The Prevalence of Mental Problems for Chinese Children and Adolescents During COVID-19 in China: A Systematic Review and Meta-Analysis

Investigating psychometric properties of short versions of the depressive experiences questionnaire: Findings from a representative large sample of Chinese adolescents

BACKGROUND

Adolescence involves a period of swift change, including the development of personality vulnerabilities (i.e., dependency and self-criticism) that act as transdiagnostic factors to psychopathology. Over the past several decades, numerous short revisions have condensed the Depressive Experiences Questionnaire (DEQ) into more efficient measures of personality vulnerability. Prior research has investigated the psychometric properties of the short DEQs in adult and clinical samples. However, there has been insufficient exploration within adolescents, who are in addition marked by fluctuating personality vulnerabilities.

METHOD

A representative large sample of adolescents and emerging adults in China aged 10 to 25 (N = 23,953) was administered five short DEQs, including the Revised DEQ (RevDEQ), Reconstructed DEQ (RecDEQ), Theoretical DEQ-21/12 (TDEQ-21/12) and adolescent DEQ (DEQ-A). The data was evaluated for internal consistency and criterion-related validity, while factor structure and measurement invariances across gender and age groups were analyzed by confirmatory factor analysis (CFA). A subset of the original sample (N = 2874) was retested after six months and analyzed for test-retest reliability and cross-time invariance.

RESULT

CFA of the TDEQ-21/12 and RecDEQ supported the intended two-factor model. Good criterion-related validity, internal consistency and test-retest reliability for these three versions were found. Satisfying measurement invariances across gender, time, and age groups were established.

LIMITATION

The study's scope was confined to non-clinical adolescent populations within China, highlighting a gap in cross-cultural and clinical applicability.

CONCLUSION

The present study supports the use of the TDEQ-21/12 and RecDEQ as valid and concise instruments for measuring Chinese adolescent personality vulnerability.

Sleep disturbance and internalizing symptoms in adolescents: a moderated mediation model of self-control and mindfulness

OBJECTIVES

Despite accumulating evidence regarding the impact of sleep disturbance on internalizing symptoms among adolescents, the underlying psychological mechanisms remain inadequately explored. This study aimed to investigate a conceptual framework elucidating how sleep disturbance influences internalizing symptoms in adolescents through the mediating role of self-control, with mindfulness as a moderator.

METHODS

In this cross-sectional study, 1876 Chinese adolescents (Mage = 14.88 years, SD = 1.47 years, range = 12-19 years, 44.7% boys) completed the Youth Self-Rating Insomnia Scale (YSIS), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Brief Self-control Scale (BSCS), and Mindful Attention Awareness Scale-Children (MAAS-C) to provide data on sleep-related variables, internalizing symptoms (anxiety and depression), self-control, and mindfulness, respectively. The PROCESS macro for SPSS was applied to perform moderated mediation analysis.

RESULTS

Sleep disturbance demonstrated a significant positive correlation with internalizing symptoms in adolescents, including anxiety (β = 0.481, p < 0.001) and depression (β = 0.543, p < 0.001). Self-control served as a mediator between sleep disturbance and two forms of internalizing symptoms. Moreover, mindfulness moderated the pathways from self-control to internalizing symptoms (for anxiety symptoms: β = 0.007, p < 0.001; for depression symptoms: β = 0.006, p < 0.001), and the mediating relationships were weaker for adolescents exhibiting higher levels of mindfulness.

CONCLUSIONS

Our findings enhance understanding of the impact, pathways, and influencing factors of sleep disturbance on adolescent internalizing symptoms, suggesting the importance of enhancing mindfulness levels in addressing self-control deficits and subsequently reducing internalizing symptoms among adolescents.

