Anxiety in Older Adolescents at the Time of COVID-19

Psychological strains after the crisis: evaluating separation anxiety among Iranian children and adolescents in the post-COVID-19 era

OBJECTIVES

The objective of this study was to specifically investigate Separation Anxiety Disorder (SAD), as one of the noteworthy disorders within the spectrum of anxiety disorders, among children and adolescents, after overcoming the crises caused by the Coronavirus Disease 2019 (COVID-19) pandemic. Efforts were also made to identify socio-demographic factors that could be associated with changes in SAD level and also to assess the effect of different constituting dimensions of SAD on the severity of this disorder.

METHODS

In this cross-sectional study, face-to-face interviews were conducted with the parents of 317 (7-13-year-old) Iranian students, who were selected through a multi-stage random sampling method in the city of Shiraz. During the interviews, socio-demographic data were collected, and subsequently, SAD symptoms and dimensions were assessed using the Separation Anxiety Assessment Scale (Parent Version) (SAAS-P) questionnaire. Later, employing the Partition Around Medoids (PAM) statistical method, the participants were categorized into two groups with low and high levels of SAD. Also, to understand the interaction between the different dimensions of SAD, the network analysis method was employed. Finally, univariate analysis and logistic regression were utilized, with a significance level of 0.05, to determine potential associating factors with the level of SAD.

RESULTS

The sample included 128 girls and 189 boys with a mean age of 9.63 ± 2.63 and 9.63 ± 1.95 years respectively. Based on the PAM method, 51.1% of the participants presented a high level of SAD. According to network analysis, it was demonstrated that the "fear of abandonment" dimension plays a central role in high levels of SAD. Based on logistic regression, female gender, age ≥ 10 years, parents' unacademic educational background, mother's employment, and child's history of physical/mental problems were significantly associated with the high level of SAD.

CONCLUSIONS

A considerable number of the participants in this study presented a high level of SAD with the "fear of abandonment" being a key influential dimension of elevated levels of this disorder. Maternal employment, female gender, child's history of health issues, and low parental education were identified as important contributors to the high SAD level. Considering these factors allows for more effective diagnostic and therapeutic interventions. However, the need for further studies remains crucial.

Visualizing Mental Health Through the Lens of Pittsburgh Youth: A Collaborative Filmmaking Study During COVID-19

Youth mental health has been significantly impacted by COVID-19, with concerns of rising anxiety-related and depressive symptoms and reduced quality of life. This study provides a nuanced understanding of mental health stressors and supports in the lives of youth during the pandemic. Using Collaborative Filmmaking, an embodied, visual, and participatory research method, participants in Pittsburgh, Pennsylvania, were trained to create, analyze, and screen films about mental health. The films elucidated numerous stressors impacting youth mental health, including educational stressors (e.g., academic pressure and relationships with teachers), personal and social stressors (e.g., social and cultural expectations), and current events (e.g., the election and the political system). Supports included individual level supports (e.g., hobbies, self-care, spending time outdoors), and interpersonal level supports (e.g., family and socializing). Several themes were discussed as both stressors and supports, such as family, COVID-19, and social media. Overall, educational stressors are major contributors to adverse mental health symptoms among youth, which have been magnified by the COVID-19 pandemic. Youth discussions of the importance of self-care and engaging in healthy hobbies demonstrated strong awareness about maintaining mental health, though structural-level recommendations are still needed to improve youth mental health. Screening the Collaborative Films with the public illuminated several additional opportunities for action, including structural and social actions (e.g., changing policies and social norms around mental health). Given the structural nature of the stressors mentioned by participants, systemic changes as well as policy level action and programming are needed to address the intersectional nature of current mental health concerns among youth.

COVID-19-Related distress, body image, and eating behaviors: a cross-sectional explanatory model

BACKGROUND

The COVID-19 pandemic has been associated with increased body dissatisfaction and disordered eating behaviors in adolescents. To better understand these associations, this study tested an explanatory model in which appearance-focused social media use, internalization of social media pressure, and mindfulness abilities mediated the relationship between COVID-related distress and body dissatisfaction, which in turn was associated with dietary restraint and binge eating episodes.

METHODS

Adolescents (N = 493, Mage= 16.7; 47.5% girls) recruited within high schools completed online measures. We conducted model testing through path analysis in MPlus, using modification indices to derive a well-fitting model.

RESULTS

The initially hypothesized model was a poor fit for the data. The final well-adjusted model confirmed several significant paths and supported the parallel mediational roles of social media (specifically, the use of appearance-focused social media and internalization of social media pressure) along with mindfulness, on the relationship between COVID-19-related distress and body satisfaction. Model adjustments involved adding three paths, resulting in two additional significant indirect effects, and suppressing one path.

CONCLUSIONS

Findings suggest that mindfulness, media use and the internalization of social media pressure are potential key processes explaining body dissatisfaction and eating disorders among adolescents who experienced higher levels of COVID-related distress.

Adolescent coping and social media use moderated anxiety change during the COVID-19 pandemic

INTRODUCTION

Adolescence is a sensitive period during which stressors and social disruptions uniquely contribute to anxiety symptoms. Adolescent's coping strategies (i.e., avoidance and approach) during the coronavirus disease 2019 (COVID-19) pandemic may be differentially related to anxiety symptom changes. Further, social media use (SMU) is ubiquitous and may serve as an avenue to deploy avoidant and/or approach coping.

METHOD

Participants included 265 adolescents (ages 12-20 years; 55.8% female, 43.8% male) and one parent per adolescent. At two time points separated by ~6 months, adolescents reported on SMU and coping strategies, and parents and adolescents reported demographic information and adolescents' anxiety symptoms. Data were collected online in the United States, from summer 2020 through spring 2021.

RESULTS

Increases in avoidant coping predicted increasing anxiety, particularly when approach coping decreased. Decreases in both avoidant coping and SMU coincided with decreasing anxiety. Older adolescents showed decreasing anxiety when avoidant coping declined and SMU increased.

CONCLUSION

Coping strategies and SMU predicted patterns of adolescent anxiety symptom change across 6 months during the COVID-19 pandemic. Results highlight that coping and SMU should be contextualized within the time course of stressors.

Investigating the impact of the COVID-19 pandemic on older adolescents' psychological wellbeing and self-identified cognitive difficulties

Background

The COVID-19 pandemic coincides with growing concern regarding the mental health of young people. Older adolescents have faced a particular set of pandemic-related challenges and demonstrate heightened vulnerability to affective disorders (particularly anxiety). Anxiety symptoms are associated with a range of cognitive difficulties. Older adolescents may therefore be susceptible to pandemic-related declines in wellbeing and associated cognitive difficulties.

Methods

At three timepoints, independent samples of young people aged 16-18 years (N = 607, 242, 618 respectively) completed an online survey. Data collection coincided with periods of lockdown (timepoints 1 and 3) and young people returning to school (timepoint 2). The survey assessed subjective impacts of the pandemic on overall wellbeing, anxiety and cognitive function.

