical trial to investigate physiological consequences associated with chronic stress of pandemic community lockdown on children. As a part of the clinical trial, children provided saliva samples. Saliva samples were analyzed for cortisol and salivary alpha amylase (sAA) content. This secondary cross-sectional analysis included 94 preadolescent children located within the Greater Boston, Massachusetts community. Children participated in the study either before, during, or following the pandemic community lockdown to form three groups for comparison. In response to chronic stress caused by the pandemic community lockdown, participants demonstrated dysregulation of fast-acting catecholamine response of the locus-coeruleus-norepinephrine system and slower-acting glucocorticoid response, resulting in an asymmetrical relationship of hypocortisolism (M = 0.78 ± 0.19 μg/mL, p < 0.001) paired with higher sAA (M = 12.73 ± 4.06 U/mL, p = 0.01). Results suggest that the abrupt COVID-19 disruption to daily life, including the stressful experience of community lockdown, had physiological effects on typically developing children. Further research is required to investigate mental health outcomes of children following the chronic stress of the pandemic community lockdown.

Evaluating Spatial, Cause-Specific and Seasonal Effects of Excess Mortality Associated with the COVID-19 Pandemic: The Case of Germany, 2020

BACKGROUND

Evaluating mortality effects of the COVID-19 pandemic using all-cause mortality data for national populations is inevitably associated with the risk of masking important subnational differentials and hampering targeted health policies. This study aims at assessing simultaneously cause-specific, spatial and seasonal mortality effects attributable to the pandemic in Germany in 2020.

METHODS

Our analyses rely on official cause-of-death statistics consisting of 5.65 million individual death records reported for the German population during 2015-2020. We conduct differential mortality analyses by age, sex, cause, month and district (N = 400), using decomposition and standardisation methods, comparing each strata of the mortality level observed in 2020 with its expected value, as well as spatial regression to explore the association of excess mortality with pre-pandemic indicators.

RESULTS

The spatial analyses of excess mortality reveal a very heterogenous pattern, even within federal states. The coastal areas in the north were least affected, while the south of eastern Germany experienced the highest levels. Excess mortality in the most affected districts, with standardised mortality ratios reaching up to 20%, is driven widely by older ages and deaths reported in December, particularly from COVID-19 but also from cardiovascular and mental/nervous diseases.

CONCLUSIONS

Our results suggest that increased psychosocial stress influenced the outcome of excess mortality in the most affected areas during the second lockdown, thus hinting at possible adverse effects of strict policy measures. It is essential to accelerate the collection of detailed mortality data to provide policymakers earlier with relevant information in times of crisis.

Pediatric Mental Health Emergencies During 5 COVID-19 Waves in New York City

OBJECTIVES

To describe the proportion of pediatric mental health emergency department (MH-ED) visits across 5 COVID-19 waves in New York City (NYC) and to examine the relationship between MH-ED visits, COVID-19 prevalence, and societal restrictions.

METHODS

We conducted a time-series analysis of MH-ED visits among patients ages 5 to 17 years using the INSIGHT Clinical Research Network, a database from 5 medical centers in NYC from January 1, 2016, to June 12, 2022. We estimated seasonally adjusted changes in MH-ED visit rates during the COVID-19 pandemic, compared with predicted prepandemic levels, specific to each COVID-19 wave and stratified by mental health diagnoses and sociodemographic characteristics. We estimated associations between MH-ED visit rates, COVID-19 prevalence, and societal restrictions measured by the Stringency Index.

RESULTS

Of 686 500 ED visits in the cohort, 27 168 (4.0%) were MH-ED visits. The proportion of MH-ED visits was higher during each COVID-19 wave compared with predicted prepandemic trends. Increased MH-ED visits were seen for eating disorders across all waves; anxiety disorders in all except wave 3; depressive disorders and suicidality/self-harm in wave 2; and substance use disorders in waves 2, 4, and 5. MH-ED visits were increased from expected among female, adolescent, Asian race, high Child Opportunity Index patients. There was no association between MH-ED visits and NYC COVID-19 prevalence or NY State Stringency Index.

CONCLUSIONS

The proportion of pediatric MH-ED visits during the COVID-19 pandemic was higher during each wave compared with the predicted prepandemic period, with varied increases among diagnostic and sociodemographic subgroups. Enhanced pediatric mental health resources are essential to address these findings.

