Life Conditions during COVID-19 Lockdown and Mental Health in Spanish Adolescents

The role of family relationships on adolescents' development and adjustment during the COVID-19 pandemic: A systematic review

In typical times, adolescents' relationships with family members influence changing cognitive, social, and physical aspects of their development. The COVID-19 pandemic, however, impacted the full family system in ways that were unprecedented. Scholars of adolescence worldwide were driven to understand how adolescents' relationships with family members changed due to these dramatic societal shifts and the influence these relationships had on adolescents' well-being. This systematic review examined two research questions with 189 articles published from 2020-2022: (1) How has the COVID-19 pandemic impacted families with adolescents, including broader family functioning, family relationship qualities, and parenting? and (2) How has the pandemic or pandemic-related stressors interacted with family functioning, family relationships, and parenting of adolescents to impact adolescent well-being and adjustment? Additionally, examination of the relevant studies were divided into sub-themes of pandemic influence: (a) family environment and routines, (b) family difficulties, (c) parenting and parent-adolescent relationships, and (d) sibling relationships.

Unpacking the Mood States of Children and Youth in Saskatchewan, Canada, in the Context of the COVID-19 Pandemic: Insights from the "See Us, Hear Us 2.0" Study

BACKGROUND/OBJECTIVES

The COVID-19 pandemic created a growing need for insights into the mental health of children and youth and their use of coping mechanisms during this period. We assessed mood symptoms and related factors among children and youth in Saskatchewan. We examined if coping abilities mediated the relationship between risk factors and mood states.

METHODS

"See Us, Hear Us 2.0", a cross-sectional study of 563 child-parent dyads, provided the data. The dependent variable, current mood state, was measured by the CoRonavIruS health Impact Survey (CRISIS) scale. Independent variables included sociodemographics, behaviors, household conditions, and coping ability. Multiple linear regression and mediation analyses were conducted, ensuring sample representativeness with sampling weights and addressing missing data through multiple imputations.

RESULTS

The participants reported mood symptoms ("moderate" to "extreme") ranging from 23% to 38% on the CRISIS scale. Factors such as older children, hybrid learning, disrupted activities, and increased screen time worsened moods. The ethnic minority groups (BIPOC) living in mid-sized cities/towns experienced more negative moods compared to Whites residing in cities. Coping ability mediated the relationship between extracurricular activities and mood states.

CONCLUSIONS

Our results underscore the importance of tailored interventions, recognizing the diverse needs of specific age groups, gender identities, and ethnicities and addressing the adverse effects of the pandemic-related disruptions on the mental health and well-being of school children in Saskatchewan. Our study also suggests prioritizing the diverse needs of children and youth during the planning and implementation of mental health services in the province.

COVID-19 and University Students' Well-Being: An Ecological and Multidimensional Perspective on Post-Pandemic Effects

In February 2020, the Italian government started to adopt measures to contain the spread of COVID-19. This emergency had a strong impact on people's lives and daily activities, negatively affecting their well-being. One of the groups of people that suffered the most from the pandemic emergency and the related isolation was university students. Based on these considerations, this article analyzes the effects of COVID-19 on Italian students' well-being during three periods: the first lockdown (March-April 2020), one year later (March-April 2021), and two years after the lockdowns (March-April 2022). Three samples comprising a total of 765 participants (M = 21 years, SD = 2.87) completed an online self-report questionnaire, which included the I COPPE scale (its short form), a tool that measures the perception of present and future well-being, both as an overall evaluation and its six specific domains: interpersonal, community, occupational, physical, psychological, and economic. The results indicated a general trend in the well-being levels of university students from the beginning of the pandemic to 2022. Compared to 2020, in 2021, there was a sharp decline in well-being, whereas in 2022, there was an increase in well-being levels. Practical implications, limitations, and future recommendations arising from the present study are extensively discussed.

Adolescent mental well-being in time of crises: The role of social and residential contexts

BACKGROUND

The extent of the impact and the interconnections among factors within social and residential contexts during the COVID-19 lockdowns on mental well-being remain to be elucidated. We identified latent classes of each of social and residential context during the lockdown and examined their associations with mental well-being among adolescents in France 1-year after the first lockdown.

METHODS

We used data collected in 2021 in a cross-sectional school-based pilot study for EXIST, from 387 participants ages 12-15 years. Participants reported retrospectively on characteristics of their social and residential contexts during the lockdown, and their current mental well-being in self-report questionnaires. We used latent class analysis to identify latent classes of social and residential contexts, and linear regression models to examine the associations between these contexts and mental well-being.

RESULTS

Four social context classes were identified: class 1 "Low opportunity for social contact at home," class 2 "Moderate opportunity for social contact at home," class 3 "High opportunity for social contact at home," and class 4 "Very high opportunity for social contact at home." Relative to class 4, lower levels of mental well-being were observed among adolescents in class 1 (b = -4.08, 95% CI [-8.06; -0.10]) 1 year after the lockdown. We identified four residential context classes based on proximity to nature, type of residence (e.g., apartment, house), and level of neighborhood deprivation. No association was detected between residential context during the lockdown and adolescent mental well-being one-year later.

CONCLUSION

A limited social context may negatively impact adolescent mental well-being during crises.

Suicidal ideation and attempts among adolescents from a tertiary hospital in Turkey: A comparative study of pre and postpandemic periods

AIM

This study aims to compare changes in rates of suicidal ideation (SI) and attempts (SA) among adolescents during pre, mid and later periods of the pandemic.

MATERIAL AND METHOD

This study included adolescents who presented to the adolescent medicine clinic in Turkey between March-May 2019 (prepandemic = T0), March-May 2021(mid period of the pandemic = T1) and March-May 2022 (late period year of the pandemic = T2). SI and SA data were assessed through the electronic hospital records of the "HEEADSSS" inventory.

RESULTS

The charts of 2113 adolescents were evaluated. The rates of both SI (p = .015) and SA (p = .026) were determined to be higher during the pandemic (T1+T2) compared to the pre-pandemic period, with a 1.4-fold increase in SI and a 1.5-fold increase in SA. The rates of SI did not differ according to gender, (p = .090). In contrast, SA rate was significantly higher in females (7.3%) than males (3.6%) (p = .001).

CONCLUSION

This study reveals an increase in SI and SA among adolescents during the first 2 years of the pandemic. In challenging times, health professionals should prioritize the identification and treatment of mental health issues, including screening for depression and suicide risk.

Perceived changes in peer relationships and behavioral health among college students during covid-19

Objective: Covid-19 has resulted in changes to college students' daily lives due to recommendations to socially distance. Social distance is likely to affect youths' peer relationships at a time when these relationships remain important for development. Participants and Methods: The current study utilized survey data to examine perceived changes in peer relationships and the association with behavioral health among 275 college students (Mage = 18.69, SD =.72) during the fall/spring of 2020-2021. Results: Quantitative results indicated that participants reported significant perceived decreases in peer support but did not report significantly worse quality of closest friendships. Qualitative responses from an open-ended survey question supported these quantitative results suggesting that although many participants perceived decreases in quality of relationships, there was also the perception that friendships became closer. Participants who perceived decreased peer relationship support and quality were more likely to report depressive symptoms and loneliness when compared to participants who perceived no changes.

COVID-19 lockdown and lifestyles: A narrative review

Background

The primary objective worldwide during the coronavirus disease 2019 (COVID-19) pandemic had been controlling disease transmission. However, lockdown measures used to mitigate transmission affected human behavior and altered lifestyles, with a likely impact on chronic non-communicable diseases. More than a year into the pandemic, substantial peer-reviewed literature emerged on altered lifestyles following the varying lockdown measures imposed globally to control the virus spread. We explored the impact of lockdown measures on six lifestyle factors, namely diet, physical activity, sleep, stress, social connectedness, and the use of tobacco, alcohol, or other harmful substances.

Methods

We comprehensively searched PubMed and the World Health Organization's global literature database on COVID-19 and retrieved 649 relevant articles for the narrative review. A critical interpretative synthesis of the articles was performed.

Results

Most of the articles included in the review identified the negative effect of lockdown measures on each of the lifestyle factors in many parts of the world. Encouraging lifestyle trends were also highlighted in a few articles. Such trends can positively influence the outcome of lifestyle-related chronic diseases, such as obesity and diabetes.

