Impact of the COVID-19 Pandemic on Mental Health Outcomes of Healthy Children, Children With Special Health Care Needs and Their Caregivers-Results of a Cross-Sectional Study

Bridging the gaps in pediatric complex healthcare: the case for home nursing care among children with medical complexity

BACKGROUND

Children with medical complexity (CMC) comprise < 1% of the pediatric population, but account for nearly one-third of healthcare expenditures. Further, while CMC account for up to 80% of pediatric inpatient hospital costs, only 2% of Medicaid spending is attributed to home healthcare. As a result, the current health system heavily relies on family caregivers to fill existing care gaps. This study aimed to: (1) examine factors associated with hospital admissions among CMC and (2) contextualize the potential for home nursing care to improve outcomes among CMC and their families in South Carolina (SC).

METHODS

This mixed-methods study was conducted among CMC, their family caregivers, and physicians in SC. Electronic health records data from a primary care clinic within a large health system (7/1/2022-6/30/2023) was analyzed. Logistic regression examined factors associated with hospitalizations among CMC. In-depth interviews (N = 15) were conducted among physicians and caregivers of CMC statewide. Patient-level quantitative data is triangulated with conceptual findings from interviews.

RESULTS

Overall, 39.87% of CMC experienced ≥ 1 hospitalization in the past 12 months. CMC with higher hospitalization risk were dependent on respiratory or neurological/neuromuscular medical devices, not non-Hispanic White, and demonstrated higher healthcare utilization. Interview findings contextualized efforts to reduce hospitalizations, and suggested adaptations related to capacity and willingness to provide complex care for CMC and their families.

CONCLUSIONS

Findings may inform multi-level solutions for accessible, high-quality home nursing care among CMC and their families. Providers may learn from caregivers' insight to emphasize family-centered care practices, acknowledging time and financial constraints while optimizing the quality of medical care provided in the home.

Impact of Covid-19 on Psychosocial Well-Being of School-Going Children: A Cross-Sectional Study

INTRODUCTION

The mandated closure of schools due to Covid-19 is likely to have a negative impact on school-going children. This study aimed to assess the psychosocial well-being of school children during the pandemic in eastern India.

METHODS

This cross-sectional study was conducted in the outpatient pediatric department of tertiary care teaching hospitals. Children between the ages of 4 and 14 were enrolled. The main outcome measures included the Emotional Symptoms Scale, Conduct Problem Scale, Hyperactivity Scale, Peer Problem Scale, and Prosocial Scale from the Strength and Difficulties Questionnaire (SDQ), as well as the Children's Hope Scale.

RESULTS

Out of 169 children aged 4-14, 104 (61.5%) were male, 140 (82.8%) were from urban areas, 66 (39.1%) had a family member who was a healthcare worker or frontline worker, and 12 (7.1%) had experienced the death of a family member due to Covid-19. Anxiety-related and depressive symptoms were observed in 81 (47.9%) and 70 (41.4%) children, respectively. Psychosocial difficulties with a 'clinically significant problem likely' were observed in 26 (15.4%) children, more common in males (16.35%, P=0.035) and older children (12-14 years). Children from families with healthcare/frontline workers, Covid-affected families, loss of job in the earning member, and uninvolved parenting style were associated with more psychosocial difficulties. The mean (SD) hope score was 22.46 ± 6.42 in children above eight years.

CONCLUSION

The psychosocial well-being of school-going children is adversely affected during Covid-19, particularly in families with frontline workers, loss of job, and death of family members due to Covid-19. The poor hope score in children aged 8 years and above indicates an adverse impact on their ability to achieve future goals.

Association between the COVID-19 pandemic and childhood development aged 30 to 36 months in South Korea, based on the National health screening program for infants and children database

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on the neurodevelopment of children. However, the precise effects of the virus and the social consequences of the pandemic on pediatric neurodevelopment are not yet fully understood. We aimed to compare the neurodevelopment of children between before and during the COVID-19 pandemic, as well as examine the impact of socioeconomic status (SES) and regional differences on the development.

METHODS

The study used the Korean Developmental Screening Test to compare the difference in the risk of neurodevelopmental delay between before and during the COVID-19 pandemic. Multivariable logistic regression analysis was conducted to identify the relationship between experiencing the COVID-19 pandemic and the risk of neurodevelopmental delay. Stratified analyses were performed to determine whether the developmental delays caused by the pandemic's impact varied depending on SES or regional inequality.

RESULTS

This study found an association between the experience of COVID-19 and a higher risk of neurodevelopmental delay in communication (adjusted OR [aOR]: 1.21, 95% confidence interval [CI]: 1.19, 1.22; P-value: < 0.0001) and social interaction (aOR: 1.15, 95% CI: 1.13, 1.17; P-value: < 0.0001) domains among children of 30-36 months' ages. Notably, the observed association in the Medicaid group of children indicates a higher risk of neurodevelopmental delay compared to those in the non-Medicaid group.