Changes in anxiety and depression during the COVID-19 pandemic in the European population: A meta-analysis of changes and associations with restriction policies

BACKGROUND

Early studies of common mental disorders (CMDs) during the COVID-19 pandemic mainly report increases; however, more recent findings have been mixed. Also, studies assessing the effects of restriction measures on CMDs show varied results. The aim of this meta-analysis was to assess changes in levels of CMDs from pre-/early to during the pandemic and the effects of restriction policies in the European population.

METHODS

We searched for studies assessing both pre-pandemic and peri-pandemic self-reported emotional distress and symptoms of depression or anxiety among nationally/regionally representative samples in Europe and collected microdata from those studies. Estimates of corona containment index were related to changes in CMDs using random-effects meta-regression.

RESULTS

Our search strategy resulted in findings from 15 datasets drawn from 8 European countries being included in the meta-analysis. There was no evidence of change in the prevalence of emotional distress, anxiety, or depression from before to during the pandemic; but from early pandemic periods to later periods, there were significant decreases in emotional distress and anxiety. Increased school restrictions and social distancing were associated with small increases in self-reported emotional distress.

CONCLUSIONS

Despite initial concerns of increased emotional distress and mental illness due to the COVID-19 pandemic, the results from this meta-analysis indicate that there was a decrease in emotional distress and no change in anxiety or depression in the general population in Europe. Overall, our findings support the importance of strong governance when implementing periodic and robust restriction measures to combat the spread of COVID-19.

Physical activity and physical fitness among children and adolescents after the onset of the COVID-19 pandemic in the WHO European Region: a systematic review protocol

INTRODUCTION

The implementation of COVID-19 pandemic-related restrictions resulted in limitations for physical activity (PA) opportunities, which may have initiated a longer-term behavioural change. The protocol describes the methodology for a planned systematic review that aims to summarise changes in PA and physical fitness (PF) in children and adolescents in the WHO European Region after the onset of the COVID-19 pandemic.

METHODS AND ANALYSIS

The protocol adheres to the 'Preferred Reporting Items for Systematic Review and Meta-Analysis for Protocols' (PRISMA-P) statement. Using a peer-reviewed search strategy according to the evidence-based checklist 'Peer Review of Electronic Search Strategies' (PRESS), we will perform a systematic literature search in seven databases. Inclusion criteria are all primary studies that gathered data on children and adolescents ≤19 years living in the WHO European Region and made a comparison to pre-pandemic data. Primary outcomes are PA and PF. We will assess the risk of bias with the 'Risk of Bias Instrument for Non-Randomized Studies of Exposures' (ROBINS-E). The 'Grading of Recommendations Assessment, Development and Evaluation' (GRADE) approach will be used for the evaluation of the certainty of evidence. Also, subgroup analyses will be performed (eg, for gender, age, stringency of pandemic restrictions).

ETHICS AND DISSEMINATION

Ethical approval is not required, as primary data will not be collected in this study. The results will be presented in a peer-reviewed publication and at congresses relevant to the research field.

PROSPERO REGISTRATION NUMBER

CRD42023395871.

Longitudinal Covid-19 effects on child mental health: vulnerability and age dependent trajectories

BACKGROUND

Few longitudinal studies have investigated the extended long-term impact of the Covid-19 pandemic for children's and adolescents' mental health, and a lack of uniform findings suggest heterogeneity in the impact of the pandemic.

METHODS

This study investigated child and adolescent mental health symptoms across four occasions (pre-pandemic, initial lockdown, second lockdown, and society post reopening) using data from the Dynamics of Family Conflict study. Child and adolescent depressive vulnerability, age, and sex were explored as trajectory moderators. Children and adolescents (N = 381, Mage = 13.65, SD = 1.74) self-reported their anxiety, depression, and externalizing symptoms. Mixed effects analyses were performed to investigate trajectories across measurement occasions and interaction terms between occasion and moderator variables were included to better understand the heterogeneity in the impact of the pandemic.

RESULTS

Children and adolescents reported increases in anxiety symptoms at the second lockdown (t(523) = -3.66, p < .01) and when society had reopened (t(522) = -4.90, p < .001). An increase in depression symptoms was seen when society had reopened relative to the three previous measurement occasions (ps < 0.01). Depressive vulnerability moderated the trajectory for anxiety symptoms (F(3,498) = 3.05, p = .028), while age moderated the trajectory for depression symptoms (F(3,532) = 2.97, p = .031).