Conclusions

The lockdown associated with COVID-19 has largely had a negative impact on the lifestyles of individuals and communities across many countries and cultures. However, some individuals and communities also initiated positive lifestyle-related behavioral changes. If the knowledge generated by studying the impact of COVID-19-related lockdowns on the six lifestyle factors is further consolidated, it could improve chronic disease outcomes. This will help better understand lifestyle behaviors amidst crises and assist in redesigning extreme public health measures such as lockdowns.. It is up to governments, communities, and healthcare/academic entities to derive benefit from lessons learned from the pandemic, with the ultimate objective of better educating and promoting healthy lifestyles among communities.

Effect of the COVID-19 pandemic on potential health emergencies in paediatric patients: a retrospective cohort study

The COVID-19 pandemic compromised the principles underlying the functioning of public health, which is understood as the prevention of diseases and care for the health of entire communities. During the pandemic period, the efforts of the health system focused on patients with suspected infection and those infected with the SARS-CoV-2 virus, which led to changes in the provision of health services and the characteristics of patients receiving medical services at the pre-hospital stage. The objective of this study was to investigate the effects of the COVID-19 pandemic on potential health emergencies in paediatric patients based on the International Statistical Classification of Diseases and Related Health Problems (ICD-10). The data used in the study were derived from interventions carried out by Emergency Medical Teams (EMT) in central and eastern Poland, involving patients who were under 18 years of age (n = 12,619). The data were collected from 1 January 2017 to 31 December 2022. The study used descriptive statistics, the Mann-Whitney U Test, and the Chi-square test. The study reveals that fewer paediatric patients (5.28%) were provided medical services by EMTs during the COVID-19 pandemic compared to the pre-pandemic period (5.86%). There was a decrease in the number of injuries in paediatric patients (from 42.0 to 32.7%; p < 0.001), and more patients were left at the location from which the call was made (18.9 vs. 23.9%; p < 0.001). Moreover, during the pandemic, as compared to the pre-pandemic period, there was an increase in the number of cases of pre-hospital assistance provided to paediatric patients with fever, irrespective of gender, area (village, city) or patient age. During the pandemic, paediatric patients consumed alcohol more frequently. The age of patients who were provided with assistance by EMTs decreased (median of 10.0 vs. 9.0; p < 0.001). The COVID-19 pandemic brought about changes in the prevalence of potential health emergencies in children. The incidence of injuries decreased, while the number of interventions due to fever and alcohol consumption increased. There was a reduction in the number of patients transported to the hospital. In addition, the age of patients who received medical assistance decreased. The study shows health problems that were faced by paediatric patients during the COVID-19 pandemic and, therefore, can be helpful in preparing the healthcare system for emergency situations.

Indonesian COVID-19 lesson: A mixed-methods study on adolescent health status and health services during pandemic

TOPIC

The COVID-19 pandemic affected adolescents' physical and psychological health. There must be specific services to cater to the needs of adolescents during COVID-19 in Indonesia. Lessons learned from previous pandemics will be beneficial for nurses and other health professionals to prepare services for future pandemics.

PURPOSE

This mixed-method study aimed to examine 459 Indonesian adolescents' health, literacy, preventive measures, and preferred health services during the COVID-19 pandemic. This study also examines sociodemographics, respondent characteristics, health information sources, and media choices.

RESULTS

A total of 47.5% of adolescents knew about COVID-19, 26.8% experienced physical health changes, and 61.7% considered wearing masks. Adolescent health information came from teachers (26.6%) and the Internet (32.9%). Psychological changes showed 67.8% irritation. Indonesians preferred online counseling (53.8%) and WhatsApp (45.8%) for pandemic health services. COVID-19 literacy did not affect physical or mental health (p > 0.05).

CONCLUSIONS

Most adolescents reported mental and physical health changes during COVID-19. Our data suggest that adolescents' strong COVID-19 knowledge did not prevent anxiety and other psychological difficulties. The longitudinal studies could be utilized if pandemic demands social and physical distance. The government, as well as nurses, might utilize WhatsApp-based remote online treatment for health services.

Scoping review: longitudinal effects of the COVID-19 pandemic on child and adolescent mental health

The COVID-19 pandemic and associated containment measures have massively changed the daily lives of billions of children and adolescents worldwide. To investigate the global longitudinal effects on various mental health outcomes over a period of 1.5 years, we conducted a scoping review in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We included the peer-reviewed articles from PubMed, Web of Science, and APA PsycInfo that were published between December 2019 and December 2021, followed a longitudinal or repeated cross-sectional design, and quantitatively assessed with clinical questionnaires the effect of the COVID-19 pandemic or a related stressor on mental health indicators in community samples of children and adolescents.The results of our qualitative analysis of 69 studies indicate a general trend of less psychological well-being and more mental health problems, such as heightened stress, and depressive and anxiety symptoms during the pandemic. Data suggest that both protection measure intensity and infection dynamics were positively associated with severity of the psychopathology. The most reported influencing factors were age, gender, socio-economic status, previous state of mental and physical health, self-regulation abilities, parental mental health, parenting quality, family functioning, social support, isolation and loneliness, health-related worries, and consistent routines and structure. Our results demonstrate that children and adolescents worldwide have experienced more mental health problems due to the COVID-19 pandemic. They call for improved access to child and adolescent mental health care and prioritisation of child and adolescent welfare in political decision making.

The longitudinal impact of the COVID-19 pandemic on adolescents' internalizing symptoms, substance use, and digital media use

The present study examined the long-term effects of the COVID-19 pandemic on adolescent internalizing symptoms, substance use, and digital media use before and during the pandemic. A nationally representative longitudinal cohort of 3718 Israeli adolescents aged 12-16 at baseline completed measures of internalizing symptoms (anxiety, depression, and somatization), the prevalence of substance use (i.e., previous 30-day use of tobacco, alcohol, and cannabis), and average daily use of internet/television, video games, and social media. Social support and daily routines were assessed as potential protective factors for mental health. Data were collected in 10 public schools at four measurement points: before the Covid-19 outbreak (September 2019), after the first wave lockdown (May 2020), after the third wave lockdown (May 2021), and after the fifth wave of the pandemic (May 2022). Multi-level mixed models were used to analyze the longitudinal data. The results showed significant increases in internalizing symptoms, substance use (tobacco, alcohol, and cannabis), and daily screen time from the start of the study to the 33-month follow-up. Social support and daily routines moderated the increases in internalizing symptoms and digital media use. These findings highlight the need for public and educational mental health services to address the continuing impact of the pandemic on adolescents.

Evaluation of the concerns of Spanish university students in the face of current major challenges

The concerns of students and young people have been on the rise in recent years. Recent events such as the Covid-19 pandemic or the invasion of Ukraine have contributed to this. Mental health, the high cost of living, the need to re-evaluate the way we work or the fight against climate change are among the main concerns of young people. The aim of this work is to find out the level of concern of university students about these problems that can condition their current life and to analyze whether these concerns can affect their academic performance, also distinguishing according to gender and age. To this end, a nationwide survey was carried out among this group in Spain. This work is the first of its kind to be carried out in Spain. The results obtained may be of great use to both educational institutions and government agents, with a view to offering policies that will improve the educational level and welfare of university students.

Prevalence and correlates of internalizing and externalizing mental health problems among in-school adolescents in eastern Ethiopia: a cross-sectional study

Adolescent's mental health issues are a major social burden and a significant public health issue, but they have not received enough attention in Ethiopia. Therefore, this study aimed to determine the prevalence and correlates of internalizing and externalizing mental health problems among in-school adolescents in the Harari region, eastern Ethiopia. A cross-sectional study was conducted among 3227 in-school adolescents. Multistage sampling was used to select schools and eligible students to participate in the study. A guided, self-administered strength and difficulty questionnaire measured mental health problems. Data were double-entered, validated, and cleaned using EpiData 3.1 and analyzed using STATA version 17. Ordinal logistic regression analysis was performed to estimate the adjusted odds ratio between mental health problems and their correlates. Statistical significance was set at p-value < 0.05. The magnitudes of mental health problems among in-school adolescents by subscale was 24.17% (95% CI 22.72; 25.67) for internalizing and 11.93% (95% CI 10.85; 13.09) for externalizing problems. A high internalizing problem score was associated with females, rural residents, alcohol users, attending public schools, those bullied at school, and those in the lowest wealth index. Likewise, the likelihood of a high externalizing problem score was high among alcohol users, adolescents whose fathers are uneducated, rural, and bullied at school. The study suggests that mental health problems are prevalent among in-school adolescents in Ethiopia, especially internalizing problems. The study also identifies several risk factors associated with internalizing and externalizing problems, such as wealth index, school types, alcohol use, bullying, and rural residence. These factors may indicate the need for more mental health awareness and support programs for adolescents in Ethiopia. This highlights that schools and communities should prioritize mental health awareness and support programs for adolescents. These programs should be tailored to address the specific needs of the population, such as rural residents, those in the lowest wealth index, and those who have experienced bullying.