CONCLUSIONS

These findings highlight the need to be concerned about the neurodevelopment of children who experienced the COVID-19 pandemic. The study also calls for increased training and support for Medicaid children, parents, teachers, and healthcare practitioners. Additionally, policy programs focused on groups vulnerable to developmental delays are required.

National study on the risks of COVID-19 infection for paediatric kidney transplant recipients: a retrospective, cross-sectional study

INTRODUCTION

During the COVID-19 pandemic, evidence emerged that immunosuppressed children were less affected by COVID-19 infections compared with immunosuppressed adults. The aim of our study was to investigate how COVID-19 infections affected paediatric kidney transplant recipients (pKTR) in the UK.

METHODS

Questionnaires regarding COVID-19 infection data and care of pKTR during the COVID-19 pandemic were sent to all 13 UK paediatric nephrology centres examining asymptomatic and symptomatic pKTR with positive COVID-19 PCR testing from 1 April 2020 to 1 December 2021.

RESULTS

63 pKTR who were 3.1 (range 0.1-15) years post-transplantation had COVID-19 infection with positive SARS-CoV-2 PCR RNA. Classical COVID-19 symptoms were present in half of the patients; with atypical presentations including diarrhoea (13%) and lethargy (13%) also noted, while a third of patients were asymptomatic. Eighteen patients (28%) were hospitalised including five asymptomatic patients admitted for other reasons. No patients needed ventilation or intensive care admission, and one patient received supplemental oxygen. There was evidence of acute kidney injury (AKI) in 71% of patients, but no patients needed kidney replacement therapy with haemofiltration or dialysis.

CONCLUSION

We report 10.4% of the UK paediatric renal transplantation population had documented COVID-19 infections with positive SARS-CoV-2 PCR RNA with 28% of those affected requiring hospitalisation. The increased incidence of AKI, particularly after the first wave of the COVID-19 pandemic, was possibly due to increased testing. There was low morbidity and mortality compared with the adult population.

Quality of life and family management of paediatric chronic condition amidst the COVID-19 pandemic

PURPOSE

This study aimed to describe the perception of parents of children/adolescents with chronic conditions of their quality of life and family functioning during the COVID-19 pandemic and explore how the COVID-19 pandemic affected family management of children/adolescents' chronic conditions.

DESIGN AND METHODS

A total of 237 parents of children/adolescents with chronic conditions participated in this cross-sectional study. Data were collected through an online questionnaire using the Paediatric Quality of Life Inventory™ Family Impact Module and an open-ended question about the impact of the pandemic on the family management of the paediatric chronic condition.

RESULTS

The Total Score of PedsQL™ FIM was slightly higher than the midpoint of the scale (M = 60.27; SD = 19.04), and the impact of the pandemic on the family's management of the chronic condition was perceived by 30% of parents as high or moderate. Statistically significant differences were found between parents who reported a high or moderate impact of the pandemic and those reporting little or no impact of the pandemic regarding parental quality of life and family functioning (t (233) = 8.13, p = .00, Cohen's d = 1.14). Two themes emerged from the analysis of the open-ended question: Impact on the child/adolescent and Impact on the family.

CONCLUSIONS

Parents of children/adolescents with chronic conditions reported an average quality of life, and the COVID-19 pandemic significantly impacted the family management of chronic conditions.

PRACTICE IMPLICATIONS

These results highlight the importance of developing interventions to support families in complex situations and contexts, targeting family functioning, family quality of life, and emotional management.

[Social pediatric care situation and needs during the COVID-19 pandemic from 2020 to 2022. What is needed now?]

BACKGROUND

Children and adolescents with social pediatric care needs represent a group with special challenges. The aim of this qualitative study was to describe social pediatric care during the pandemic from the perspective of experts. From this, conclusions were to be drawn for any social pediatric care needs that may have arisen.

METHODS

Between May and November 2022, 25 experts from the field of social pediatrics were interviewed using guided interviews on the following topics: deviations in care, utilization behavior of families, individual burdens and resources, and sustainable needs. The interviews were analyzed by two research assistants.

RESULTS

Overall, the social pediatric care offer was temporarily clearly limited. While families who were already well connected before the pandemic could be adequately cared for with the help of telephone/video contacts, an unreported number of at-risk groups, were described, for example, those with low competence to act, who did not make use of services or did so with delays. It was observed that there was a need for care for newly developed mental disorders and regression in therapy due to limited opportunities for support, as well as a need to catch up on missed opportunities for early support in the case of developmental disorders.

DISCUSSION

To meet the needs that have arisen, underserved families should be identified and cared for promptly, taking individual characteristics into account. To this end, for example, more outreach services should be established that reach affected families unbureaucratically.