Mental health among children with and without reading difficulties

This study explored the relationship between mental health, i.e., depression and anxiety, and reading difficulties (RD) in Chinese elementary school children. Participants were 1535 grades 3, 4, and 5 students from three elementary schools in Xi'an, China. Children with and without RD were compared to their depression and anxiety. Additionally, children's self-ratings, parents' ratings, and teachers' ratings of depression and anxiety were compared to better understand mental health issues of Chinese children with RD. The findings showed that Chinese children with RD experienced more depression but not anxiety compared to their typically developing peers across all three grade levels. Reports from all three informants consistently reflected that children with RD experienced more depression. However, some inconsistencies were found between self-reported levels of depression and anxiety and the observations made by parents and teachers. Children reported experiencing more depression than their parents and teachers observed but less anxiety than their parents reported. This study emphasizes the importance of understanding the links between RD and mental health and the need for appropriate intervention programs to help children with RD cope with the mental health challenges.

[Emotional well-being, perceptions and attitudes against COVID-19 on adolescents]

INTRODUCTION

The worldwide pandemic of SARS-Cov2 has had a great impact on the lives of adolescents, affecting their health and well-being. There is little evidence of the emotional impact of the pandemic on adolescents.

OBJECTIVE

To explore the knowledge, perceptions, and attitudes of young people regarding COVID-19 and its impact on emotional well-being.

METHOD

A cross-sectional observational and descriptive study based on a survey of students aged 16-20 from five high schools in Barcelona metropolitan area.

RESULTS

The study was carried out on 291 surveys. Females made up 56.7% of the population. The average age was 16.9 years. A greater lack of knowledge about the transmission of the disease was detected. The most frequently used sources of information were social networks. In terms of emotional distress, the most important aspects were worry about getting sick (64%), family financial problems (46%), anxiety and irritability (27%), and apathy (26.5%). Gender differences were detected in terms of worries (women: 28.8%; men: 11.1%), sadness (women: 29.3%, men: 15.5%), and feelings of fear (women: 24.5%; men: 11%). 16.7% of the participants consulted a mental health professional, with this being more common in women (women: 23.8%; men: 7.4%).

CONCLUSIONS

COVID-19 has affected the emotional well-being of adolescents, especially the female population. It is necessary to implement emotional well-being strategies in early childhood to cope with possible stressful situations in daily life and avoid future mental health problems. There is a growing use of social media to combat social isolation. The results of the study hold the potential to strategies aimed at preempting forthcoming biopsychosocial distress.

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.

Depression, anxiety, stress symptoms and their determinants among secondary students with vision impairment in rural Northwestern China during the COVID-19 pandemic

Objective

The measures implemented to control the spread of Coronavirus disease 2019 (COVID-19) could affect children's mental and vision health. Youth particularly from minority and socioeconomically disadvantaged backgrounds were more likely to be impacted by these measures. This study aimed to examine the mental health of children with vision impairment and associated factors in North-western China during the COVID-19 pandemic.

Methods

A cross-sectional study was conducted among 2,036 secondary school children living in Ningxia Hui Autonomous Region. Participants completed a survey on sociodemographic and lifestyle information and answered the Chinese version of the 21-item Depression Anxiety Stress Scales (DASS-21) questionnaire. Presenting visual acuity was measured by a trained enumerator. Multivariate logistic regression analysis was used to identify potential risk factors for mental health problems.

Results

Responses from 1,992 (97.8%) children were included in the analysis after excluding those with incomplete mental health outcome data. The prevalence of depression, anxiety and stress symptoms within the dataset were 28.9, 46.4, and 22.3%, respectively. The distribution of children with different stress levels differed significantly between those with and without vision impairment (p = 0.03). Multivariable logistic regression analyses revealed that depression symptoms decreased with higher parental education (OR, 0.76, 95% confidence intervals (CI):0.63-0.96), longer sleep duration (OR, 0.90, 95% CI: 0.81-0.97) and longer study time (OR, 0.82, 95% CI: 0.74-0.91), whereas they increased with higher recreational screen time (OR, 1.19, 95% CI: 1.08-1.32). Anxiety symptoms decreased with higher parental education (OR, 0.80, 95% CI: 0.66-0.96) and increased with higher recreational screen time (OR, 1.15, 95% CI: 1.04-1.27) and being a left-behind child (OR, 1.26, 95% CI: 1.04-1.54). In addition, stress symptoms decreased with longer sleep duration (OR, 0.92, 95%CI: 0.85-0.99) and increased with higher number of siblings (OR, 1.10, 95% CI: 1.01-1.19), higher recreational screen time (OR, 1.15, 95% CI: 1.04-1.28) and older age (OR,1.12, 95% CI: 1.004-1.24).