Correlation Between Adolescent Mental Health and Sleep Quality: A Study in Indonesian Rural Areas During the COVID-19 Pandemic

Objective

The study aims to analyze the correlation between sleep quality and adolescent mental health in rural areas during the Coronavirus Disease 2019 (COVID-19) pandemic.

Material and Methods

A cross-sectional study was conducted in Bandung rural area in February 2023. The subjects were adolescents aged 12-15 years who attended high school in Sagaracipta Village. To assess mental health, the Strength and Difficulties Questionnaire (SDQ) was used. Meanwhile, sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. The questionnaires were distributed and then filled in directly by the participants under close supervision. The relationship between mental problems and sleep quality was analyzed with the Spearman Rank correlation. The confidence range employed was 95%, while p< 0.05 was considered statistically significant.

Results

The results showed that at two junior high schools in Sagaracipta Village, 70.6% of the 109 subjects had poor sleep quality. Among the subjects, a significant number exhibited abnormal scores on various subscales. Specifically, 24 subjects (22%) showed abnormalities in the emotional subscales, 18 (16.5%) in conduct, 5 (4.6%) in hyperactivity, 15 (13.8%) in problems with peers, 26 (23.9%) in total difficulty, but there were no abnormal subjects on the pro-social sunscale. Based on the Rank Spearman correlation test, there was a statistically significant correlation between sleep quality and the emotional, behavioral, hyperactivity, and overall difficulties subscales, with coefficients of 0.247; 0.258; 0.22; and 0.310 as well as p-values of 0.010; 0.007; 0.021; and 0.001 respectively.

Conclusion

During the COVID-19 pandemic, there was a correlation between mental health and sleep quality among adolescents in rural area.

Social determinants associated with psychological distress in children and adolescents during and after the first COVID-19-related lockdown in France: results from the CONFEADO study

BACKGROUND

This study aimed to analyze the parental socio-demographic characteristics of children and adolescents aged 9 to 18 years old, as well as the living and housing conditions associated with the psychological distress in these two sub-populations during and after France's first national COVID-19-related lockdown in spring 2020.

METHODS

We used data from the cross-sectional, observational, web-based study CONFEADO, which collected data on children and adolescents' living and housing conditions and socio-demographic characteristics as well as those of their parents. It also collected data on children's and adolescents' health behaviors and psychological distress. We assessed psychological distress using the 10-item Children and Adolescents Psychological Distress Scale (CAPDS-10), and performed a multinomial logistic regression.

RESULTS

A total of 2882 children and adolescents were included in the present study. Factors associated with moderate psychological distress included being a female, parental financial difficulties, a lack of a private living space at home for the child/adolescent, and the following child health behaviors: no leisure or recreational activities with adults in the household, doing less than one hour of school homework a day, and not going outside during the lockdown. Severe psychological distress was associated with the parent's occupation (especially essential frontline workers), a lack of a private living space at home for the child/adolescent, and the following child health behaviors: spending over 5 h a day on social media, doing less than one hour of school homework a day, and no leisure or recreational activities with adults in the household.

CONCLUSIONS

This study emphasizes the impact of housing and living conditions, as well as parents' socio-economic characteristics on children's health behaviors and psychological needs during the first COVID-19-related lockdown in France. Our results suggest that health policies implemented during future pandemics should consider these structural social determinants to prevent severe psychological distress in children and adolescents.

Worsening of alcohol abuse disorder in a Spanish population during the first twelve months of the COVID-19 pandemic and associated factors: retrospective, ecological and community study

PURPOSE

To analyse: (1) Changes in clinical parameters and in the use of social healthcare resources by patients with alcohol abuse disorder between the six months prior to the start of the pandemic and the first year of the pandemic. (2) The factors related to a worsening of clinical parameters among patients with alcohol abuse disorder.

METHODS

A retrospective and observational study of a population who have been diagnosed with alcohol abuse disorders according to their primary health care (PHC) electronic medical records was performed. The total sample was made up of 11,384 patients. The variables (sociodemographic variables, chronic comorbidities, analytical parameters related to alcohol abuse disorder, COVID-19 infection, and use of healthcare resources) were collected in three different time periods: (i) six months before the onset of the strict lockdown, (ii) six months following the end of lockdown and (iii) from six to twelve months after the end of lockdown. Paired Student's T-test and a multivariate logistic regression were performed.

RESULTS

Along the first year after the onset of the pandemic, between 44% and 54% of the patients suffered a decline in every clinical parameter. The number of PHC nursing, GP visits and social worker visits reduced significantly. As regards the associated factors related to deterioration of alcohol abuse disorder, being younger than 40 years old, having an income of over 18,000 euros/year and not having visited the social worker were associated with a worsening of the disorder.

CONCLUSIONS

These results suggest that the impact of COVID-19 on this group has been high, and the social care offered to these patients plays a significant role in minimising the repercussions of the pandemic.

Mental Health in the Post-Lockdown Scenario: A Scientometric Investigation of the Main Thematic Trends of Research

Since the outbreak of COVID-19, researchers and clinicians have published scientific articles on the SARS-CoV-2 virus and its medical, organizational, financial, and psychological implications. However, many effects have been observed in the post-lockdown scenario. In this study, we adopted a scientometric-bibliometric approach to drawing the state of the art regarding the emotional and psychological effects of the pandemic after the lockdown. In Scopus, we found 791 papers that were subsequently analyzed using CiteSpace. The document co-citation analysis (DCA) computation generated a network of eight major clusters, each representing a central area of investigation. Specifically, one major cluster-cluster no. 1-focuses on the long-term effects of the COVID-19 pandemic and individuals' ability to develop adaptive coping mechanisms and resilience. The results allow us to frame the fields covered by researchers more precisely and the areas that still need more investigation.

Manifest anxiety and quality of life in schoolchildren with ADHD during confinement due to the COVID-19 pandemic

The pandemic generated by COVID-19 forced the governments of all countries to enter into quarantine, modifying the daily coexistence among family members.

The impact of COVID-19 lockdown on child and adolescent mental health: systematic review

COVID-19 was declared a pandemic in March 2020, resulting in many countries worldwide calling for lockdowns. This study aimed to review the existing literature on the effects of the lockdown measures established as a response to the COVID-19 pandemic on the mental health of children and adolescents. Embase, Ovid, Global Health, PsycINFO, Web of Science, and pre-print databases were searched in this PRISMA-compliant systematic review (PROSPERO: CRD42021225604). We included individual studies reporting on a wide range of mental health outcomes, including risk and protective factors, conducted in children and adolescents (aged ≤ 19 years), exposed to COVID-19 lockdown. Data extraction and quality appraisal were conducted by independent researchers, and results were synthesised by core themes. 61 articles with 54,999 children and adolescents were included (mean age = 11.3 years, 49.7% female). Anxiety symptoms and depression symptoms were common in the included studies and ranged 1.8-49.5% and 2.2-63.8%, respectively. Irritability (range = 16.7-73.2%) and anger (range = 30.0-51.3%), were also frequently reported by children and adolescents. Special needs and the presence of mental disorders before the lockdown, alongside excessive media exposure, were significant risk factors for anxiety. Parent-child communication was protective for anxiety and depression. The COVID-19 lockdown has resulted in psychological distress and highlighted vulnerable groups such as those with previous or current mental health difficulties. Supporting the mental health needs of children and adolescents at risk is key. Clinical guidelines to alleviate the negative effects of COVID-19 lockdown and public health strategies to support this population need to be developed.

Physical, psychological, and behavioral problems among children and adolescents in countries with different economic statuses during the COVID-19 pandemic: a systematic review and meta-analysis

Introduction

The COVID-19 pandemic has impacted children and adolescents' physical activity (PA), sleeping patterns, and psychological and behavioral health. Yet, little is known about the differences between those in countries with various economic statuses.