Results

Findings demonstrated the detrimental impact of the COVID-19 pandemic on older adolescents' psychological wellbeing-a finding that was consistent across samples. The majority of young people at each timepoint experienced heightened anxiety. Crucially, pandemic-related anxiety was associated with self-identified cognitive difficulties, a pattern of association that was evident at all three timepoints. The nature and extent of these difficulties were predictive of specific pandemic-related concerns in this age group.

Conclusions

Older adolescents' experiences of the pandemic are characterised by subjective declines in wellbeing and stable patterns of association between anxiety and self-identified cognitive difficulties. Implications are discussed with reference to future research and intervention.

The mental condition of Polish adolescents during the COVID-19 pandemic and war in Ukraine

Recently, the experience of the COVID-19 global pandemic has significantly affected the mental condition of entire societies by increasing anxiety and stress resulting from its sudden and completely unexpected nature. In Poland, apart from the pandemic, there is an ongoing threat of an armed conflict just across the border, which can constitute direct and indirect threats to physical and mental health. Each of these situations is unusual and difficult. It is also in sharp contrast to the developmental needs of children and adolescents. It especially violates the principal need of this developmental period, which is to grow up in a predictable as well as physically and emotionally safe environment. The purpose of the conducted research was to assess the psychological condition of Polish adolescents, whose social situation is difficult, in order to take appropriate preventive measures based on this assessment. The study was conducted using the "Who are You?" Scale of Transparency Anxiety and the Revised Child Anxiety and Depression Scale (RCADS), as well as a researcher-made survey containing questions about well-being in relation to the pandemic, distance learning and the ongoing war in a neighbouring country. Approval was obtained from the Bioethics Committee to conduct the projected research. The study included 945 adolescents aged 11 to 15 (M = 13.10; SD = 1.11) making a representative sample of adolescents from 14 regions in Poland. The results of the research and analyses show that the adolescents under study have a medium level of intensity of neuroticism, with the highest levels occurring in adolescents aged 14. Moreover, the adolescents manifest relatively lower symptoms of anxiety and depression as well as concern about the pandemic and the war in Ukraine than expected.

Anxiety in Children and Adolescents in the Covid-19 Pandemic: A Systematic Review

The aim of this study was; to define the anxiety and anxiety-related factors experienced by children/adolescents during the Covid-19 pandemic on a global scale. Study data were collected between 15.04.2021 and 30.04.2021 by using keywords (child, children, adolescents, adolescents, mental health, anxiety, anxiety and stress) in Turkish and English. The data sources of this study are PubMed, Web of Science, and Google Scholar t. As a result of the evaluations, a total of n=6185 articles were reached from all databases. After the evaluation of the full texts, the study was completed with n=31 articles. Eleven of the articles evaluated in this study were published in China. The anxiety prevalence of children and adolescents varies between 1.84-45.0%. As a result of the evaluated studies; It has been observed that women, those with chronic-psychiatric diseases, those who are older, separated from family members, migrant children and adolescents are more likely to experience anxiety. Some of the anxiety symptoms of children and adolescents are nervousness, irritability, anxiety, and suicidal ideation. In conclusion, anxiety levels and anxiety-related factors of children and adolescents living in various countries of the world during the Covid-19 pandemic were determined.

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.

Changes in behavior and quality of life in German young children during the COVID-19 pandemic-results from the COVID kids bavaria study

Introduction

The COVID-19 pandemic with its containment measures such as closures of schools and daycare facilities led to numerous restrictions in daily life, putting developmental opportunities and health-related quality of life in children at risk. However, studies show that not every family was impacted equally by the pandemic and that this exceptional health and societal situation reinforced pre-existing health inequalities among the vulnerable. Our study aimed at analyzing changes in behavior and health-related quality of life of children attending elementary schools and daycare facilities in Bavaria, Germany in spring 2021. We also sought to identify associated factors contributing to inequalities in quality of life.

Methods

Data from a multi-center, open cohort study ("COVID Kids Bavaria") conducted in 101 childcare facilities and 69 elementary schools across all electoral districts of Bavaria were analyzed. Children attending these educational settings (aged 3-10 years) were eligible for participation in a survey on changes in behavior and health-related quality of life. The KINDL^R questionnaire (based on children's self-report and parental report) was administered about one year after the onset of the pandemic (spring 2021). Descriptive and logistic regression analyses and comparisons to pre-pandemic KiGGS (German Health Interview and Examination Survey for Children and Adolescents) data were undertaken.

Results

Among respondents, a high percentage of parents reported changes in their children's eating and sleeping behavior, sports and outdoor activities as well as altered screen time. Health-related quality of life in KINDL^R analyses compared to pre-pandemic population averages were lower in all age groups (for 3-6-year-old KINDL^R-total score: COVID Kids Bavaria MD 74.78 ± 10.57 vs KiGGS data 80.0 ± 8.1; 7-10 years-old KINDL^R-total score: COVID Kids Bavaria MD 73.88 ± 12.03 vs KiGGS data 79.30 ± 9.0). No significant differences were detected with regard to associated factors, namely type of institution, sex of the child, migration background, household size and parental education.

Conclusion

These findings suggest a relevant impact of the COVID-19 pandemic on children's behavior and health-related quality of life one year after the onset of the pandemic. Further analyses in large-scale longitudinal studies are needed to determine the effects of specific pandemic or crisis associated factors contributing to health inequalities.

Loneliness, affective disorders, suicidal ideation, and the use of psychoactive substances in a sample of adolescents during the COVID-19 pandemic: A cross-sectional study

PROBLEM

The global coronavirus (COVID-19) pandemic has been challenging for adolescents. Indeed, with the closure of schools and social centers and reduction of extracurricular activities, increased social isolation has compounded difficulties in and with school performance, loneliness, and social networking. Increased risk of mental health problems, substance abuse, affective disorders, suicidal ideation, and suicide has been reported in adolescents.

METHODS

This cross-sectional study assesses the association between loneliness, depression, anxiety, suicidal ideation, the use of social networks, and school achievement in a sample of Italian adolescents during the COVID-19 pandemic. This study also explores emotional dysregulation through the association between affective disorders (depression and anxiety), substance use, and social networks. The sample comprises adolescents in the first and second grades of high school during the pandemic; participants received an email explaining the purpose of the e-research. Data were collected using the Strengths and Difficulties Questionnaire, the Achenbach System of Empirically Based Assessment, and the Loneliness Scale.

FINDINGS

A total of 505 adolescents completed the web survey. Data revealed that students experienced difficulties with loneliness, problems with school achievement, and extracurricular activities. The mean scores for depression and anxiety were close to the borderline range. A total of 14.3% of adolescents intentionally harmed themselves or attempted suicide.

CONCLUSIONS

This study raises concerns about the impacts of the pandemic on adolescents that require the attention of adult reference figures who deal with adolescents, such as parents, teachers, and healthcare professionals. Results indicate the necessity of providing early interventions aimed at the prevention of psychopathologies and the promotion of adolescent mental health due to the pandemic.