Conclusion

A considerable proportion of our sample experienced mental health problems during the pandemic. Healthcare planners in China should consider interventions such as reducing recreational screen time, ensuring sufficient sleep, and timely detection of mental health symptoms among socioeconomically disadvantaged groups.

Impact of COVID-19 on the mental health of children and young people: an umbrella review

BACKGROUND

Over the past 3 years, a multitude of studies have highlighted the impact of the COVID-19 pandemic on the mental health of children and young people (CYP). In this umbrella review, we synthesise global evidence on the impact of COVID-19 on the mental health of CYP from existing systematic reviews with and/or without meta-analysis.

METHODS

Adopting the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we evaluated 349 citations and identified 24 eligible reviews with medium to high methodological quality to be reviewed narratively.

RESULTS

Most of the reviews reported a high prevalence of anxiety disorders, depression, suicidal behaviour, eating disorders and other mental health problems. Most studies that used data at multiple time points indicate a significant increase in mental health problems in CYP, particularly in females and older adolescents.

CONCLUSIONS

Multipronged psychosocial care services, policies and programmes are needed to alleviate the burden of mental health problems in CYP as a consequence of the COVID-19 pandemic and associated global health measures.

PROSPERO REGISTRATION NUMBER

CRD42021276312.

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.

The Mediating Role of Callous-Unemotional Traits in the Relationship between Parental Aggression and Behavioral Problems among Chinese Preschoolers

It is well known that aggressive parenting is associated with behavioral problems among Western children in their early childhood, but this has rarely been examined among Chinese preschoolers. The purpose of this study is to explore the relationship between aggressive parenting, callous-unemotional traits (CU traits), and behavioral problems among a large Chinese preschool sample. Data were collected in Wuhu city, China, from 1879 preschoolers (54% of whom were male) with a mean age of 65.66 months (standard deviation = 9.41). Parents provided information about the frequency of aggressive parenting, children's behaviors, and demographic characteristics via an online questionnaire. Mediation models were applied to analyze the associations between aggressive parenting, CU traits, and behavioral problems. Preschoolers' age, gender, and family socioeconomic status were considered as covariates. The findings of our study revealed that higher frequencies of parental psychological and physical aggression were associated with high levels of CU traits, which were related to increased levels of preschoolers' behavioral problems. This study extends previous studies by revealing a positive relationship between aggressive parenting and behavioral problems among Chinese preschoolers via CU traits and highlights the risks of aggressive parenting. Interventions for improving parenting strategies and lessening callous-unemotional traits should be developed to help reduce behavioral problems.

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 and common mental health symptoms in the early phase of the pandemic: An umbrella review of the evidence

BACKGROUND

There remains uncertainty about the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on mental health. This umbrella review provides a comprehensive overview of the association between the pandemic and common mental disorders. We qualitatively summarized evidence from reviews with meta-analyses of individual study-data in the general population, healthcare workers, and specific at-risk populations.