Perceived social support and characteristics of social networks of families with children with special healthcare needs following the COVID-19 pandemic

Background

Children with special healthcare needs (CSHCN) require more support than the average of their peers. Support systems for CSHCN were particularly affected by pandemic control measures. Perceived social support is a resource for health and wellbeing for CSHCN and their families. Associations of social support, mental health and socioeconomic status (SES) have been described. This study aims to (1) assess perceived social support in families with and without CSHCN; (2) describe structure and types of social networks of families with and without CSHCN; and (3) explore associations between perceived social support, disease complexity, child and caregiver mental health, and SES.

Methods

This is the third of a sequential series of cross-sectional online surveys conducted among caregivers of children ≤ 18 years in Germany since the beginning of the COVID-19 pandemic, administered between 1st December 2022 and 10 March 2023. The Brief Social Support Scale (BS6) assessed perceived social support. Child and parental mental health were assessed using the Strengths and Difficulties Questionnaire (SDQ) and WHO-5 Wellbeing index. The CSHCN-Screener identified CSHCN. Descriptive statistics and linear regression modeling assessed associations between perceived social support, parent-reported child mental health problems, disease complexity, caregiver mental wellbeing and SES.

Results

The final sample included 381 participants, among them 76.6% (n = 292) CSHCN. 46.2% (n = 176) of caregivers reported moderate, i.e., at least occasional social support. Social support was largely provided by informal social networks consisting of partners, relatives and neighbors/friends. Linear regression modeling revealed associations of lower perceived social support with higher disease complexity of the child, lower caregiver mental wellbeing, lower SES and increasing caregiver age.

Conclusion

The results of this study describe inequalities in perceived social support according to disease complexity of the child, caregiver mental health and socioeconomic status. They highlight the importance of social support and support networks as a resource for wellbeing of caregivers and CSHCN. Moving on from the COVID-19 pandemic, recovery strategies should focus on low-threshold interventions based in the community to improve social support for families with CSHCN and actively involve caregivers in identifying needs and co-creating new approaches.

Prevalence and factors associated with mental illness symptoms among school students post lockdown of the COVID-19 pandemic in the United Arab Emirates: A cross-sectional national study

Limited data exists on the mental health of children in the United Arab Emirates (UAE). This study aimed to fill this gap by examining the prevalence of anxiety, depression, and risk for Post-Traumatic Stress Disorder (PTSD) among school students in post-lockdown of the COVID-19 pandemic. A sample of 3,745 school students participated, responding to standardized tests (Mood and Feeling Questionnaire-Child Self-Report, Screen for Child Anxiety Related Disorders-Child Version, and Children's Revised Impact of Event Scale-8). Findings showed that the risk for PTSD was the most prevalent (40.6%), followed by symptoms of anxiety (23.3%), and depression (17.1%). For gender differences, symptoms of the three conditions (depression, anxiety, and PTSD) were higher in female students (9.2%) compared to male peers (7.7%) (p = 0.09). Moreover, symptoms of depression and anxiety were found to be higher among late adolescents (p<0.05). Further analysis revealed that having medical problems was a positive predictor for anxiety (OR = 2.0, p<0.01) and risk for PTSD (OR = 1.3, p = 0.002); similarly, witnessing the death of a close family member due to COVID-19 (OR for depression, anxiety, and PTSD = 1.7, p<0.01) were positive predictors associated with PTDS, depression, and anxiety. The study concluded that post COVID-19 lockdown, symptoms of anxiety, depression, and risk for PTSD were found to be prevalent among school students in the UAE. Researchers put forward recommendations on the initiation of a national school mental health screening program, the provision of follow-up services for vulnerable students, and the integration of a mental health support system in the disaster preparedness plans.

Parental anxiety and depression are associated with adverse mental health in children with special needs during the COVID-19 pandemic

Introduction

The coronavirus disease 2019 (COVID-19) pandemic has led to restrictions in various areas of life, including social life, work, leisure, health, and education. Vulnerable groups, such as children with special needs and their parents, may be at increased risk of experiencing exacerbated mental health problems during stressful periods such as the COVID-19 lockdowns.

Materials and methods

Telephone interviews were conducted with 954 parents of children with special needs. We assessed parental levels of generalized anxiety and depression using the validated GAD-7 and PHQ-8 scales. Parents were asked to rate family burden and their worry about the COVID-19 crisis, as well as their children's adverse mental health symptoms and health behaviors. Parents also reported their children's worries about the COVID-19 crisis. We conducted regressions to examine the relationship between parents' mental health problems and their children's adverse mental health symptoms and health behaviors. Qualitative data from open-ended questions were coded thematically and major themes of parental worry about the COVID-19 crisis were identified.