Epidemic of Depression and Anxiety in child and adolescent population during COVID-19 pandemic: A systematic review and meta analysis of the prevalence of depression and anxiety

COVID-19 has caused mayhem in the life of people. It has disrupted the social fabric of life. The children and adolescent population has been particularly affected by its direct and indirect effects. This systematic review aims to find the prevalence of depression and anxiety in children and adolescent age groups. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for finding the prevalence of depression and anxiety. We found the total number of participants to be 71,016. A random effect model was used for conducting meta-analysis. The prevalence of depression was mentioned in 17 studies of 23 and the pooled prevalence was 27% [95% confidence interval: 21%-36%] and heterogeneity (I2 statistics; P <.00001) was 100%. The prevalence of anxiety was found in 20 studies of 23 and the pooled anxiety prevalence was 25% (95% confidence interval: 16%-41%) and heterogeneity (I2 statistics; P < .00001) was found to be 100%. The summary of the findings has been provided. Due to high heterogeneity, moderator analysis was performed separately for depression and anxiety subgroups. The study design consisted of cross-sectional studies and some studies conducted through online surveys. The age range varied considerably from 1 year to 19 years; 5 studies had participants aged more than 19 years, but the mean age of the total sample was less than 18 years. We conclude that indeed there is a mental health epidemic among the child and adolescent population. We recommend early intervention and tailored made strategies should for management. As the pandemic is enduring, rigorous monitoring should be done. This age group is under extra pressure owing to a large uncertainty about their studies as well their future.

Somatic symptoms associated with mental distress during the COVID-19 pandemic: a systematic review

OBJECTIVE

The primary objective of this article was to systematically review the prevalence of somatic symptoms in patients, healthcare workers and general population during the COVID-19 pandemic. The secondary objectives were to record the association between somatic symptoms and indices of mental distress and to record the qualitative characteristics of such somatic complaints.

METHODS

Following the PRISMA methodology we systematically searched PubMed, Scopus and Google Scholar for primary research reporting on somatic symptoms in association with mental distress. We specifically sought papers reporting on bodily distress disorder, somatic symptoms disorder or medically unexplained symptoms.

RESULTS

1569 papers were retrieved, which yielded 36 relevant studies after screening. 15 studies referred to healthcare workers, 13 to general population, 5 to COVID-19 patients, 2 compared medical with non-medical professionals and 1 was studying COVID-19 patients some of which were also healthcare workers. The reported prevalence of somatic symptoms ranged from 7.4% to 67.8%. Commonly seen symptoms were shortness of breath, dyspnea, palpitations and pain in arms, legs and joints.

CONCLUSIONS

Our systematic review suggests that somatic symptoms are very frequent during the pandemic and are often linked to mental distress. All three population groups are affected.

On the Waves of the COVID-19 Pandemic

The COVID-19 pandemic has been a tsunami that has deeply changed the lives of the people all over the planet [...].

Mindset and perceived parental support of autonomy safeguard adolescents' autonomous motivation during COVID-19 home-based learning

During school closures throughout the COVID-19 pandemic, less support from peers and teachers may have required more autonomous motivation from adolescents. Little is known about factors that could shield against these negative effects. Driven by two influential motivational theories, we examined how mindset, feelings of school burnout and the three basic psychological needs of the self-determination theory, could predict changes in autonomous motivation when controlling for pre-pandemic levels of motivation. The results from a sample of Dutch adolescents (Mage = 14.63 years) and their parents (Mage = 48.65 years) showed that endorsing a growth mindset was positively associated with autonomous motivation during the school closures, while feelings of school burnout were negatively associated with autonomous motivation. Additionally, perceived parental autonomy support (i.e. a measure of the basic psychological need of autonomy) related to more autonomous motivation during home-based learning. Our findings highlight the personal and family factors that influence how adolescents respond to home-based learning and suggest ways to keep adolescents motivated and diminish possible negative consequences during future home-based learning situations.

Relational Competence, School Adjustment and Emotional Skills: A Cross-Sectional Study in a Group of Junior and High School Students of the Sicilian Hinterland

Research has demonstrated the influence of emotional adjustment on the manifestation of problematic behaviors in adolescence, especially during the COVID-19 pandemic. The aim of the present research is to investigate the role of self-esteem and relational skills on school performance in a group of middle and high school students during the COVID-19 period. The research involved 392 students, aged between 11 and 20 (M = 13.78; S.D. = 2.56). Participants completed the following instruments: an anamnestic constructed ad hoc questionnaire; the Interpersonal Relationships Test, in order to evaluate the perception of adolescents concerning the quality of their relationships in social, family and school contexts; and the Multidimensional Test of Self-Esteem, structured in six scales, which coincide with the dimensions considered constitutive of self-esteem. The preliminary data have shown how the older girls, attending the high school, tend to manifest a higher level of social competence with peer group and teachers. Furthermore, the perception of a reduced emotional self-efficacy but an elevated environmental control and good interpersonal skills seem to predict the school adjustment. Understanding adolescents' perceptions of difficulties and their social support networks can offer some insight into how major social changes can be associated with individual well-being, especially during the COVID-19 pandemic.

Trends in health behaviors and mental health among Korean adolescents in Korea over 5 years, 2017-2021: focusing on the comparisons before and during the COVID-19 pandemic

Objectives

We investigated recent trends in health behaviors and mental health conditions among Korean adolescents from 2017 to 2021 and compared the changes before and during the coronavirus disease 2019 (COVID-19) pandemic.

Methods

Data analysis was conducted on 289,415 adolescents participating in the Korea Youth Risk Behavior Web-Based Survey, an annual cross-sectional study from 2017 to 2021. All analysis was conducted using sex stratification, and the annual percentage change (APC) was calculated.

Results

Alcohol consumption and smoking decreased in the first year of the COVID-19 pandemic compared with before, except for girls from the low-income level. The prevalence of inadequate physical activity for both boys and girls increased in 2020 compared with the pre-COVID-19 period and decreased again by 2021. The prevalence of obesity in both sexes increased regardless of the period (boys, APC = 8.2%, 95% confidence intervals (CI), 6.4-10.1; girls, APC = 3.3%, 95% CI, 1.8-4.8). The prevalence of stress, depression, and suicidal ideation, plans, and attempts for both sexes decreased in 2020 compared to the pre-COVID-19 period. By 2021, this prevalence had returned to a level similar to before the pandemic. No significant APC changes were observed in the prevalence of mental health.

Conclusions

These findings demonstrate the trends and APCs in health behaviors and mental health conditions among Korean adolescents over the last 5 years. We must pay attention to the heterogeneous and multifaceted features of the COVID-19 pandemic.

Assessment of COVID-19 Anxiety Levels and Attitudes to COVID-19 Vaccine among Older Adults in Poland: A Pilot Study

BACKGROUND

The fear of being infected with the SARS-CoV-2 has become widespread, especially among older adults. Information campaigns to promote mass vaccination against COVID-19 are a key element in controlling and preventing the spread of the COVID-19 pandemic. However, their success primarily depends on vaccination coverage in a given population. The aim of this study was to assess the severity of COVID-19 anxiety and attitudes towards COVID-19 vaccines among older adults in Poland.