Methods

Articles published from database inception through 16 March 2022 were retrieved using CINAHL Complete, Cochrane Library, EMBASE, Medline, PubMed, and PsycINFO. High-quality studies that reported the number of participants with parameters associated with PA, sleeping patterns, and psychological and behavioral problems in young people aged under 18 years during the pandemic were included. We referenced the Canadian 24-Hour Movement Guidelines for PA and sleep duration to provide the event rate for young people who were not compliant with the guidelines. The event rate of young people who had decreased sleep quality and experienced psychological and behavioral problems were also investigated. A subgroup analysis was conducted to identify the differences in those in countries with diverse economic statuses. Funnel plot analysis and Egger's test were also conducted to identify any risk of publication bias.

Result

A total of 66 studies with 1,371,168 participants aged between 0 and 18 years, involving 27 countries, were included. During the pandemic, we identified that 41% (95% CI: 39%, 43%; I2 = 96.62) and 43% (95% CI: 34%, 52%; I2 = 99.42) of young people did not meet the PA and sleep duration recommendation guidelines. In addition, 31% (95% CI: 28%, 35%; I2 = 99.66) of young people had decreased their sleep quality. Yet, no significant difference was found across countries with different economic statuses. However, the event rates of participants with psychological and behavioral problems were 32% (95% CI: 28%, 36%; I2 = 99.85) and 19% (95% CI: 14%, 25%; I2 = 99.72), respectively. In addition, the rate of psychological problems was more severe in those who live in lower middle-income countries (p < 0.001), while the rate of behavioral problems was more severe in those who live in high-income countries (p = 0.001).

Discussion

During the pandemic, the discouragement of PA, poor sleep quality, and high risk of psychological and behavioral problems are concerning. A large number of young people did not comply with the recommendation guidelines. Timely implementation of recovery plans is critical to address the adverse effects on young people.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=309209, identifier CRD42022309209.

Associations between adolescents' empathy and prosocial attributes before and during the COVID-19 pandemic

BACKGROUND

Adolescence is a formative period of social development. Adolescents have experienced considerable changes in their lives due to the COVID-19 pandemic. We conducted a longitudinal study to examine the effects of the COVID-19 pandemic on adolescents' prosocial attributes and empathy, as well as their longitudinal bilateral relationships.

METHODS

A total of 2,510 students from five junior schools in Sichuan Province were recruited via random cluster sampling. Data were collected in December 2019 (Wave 1, before the outbreak of the pandemic) and July 2020 (Wave 2, during the pandemic) in Chengdu, Sichuan, China. Prosocial attributes and empathy were measured with the Positive Youth Development Scale (GPYDS) subscale and Chinese Empathy Scale, respectively.

RESULTS

During the pandemic, both empathy and prosocial attributes decreased significantly from 49.89 (9.12) and 49.89 (8.80) before to 48.29 (8.72) and 49.39 (9.26) (p < 0.001), respectively. A higher level of empathy at Wave 1 significantly predicted higher prosocial attributes at Wave 2 (β = 0.173, SE = 0.021, t = 8.430, p < 0.001). A lower prosocial attributes score predicted a significantly lower empathy score from Wave 1 to Wave 2 (β = 0.100, SE = 0.021, t = 4,884, p < 0.001).

CONCLUSIONS

The COVID-19 pandemic has had detrimental effects on adolescents' empathy and prosocial attributes. Special attention should be given to these two longitudinally associated factors in any social crisis, such as the COVID-19 pandemic, considering their importance for adolescents' physical, mental, and social development.

Annual Research Review: The impact of Covid-19 on psychopathology in children and young people worldwide: systematic review of studies with pre- and within-pandemic data

BACKGROUND

The high volume and pace of research has posed challenges to researchers, policymakers and practitioners wanting to understand the overall impact of the pandemic on children and young people's mental health. We aimed to search for and review the evidence from epidemiological studies to answer the question: how has mental health changed in the general population of children and young people?

METHODS

Four databases (Medline, CINAHL, EMBASE and PsychINFO) were searched in October 2021, with searches updated in February 2022. We aimed to identify studies of children or adolescents with a mean age of 18 years or younger at baseline, that reported change on a validated mental health measure from prepandemic to during the pandemic. Abstracts and full texts were double-screened against inclusion criteria and quality assessed using a risk of bias tool. Studies were narratively synthesised, and meta-analyses were performed where studies were sufficiently similar.

RESULTS

6917 records were identified, and 51 studies included in the review. Only four studies had a rating of high quality. Studies were highly diverse in terms of design, setting, timing in relation to the pandemic, population, length of follow-up and choice of measure. Methodological heterogeneity limited the potential to conduct meta-analyses across studies. Whilst the evidence suggested a slight deterioration on some measures, overall, the findings were mixed, with no clear pattern emerging.

CONCLUSIONS

Our findings highlight the need for a more harmonised approach to research in this field. Despite the sometimes-inconsistent results of our included studies, the evidence supports existing concerns about the impact of Covid-19 on children's mental health and on services for this group, given that even small changes can have a significant impact on provision at population level. Children and young people must be prioritised in pandemic recovery, and explicitly considered in planning for any future pandemic response.

Factors Associated with Increased or Decreased Stress Level in French Children during the First COVID-19 Lockdown

In spring 2020, governments of many countries implemented lockdown measures to prevent the spread of the COVID-19 pandemic. Worldwide, the pandemic forced about 1.5 billion children to stay at home for several weeks and to experience homeschooling. The objective of this study was to assess the variation in stress levels and associated factors in school-aged children in France during the first COVID-19 lockdown. A cross-sectional study using an online questionnaire was designed by an interdisciplinary team involving hospital child psychiatrists and school doctors. Between 15 June and 15 July 2020, Educational Academy of Lyon (France) invited the parents of school-aged children to participate in this survey. The first part of the questionnaire concerned the children with data on lockdown conditions, socio-demographic data, daily rhythms (eating and sleeping), perceived stress variations, and feelings. The second part assessed parental perspectives on their child's psychological state and use of the mental health care system. Multivariate logistic regression was performed to identify factors associated with stress variation (increased or decreased). A total of 7218 questionnaires were fully completed by children from elementary school to high school with a balanced sex ratio. In summary, 29% of children reported a higher stress level during the lockdown, 34% reported a lower stress level, and 37% reported no stress variation in the usual situation prior to COVID-19. Parents were most often able to identify signs of increased stress levels in their children. The most influential factors in the variation of stress for children were academic pressure, family relationships, and fear of being infected or infecting a family member with SARS-CoV-2. Our study underlines the high impact of school attendance stressors on children in usual conditions and encourages vigilance for children whose stress levels have decreased during the lockdown but who may have increased difficulty re-exposing themselves upon deconfinement.

Mental Health and Physical Complaints of German Children and Adolescents before and during the COVID-19 Pandemic: A Repeated Cross-Sectional Study

The potential impact of the COVID-19 pandemic on young people's mental and physical health is of increasing concern. We examined the levels of internalizing and externalizing problem behavior and physical complaints before and during the COVID-19 pandemic in Germany. Data came from a repeated cross-sectional study on child and youth health in schools in Germany. Assessments took place from November to February each year. Two data collections were conducted before the COVID-19 pandemic in 2018-2019 and in 2019-2020. Collections during the pandemic took place in 2020-2021 and 2021-2022. A total of 63,249 data observations were included in the analyses. Multilevel analyses were used to examine temporal trends in mean emotional problems (e.g., often unhappy, downhearted), hyperactivity-inattention (e.g., constantly fidgeting or squirming), conduct problems (e.g., fights with other children), and physical complaints. Models were adjusted for age, gender, school type, socioeconomic status, and sensation seeking. During the COVID-19 pandemic, children and adolescents in Germany experienced an increase in emotional problems from the pre-pandemic cohort 2019-2020 to the pandemic cohort 2021-2022 (β = 0.56, 95% CI (0.51-0.62)) and, over the course of the pandemic, reported elevated levels of physical complaints (β = 0.19, 95% CI (0.16-0.21)). Findings of increased emotional problems and physical complaints after the two years of the pandemic support the ongoing demand for low-threshold health promotion and prevention and the need for further monitoring of young people's health in Germany.

Adolescent mental health during covid-19 pandemics: a systematic review

OBJECTIVES

The outbreak of the COVID-19 pandemic has had wide-ranging outcomes on adolescents' well-being. However, less attention has been paid to the adolescent's mental health during the pandemic. The pandemic may impair adolescents' mental health through stress spillover from other family members, contextual and policy changes, and the disruption of everyday life routines. Therefore, our research is motivated by a need to address the relative scarcity of research examining adolescent mental health during the pandemic.