Results

Parental anxiety and depression symptoms predicted adverse mental health symptoms and behaviors in children with special needs. Criteria for current depression were met by 7.9% of parents of children with special needs, whereas 4.7% of the general population in Vorarlberg met the criteria for current depression according to data from the Austrian Health Interview Survey in 2019. Parental self-ratings of both depression and anxiety were highly correlated. The majority of parents reported being burdened (79.1%) or worried (67.8%) about the COVID-19 crisis. The main themes of parental worry about the COVID-19 crisis included COVID-19 infection (40.6%), economic situation (13.1%), uncertainty (8.4%), lack of social contact with family and friends (8.1%), family health status (7.5%), and school life (7.5%).

Discussion

Mental health symptoms in parents of children with special needs were strongly associated with increased adverse mental health symptoms and health behaviors in their children. Parents of children with special needs were more likely to be depressed during the COVID-19 pandemic than adults in 2019. We call for additional mental health support to reduce the mental health burden in families with children with special needs.

Child Rights during the COVID-19 Pandemic: Learning from Child Health-and-Rights Professionals across the World

The COVID-19 pandemic underscores the importance of a child rights-based approach to policymaking and crisis management. Anchored in the United Nations Convention on the Rights of the Child, the 3P framework-provision, protection, and participation-forms the foundation for health professionals advocating for children's rights. Expanding it with two additional domains-preparation and power-into a 5P framework has the potential to enhance child rights-based policies in times of crisis and future pandemics. The study aimed to (1) gather perspectives from child health-and-rights specialists on how children's rights were highlighted during the early phase of the pandemic in their respective settings; and (2) evaluate the usefulness of the 5P framework in assessing children's visibility and rights. A qualitative survey was distributed among child health-and-rights professionals; a total of 68 responses were analysed in Atlas.ti 9 from a multi-disciplinary group of policymakers and front-line professionals in eight world regions. As framed by the 5Ps, children's rights were generally not safeguarded in the initial pandemic response and negatively impacted children's health and wellbeing. Further, children lacked meaningful opportunities to raise their concerns to policymakers. The 5P framework holds the potential to shape an ethical child rights-based decision-making framework for future crises, both nationally and globally.

COVID-19 in Western Australia: 'The last straw' and hopes for a 'new normal' for parents of children with long-term conditions

BACKGROUND

Children with long-term conditions are vulnerable due to the treatments required for their conditions. Since the start of the coronavirus disease 2019 (COVID-19) pandemic, Western Australians experienced restrictions that changed daily life activities but were able to return to some of their previous routines due to the restrictions.

AIM

The study explored the stress experiences of parents caring for children with long-term conditions during COVID-19 in Western Australia.

DESIGN AND PARTICIPANTS

The study was codesigned with a parent representative caring for children with long-term conditions to ensure essential questions were targeted. Twelve parents of children with various long-term conditions were recruited. Ten parents completed the qualitative proforma, and two parents were interviewed in November 2020. Interviews were audio-recorded and transcribed verbatim. Data were anonymised and analysed using reflexive thematic analysis.

FINDINGS

Two themes were produced: (1) 'Keep my child safe' describes the children's vulnerabilities due to their long-term conditions, the adjustments parents' made to keep their children safe and the various consequences faced. (2) 'COVID-19's silver lining' covers the positives of the COVID-19 pandemic, including their children having fewer infections, the availability of telehealth appointments, relationship improvements and the parent's hopes for a new normal where behaviours prevent transmission of infectious (e.g., hand sanitising).

CONCLUSION

Western Australia provided a unique context for the COVID-19 pandemic due to no transmission of the virus severe acute respiratory syndrome coronavirus 2 at the time of the study. The tend and befriend theory aids in explaining the parents' stress experiences, and the application highlights a unique aspect of this theory. Parents tended to their children during COVID-19, but many could no longer rely on others for connection, support and respite, and became further isolated in attempting to protect their children due to COVID-19 consequences. The findings highlight that some parents of children with long-term conditions need specific attention during times of pandemics. Further review is recommended to support parents through the impact of COVID-19 and similar crises.

PATIENT OR PUBLIC CONTRIBUTION

This study was codesigned with an experienced parent representative who was part of the research team and involved throughout the research process to ensure meaningful end-user engagement and ensure essential questions and priorities were addressed.

Mental Health Trajectories of Children and Caregivers Using School-Based Health Centers During the COVID-19 Pandemic

INTRODUCTION

This was a prospective study of children registered at school-based health centers (SBHCs) in Canada. The objectives were to compare mental health trajectories of children and parents/caregivers who accessed SBHCs during the pandemic relative to those who did not.

METHOD

Parents/caregivers of children who attended SBHCs completed the Strengths and Difficulties Questionnaire (SDQ) and the Generalized Anxiety Disorder-7 (GAD-7) at three time points during the pandemic. The primary analysis used linear mixed models to examine the relationship between SBHC visits during the pandemic and children's SDQ score trajectories. The secondary analysis was the same for parents'/caregivers' GAD-7 scores.