METHODS

This pilot study was conducted among a total of 127 older participants, including 108 students (85%) of Third Age Universities in Bialystok and 19 patients (15%) of the Department and Clinic of Geriatrics of the Hospital of the Ministry of Internal Affairs and Administration in Bialystok. The study used a diagnostic survey based on an author-designed questionnaire and four standardized psychometric tools: The Fear of COVID-19 Scale (FCV-19S), Coronavirus Anxiety Scale (CAS), The Drivers of COVID-19 Vaccination Acceptance Scale (DrVac-COVID19S), and Scale to Measure the Perception of SARS-CoV-2 Vaccines Acceptance (The VAC-COVID-19 Scale).

RESULTS

COVID-19 vaccination coverage in the study group was 88.2%, with three doses in most cases. We found a negative vaccination status only in women taking part in the study. Men scored significantly higher on DrVac-COVID19S and its Value subscale, and markedly lower on FCV-19S. We did not observe significant differences in the scales' scores between age groups. Respondents recruited from the Third Age Universities had significantly higher scores than geriatric clinic patients in the Knowledge subscale of DrVac-COVID19S. In the case of FCV-19S, no correlation with the results obtained in other scales used in the study was found. Additionally, no correlation was found between CAS scores and the following scales: DrVac-COVID19S (total), DrVac-COVID19S Knowledge (K) subscale, DrVac-COVID19S Autonomy (A) subscale and VAC-COVID-19-Scale-positive subscale. The other scales were strongly correlated with each other-the correlations were statistically significant.

CONCLUSIONS

Subjective COVID-19 anxiety in the study group was moderate. Seniors were more likely to show positive vaccine attitudes, as confirmed by the percentage of respondents vaccinated against COVID-19 with at least one dose. However, there is still a percentage of unvaccinated individuals in the population of seniors; therefore, measures should be taken to motivate this age group and encourage preventive vaccination against COVID-19. Furthermore, representative studies on COVID-19 anxiety and attitudes towards the COVID-19 vaccine among Polish seniors are needed to determine a more precise prevalence of these phenomena and potential correlations on a national level.

COVID-19 and mental health disorders in children and adolescents (Review)

The new coronavirus has been present for two years and has had a widespread and sustained impact worldwide. There is growing evidence in the literature that COVID-19 may have negative effects on mental illness in patients and in healthy populations. The unprecedented changes brought about by COVID-19, such as social isolation, school closures, and family stress, negatively affect people's mental health, especially that of children and adolescents. The purpose of this paper is to review the literature and summarize the impact of COVID-19 disorders on children's and adolescents' mental health, the mechanisms and risk factors, screening tools, and intervention and prevention. We hope that the mental dysfunction caused by the pandemic will be mitigated through appropriate and timely prevention and intervention.

The COVID-19 Pandemic and Adolescents’ Psychological Distress: A Multinational Cross-Sectional Study

Background: The coronavirus disease 2019 (COVID-19) pandemic has continued for more than two years, and the impact of this pandemic on mental health has become one of the most important research topics in psychiatry and psychology. The aim of the present study was to assess psychological distress in adolescents across five countries (Sweden, Morocco, Serbia, Vietnam, and the United States of America) during the COVID-19 pandemic. Methods: Using nonparametric analyses we examined the impact of COVID-19 on distress, measured by the Brief Symptom Inventory, in a sample of 4670 adolescents. Results: Our results showed that the association between the COVID-19 impact and psychological distress in adolescents’ lives was positive and moderate in Morocco and Serbia, positive and weak in Vietnam and the United States of America, and negative and weak in Sweden. We also found that female adolescents reported higher distress levels than male adolescents. Conclusions: COVID-19 impacted adolescents and their psychological distress differently depending on their residence.

COVID-19 quarantine in adolescents with autoimmune rheumatic diseases: mental health issues and life conditions

Objectives

To assess mental health and life conditions in adolescents with autoimmune rheumatic diseases (ARDs) and healthy controls quarantined during COVID-19 pandemic.

Method

A cross-sectional study included 155 ARD adolescents and 105 healthy controls. Online survey included self-reported strengths and difficulties questionnaire (SDQ), and a semi-structured questionnaire with demographic data, daily home and school routine, physical activities, and COVID-19 information during the pandemic.

Results

Among patients, 56% had juvenile idiopathic arthritis (JIA), 29% juvenile systemic lupus erythematosus (JSLE), and 15% juvenile dermatomyositis (JDM). No differences were found regarding sex, ethnicity, and current age between ARD patients and controls (p > 0.05). Abnormal emotional SDQ (38% vs. 35%, p = 0.653) were similar in both groups. Logistic regression analyses in ARD patients demonstrated that female (OR = 2.4; 95%CI 1.0–6.0; p = 0.044) was associated with severe emotional SDQ dysfunction, whereas sleep problems were considered as a risk factor for both worse total SDQ (OR = 2.6; 95%CI 1.2–5.5; p = 0.009) and emotional SDQ scores (OR = 4.6; 95%CI 2.2–9.7; p < 0.001). Comparisons between ARD patients with and without current prednisone use showed higher median scores of peer problems in the first group [3 (0–10) vs. 2 (0–7), p = 0.049], whereas similar median and frequencies between JIA, JSLE, and JDM (p > 0.05).

Conclusions

Approximately one third of JIA, JSLE, and JDM patients presented abnormal total and emotional scores of SDQ during COVID-19 quarantine. Sleep problems were the main factor associated with emotional difficulties in these ARD adolescents. The knowledge of mental health issues rates in adolescents with ARD supports the development of prevention strategies, like sleep hygiene counseling, as well as the references of the affected patients to specialized mental health services, as necessary.

Key Points • One third of ARD patients presented mental health issues during COVID-19 quarantine • Sleep problems were associated with emotional difficulties. • It is necessary to warn pediatric rheumatologists about the importance of sleep hygiene counseling.

Socio-ecological Resilience Relates to Lower Internalizing Symptoms among Adolescents during the Strictest Period of COVID-19 Lockdown in Perú

The COVID-19 pandemic has touched the lives of adolescents around the world. This short-term longitudinal, observational study followed 1,334 adolescents (11–17 yo) to investigate whether social-ecological resilience relates to intra- and inter-personal resources and/or the caregiver relationship relates to changes in internalizing symptoms during five stressful weeks of COVID-19 lockdown in Perú. In this work, we contextualize social-ecological resilience in relation to culturally-relevant personal and caregiver resources that youth can use to adapt to stressful situations. We found that adolescents who reported higher levels of personal, caregiver, and overall resilience had lower levels of anxiety and depressive symptoms at week six. We also find that personal, caregiver, and overall resilience moderated the change in anxiety symptoms from week 6 to week 11 of lockdown in 2020. Our findings underscore the importance of social-ecological resilience related to both intra/interpersonal resources and the caregiver relationship for minimizing the harmful impacts of COVID-19 on adolescent internalizing symptoms.