CONCLUSION

The delayed and negative impact on children's and adolescents' mental health underscores the need for continued monitoring, and implementation of support systems to help and mitigate further deterioration.

Adolescent Mental Health during the COVID-19 Pandemic: The Interplay of Age, Gender, and Mental Health Outcomes in Two Consecutive Cross-Sectional Surveys in Northern Italy

The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on the mental health and well-being of adolescents. This study aimed to investigate the development of health-related quality of life (HRQoL) and mental health among adolescents in Northern Italy by comparing cross-sectional surveys conducted in 2021 and 2022, with a particular focus on the influence of age and gender. The sample included adolescents aged 11-19 years from public schools in South Tyrol. Validated psychometric instruments were used to assess HRQoL, anxiety and depression symptoms, and psychosomatic complaints. Sociodemographic variables, COVID-19 burden, and pandemic-related factors were measured. Statistical analyses included chi-square tests, correlation coefficients, and logistic regression analyses. The results indicated that while the self-reported burden of adolescents decreased significantly in 2022 (n = 1885) compared to 2021 (n = 1760), there were no significant differences in symptoms of anxiety, depressive symptoms, low HRQoL, and increased psychosomatic complaints between the two surveys for both early and late adolescents. Females consistently had higher percentages for all outcome variables, and symptoms of anxiety increased with age in females, but not in males. Both genders experienced an increase in depressive symptoms and low HRQoL with age. The co-occurrence of mental health outcomes was observed, suggesting overlapping patterns among anxiety, depression, low HRQoL, and psychosomatic complaints. These findings underscore the intricate relationship between age, gender, and mental health outcomes among adolescents during the pandemic. It is important to recognize that late adolescents may exhibit distinct vulnerabilities and may require tailored support approaches to address their specific mental health challenges, differing from those needed for early adolescents.

Anxiety increased among children and adolescents during pandemic-related school closures in Europe: a systematic review and meta-analysis

BACKGROUND

Considering the heterogenous evidence, a systematic review of the change in anxiety in European children and adolescents associated with the COVID-19 pandemic is lacking. We therefore assessed the change compared with pre-pandemic baselines stratified by gender and age as well as evaluated the impact of country-specific restriction policies.

METHODS

A registration on the 'International Prospective Register of Systematic Reviews' (PROSPERO) occurred and an a priori protocol was published. We searched six databases (PubMed, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, WHO COVID-19) using a peer-reviewed search string with citation tracking and grey literature screening. Primary outcomes were: (1) general anxiety symptoms; and (2) clinically relevant anxiety rates. We used the Oxford COVID-19 Stringency Index as an indicator of pandemic-related restrictions. Screening of title/abstract and full text as well as assessing risk of bias (using the 'Risk of Bias in Non-randomized Studies of Exposure' [ROBINS-E]) and certainty of evidence (using the 'Grading of Recommendations Assessment, Development and Evaluation' [GRADE]) was done in duplicate. We pooled data using a random effects model. Reporting is in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement.

RESULTS

Of 7,422 non-duplicate records, 18 studies with data from 752,532 pre-pandemic and 763,582 pandemic participants met full inclusion criteria. For general anxiety symptoms the total change effect estimate yielded a standardised mean difference (SMD) of 0.34 (95% confidence interval [CI], 0.17-0.51) and for clinically relevant anxiety rates we observed an odds ratio of 1.08 (95%-CI, 0.98-1.19). Increase in general anxiety symptoms was highest in the 11-15 years age group. Effect estimates were higher when pandemic-related restrictions were more stringent (Oxford Stringency Index > 60: SMD, 0.52 [95%-CI, 0.30-0.73]) and when school closures (School Closure Index ≥ 2: SMD, 0.44 [95%-CI, 0.23-0.65]) occurred.

CONCLUSION

General anxiety symptoms among children and adolescents in Europe increased in a pre/during comparison of the COVID-19 pandemic; particularly for males aged 11-15 years. In periods of stringent pandemic-related restrictions and/or school closures a considerable increase in general anxiety symptoms could be documented. PROSPERO registration: CRD42022303714.

Evolution of Youth's Mental Health and Quality of Life during the COVID-19 Pandemic in South Tyrol, Italy: Comparison of Two Representative Surveys

BACKGROUND

The coronavirus disease 2019 pandemic has led to an increase in youth mental health problems worldwide. Studies have revealed substantial variation in the incidence of these problems across different regions. Longitudinal studies of children and adolescents in Italy are lacking. This study aimed to investigate the development of health-related quality of life (HRQoL) and mental health in Northern Italy by comparing surveys conducted in June 2021 and in March 2022.