RESULTS

There were 435 children included. SDQ and GAD-7 scores worsened over time for children and parents/caregivers who attended SBHCs during the pandemic compared to those who did not.

DISCUSSION

Children and parents/caregivers with worsening mental health symptoms may have sought care at SBHCs since they were accessible during the pandemic.

Socioeconomic Deprivation and Inequalities in Mental Well-Being during the COVID-19 Pandemic among Adolescents

The COVID-19 pandemic highlighted the existing inequalities in education and mental health. The aim of this study was to examine socioeconomic disadvantages and mental well-being inequalities among Slovenian adolescents in October 2020. The study used nationally representative data from 3052 adolescents aged 14 and 18 (Mage = 14.4 and 18.4). The WHO-5 Well-Being Index (WHO-5) was used to measure mental well-being and risk for depression. Multinomial logistic regression was used to identify differences in the pattern of associations regarding sociodemographic characteristics and experiences during the pandemic with poor well-being and risk for depression. Our study found that adolescents from socially disadvantaged families faced poorer conditions as regards academic performance, had fewer opportunities to socialise with friends online, and were more likely to feel lonely; they reported lower levels of mental well-being and were at a higher risk for depression. The unemployment of both parents and adolescents' perceptions of family wealth were found to be the most important predictors of depression risk. In addition, experiencing deprivation and economic hardship during the pandemic was also identified as a significant predictor. The study concludes that social and economic conditions were critical determinants of adolescents' mental health during the pandemic and that effective intervention is needed to promote their well-being and reduce inequalities.

Parents voice their experiences of caring for children with special healthcare needs amid the COVID-19 pandemic

PURPOSE

The purpose of this study was to understand the experiences of parents and caregivers of children with special healthcare needs during the COVID-19 pandemic.

DESIGN AND METHODS

In this descriptive phenomenological study, the researchers used purposive and snowball sampling to recruit nineteen participants, ranging in age from 21 to 55 years of age until saturation was established. Colaizzi's method guided data analysis. Iterative examination of the interview transcripts, an audit trail, bracketing, and validation of findings with a subset of participants established trustworthiness.

RESULTS

Navigating the COVID-19 Pandemic was the overarching theme. Four major themes emerged under Navigating the COVID-19 Pandemic as follows: Disruptions in Daily Life, Shifts in Daily Life, Innovations in Daily Life, and Surprising Silver Linings.

CONCLUSION

This study elucidated an in-depth understanding of the positive and negative impacts of the pandemic on the lives of families living with a child with special needs. The COVID-19 pandemic profoundly affected families and parenting approaches. Parents of children with special healthcare needs in this study found day-to-day living especially difficult in similar and unique ways. For virtually all parents the pandemic added new challenges in meeting their child's physical, mental, social, and educational needs. Parents and caregivers revealed innovative ways of maintaining a sense of normalcy during the height of the pandemic.

PRACTICE IMPLICATIONS

These findings demonstrate the importance of developing interventions and creating public health policies as we move beyond the current pandemic and plan for potential outbreaks in the future.

Child and Adolescent Mental Health during the COVID-19 Pandemic: Challenges of Psychiatric Outpatient Clinics

BACKGROUND

Worldwide national surveys show a rising mental health burden among children and adolescents (C&A) during COVID-19. The objective of the current study is to verify the expected rise in visits to psychiatric outpatient clinics of C&A, especially of new patients.

METHODS

a cross-sectional study focusing on visits as recorded in electronic medical records of eight heterogeneous C&A psychiatric outpatient clinics. The assessment was based on visits held from March to December of 2019 (before the pandemic) in comparison to visits held in 2020 (during the pandemic).

RESULTS

The number of visits was similar for both periods. However, in 2020, 17% of the visits used telepsychiatry (N = 9885). Excluding telepsychiatry reveals a monthly decrease in traditional in-person activities between 2020 and 2019 (691.6 ± 370.8 in 2020 vs. 809.1 ± 422.8 in 2019, mean difference = -117.5, t (69) = -4.07, p = 0.0002, Cohen's d = -0.30). Acceptation of new patients declined during 2020, compared to 2019 (50.0 ± 38.2 in 2020 vs. 62.8 ± 42.9 in 2019; Z = -3.12, p = 0.002, r = 0.44). Telepsychiatry was not used for new patients.

CONCLUSIONS

The activity of C&A psychiatric outpatient clinics did not rise but was guarded due to the use of telepsychiatry. The decline in visits of new patients was explained by the lack of use of telepsychiatry for these patients. This calls for expanding the use of telepsychiatry, especially for new patients.