Screening for anxiety and its determinants among secondary school students during the COVID-19 era: a snapshot from Qatar in 2021

Background

Anxiety among adolescents may lead to disability and has a tremendous impact on one's quality of life. The alarming COVID-19 pandemic is expected to increase the anxiety level of adolescents especially with enforced governmental management strategies. This study will assess anxiety symptoms among secondary school students during the COVID-19 pandemic in Qatar.

Methods

We conducted an analytical cross-sectional study among adolescents attending independent secondary schools in Qatar. First, potential participants were invited through Microsoft teams. Next, a total of 750 participants were assessed through the Generalized Anxiety Disorder-7 (GAD-7) tool. We then conducted descriptive analyses and the Chi-square test to examine significant determinants of anxiety, which was followed by logistic regression analysis. In the end, the scale was tested for its internal consistency using Cronbach's alpha.

Results

Anxiety symptoms were seen in 37.2% of the participants. Female gender, previous history of mental illness, comorbidities, permissive parenting style, and spending more than 12 h per day on the internet were significant determinants of anxiety. Furthermore, a previous history of mental illness, low perceived social support, isolation, and social distancing predicted anxiety.

Conclusions

Anxiety is common among secondary school students in Qatar, and preventive interventions must target the determinants, especially during a pandemic.

The status of adolescent health during the COVID-19 pandemic

Coronavirus is a life-threatening disease with many devastating psychological, emotional, social, and sexual implications, especially for vulnerable people. This cross-sectional study aimed to assess adolescent health and anxiety during the COVID-19 pandemic. 1300 male adolescents filled out the Male Adolescent Health Need Assessment Scale (MAHNAS) and corona-related anxiety scale (CRAS) from January to May 2021. Data analysis was done using SPSS version 22. The mean age of adolescents was 15.5±2.25, and most of them (65%) were studying in high school. The mean scores for physical health were 78±7.55, psychological health 48.8±5.55, social health 48.21±8.61, sexual health 50.35±9.05, and anxiety scores were severe (46.76) in this study. There was a significant negative relationship between anxiety and health needs. The COVID-19 pandemic greatly affected the health needs of adolescents. Effective approaches and policies in this crisis, especially for adolescents, can alleviate the anxious reactions and be a way to meet their health needs appropriately.

Health-related quality of life, Mediterranean diet, physical activity and socioeconomic factors of Greek adolescents during COVID-19: A cross sectional study

BACKGROUND: Health related quality of life of the adolescents during quarantine and social isolation potentially decreases, with significant alteration on physical activities and nutrition behaviour. OBJECTIVE: The present study investigates the relationship between Greek adolescents’ health related quality of life and socioeconomic factors, lifestyle and dietary characteristics, along with their adherence to the Mediterranean Diet immediately after the lockdown period in Greece. METHODS: A total sample of 459 students aged 12–16 years old were recruited from secondary schools in the area of Athens. The KIDSCREEN-27 questionnaire for children and adolescents, the KIDMED test, the Godin and Shephard Leisure Time Physical Activity Questionnaire and the Family Affluence Scale III, were used for the statistical analysis. T-tests, Kruskal Wallis, Chi-square, Anova tests and multiple regression analyses were employed. RESULTS: Econometric analysis reveals that adolescents’ health related quality of life is higher among boys, adolescents who live with both parents, tend to sleep more during night and do not spend many hours on screen viewing. Also, adolescents with higher family affluence level, being physically active and with a high adherence to the Mediterranean Diet have higher health related quality of life. CONCLUSIONS: Adolescents’ adherence to the Mediterranean Diet, physical activity, socioeconomic characteristics and life style behaviors are highly correlated with perceived health related quality of life during COVID-19 period.

Effects of COVID-19 pandemic on mental health of children and adolescents: A systematic review of survey studies

Objective

Mental health problems among children and adolescents are increasingly observed during the outbreak of COVID-19, leading to significant healthcare concerns. Survey studies provide unique opportunities for research during this pandemic, while there are no existing systematic reviews in this setting. The objective was to summarize existing survey studies addressing the effects of the current COVID-19 pandemic on the mental health of children and adolescents.

Methods

For this systematic review, we performed an electronic search in multiple databases from December 2019 to December 2020. The quality appraisal of the included studies was performed with the Critical Appraisal Skills Programme Qualitative Checklist. Because of the high methodological heterogeneity between studies, a narrative synthesis of the qualitative data was used.

Results

In total, 35 survey studies with 65,508 participants, ranging from 4 to 19 years of age, are included in this review. Anxiety (28%), depression (23%), loneliness (5%), stress (5%), fear (5%), tension (3%), anger (3%), fatigue (3%), confusion (3%), and worry (3%) were the most common mental health issues reported. Children and adolescents with psychiatric and/or developmental disorders, such as severe obesity, chronic lung disease, attention deficit hyperactivity disorder, cystic fibrosis, and obsessive-compulsive disorders, were especially vulnerable to the mental health effects of the COVID-19 pandemic. Age, gender, psychological quality, and negative coping strategies were identified as risk factors for the development of mental health problems. Social and family support, along with a positive coping style, was associated with better outcomes.

Conclusion

The impact of the COVID-19 pandemic on mental health of children and adolescents is multifaceted and substantial. Survey studies regarding child and adolescent mental health amid COVID-19 indicated that anxiety, depression, loneliness, stress, and tension are the most observed symptoms. Positive coping strategies with family and social support may be important to achieving better outcomes. Due to limited available evidence, more well-designed studies in this area are urgently needed.

Anxiety in Paediatric Patients Diagnosed with COVID-19 and the Affecting Factors

OBJECTIVE

Children may be greatly affected by events that increase stress in individuals in general and are reported as the vulnerable groups during the coronavirus disease-19 (COVID-19) pandemic. But most of the studies in the literature investigating the mental effects of the pandemic on children were conducted with healthy children and limited study has evaluated the effect on children diagnosed with COVID-19. The aim of this study is to determine the anxiety level in paediatric patients diagnosed with COVID-19 and the affecting factors.

METHODS

This descriptive study was conducted with 292 children aged 8-18 years who were diagnosed with COVID-19. Data were collected using the Descriptive Characteristics Questionnaire and the Screen for Child Anxiety Related Emotional Disorders (SCARED). Interviews were held by phone.

RESULTS

Males were 51.4% of participants, the mean age was 16.04 ± 1.93. 84.1% of them had a chronic disease; the transmission source was family/relatives/friends for 41.1%. By social isolation, 49.3% were affected and 33.2% were affected by disease symptoms the most in this process. The most common symptoms were headache (61.6%), and asthenia (59.9%). Mean anxiety scale score was 25.5 ± 14.37. The effect of gender, number of symptoms and transmission source on anxiety score was significant (p < 0.05).