CONTENT

This systematic review was conducted through the medical database, Web of Science, Scopus, Medline, Embase, Google Scholar, and Cochrane databases for peer-reviewed, cross-sectional, cohort studies assessing the mental health status of adolescents during the Covid-19 virus pandemic from May 2020 till Dec 2022 without language restriction. Keywords were selected based on the Mesh terms and Emtree.

SUMMARY

Studies on coronavirus have revealed many significant psychological effects on teens of all ages. The most commom problems were on the stress and anxiety, sleep disorders, depression, post-traumatic stress disorder. Risk factors were concidered as prior mental health problem, female sexuality, fear of covid-19, nutrition, physical activity and listening the covid 19 news.

OUTLOOK

Considering the critical age of teenagers, the role of parents is vital. Health policy maker should support parents as a key factors to approprate care for adolescent. Parents should be educated on parenting methods during the covid pandemic to avoid irreparable damage of adolescent's mental health.

Digitally Deprived Children in Europe

The COVID-19 pandemic has completely changed the need for internet connectivity and technological devices across the population, but especially among school-aged children. For a large proportion of pupils, access to a connected computer nowadays makes the difference between being able to keep up with their educational development and falling badly behind. This paper provides a detailed account of the digitally deprived children in Europe, according to the latest available wave of the European Union - Statistics on Income and Living Conditions (EU-SILC). We find that 5.4% of school-aged children in Europe are digitally deprived and that differences are large across countries. Children that cohabit with low-educated parents, in poverty or in severe material deprivation are those most affected.

Joys or Sorrows of Parenting During the COVID-19 Lockdown: A Scoping Review

Objectives: The aim of this scoping review was to map out the existing evidence of the impact of the COVID-19 lockdown on parents of children and adolescents. We sought to: 1) identify parenting domains that were particularly affected by lockdown measures, 2) describe the challenges and opportunities of lockdown measures in these domains, and 3) define protective and exacerbating factors modulating the effect of lockdown measures on parents. Methods: We identified five main domains investigated in the context of parenting during the early COVID-19 lockdown derived from 84 studies: health and wellbeing, parental role, couple functioning, family and social relationships, and paid and unpaid work. For each domain, we listed challenges and opportunities, as well as discriminant factors. Results: The lockdown impacted all five different but interconnected domains, introduced new roles in parents' lives, and particularly affected women and vulnerable populations. Conclusion: This scoping review highlights the importance of approaching public health policymaking from a social justice perspective. Such an approach argues for social and public health policies to promote health accounting for its social, economic, political, and commercial determinants.

Emotional, hyperactivity and inattention problems in adolescents with immunocompromising chronic diseases during the COVID-19 pandemic

OBJECTIVE

To assess factors associated with emotional changes and Hyperactivity/Inattention (HI) motivated by COVID-19 quarantine in adolescents with immunocompromising diseases.

METHODS

A cross-sectional study included 343 adolescents with immunocompromising diseases and 108 healthy adolescents. Online questionnaires were answered including socio-demographic data and self-rated healthcare routine during COVID-19 quarantine and validated surveys: Strengths and Difficulties Questionnaire (SDQ), Pittsburgh Sleep Quality Index (PSQI), Pediatric Quality of Life Inventory 4.0 (PedsQL4.0).

RESULTS

The frequencies of abnormal emotional SDQ scores from adolescents with chronic diseases were similar to those of healthy subjects (110/343 [32%] vs. 38/108 [35%], p = 0.548), as well as abnormal hyperactivity/inattention SDQ scores (79/343 [23%] vs. 29/108 [27%], p = 0.417). Logistic regression analysis of independent variables associated with abnormal emotional scores from adolescents with chronic diseases showed: female sex (Odds Ratio [OR = 3.76]; 95% Confidence Interval (95% CI) 2.00‒7.05; p < 0.001), poor sleep quality (OR = 2.05; 95% CI 1.08‒3.88; p = 0.028) and intrafamilial violence during pandemic (OR = 2.17; 95% CI 1.12‒4.19; p = 0.021) as independently associated with abnormal emotional scores, whereas total PedsQL score was inversely associated with abnormal emotional scores (OR = 0.95; 95% CI 0.93‒0.96; p < 0.0001). Logistic regression analysis associated with abnormal HI scores from patients evidenced that total PedsQL score (OR = 0.97; 95% CI 0.95‒0.99; p = 0.010], changes in medical appointments during the pandemic (OR = 0.39; 95% CI 0.19-0.79; p = 0.021), and reliable COVID-19 information (OR = 0.35; 95% CI 0.16‒0.77; p = 0.026) remained inversely associated with abnormal HI scores.

CONCLUSION

The present study showed emotional and HI disturbances in adolescents with chronic immunosuppressive diseases during the COVID-19 pandemic. It reinforces the need to promptly implement a longitudinal program to protect the mental health of adolescents with and without chronic illnesses during future pandemics.

Adolescent psychological well-being during the COVID-19 lockdown: the role of leisure activities and online peer communication

The present study investigated the effects of leisure activities and online peer relationships on the development of psychological difficulties in adolescents during the COVID-19 lockdown in Italy. Data were collected in April and May 2020. The parents of 1,020 Italian adolescents aged 14-18 (51.9% girls) completed questionnaires about the experiences and behaviors of their children before and during the lockdown. A moderation regression analysis was applied to test the research hypotheses. The findings indicated that adolescents who were more active in sports and social activities prior to the COVID-19 pandemic showed greater psychological distress during the lockdown. Moreover, increased reading, game playing, and exercise during the lockdown effectively compensated for the interruption of pre-pandemic sports and social activities, and represented a protective factor for adolescents' mental health. Finally, increased online contact with peers during the lockdown protected against the development of psychological difficulties, regardless of adolescents' engagement in sports and social activities prior to the pandemic. The findings provide new and useful information about the role of leisure activities and online contact with peers in protecting against psychological difficulties in adolescents, especially during situations of isolation and social distancing, as in the COVID-19 national lockdown.

Somatic, Emotional and Behavioral Symptomatology in Children during COVID-19 Pandemic: The Role of Children's and Parents' Alexithymia

The COVID-19 pandemic has deeply affected the psychophysical wellbeing of children worldwide. Alexithymia, a personality trait involving difficulties in identifying and expressing feelings represents a vulnerability factor for stress-related disorders. Under pandemic stress exposure, we aimed to investigate the role of parents' and children's alexithymia in the psychophysical symptomatology shown by children and to evaluate possible differences according to age, gender and history of COVID-19 infections. The perception of parents and children about the impact of the pandemic on children's emotional, social and physiological wellbeing was also explored. Sixty-five familial triads were surveyed in the period from March to May 2022: children (n = 33 males; mean age = 9.53, sd = 1.55), mothers (mean age = 44.12; sd = 6.10) and fathers (mean age = 47.10; sd = 7.8). Both parental and children's alexithymia scores were significantly associated with somatic and externalizing symptomatology in children. Self-reported anger and externally oriented thinking scores were higher in younger children (age 8-9.9 years) than in older ones (10-12 years). Girls scored higher than boys in somatic complaints, as reported by parents. No difference emerged between children affected/not affected by COVID-19. Notably, children reported a greater negative impact of the pandemic on their emotional and psychosocial well-being than their parents. The findings emphasize the role of alexithymia in the occurrence of psychophysical symptoms in children during the COVID-19 pandemic. The reduced parental awareness of the emotional burden imposed by the pandemic on children indicates the need to better consider how epidemics affect children's mental health and to develop adequate preventive strategies to support them in these exceptional times.