METHODS AND FINDINGS

A systematic search was carried out in 5 databases for peer-reviewed systematic reviews with meta-analyses of prevalence of depression, anxiety, and post-traumatic stress disorder (PTSD) symptoms during the pandemic published between December 31, 2019 until August 12, 2022. We identified 123 reviews of which 7 provided standardized mean differences (SMDs) either from longitudinal pre- to during pandemic study-data or from cross-sectional study-data compared to matched pre-pandemic data. Methodological quality rated with the Assessment of Multiple Systematic Reviews checklist scores (AMSTAR 2) instrument was generally low to moderate. Small but significant increases of depression, anxiety, and/or general mental health symptoms were reported in the general population, in people with preexisting physical health conditions, and in children (3 reviews; SMDs ranged from 0.11 to 0.28). Mental health and depression symptoms significantly increased during periods of social restrictions (1 review; SMDs of 0.41 and 0.83, respectively) but anxiety symptoms did not (SMD: 0.26). Increases of depression symptoms were generally larger and longer-lasting during the pandemic (3 reviews; SMDs depression ranged from 0.16 to 0.23) than those of anxiety (2 reviews: SMDs 0.12 and 0.18). Females showed a significantly larger increase in anxiety symptoms than males (1 review: SMD 0.15). In healthcare workers, people with preexisting mental disorders, any patient group, children and adolescents, and in students, no significant differences from pre- to during pandemic were found (2 reviews; SMD's ranging from -0.16 to 0.48). In 116 reviews pooled cross-sectional prevalence rates of depression, anxiety, and PTSD symptoms ranged from 9% to 48% across populations. Although heterogeneity between studies was high and largely unexplained, assessment tools and cut-offs used, age, sex or gender, and COVID-19 exposure factors were found to be moderators in some reviews. The major limitations are the inability to quantify and explain the high heterogeneity across reviews included and the shortage of within-person data from multiple longitudinal studies.

CONCLUSIONS

A small but consistent deterioration of mental health and particularly depression during early pandemic and during social restrictions has been found in the general population and in people with chronic somatic disorders. Also, associations between mental health and the pandemic were stronger in females and younger age groups than in others. Explanatory individual-level, COVID-19 exposure, and time-course factors were scarce and showed inconsistencies across reviews. For policy and research, repeated assessments of mental health in population panels including vulnerable individuals are recommended to respond to current and future health crises.

School closures during COVID-19: an overview of systematic reviews

OBJECTIVES

To assess the benefits and drawbacks of school closures and in-school mitigations during the COVID-19 pandemic.

DESIGN

Overview of systematic reviews (SRs).

SEARCH METHODS

We searched six databases and additional resources on 29 July 2022: MEDLINE, Embase, Google Scholar, Cochrane Library, COVID-END inventory of evidence synthesis, and Epistemonikos.

ELIGIBILITY CRITERIA

We selected SRs written in English that answered at least one of four specific questions concerning the efficacy and drawbacks of school closures. Their primary studies were conducted in primary and secondary schools, including pupils aged 5-18. Interventions included school closures or mitigations (such as mask usage) introduced in schools.

DATA COLLECTION AND ANALYSIS

We used AMSTAR 2 to assess confidence in the included SRs, and GRADE was used to assess certainty of evidence. We performed a narrative synthesis of the results, prioritising higher-quality SRs, those which performed GRADE assessments and those with more unique primary studies. We also assessed the overlap between primary studies included in the SRs.

MAIN OUTCOME MEASURES

Our framework for summarising outcome data was guided by the following questions: (1) What is the impact of school closures on COVID-19 transmission, morbidity or mortality in the community? (2) What is the impact of COVID-19 school closures on mental health (eg, anxiety), physical health (eg, obesity, domestic violence, sleep) and learning/achievement of primary and secondary pupils? (3) What is the impact of mitigations in schools on COVID-19 transmission, morbidity or mortality in the community? and (4) What is the impact of COVID-19 mitigations in schools on mental health, physical health and learning/achievement of primary and secondary pupils?

RESULTS

We identified 578 reports, 26 of which were included. One SR was of high confidence, 0 moderate, 10 low and 15 critically low confidence. We identified 132 unique primary studies on the effects of school closures on transmission/morbidity/mortality, 123 on learning, 164 on mental health, 22 on physical health, 16 on sleep, 7 on domestic violence and 69 on effects of in-school mitigations on transmission/morbidity/mortality.Both school closures and in-school mitigations were associated with reduced COVID-19 transmission, morbidity and mortality in the community. School closures were also associated with reduced learning, increased anxiety and increased obesity in pupils. We found no SRs that assessed potential drawbacks of in-school mitigations on pupils. The certainty of evidence according to GRADE was mostly very low.