CONCLUSION

Paediatric patients diagnosed with COVID-19 were found to have high anxiety levels. It is recommended to re-evaluate the duration of children's social participation and support the management of COVID-19 symptoms that affect their anxiety level.

Academic performance under COVID-19: The role of online learning readiness and emotional competence

The COVID-19 pandemic caused school closures and social isolation, which created both learning and emotional challenges for adolescents. Schools worked hard to move classes online, but less attention was paid to whether students were cognitively and emotionally ready to learn effectively in a virtual environment. This study focused on online learning readiness and emotional competence as key constructs to investigate their implications for students' academic performance during the COVID-19 period. Two groups of students participated in this study, with 1,316 high school students (Mean age = 16.32, SD = 0.63) representing adolescents and 668 college students (Mean age = 20.20, SD = 1.43) representing young adults. Structural equation modeling was conducted to explore the associations among online learning readiness, emotional competence, and online academic performance during COVID-19 after controlling for pre-COVID-19 academic performance. The results showed that, for high school students, both online learning readiness and emotional competence were positively associated with online academic performance during COVID-19. However, for college students, only online learning readiness showed a significant positive relationship with online academic performance during COVID-19. These results demonstrated that being ready to study online and having high emotional competence could make adolescents more resilient toward COVID-19-related challenges and help them learn more effectively online. This study also highlighted different patterns of associations among cognitive factors, emotional factors, and online academic performance during COVID-19 in adolescence and young adulthood. Developmental implications were also discussed.

Is coronavirus pandemic-related anxiety higher in children with chronic kidney disease than healthy children?

BACKGROUND

Since the emergence and worldwide spread of the new coronavirus (COVID-19) pandemic, it has caused people to experience adverse psychological effects. This study aimed to assess anxiety levels during COVID-19 in children with chronic kidney disease (CKD), including nephrotic syndrome (NS) and kidney transplantation (Tx).

METHODS

A case-controlled, cross-sectional study was conducted with children aged 10-18 years, who had a diagnosis of CKD or NS, or Tx, and followed in our center between April and July 2020. A healthy control group was recruited with age- and gender-matched children. A questionnaire with printed and online versions was designed in three parts: the first addressed demographic characteristics, the second addressed opinions about the pandemic, and the third was the Turkish version of the Revised Child Anxiety and Depression Scale - Child Version.

RESULTS

A total of 88 children completed the questionnaire. The patient and control groups were similar in terms of gender, age, household members and history of psychiatric treatment. Both groups stated that coronavirus is a risky disease for children (63.6%), and that they were afraid of contagion (69.3%). Only half of them were receiving realistic and informative answers from family members. In the Revised Child Anxiety and Depression Scale - Child Version, 66% of them received a high score on at least one subscale. The social phobia scores of the control group were higher than those of the patient group, although the proportion of high scores was similar in both groups. The ratio of high-scored participants was higher in CKD patients for panic disorder, and was lower in the immunosuppressive agent group for social phobia.

CONCLUSION

The current COVID-19 pandemic is a disaster that children encounter for the first time in their lives. It does not exclusively cause anxiety among children with chronic kidney diseases but also affects healthy children.

Anxiety and depressive symptomatology among children and adolescents exposed to the COVID-19 pandemic: A systematic review

Background/Aim. Children and adolescents are sensitive groups for the development of mental disorders during the crisis. The aim of this systematic review was to assess the impact of the COVID-19 pandemic on anxiety and depressive symptomatology in the population of children and adolescents. Methods. The investigation was based on a systematic review followed by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol, including Ovid MEDLINE, Embase, Global Health, and APA Psyc Info databases, to identify relevant studies reporting anxiety and depressive symptoms among children and adolescents during the COVID-19 pandemic. A total of 27 articles were included. Results. Anxiety symptoms increased from 28.3% before the pandemic to 49.5% during confinement [General Anxiety Disorder (GAD)-7 ? 11)] (McNemar test, p < 0.0001). More depressive symptomatology was found, as well as weight and sleep disturbances which are the characteristics of children and adolescents? mental health. Additionally, female teenagers were experiencing grater declines in mood disorders than male teenagers during the COVID-19 crisis. On the one hand, different positive correlations between anxiety and other variables, were found, such as clinical depressive symptoms and anxiety (3/14), smartphone and internet addiction (2/14), lower levels of family income (2/14), perceived threats (2/14), higher grades at school (2/14), and loneliness (1/14). On the other hand, positive correlations were reported between depression and children and adolescents that were socially disconnected (3/17). Finally, mothers with higher level of education and income were associated with higher level of happiness (2/17). Conclusion. COVID-19 has a strong impact on the mental health of children and adolescents regarding depression and anxiety symptoms. Prevention programs focused on coping strategies should be conducted in elementary schools, middle schools, and high schools. Mental health should become a priority matter for governments, and the current pandemic could be an opportunity to highlight the importance of mental well-being and to invest in the betterment of clinical trainings, treatments and mental health research.

Exploring mental health stigma among chinese-english bilinguals: Dual-process model of emotional competence, flipped learning readiness, and academic performance in Mainland Chinese Universities

Due to severe global competition and performance-related academic challenges, Chinese students are compelled to learn English and become bilinguals despite their non-English majors. Consequently, these students frequently experience psychological issues, including mental health stigma. Hence, the present study aims to explore the psychological factors associated with the academic performance of Chinese-English bilinguals as an outcome of their emotional competence, flipped learning readiness, and mental health stigma. Drawing on data from 448 Chinese-English bilingual students in universities in mainland China, the results based on structural equation modeling (SEM) indicated that their academic performance, flipped learning readiness, and emotional competence are negatively influenced by their mental health stigma. Moreover, the findings also validate that both flipped learning readiness and emotional competence significantly mediate the indirect effects of mental health stigma on the academic performance of bilinguals. The study's implications offer new and compelling evidence on the primary issue of mental health stigma among Gen Z bilingual students to raise deterrence against this psychological menace through collaboration across policymakers, academics, and mental healthcare providers.

Narrative review: COVID-19 and pediatric anxiety

The coronavirus (COVID-19) pandemic has brought focus to the effects of anxiety on children. This study aimed to review the existing literature regarding the impact of the pandemic on pediatric anxiety. This review analyzed the existing literature between the open-sourced collection on PubMed inputting "anxiety disorder in children during pandemic" and "pediatric anxiety OR child anxiety AND COVID" and that of the Journal of the American Academy of Child & Adolescent Psychiatry using the keywords "social anxiety AND COVID." This yielded 149 + 312 (461) entries and 68 articles were selected. Anxiety was found to have a prevalence of 18.9-23.87% in children during the COVID-19 pandemic whereas adolescent populations demonstrated a prevalence of 15.4-39.9%. Female gender was the most studied risk factor and physical activity was the most documented preventative factor. This review supported the notion that the COVID-19 pandemic is a major contributor to anxiety in the pediatric population.