Growth-Related Responses to the Threat of COVID-19 among Adolescents

The main objective of our study was to determine whether the experience of the types of pandemic threats included in the study, could activate development responses among adolescents and what the role of the level of stress experienced during the COVID-19 pandemic is in the process of post-traumatic PTG growth. We also made an attempt to investigate whether personality traits and gender were predictors of PTG growth in adolescents. Therefore, the theoretical bases for the interpretation of the obtained results are models of post-traumatic growth (PTG), mainly by Calhoun and Tedeschi. The research was conducted in March 2020. The study subjects were 405 adolescents aged 14 to 20 years, with an average age of 17 years, of whom 59% were females and 41% were males. The following methods were used in the study: IPIP-BFM-20 to estimate five personality traits, PSS- to diagnose perceived stress, and an in-house questionnaire of pandemic threats experienced by adolescents (KŻP). The results showed that the various types of 'pandemic' threats (threats to life, family, and lifestyle) are positive predictors of growth-related changes; additionally, such factors as personality traits (here: extroversion), stress level, and gender had a positive mediating effect on growth-related changes. It was also possible to show that out of the four dimensions of post-traumatic growth, three could be activated under pandemic conditions. These were: changes in relationships with others, greater appreciation of everyday life, and spiritual changes. Changes in self-perception-one of the dimensions of post-traumatic growth, were not activated due to experiencing three types of pandemic threats.

Mental Health of Siblings of Children with Rare Congenital Surgical Diseases during the COVID-19 Pandemic

INTRODUCTION

 The COVID-19 pandemic has affected every aspect of our society, particularly vulnerable groups, such as families with children suffering from rare diseases. However, the psychosocial influences of COVID-19 on the healthy siblings of children with rare diseases have not been investigated yet. Thus, the study aimed to evaluate the mental health of healthy siblings of children with rare congenital surgical diseases during the COVID-19 pandemic.

MATERIAL AND METHODS

 Siblings of children with rare congenital surgical diseases were investigated cross-sectionally between April 2020 and April 2021. Data on mental health were collected using the parent-version of the Strengths and Difficulties Questionnaire (SDQ).

RESULTS

 Out of 104 families, 81 (77.88%) participated in the survey. Healthy siblings presented with comparable levels of emotional and behavioral difficulties compared with population norms before the COVID-19 pandemic. Compared with studies that surveyed child and adolescent mental health during the COVID-19 pandemic, parents of siblings in this study reported a significantly lower impairment rate. Psychosocial and disease-specific risk factors of the respective outcomes in healthy siblings were identified through regression analysis models.

CONCLUSION

 In general, health-care professionals should be aware of the possibility of siblings' mental health being at risk. Therefore, screening for psychosocial deficits may be essential in preventing psychiatric disorders in this population, especially during pandemics.

TRIAL REGISTRATION

 ClinicalTrials.gov: NCT04382820 (registered April 8, 2020).

The adaption of the Chinese version of the COVID Stress Scales as a screening instrument of stress: Psychometric properties during the COVID-19 pandemic

The COVID Stress Scales (CSS) was used to access related distress concerning Corona Virus Disease 2019 (COVID-19). Based on China's epidemic prevention and control policies during the COVID-19 pandemic, the adaption of the Chinese version of the CSS was developed. Our study evaluated the reliability and validity of the Chinese adapted version of the CSS during the COVID-19 pandemic. An online survey was employed to construct a national sample of 2,116 participants in Chinese mainland. We examined the factor structure, internal consistency, convergent validity, discriminant validity, and concurrent validity. The results demonstrated that the six-factor solution for the Chinese adaptation of the CSS proved a good fit with the data after comparing the factor structure with the five-factor model. The six-factor model had good reliability and supported good convergent, discriminant, and concurrent validity of the CSS Chinese adaption. Overall, our findings supported the Chinese adapted version of the CSS as a psychometrically sound measure of stress during the COVID-19 pandemic in China.

Mental sequelae of the COVID-19 pandemic in children with and without complex medical histories and their parents: well-being prior to the outbreak and at four time-points throughout 2020 and 2021

The objective of this study is to understand the long-term mental sequelae for families over the course of the COVID-19 pandemic by longitudinally investigating the well-being of children with and without complex medical histories and their parents. Well-being of 200 children (between 7 and 18 years of age; 73 typically developing, 46 born very preterm, 73 with complex congenital heart disease) and 175 of their parents was assessed prior to and during the first (April-May 2020), second (October-November 2020), third (April-May 2021), and fourth wave (October-November 2021) of the pandemic with standardized questionnaires. Linear mixed models were used to investigate longitudinal changes in child and parent well-being compared to before the pandemic. Social and COVID-19-specific determinants were investigated as predictors of impaired well-being. To illustrate clinical relevance, the proportion of children and parents scoring > 1 SD below normative mean/median was reported. Compared to before the pandemic, child proxy-reported well-being was lower during the first but not the second, third, and fourth waves. Child self-reported well-being was not lower during the pandemic compared to before. Parent well-being dropped during the first wave and remained low throughout the subsequent waves. Proxy-reported child and self-reported parent well-being was lower in families with sparse social support and poor family functioning. Parents of typically developing children reported lower well-being than parents of children born very preterm or with a complex congenital heart disease. In November 2021, 20% of children (both self- and proxy-report) and 24% of parents scored below the normal range compared to 11% (child self-report), 10% (child proxy-report), and 16% (parent self-report), respectively, before the pandemic. The pandemic continues to impact the well-being of parents of school-aged children with and without complex medical histories more than 1 year after its outbreak. Children's well-being was specifically affected during the first wave of the pandemic and has recovered thereafter. Families with sparse social support and poor family functioning are particularly at risk for compromised well-being and support should be provided to them.

Risks and Resources for Depressive Symptoms and Anxiety in Children and Adolescents During the COVID-19 Pandemic - Results of the Longitudinal COPSY Study

Background

Mental health during the COVID-19 pandemic is of particularly high relevance. Especially for children and adolescents, the pandemic and its restrictions represent a significant burden. The present study aims to identify risks and resources for depressive symptoms and anxiety in children and adolescents during the pandemic in Germany.

Materials and Methods

Self-reported data from the first wave of the longitudinal COVID-19 and Psychological Health (COPSY) study were used to investigate risks and resources among n = 811 children and adolescents aged 11-17 years. Depressive symptoms and anxiety were measured at the first follow-up 6 months later. Multivariate linear regression analyses were performed to investigate the effects of risks and resources on depressive symptoms and anxiety.

Results

Parental depressive symptoms predicted depressive symptoms and anxiety in children and adolescents 6 months later. Female gender was identified as a risk factor for anxiety during the pandemic. None of the potential resources were associated with depressive symptoms or anxiety at the follow-up.

Conclusion

The findings provide evidence of risk factors for depressive symptoms and anxiety during the COVID-19 pandemic. Children and adolescents who face risk factors need to be identified early and monitored during the pandemic. Family-based intervention programs are needed to help vulnerable children and adolescents cope with the challenges of the pandemic.

Children and Adolescents' Mental Health Following COVID-19: The Possible Role of Difficulty in Emotional Regulation

The COVID-19 pandemic has shattered routines throughout the world, creating closures and social isolation. Preliminary studies conducted during the pandemic have shown that children and adolescents are mainly affected by social distancing and the lack of a supportive framework. The purpose of the present study was to compare mental health symptoms of 430 children and adolescents who sought mental health services in the community before vs. during the pandemic. The study examined children's perceived burden of the pandemic, reports of emotional and behavioral problems (SDQ) anxiety (SCARED), depressed moods (SMFQ-C), and difficulty in emotional regulation (DERS), as well as intervening variables such as age and gender. Furthermore, the effect of difficulty in emotional regulation on children's mental health symptoms was explored. Findings indicate an increase in all mental health symptoms excluding anxiety, during the pandemic. Boys reported more difficulty in emotional regulation during the pandemic than before, and girls reported more emotional and behavioral problems. Children reported an increase in emotional and behavioral problems and adolescents in peer relationship problems. Difficulty in emotional regulation predicted all mental health symptoms in both samples, more so in girls and adolescents. These initial findings support the need for further studies to examine the long-term mental health effects of COVID-19 pandemic on children and adolescents.

Self-Reported Anxiety in Spain: A Gendered Approach One Year After the Start of COVID-19 Pandemic

The COVID-19 pandemic has an impact on mental health. However, there is little evidence on how different axes of social inequity influence mental health from a gender perspective and over time. Our aim is to analyze anxiety according to gender identity and other axes of social inequities (migration status, sexual orientation, age, and employment conditions) one year after the start of the COVID-19 pandemic in Spain. We conducted a cross-sectional study among adults living in Spain with an online survey from April 8 to May 28, 2021. The main variable was anxiety measured by Generalized Anxiety Disorder Scale (GAD-7). Sex-stratified multivariate logistic regression models were constructed to assess the association between axes of inequities and anxiety. Our findings (N = 2,053) suggest that women have greater anxiety risk than men (35.2 vs. 28.2%, respectively). We observe in both genders that there is a clear age gradient, with anxiety decreasing as age increases; and that there is an association between worsening employment status and anxiety risk, although there is a difference between women by education level. Additionally, not having Spanish nationality is also associated with greater anxiety risk in women. In men, identifying as non-heterosexual is associated with a higher risk of anxiety. The axes of inequities have different effects according to gender identity. These differences in anxiety risk by population subgroup must be taken into account in order to sensibly and equitably treat the surge in mental health disorders brought on by the COVID-19 pandemic.