Cross-cultural equivalence of parental ratings of child difficulties during the pandemic: Findings from a six-site study

OBJECTIVES

The Strengths and Difficulties Questionnaire (SDQ) has been shown to be invariant across informants, developmental stage and settings, but tests of cross-cultural equivalence are limited to adolescents' self-reports. The COVID-19 pandemic makes this gap particularly pertinent, given the need to understand whether distinct government approaches (e.g., school closures) are uniquely associated with variability in children's psychosocial outcomes and the reliance on parents' ratings for young children.

METHODS

Within a Confirmatory Factor Analysis framework, we tested the cross-cultural measurement invariance of the SDQ across six countries: Australia, China, Italy, Sweden, the United Kingdom and USA, using a sample of 1761 parents of 3- to 8-year-olds (M = 5.76, SD = 1.09).

RESULTS

A five-factors model showed good fit to the data and partial cross-cultural scalar invariance. In this sample, Swedish parents reported the fewest peer problems (Cohen's d = 0.950) and the highest prosocial scores (Cohen's d = 0.547), whilst British parents reported the greatest child emotional (Cohen's d = 0.412) and hyperactivity problems (Cohen's d = 0.535).

CONCLUSIONS

The present results indicate that the parent-version of the SDQ is appropriate for use and comparison across different contexts during the pandemic.

The Psychological Impact of COVID-19 Admission on Families: Results from a Nationwide Sample in Greece

The aim of the present study was to assess the psychological impact of hospitalization during the COVID-19 pandemic on parents and their offspring. We performed a nationwide cross-sectional study in Greece based on an Internet questionnaire survey. A convenience sample of parents whose offspring had been hospitalized due to COVID-19 (including multisystem inflammatory syndrome in children, MIS-C), diagnosed with COVID-19 but not hospitalized, and hospitalized for another reason during the pandemic were enrolled. Parental stress was assessed using the Perceived Stress Scale (PSS) and the Revised Impact of Event Scale (IES-R) tools, and childhood mental wellbeing with the Children’s Revised Impact of Event 13 (CRIES-13) scale. Out of 214 received responses, stress levels were significantly higher in parents whose children had been admitted for COVID-19 or MIS-C versus those not admitted or admitted for other reasons (p < 0.001, for PSS/IES-R). Parental and childhood stress levels were correlated. In the multivariable linear regression analysis, children’s hospitalization because of COVID-19 or MIS-C, younger parental age, the existence of comorbidities, and another family member’s hospitalization because of COVID-19 were independent factors for higher stress. In light of the above, stricter hospital admission criteria for COVID-19 could be implemented, and psychological support for eventually admitted families may be beneficial.

Stronger association of perceived health with socio-economic inequality during COVID-19 pandemic than pre-pandemic era

Objective

The COVID-19 pandemic has changed peoples’ routine of daily living and posed major risks to global health and economy. Few studies have examined differential impacts of economic factors on health during pandemic compared to pre-pandemic. We aimed to compare the strength of associations between perceived health and socioeconomic position (household income, educational attainment, and employment) estimated before and during the pandemic.

Methods

Two waves of nationwide survey [on 2018(T1;n = 1200) and 2021(T2;n = 1000)] were done for 2200 community adults. A balanced distribution of confounders (demographics and socioeconomic position) were achieved across the T2 and T1 by use of the inverse probability of treatment weighting. Distributions of perceived health [= (excellent or very good)/(bad, fair, or good)] for physical-mental-social-spiritual subdomains were compared between T1 and T2. Odds of bad/fair/good health for demographics and socioeconomic position were obtained by univariate logistic regression. Adjusted odds (aOR) of bad/fair/good health in lower household income(< 3000 U.S. dollars/month) were retrieved using the multiple hierarchical logistic regression models of T1 and T2.

Results

Perceived health of excellent/very good at T2 was higher than T1 for physical(T1 = 36.05%, T2 = 39.13%; P = 0.04), but were lower for mental(T1 = 38.71%, T2 = 35.17%; P = 0.01) and social(T1 = 42.48%, T2 = 35.17%; P < 0.001) subdomains. Odds of bad/fair/good health were significantly increased at T2 than T1 for household income (physical-mental-social; all Ps < 0.001) and educational attainment (social; P = 0.04) but not for employment (all Ps > 0.05). AORs of bad/fair/good health in lower household income were stronger in T2 than T1, for mental [aOR (95% CI) = 2.15(1.68–2.77) in T2, 1.33(1.06–1.68) in T1; aOR difference = 0.82(P < 0.001)], physical [aOR (95% CI) = 2.64(2.05–3.41) in T2, 1.50(1.18–1.90) in T1; aOR difference = 1.14(P < 0.001)] and social [aOR (95% CI) = 2.15(1.68–2.77) in T2, 1.33(1.06–1.68) in T1; aOR difference = 0.35(P = 0.049)] subdomains.

Conclusions

Risks of perceived health worsening for mental and social subdomains in people with lower monthly household income or lower educational attainment became stronger during the COVID-19 pandemic compared to pre-pandemic era. In consideration of the prolonged pandemic as of mid-2022, policies aiming not only to sustain the monthly household income and compulsory education but also to actively enhance the perceived mental-social health status have to be executed and maintained.