CONCLUSIONS

School closures during COVID-19 had both positive and negative impacts. We found a large number of SRs and primary studies. However, confidence in the SRs was mostly low to very low, and the certainty of evidence was also mostly very low. We found no SRs assessing the potential drawbacks of in-school mitigations on children, which could be addressed moving forward. This overview provides evidence that could inform policy makers on school closures during future potential waves of COVID-19.

The impact of the COVID-19 pandemic and related policy responses on non-COVID-19 healthcare utilization in China

We investigate the impact of the COVID-19 pandemic and related policy responses on non-COVID-19 healthcare utilization (i.e., different types of outpatient care) up to October 2020 in China. Using an administrative database from a large prefecture-level city, we find that both direct exposure to the COVID-19 pandemic and the strict containment policy responses led to reductions in outpatient care utilization. The largest decline during the lockdown was observed in preventive care visits, which nevertheless recovered to pre-pandemic levels 2 months after the lockdown. The disruptions in prenatal care visits could not be offset by the recovery later on. Chronic care and emergency department visits had not returned to pre-pandemic levels as of October 2020, which may be driven by extended days' supply of prescription medication, increased use of telemedicine, and improved health-protective behaviors. In the reopening period, there were increases in visits for mental and sleep disorders, especially among children, and for medical abortion. Among health facilities at all levels, primary care facilities saw the least reductions in total outpatient visits. Our results emphasize the need for strategies to ensure access to urgent or essential care services when managing the current epidemiologic transition and future crises.

Bibliometric and visualization analysis of research trend in mental health problems of children and adolescents during the COVID-19 pandemic

Objectives

To analyze the evolution of research on children and adolescents mental health issues during COVID-19 pandemic and discuss research hotspots and cutting-edge developments.

Methods

The literature obtained from the web of science core collection as of June 28, 2022, was analyzed using Citespace, VOSviewer bibliometric visualization mapping software.

Results

A total of 6,039 relevant papers were found, of which 5,594 were included in the study. The number of literatures is growing since 2020; and the country, institution, and journal publications were analyzed. The co-citation analysis shows that there are more research articles among the highly cited articles and a lack of systematic reviews that use critical thinking for review. In the cluster analysis, mental health and life change were the most representative. The timeline view of the keywords shows that Online learning (#0), Public health (#1), and Mental health (#2) are the three largest clusters and shows the change over time.

Conclusion

This study helped analyze the mental health of children and adolescents during the COVID-19 pandemic and identified hot trends and shortcomings, which are important references for the theoretical basis of future research and decision making and technical guidance for systematic reviews.

Indirect effects of COVID-19 on child and adolescent mental health: an overview of systematic reviews

INTRODUCTION

To control the spread of COVID-19, mitigation strategies have been implemented globally, which may have unintended harmful effects on child and adolescent mental health. This study aims to synthesise the indirect mental health impacts on children and adolescents globally due to COVID-19 mitigation strategies.

METHODS

We included relevant reviews from MEDLINE, Embase, PsycINFO, LILACS, CINAHL, The Cochrane Library and Web of Science until January 2022 that examined the impact of COVID-19-related lockdown and stay-at-home measures on the mental health of children and adolescents. Data extraction and quality assessments were completed independently and in duplicate by BC and LH. A Measurement Tool to Assess Systematic Reviews-2 was used to assess the methodological quality.

RESULTS

Eighteen systematic reviews, comprising 366 primary studies, found a pooled prevalence of 32% for depression (95% CI: 27 to 38, n=161 673) and 32% for anxiety (95% CI: 27 to 37, n=143 928) in children and adolescents globally following COVID-19 mitigation measures. Subgroup analyses also uncovered important differences for both depression and anxiety by World Health Organization regions with few studies from Africa and relative high burden of anxiety and depression in the Eastern Mediterranean region.