Longitudinal impact of psychosocial status on children's mental health in the context of COVID-19 pandemic restrictions

Emerging research suggests that the prevalence of child and adolescent mental health problems has increased considerably during the COVID-19 crisis. However, there have been few longitudinal studies on children's mental health issues according to their social determinants in this context, especially in Europe. Our aim was to investigate the association between family socioeconomic status (SES) and children' mental health during the period of school closure due to COVID-19. Longitudinal data came from 4575 children aged 8-9 years old in 2020 and participating in the ELFE population-based birth cohort that focuses on children's health, development and socialization. Parents completed the Strengths and Difficulties Questionnaire (SDQ) when children were (a) 5 years of age and (b) 9 years of age, which corresponded to the period of school closure due to the COVID-19 pandemic in France. We retrieved data from the ELFE cohort collected on children from birth to age 5 years (birth, 1 year, 2 years, 3,5 years and 5 years). Socioeconomic status (SES) was measured based on information obtained when the child was 5 years old. Data were analyzed using multinomial logistic regression models. Children's elevated levels of symptoms of Attention-deficit/Hyperactivity disorder (ADHD) during the period of school closure were significantly associated with prior low family SES (aOR 1.26, 95% CI 1.08-1.48). Children's elevated symptoms of hyperactivity/inattention and of emotional symptoms were associated with decline in income during the COVID crisis (respectively, aOR 1.38, 95% CI 1.16-1.63 and aOR 1.23, 95% CI 1.01-1.51). Moreover, when testing interactions, a low prior SES was significantly associated with a higher risk of emotional symptoms aOR 1.54 (1.07-2.21), only for children whose families experienced a decline in income, while gender, parental separation and prior mental health difficulties were not associated. This study underlines the impact of the financial crisis related to the COVID-19 epidemic on children's mental health. Both pre-existing family SES before lockdown and more proximal financial difficulties during the COVID crisis were negatively associated with children's psychological difficulties during the period of school closure. The pandemic appears to exacerbate mental health problems in deprived children whose families suffer from financial difficulties.

Perceived Changes in Emotions, Worries and Everyday Behaviors in Children and Adolescents Aged 5-18 Years with Type 1 Diabetes during the COVID-19 Pandemic

The COVID-19 pandemic and the consequent restrictive measures may be related to increased stress and anxiety and to changes in daily behaviors. Children with type 1 diabetes (T1D) are a vulnerable group due to their difficulties in achieving glycemic control and to their medical and psychological comorbidities. The purpose of the current study was to the investigate the changes on emotional and behavioral parameters in children with T1D due to the Coronavirus crisis. A total of 152 children and adolescents, aged 5−18, were studied: 114 (62 boys) with T1D and 38 (19 boys) healthy volunteers (HV) (controls). The study was performed at the Diabetes Center, Aghia Sofia Children’s Hospital, during the first national lockdown in Greece. The CRISIS questionnaire was completed by parents/caregivers. The data were collected in May 2020 and referred to two time-points: three months prior (before the pandemic), and the past two weeks. During the lockdown, it was observed significant aggravation in the “Emotion/Worries (EW)” symptoms in both groups (logEW-before vs. logEW-during the crisis, T1D: 2.66 ± 0.23 vs. 3.00 ± 0.21, p < 0.001 and HV: 2.62 ± 0.16 vs. 2.83 ± 0.18, p < 0.001). Deterioration of “ΕW” was recorded for 93.0% of those with T1D and 92.1% of the HV. “EW” during the lockdown were affected by: previous psychological condition, COVID-related concerns, and “Life Changes due to the COVID-19 crisis in the past two weeks (LC)”. Deterioration was observed in the “daily behaviors” and “use of digital media” for all of the children. The crisis and the associated restrictions negatively affected both the lifestyle parameters and the behavioral and emotional variables of the children with T1D.

Review: Mental health impacts of the COVID-19 pandemic on children and youth - a systematic review

BACKGROUND

The COVID-19 pandemic has posed an unprecedented threat to global mental health. Children and adolescents may be more susceptible to mental health impacts related to their vulnerable developmental stage, fear of infection, home confinement, suspension of regular school and extracurricular activities, physical distancing mandates, and larger scale threats such as global financial recessions and associated impacts. Our objective was to review existing evidence of the COVID-19 pandemic's global impact on the mental health of children and adolescents <19 years of age and to identify personal and contextual factors that may enhance risk or confer protection in relation to mental health outcomes.

METHODS

We conducted a search of peer-reviewed and preprint research published in English from January 1, 2020, to February 22, 2021. We included studies collecting primary data on COVID-19-related mental health impacts on children and adolescents. We graded the strength of included articles using the Oxford Centre for Evidence-Based Medicine rating scheme.

RESULTS

Our search and review yielded 116 articles presenting data on a total of 127,923 children and adolescents; 50,984 child and adolescent proxy reports (e.g., parents, healthcare practitioners); and >3,000 chart reviews. A high prevalence of COVID-19-related fear was noted among children and adolescents, as well as more depressive and anxious symptoms compared with prepandemic estimates. Older adolescents, girls, and children and adolescents living with neurodiversities and/or chronic physical conditions were more likely to experience negative mental health outcomes. Many studies reported mental health deterioration among children and adolescents due to COVID-19 pandemic control measures. Physical exercise, access to entertainment, positive familial relationships, and social support were associated with better mental health outcomes.

CONCLUSIONS

This review highlights the urgent need for practitioners and policymakers to attend to and collaborate with children and adolescents, especially those in higher risk subgroups, to mitigate short- and long-term pandemic-associated mental health effects.

Mostly worse, occasionally better: impact of COVID-19 pandemic on the mental health of Canadian children and adolescents

This large cross-sectional study examined the impact of COVID-19 emergency measures on child/adolescent mental health for children/adolescents with and without pre-existing psychiatric diagnoses. Using adapted measures from the CRISIS questionnaire, parents of children aged 6-18 (N = 1013; 56% male; 62% pre-existing psychiatric diagnosis) and self-reporting children/adolescents aged 10-18 (N = 385) indicated changes in mental health across six domains: depression, anxiety, irritability, attention, hyperactivity, and obsessions/compulsions. Changes in anxiety, irritability, and hyperactivity were calculated for children aged 2-5 years using the Strengths and Difficulties Questionnaire. COVID-19 exposure, compliance with emergency measures, COVID-19 economic concerns, and stress from social isolation were measured with the CRISIS questionnaire. Prevalence of change in mental health status was estimated for each domain; multinomial logistic regression was used to determine variables associated with mental health status change in each domain. Depending on the age group, 67-70% of children/adolescents experienced deterioration in at least one mental health domain; however, 19-31% of children/adolescents experienced improvement in at least one domain. Children/adolescents without and with psychiatric diagnoses tended to experience deterioration during the first wave of COVID-19. Rates of deterioration were higher in those with a pre-exiting diagnosis. The rate of deterioration was variable across different age groups and pre-existing psychiatric diagnostic groups: depression 37-56%, anxiety 31-50%, irritability 40-66%, attention 40-56%, hyperactivity 23-56%, obsessions/compulsions 13-30%. Greater stress from social isolation was associated with deterioration in all mental health domains (all ORs 11.12-55.24). The impact of pre-existing psychiatric diagnosis was heterogenous, associated with deterioration in depression, irritability, hyperactivity, obsession/compulsions for some children (ORs 1.96-2.23) but also with improvement in depression, anxiety, and irritability for other children (ORs 2.13-3.12). Economic concerns were associated with improvement in anxiety, attention, and obsessions/compulsions (ORs 3.97-5.57). Children/adolescents with and without pre-existing psychiatric diagnoses reported deterioration. Deterioration was associated with increased stress from social isolation. Enhancing social interactions for children/adolescents will be an important mitigation strategy for current and future COVID-19 waves.