Correlates of COVID-19 Pandemic on Anxiety among Adults in Appalachia, USA

BACKGROUND

Anxiety problems have increased in the COVID-19 pandemic worldwide. However, very little is known about the anxiety rates in the new normal phase of the disease when adults have been assumed to be adjusted. The study aimed to find out the difference in anxiety in a convenience sample of Appalachian adults during the new normal phase of the COVID-19 pandemic, examine its association with sociodemographic factors, and compare it with the anxiety levels before the pandemic as recalled by the participants.

STUDY DESIGN

A cross-sectional study.

METHODS

The Generalized Anxiety Disorder-7 scale was used in the present study. The Chi-square test was used to examine the difference between the severity of anxiety before and during the new normal phase of the COVID-19 pandemic in terms of sociodemographic and behavioral correlates. Pearson correlation was used to see the strength of the association between anxiety and age.

RESULTS

Although the anxiety rate was stabilized by the time people approached the new normal phase of the COVID-19 pandemic, its severity increased significantly among those with preexisting anxiety (P=0.001). Anxiety was found highly associated with female and minority gender, student status, lower education and income level, marital status, cohabitation with parents, and cigarette consumption (P=0.001). A slight inverse association was observed between age and anxiety before and during the new normal phase of the COVID-19 pandemic (P=0.001).

CONCLUSION

The young and females seem to be suffering from a higher burden of anxiety. Research is suggested to identify ways to develop social support-based community programs to address this issue.

Connection to Nature Boosts Adolescents’ Mental Well-Being during the COVID-19 Pandemic

Growing evidence suggests that connection to nature may be linked to mental health and well-being. Behavioral changes brought about by the COVID-19 pandemic could negatively affect adolescents’ connection to nature, subsequently impacting health and well-being. We explored the relationship between connection to nature and well-being before and during the pandemic through a nationally representative survey of adolescents across the United States (n = 624) between April and June 2020. Survey items focused on connection to nature, mental well-being, and participation in outdoor activities before and during the pandemic. Paired-sample t-tests revealed declines in connection to nature, mental well-being, and participation in outdoor activities during the pandemic. Multiple linear regression analyses examining connection to nature’s mediating role between outdoor activity participation and mental well-being indicated that connection to nature fueled higher levels of mental well-being at both time intervals. Z scores comparing connection to nature’s mediating role between outdoor activity participation and mental well-being between time intervals indicate that during the pandemic, the direct effect of outdoor activities on mental well-being increased, generating a greater impact than before the pandemic. This study illustrates how the health and well-being benefits associated with adolescents’ outdoor activities are reinforced when those activities also foster a stronger connection to nature.

iCOPE With COVID-19: A Brief Telemental Health Intervention for Children and Adolescents During the COVID-19 Pandemic

The COVID-19 pandemic has prompted extensive disruptions to the daily lives of children and adolescents worldwide, which has been associated with an increase in anxiety and depressive symptoms in youth. However, due to public health measures, in-person psychosocial care was initially reduced, causing barriers to mental health care access. This study investigated the feasibility, acceptability and preliminary effectiveness of iCOPE with COVID-19, a brief telemental health intervention for children and adolescents to address anxiety symptoms. Sessions were provided exclusively using videoconferencing technology. Feasibility and acceptability were measured with client satisfaction data. The main outcome measure for effectiveness was anxiety symptom severity measured using the Screen for Child Anxiety and Related Disorders (SCARED). Results indicated that the treatment was well accepted by participants. Significant reductions in anxiety were noted for social anxiety, and were observed to be trending towards a mean decrease for total anxiety. The findings suggest that this brief telemental health intervention focused on reducing anxiety related to COVID-19 is acceptable and feasible to children and adolescents. Future research using a large sample and with a longer follow-up period could inform whether symptom decreases are sustained over time.

Positive and Negative Online Experiences and Loneliness in Peruvian Adolescents During the COVID-19 Lockdown

Global COVID-19 lockdowns have disrupted adolescents' in-person social networks, increasing likelihood of loneliness. Social media can help adolescents maintain and develop peer relationships across distance. In this short longitudinal study with 735 Peruvian adolescents (ages: 11-17) from low-to-middle-income urban settings, we investigated whether online experiences relate to loneliness during initial stages of lockdown. Loneliness remained constant between week 6 and 11 of lockdown, was higher for females and similar across school-grades. Positive and negative online experiences were more frequent for older students, and females experienced more negative online experiences than males. Greater positive online experiences related to lower loneliness, with the reverse pattern for negative online experiences. Our results suggest that positive online experiences may mitigate loneliness during physical isolation.

Risk and Protective Factors for Changes in Adolescent Psychosocial Adjustment During COVID-19

The current study examined (1) changes in psychosocial adjustment among adolescents completing two surveys before COVID-19 and those completing the final survey during COVID-19 and (2) related risk/protective factors. Participants were 208 US adolescents (Mage  = 15.09, SD = 0.50, 48.8% female, 86.1% White; 40.9% COVID group) who completed longitudinal surveys assessing psychosocial adjustment and related risk/protective factors (e.g., emotion regulation, well-being pursuits). Only adolescents completing Wave 3 during COVID-19 experienced increases in depressive symptoms, negative affect, and isolation and decreases in positive affect and friendship. Several variables served as risk (i.e., dampening) and protective (i.e., eudaimonic and hedonic motives) factors of these changes. Findings highlight the range of factors that are distinctly associated with negative changes in adolescent adjustment during COVID-19.

The Assessment of the Severity of COVID-19-Related Anxiety Symptoms in Participants of the University of the Third Age in Poland: A Cross-Sectional Study among Internet Survey Respondents

Introduction: Fear of infection with SARS-CoV-2 has become widespread. All over the world, since the very beginning of the pandemic, older adults have been considered one of the groups at highest risk of SARS-CoV-2 infection and death due to COVID-19. The aim of the study was to evaluate the severity of anxiety symptoms related to COVID-19 in the older adults who are participants of the Universities of the Third Age in Poland. Material and methods: The study included participants of the University of the Third Age in Poland. A total of 296 persons were enrolled, including 258 women and 38 men. The study was a diagnostic survey, conducted with the use of the following validated psychometric scales: General Anxiety Disorder-7 (GAD-7), Short Health Anxiety Inventory (SHAI), and State-Trait Anxiety Inventory (STAI). Results: In two scales (STAI and SHAI), the mean scores demonstrated mild symptoms indicative of anxiety disorders in the older respondents. Women and men did differ significantly in terms of the scores obtained in STAI X-1 and STAI X-2. Single respondents differed significantly from divorced ones in terms of STAI X-1 scores. Moreover, widows/widowers differed significantly from divorced ones in terms of STAI X-2, and GAD-7 scores. Respondents declaring their financial status as average differed significantly from those declaring their financial status as good in terms of: STAI X-1, STAI X-2, SHAI, and GAD-7 scores. Conclusions: The subjective experience of anxiety symptoms associated with fear of contracting COVID-19 was increased due to the ongoing pandemic, but was not significantly high in the analysed population of older people. COVID-19-related anxiety was significantly more common in lonely individuals and in those of worse financial status. Women and men differed significantly in terms of perceived state anxiety and trait anxiety measured by STAI. More studies addressing COVID-19-related anxiety in older people participating in the Polish Universities of the Third Age are needed to determine a more accurate distribution of this phenomenon in Poland.