Challenges and Implications of the COVID-19 Pandemic on Mental Health: A Systematic Review

The measures put in place to contain the rapid spread of COVID-19 infection, such as quarantine, self-isolation, and lockdown, were supportive but have significantly affected the mental wellbeing of individuals. The primary goal of this study was to review the impact of COVID-19 on mental health. An intensive literature search was conducted using PsycINFO, PsyciatryOnline, PubMed, and the China National Knowledge Infrastructure (CNKI) databases. Articles published between January 2020 and June 2022 were retrieved and appraised. Reviews and retrospective studies were excluded. One hundred and twenty-two (122) relevant articles that fulfilled the inclusion criteria were finally selected. A high prevalence of anxiety, depression, insomnia, and post-traumatic stress disorders was reported. Alcohol and substance abuse, domestic violence, stigmatization, and suicidal tendencies have all been identified as direct consequences of lockdown. The eminent risk factors for mental health disorders identified during COVID-19 include fear of infection, history of mental illness, poor financial status, female gender, and alcohol drinking. The protective factors for mental health include higher income levels, public awareness, psychological counseling, social and government support. Overall, the COVID-19 pandemic has caused a number of mental disorders in addition to economic hardship. This strongly suggests the need to monitor the long-term impact of the COVID-19 pandemic on mental health.

The pandemic within the pandemic: the surge of neuropsychological disorders in Italian children during the COVID-19 era

Background

Quarantine and isolation measures during COVID-19 pandemic may have caused additional stress and challenged the mental health of the youth. Aim of the study is to investigate the COVID-19 pandemic impact on neuropsychological disorders (NPD) of Italian children and adolescents to provide general pediatric recommendations.

Material and methods

A retrospective multicenter observational study was planned by the Italian Pediatric Society (SIP) to explore the impact of COVID-19 on the access of children to pediatric Emergency Departments (pED) for the evaluation of neuropsychological symptoms, collecting the classification codes of diagnoses between March 1, 2019 and March 2, 2021. The period study was split into two sub-periods: a pre COVID-19 period (from March 1 2019 to March 1, 2020) and a COVID-19 period (from March 2, 2020 to March 2, 2021). As additional information, data on NPD hospitalizations in any pediatric department of the involved centers were recorded.

Results

During the study period, a total of 533,318 children were admitted to the pED involved in the study. Despite a 48.2% decline of pED admissions, there was a significant increase (83.1%) in patient admissions for NPD. The most frequent NPD conditions which increased during the COVID-19 pandemic were suicidal ideation (+ 147%), depression (+ 115%), eating disorder (+ 78.4%), and psychosis (+ 17.2%). During the pandemic period, a 39.5% increase in NPD hospitalizations was observed as well. The NPD disorders that mostly required hospitalizations were suicidal ideation (+ 134%), depression (+ 41.4%), eating disorder (+ 31.4%), and drug abuse (+ 26.7%).

COVID-19 pandemic had a major impact on children's health, mainly on their NPD development. Neuropsychological assessment should be required at the primary level, in the pediatrician's office, to facilitate early capture of the sign of impairment and provide an adequate treatment.

Conclusion

SIP underlines the psychological consequences of COVID 19 pandemic on the youngest and recommends an early identification of NPD in the pediatric population to avoid other serious consequences for children's physical and mental health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13052-022-01324-4.

Experiences, Motivations, and Perceived Impact of Participation in a Facebook-Based Support Group for Caregivers of Children and Youth With Complex Care Needs: Qualitative Descriptive Study

BACKGROUND

Caregivers of children and youth with complex care needs (CCNs) often require considerable support to ensure the well-being of their families. Social media present an opportunity to better support caregivers through computer-mediated communication for social support. Peer-to-peer (P2P) support groups are a way in which caregivers are accessing needed support; however, the experiences of caregivers who use these groups and the perceived impact that participation has on caregivers of children and youth with CCNs are not known.

OBJECTIVE

This study aimed to explore the experiences of caregivers of children and youth with CCNs who use a Facebook-based P2P support group to communicate, understand their motivations to use the group, and investigate its perceived impact on knowledge of programs and services and sense of community belonging among caregivers.

METHODS

A qualitative descriptive design was used to explore the experiences and perceived impact of a Facebook-based (Meta Platforms) P2P support group for caregivers of children and youth with CCNs in New Brunswick, Canada. The group was launched on the web in October 2020, during the COVID-19 pandemic, and resulted in 108 caregivers joining the group. A web-based survey was distributed, and semistructured interviews were conducted in February 2021 with a subsample of members. Thematic analysis was used to identify and report patterns related to caregivers' experiences and perceived impacts of participation.