The impact of the COVID-19 pandemic on adolescent mental health: a natural experiment

Despite widespread concern about the impact of COVID-19 on adolescent mental health, there remains limited empirical evidence that can causally attribute changes to the pandemic. The current study aimed to overcome existing methodological limitations by exploiting a serendipitously occurring natural experiment within two ongoing, multi-phase cluster randomized controlled trials. Depressive symptoms (primary outcome), externalizing difficulties and life satisfaction (secondary outcomes) were assessed at baseline (phase 1 [pre-COVID-19 group]: September - October 2018, phase 2 [COVID-19 group]: September - October 2019) and 1-year follow-up (pre-COVID-19 group: January - March 2020, COVID-19 group: February - April 2021). Participants in phase 1 (N = 6419) acted as controls. In phase 2, participants (N = 5031) were exposed to the COVID-19 pandemic between the baseline and follow-up assessments providing a natural experimental design. The primary analysis used a random intercept linear multivariable regression model with phase (exposure to the COVID-19 pandemic) included as the key predictor while controlling for baseline scores and individual and school-level covariates. Depressive symptoms were higher and life satisfaction scores lower in the group exposed to the COVID-19 pandemic. Had the COVID-19 pandemic not occurred, we estimate that there would be 6% fewer adolescents with high depressive symptoms. No effect of exposure to the pandemic on externalizing difficulties was found. Exploratory analyses to examine subgroup differences in impacts suggest that the negative impact of the COVID-19 pandemic on adolescent mental health may have been greater for females than males. Given the widespread concern over rising adolescent mental health difficulties prior to the pandemic, this paper quantifies the additional impacts of the pandemic. A properly resourced, multi-level, multi-sector public health approach for improving adolescent mental health is necessary. Following in-principle acceptance, the approved Stage 1 version of this manuscript was preregistered on the OSF at https://doi.org/10.17605/OSF.IO/B25DH. This preregistration was performed prior to data analysis.

Changes in the Mental Health of Children and Adolescents during the COVID-19 Lockdown: Associated Factors and Life Conditions

This study investigated the psychological impact of the coronavirus disease 2019 (COVID-19) among youth by analyzing their emotional/behavioral problems before and during the long-lasting lockdown in Spain. For that purpose, 699 parents with children aged 6–17 and 552 adolescents aged 12–17, who completed the parent and adolescent version of the Strengths and Difficulties Questionnaire at the beginning of 2019, responded to a survey from 26 May to 15 June 2020 that assessed psychological well-being and life conditions during quarantine (i.e., sociodemographic characteristics, situation before the lockdown, physical environment and accompaniment during the lockdown, COVID-related variables). According to both parent- and self-reports, children and youth experienced a significant worsening in emotional symptoms, conduct problems, hyperactivity/inattention, peer problems, and total difficulties subscales. Findings also suggested that impairment was mainly associated with variables related to the child’s situation prior to home quarantine, the quality and quantity of the child’s social networks during the lockdown, the daily routines the child followed, the concerns the child had about health, and the presence of economic and learning problems caused by the COVID-19. Thus, the present investigation emphasizes the need for carefully monitoring the mental health of younger people, provides guidance for the development of interventions that mitigate some of the psychological difficulties faced in a situation of confinement, and highlights the importance of paying special attention to high-risk groups.

Ontario COVID-19 and Kids Mental Health Study: a study protocol for the longitudinal prospective evaluation of the impact of emergency measures on child and adolescent mental health during the COVID-19 pandemic

INTRODUCTION

The COVID-19 pandemic has impacted the mental health (MH) of children, adolescents and parents. Whereas youth with MH disorders and neurodevelopmental disorders (NDD) may be at higher risk for exacerbations in emotional and behavioural distress, children and adolescents without pre-existing MH disorders or NDD may also experience MH deterioration due to increases in stress, changes in health behaviours, loss of activities/school closures or loss of resources. Little is known about the impact of the COVID-19 emergency measures (EMs) on children's MH over the course of the pandemic.

METHODS AND ANALYSIS

Longitudinal study of four well-established, pre-existing cohorts in Ontario (two recruited in clinical settings, two recruited in community settings). Primary outcomes include the impact of EMs on six MH domains: depression, anxiety, irritability, inattention, hyperactivity and obsessive-compulsive behaviours. Risk and protective factors related to youth MH profiles and trajectories will be identified. In addition, the effects of school mitigation strategies, changes in MH services and family factors (ie, parental MH, economic deprivation and family functioning) on children's MH will be examined. Data will be collected via repeated online survey measures selected to ensure reliability and validity for the proposed populations and distributed through the pandemic periods.

ETHICS AND DISSEMINATION

The study was approved by institutional research ethics boards at participating research sites. Results will be disseminated through a robust knowledge translation partnership with key knowledge users. Materials to inform public awareness will be co-developed with educators, public health, and MH and health service providers. Connections with professional associations and MH advocacy groups will be leveraged to support youth MH policy in relation to EMs. Findings will further be shared through conference presentations, peer-reviewed journals and open-access publications.

I Felt Like I was Going Crazy: Understanding Mother's and Young Children's Educational Experiences at Home During COVID-19

The COVID-19 disruptions to children's education have been a major issue for families. This study examined how demographic, family, and mental health characteristics of 375 low-income children and their mothers from the City of Toronto were associated with children's educational experiences at home during COVID-19. Many mothers (82.3%) reported that they and their children (80.0%) experienced challenges related to children's education at home during the pandemic. However, a small percentage of mothers (1.1%) reported that this mode of learning was better for them and their children (4.3%). The most frequently reported challenges faced by mothers was taking on the role of a teacher (43.7%) and balancing their children's remote learning with other responsibilities (19.4%). The most frequently mentioned challenges faced by children was that children lacked both motivation (21.1%) and socialization (21.1%) and had difficulty focusing (26.9%). White mothers from households with higher income and with a higher number of adults in the home reported that their children experienced higher levels of challenges related to their education at home. Maternal and child challenges with children's education at home were also related to higher levels of maternal and child mental health challenges. Our findings suggest that the online educational experiences set up following the onset of the pandemic were difficult for many children and mothers to implement in the home. Given the significant associations of these challenges with child and maternal mental health, we encourage educators to provide flexibility, empathy, and support with learning from home to both children and mothers.

Compounding inequalities: Adolescent psychosocial wellbeing and resilience among refugee and host communities in Jordan during the COVID-19 pandemic

PURPOSE

The COVID-19 pandemic and associated risk-mitigation strategies have altered the social contexts in which adolescents in low- and middle-income countries live. Little is known, however, about the impacts of the pandemic on displaced populations, and how those impacts differ by gender and life stage. We investigate the extent to which the pandemic has compounded pre-existing social inequalities among adolescents in Jordan, and the role support structures play in promoting resilience.

METHODS

Our analysis leverages longitudinal quantitative survey data and in-depth qualitative interviews, collected before and after the onset of COVID-19, with over 3,000 Syrian refugees, stateless Palestinians and vulnerable Jordanians, living in camps, host communities and informal tented settlements. We utilize mixed-methods analysis combining multivariate regression with deductive qualitative tools to evaluate pandemic impacts and associated policy responses on adolescent wellbeing and mental health, at three and nine months after the pandemic onset. We also explore the role of support systems at individual, household, community, and policy levels.

FINDINGS

We find the pandemic has resulted in severe economic and service disruptions with far-reaching and heterogenous effects on adolescent wellbeing. Nine months into the pandemic, 19.3% of adolescents in the sample presented with symptoms of moderate-to severe depression, with small signs of improvement (3.2 percentage points [pp], p<0.001). Two thirds of adolescents reported household stress had increased during the pandemic, especially for Syrian adolescents in host communities (10.7pp higher than any other group, p<0.001). Social connectedness was particularly low for girls, who were 13.4 percentage points (p<0.001) more likely than boys to have had no interaction with friends in the past 7 days. Adolescent programming shows signs of being protective, particularly for girls, who were 8.8 percentage points (p<0.01) more likely to have a trusted friend than their peers who were not participating in programming.

CONCLUSIONS

Pre-existing social inequalities among refugee adolescents affected by forced displacement have been compounded during the COVID-19 pandemic, with related disruptions to services and social networks. To achieve Sustainable Development Goal targets to support healthy and empowered development in adolescence and early adulthood requires interventions that target the urgent needs of the most vulnerable adolescents while addressing population-level root causes and determinants of psychosocial wellbeing and resilience for all adolescent girls and boys.