METHODS

A representative, large cross-sectional, online survey investigated HRQoL, psychosomatic complaints, and symptoms of anxiety and depression among 5159 and 6675 children and adolescents in 2021 and 2022, respectively, using the KIDSCREEN-10 index, HBSC symptom checklist, SCARED, CES-DC, and PHQ-2 instruments. Statistical analyses included a multivariate linear regression analysis.

RESULTS

Baseline characteristics showed significant differences in demographic variables between the two surveys. Girls and their parents reported a significantly lower HRQoL in 2021 than in 2022. Psychosomatic complaints differed significantly between sexes, and the results showed no decrease in psychosomatic complaints, anxiety, or depression between 2021 and 2022. Predictors of HRQoL, anxiety, depressive symptoms, and psychosomatic complaints in 2022 differed from those in 2021.

CONCLUSIONS

The characteristics of the 2021 pandemic, including lockdowns and home schooling, may have contributed to the differences between the two surveys. As most pandemic restrictions ended in 2022, the results confirm the need for measures to improve the mental and physical health of children and adolescents after the pandemic.

COVID-19, Wellness and Life Satisfaction in Adolescence: Individual and Contextual Issues

During and in the aftermath of the COVID-19 pandemic, several works reflected on young people's physical and psychological health. The Dual Factor Model, which we refer to as the quadripartite model, is useful for understanding children's and adolescents' psychological health and differentiating them regarding their attitude toward the effects of the COVID-19 pandemic. In this investigation, students from the fifth to twelfth year of schooling enrolled in the DGEEC study "Psychological Health and Wellbeing in Portuguese schools" were considered. Four groups were created based on life satisfaction (low or high) and psychological distress (with or without symptoms). The study included 4444 students (M = 13.39 years ± 2.41), of whom 47.8% were male. Of the participants, 27.2% were in the second cycle of primary education, and 72.8% were in lower and upper secondary education. Differences in gender and education level (as a proxy for age) were observed. Additionally, when considering students' perceptions of changes in their lives following the COVID-19 pandemic (stayed the same, became worse, became better), these three groups were compared concerning personal and contextual variables, revealing significant differences at both the individual and contextual levels. Finally, the study discusses the influence of education and health professionals and the need for friendly public policies.

Anxiety among children and adolescents during the COVID-19 pandemic in Europe: a systematic review protocol

BACKGROUND

A growing number of studies point to a high mental health burden among children and adolescents during the COVID-19 pandemic, particularly concerning anxiety. However, the study quality and effect direction are heterogeneous in the existing primary studies with a lacking overview for the European continent. Therefore, this systematic review aims to critically synthesise the evidence regarding the impact of the COVID-19 pandemic on anxiety among children and adolescents in Europe compared to a pre-pandemic baseline.

METHODS

A systematic literature search will be performed in six databases (MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, and WHO COVID-19 database) with a peer reviewed search strategy according to the evidence-based checklist Peer Review of Electronic Search Strategies (PRESS). Inclusion criteria are children and adolescents ≤ 19 years living in Europe and data report during the COVID-19 pandemic with an appropriate pre-pandemic baseline. Primary outcomes are general anxiety symptoms and clinically relevant anxiety rates. Risk of bias will be assessed using the 'Risk of Bias in Non-randomised Studies of Exposure' (ROBINS-E). Data extraction will systematically include information on study design, population characteristics, COVID-19 determinants, pre-pandemic baseline, diagnostic instruments and outcome. The certainty of evidence for each outcome will be evaluated by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach adapted to the use of non-randomised studies. All process steps will be performed independently by two reviewers; any discrepancies will be discussed and, if necessary, resolved by a third author. Also, subgroup analysis, sensitivity analysis, publication bias analysis, and meta-regression analysis, if applicable, will be performed. The systematic review was registered in the Prospective Register of Systematic Reviews (PROSPERO) and the protocol was prepared in accordance to the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) statement.

DISCUSSION

This systematic review will address the lack of a critical and comprehensive summary of findings on the COVID-19 pandemic impact on anxiety among children and adolescents in Europe. In addition, it aims to identify pandemic-policy differences, such as the effect of school-closures, and identify particularly vulnerable risk groups.

SYSTEMATIC REVIEW REGISTRATION

CRD42022303714 (PROSPERO).