RESULTS

A subsample of members in the Facebook group completed the web-based survey (39/108, 36.1%) and interviews (14/108, 12.9%). A total of 5 themes emerged from the interviews: safe space, informational support and direction, web-based connection with peers, impact on knowledge of programs and services, and degree of community belonging. Participants reported joining the group to obtain geography-specific information support and connect with peers. Many participants reported an improvement in their knowledge of programs and services and felt connected to the community; however, the short observation period and diversity among the caregiver population were cited as barriers to community belonging.

CONCLUSIONS

Social media present an important opportunity to facilitate the exchange of support between patients and caregivers in an accessible and curated environment. Findings from this study suggest that involvement in web-based, geography-specific P2P support groups can influence perceived knowledge of services and resources and sense of community belonging among caregivers of children and youth with CCNs. Furthermore, this study provides insight into the experiences and motivations of caregivers of children and youth with CCNs who participate in a private social media environment.

Designing the Well-Being of Romanians by Achieving Mental Health with Digital Methods and Public Health Promotion

Taking care of mental health is a state of mind. Amid the challenges of the current context, mental health has become one of the problems with the greatest impact on citizens and the evolution of any economy. Due to the COVID-19 pandemic, people have become more anxious, solitary, preoccupied with themselves, and depressed because their entire universe has changed, by restricting their social and professional life; the increase in concern caused by a possible illness of them or those close to them made to isolate themselves. Two qualitative (group and in-depth interviews) and one survey-based quantitative research were carried out, which allowed the quantification of the opinions, perceptions, and attitudes of Romanians regarding the effectiveness of policies for the prevention and treatment of depression. Quantitative research revealed that most of the subjects had never participated in a mental health assessment, and a quarter of them had visited a mental health specialist more than two years ago. Based on the results, proposals were elaborated, which have been addressed both to the specialists from the Ministry of Health and to those from the academic environment, that may have an impact on the elaboration of some public mental health programs.

Mental health of children with and without special healthcare needs and of their caregivers during COVID-19: a cross-sectional study

OBJECTIVE

To describe mental health outcomes and measures of pandemic burden of children with and without special healthcare needs, and their caregivers following the second wave of the COVID-19 pandemic in Germany.

DESIGN

This is the second of a sequential series of cross-sectional online surveys conducted among caregivers of children ≤18 years since the onset of the COVID-19 pandemic, administrated between 2 April 2021 and 31 July 2021.

MAIN OUTCOME MEASURES

Child and parental mental health were assessed using the Strengths and Difficulties Questionnaire and WHO-5 Well-being index. Children with Special Healthcare Needs (CSHCN) were identified using the CSHCN-Screener. Descriptive statistics, linear and hierarchical logistic regression modelling assessed associations between parent-reported child mental health problems and measures of pandemic burden, disease complexity, caregiver mental well-being and socioeconomic status.

RESULTS

521 participants were included in the final sample. There was a high prevalence of parent-reported mental health problems in n=302 (66.7%) children, particularly in CSHCN. Among caregivers, n=372 (72.5%) screened positive for depression. Logistic regression modelling showed a strong association of child mental health problems and disease complexity, parental mental well-being, increase in family conflict and inadequate social support.

CONCLUSIONS

Our study identifies CSHCN as a particularly vulnerable group in terms of mental health outcomes. Psychosocial factors were important predictors of parent-reported child mental health problems. Policy measures should consider the importance of social support systems for vulnerable children and their families, and aim to provide accessible mental health support for caregivers.

Experiences of children with disabilities during the COVID-19 pandemic in Sweden: a qualitative interview study

BACKGROUND

The impact of the COVID-19 pandemic on people with disabilities has been described as a 'triple jeopardy'. Not only have they experienced the negative social impacts of disease control measures, but access to required health services has been affected, and, not least, they are at increased risk of severe outcomes from COVID-19. This study aimed to determine how children with disabilities have experienced the pandemic in Sweden and its impact on their lives.

METHODS

Six children (5-13 years) were interviewed via video conferencing. An interview guide was adapted based on the children's communicative abilities and included augmentative and alternative communication support. Reflective field notes were included in the analysis. The data were analysed using qualitative content analysis.

RESULTS

Two themes were identified: The child's knowledge of Corona raises anxiety and fear; and Boring Corona makes the child even lonelier. The children had knowledge about and were worried about COVID-19, primarily about illness and death of their grandparents. The children longed for their grandparents and other social contacts at school, and life was described as boring and lonely. Many families lacked adequate tools to communicate with their children about the pandemic.

CONCLUSION

Given adequate support, children with disabilities and communication difficulties can give insights to their unique life situations. The interviewed children reported significant impact on their life and school life. Children were worried about their grandparents based on their knowledge about the virus. The enthusiasm with which the children engaged in the interviews is testament to the need and right of all children, regardless of communicative competence, to voice their experiences.