CONCLUSIONS

Our findings reveal a high prevalence of depression and anxiety in children and adolescents during the COVID-19 pandemic, globally, compared with prepandemic estimates. These findings highlight the urgency for governments and policymakers to strengthen mental health systems in the COVID-19 recovery, especially in low-and middle-income countries where compounding psychological stress, access and affordability of care and discrepant reporting of mental health in this population remains a challenge. We also provide insight into how to alter mitigation strategies to reduce the unintended negative consequences for the health and well-being of children and adolescents in future pandemics.

PROSPERO REGISTRATION NUMBER

CRD42022309348.

Global burden of mental health problems among children and adolescents during COVID-19 pandemic: An umbrella review

Mental health problems among children and adolescents are increasingly reported amidst the coronavirus disease (COVID-19) pandemic. In this umbrella review, we aimed to synthesize global evidence on the epidemiologic burden and correlates of child and adolescent mental health (CAMH) problems during this pandemic from existing systematic reviews and meta-analyses. Adopting the Joanna Briggs Institute (JBI) methodology, we evaluated 422 citations and identified 17 eligible reviews with medium to high methodological quality. Most of the reviews reported a high prevalence of anxiety, depression, sleep disorders, suicidal behavior, stress-related disorders, attention-deficit/hyperactivity disorder, and other mental health problems. Also, factors associated with CAMH such as age, gender, place of residence, educational attainment, household income, sedentary lifestyle, social media and internet use, comorbidities, family relationships, parents' psychosocial conditions, COVID-19 related experiences, closure of schools, online learning, and social support were reported across reviews. As most studies were cross-sectional and used nonrepresentative samples, future research on representative samples adopting longitudinal and intervention designs is needed. Lastly, multipronged psychosocial care services, policies, and programs are needed to alleviate the burden of CAMH problems during and after this pandemic.

COVID-19 and Vulnerable Children Well-Being: Interview with Left-Behind Children in Rural China

Purpose of the study: This study sought to explore the psychological well-being, academic adjustment, and quality of parental attachment of LBC during COVID-19 based on Left-Behind Children’s (LBC) word of mouth. Method: In light of the abundance of quantitative studies, this qualitative study explored the psychological, academic, and parental attachment experiences of rural LBC during COVID-19. To this end, we conducted semi-structured interviews with 22 LBCs aged 10–15 in May 2021. Result: The study results reveal that LBCs developed severe psychological illnesses after the pandemic severely disrupted their already disturbed lives. Our findings showed that most LBCs feel they do not need their parents, which reflects their long record of hopelessness and agony regarding the absence of their parents. Conclusion: Although COVID-19 is a global problem, its impact was particularly devastating for LBCs who have nobody around who could help them with their academic, personal and social need. In the modern COVID-19 era, it seems that Chinese grandparenting has become unreliable in the face of radical change in contemporary Education, society, and the economic system. Therefore, this study suggests that the Chinese government should seek to identify and monitor these children by working with NGOs that target such children.

Overcoming mental health stigma through student's awareness and project-based inclusive pedagogy in English teaching colleges: Moderating role of institutional support in China

Mental health stigma undermines collaborative work and creates communication breakdowns for students to face real-world challenges. Moreover, project-based English learning in East-Asian nations is a significant challenge for advancing students' effective learning, while students lack mental health self-awareness. Unawareness causes distractions and results in learning inefficiencies. Furthermore, without institutional support (IS) achieving effective learning could never be possible. Therefore, this study investigates the relationships between project-based learning (PBL) and mental health awareness (MHA) with effective English language teaching among university students in China. We also tested the moderation effect of IS in the relationships between PBL and MHA with effective English language learning (EEL). Using the purposive sampling technique, we collected valid responses from 713 students studying English as a foreign language in universities and colleges in Harbin, China. The findings interestingly supported the direct hypotheses between PBL and EEL, as well as MHA and EEL. Moreover, the moderating role of IS established a significant effect on both PBL and EEL, as well as MHA and EEL, respectively. Policymakers, practitioners, and academicians should understand that integrating PBL as an inclusive pedagogy method with proper IS may enhance effective learning; however, it will consume more time.