Media use before, during and after COVID-19 lockdown according to parents in a clinically referred sample in child and adolescent psychiatry: Results of an online survey in Switzerland

BACKGROUND

To investigate the consequences of COVID-19 lockdown on screen media use in children and adolescents with mental health problems, an online survey was conducted on leisure media use before, during and after the lockdown of spring 2020.

METHOD

Parents of patients (10-18 yrs) referred to child and adolescent psychiatry participated in an anonymous online survey, approximately six weeks after the first easing of lockdown measures. Parents rated the amount, the content and the psychological impact of their children's media use before, during and after the lockdown.

RESULTS

N = 477 parents completed the survey. Patients showed a significant increase in media time during the lockdown (including devices such as mobile, tablet/PC, video game console, TV, and activities such as gaming, social media) and a moderate increase in the negative impact of media use on everyday life. After the lockdown, total media time returned to pre-COVID-19 levels in most patients, but remained slightly higher in males. A worsening of the main psychopathological problem during lockdown was related to elevated media time in children (10-13 yrs), but not in adolescents (14-18 yrs).

CONCLUSION

According to parents' retrospective ratings, the increase in screen media time was reversible, and seems to reflect an expected coping strategy during lockdown. However, male patients did not completely return to pre-COVID-19 gaming time, and a small number continued to display excessive gaming.

"Stay at Home" in Italy during the COVID-19 Outbreak: A Longitudinal Study on Individual Well-Being among Different Age Groups

The restrictions imposed by the Italian government because of the coronavirus outbreak have been shown to be demanding on the Italian population. Data were collected at four different time points from 29 March 2020 to 3 May 2020 and during the final follow-up survey on 12 October 2020. In the present study, we provided longitudinal evidence on the relationship between the lockdown and mental health dimensions, such as emotional state, perceived stress, and time perspective, for three age groups. The results allowed us to observe their psychological status from different perspectives at five different time points. Notably, a negative effect of the lockdown individual well-beings emerged as a trend, and differences in individual adaptation strategies to a prolonged stressful situation were observed at the follow-up. Indeed, pairwise comparisons between age groups showed that the young adult group (18-23 years old) seemed to be the most psychologically affected by the lockdown. The findings are discussed according to the most recent literature on the topic. To the best of our knowledge, this is one of the first longitudinal studies carried out in Italy concerning the general psychological effects of the coronavirus lockdown.

The Playing Brain. The Impact of Video Games on Cognition and Behavior in Pediatric Age at the Time of Lockdown: A Systematic Review

A growing number of children and adolescents play video games (VGs) for long amounts of time. The current outbreak of the Coronavirus pandemic has significantly reduced outdoor activities and direct interpersonal relationships. Therefore, a higher use of VGs can become the response to stress and fear of illness. VGs and their practical, academic, vocational and educational implications have become an issue of increasing interest for scholars, parents, teachers, pediatricians and youth public policy makers. The current systematic review aims to identify, in recent literature, the most relevant problems of the complex issue of playing VGs in children and adolescents in order to provide suggestions for the correct management of VG practice. The method used searches through standardized search operators using keywords related to video games and the link with cognition, cognitive control and behaviors adopted during the pandemic. Ninety-nine studies were reviewed and included, whereas twelve studies were excluded because they were educationally irrelevant. Any debate on the effectiveness of VGs cannot refer to a dichotomous approach, according to which VGs are rigidly 'good' or 'bad'. VGs should be approached in terms of complexity and differentiated by multiple dimensions interacting with each other.

Traumatic Effects of the COVID-19 Outbreak in Middle School Students and Caregivers

OBJECTIVE

To investigate the traumatic effects of the COVID-19 pandemic on middle-school students and their parents.

METHODS

This epidemiological cross-sectional study was conducted with middle-school students in Denizli. A questionnaire consisting of the IES-R, CRIES-13 and a sociodemographic data form was delivered online. A total of 1059 participants who fully completed the questionnaire were included for analysis.

RESULTS

The IES-R total and subdimension scores and the CRIES-13 scores were found to be significantly higher in families with an income level of ≤2,500 TL. The CRIES-13 scores of children were found to be significantly higher in divorced families. No statistically significant difference was determined between the IES-R total and subdimension scores of the parents who were healthcare workers and the CRIES-13 scale scores of their children.

CONCLUSION

A statistically significant, positive, moderate relationship was found between the IES-R scale total and subdimension scores of parents and the CRIES-13 scale scores of children. A low socioeconomic level was seen to increase the prevalence of anxiety in adults and adolescents. The children of divorced families were found to be at higher risk of PTSD. Successful management of mental health symptoms in parents will reflect positively on the mental health status of their children.

Fear, Stress, Resilience and Coping Strategies during COVID-19 in Spanish University Students

COVID-19 (2019 coronavirus pandemic) and the resulting confinement has had an impact on mental health and the educational environment, affecting the stress, concerns, fear, and life quality of the university population. This study aimed to examine the correlation between fear of COVID-19, stress with COVID-19, and technological stress in university students, and their resilience, self-esteem, and coping strategies. The final sample comprised 180 Spanish university students, with an average age of 20.76 years (SD = 4.59). The above-mentioned effects were administered a series of self-report scales. We found statistically significant associations between fear of COVID-19 and stress with COVID-19, technological stress (total score), overload, and complexity (subdimensions of technological stress). Likewise, we found inverse relationships between the students’ fear of COVID-19 and the use of the coping strategy, cognitive restructuring. Ascertaining the factors that influence the coping strategies of undergraduate university students and their fears, psychological stress, and resilience provides valuable information for the development of educational interventions. This research has relevant implications for the diagnosis, orientation, and design of psycho-educational and clinical interventions that can improve students’ well-being and training for effective coping strategies for daily stress and this pandemic situation.

Mental Health and Physical Activity among Children and Adolescents during the COVID-19 Pandemic

Coronavirus disease 2019 (COVID-19) is causing disruptions in the global social system. Japanese children and adolescents have had their schools closed, government-mandated activity restrictions imposed, and interactions outside the home reduced. These restrictions can have a considerable psychological impact on children and adolescents. This review aims to describe the impacts of COVID-19 pandemic on physical activity and psychological status of this population. The review was conducted by searching PubMed for information on the impact of COVID-19-related activity restrictions on children and adolescents. The search identified 11 articles, three of which contained data on anxiety and psychological problems due to physical inactivity. Next, a PubMed search was conducted about physical activity and psychological status in children and adolescents under psychological stress. The search identified 368 articles, 28 of which were included in the review. For children, data that revealed a correlation between physical activity and psychological health and sedentary time leading to mood disorders were included. For adolescents, there were nine studies that reported a correlation between physical activity and psychological health and four studies that reported no correlation between physical activity and psychological health. Of the studies that reported a correlation, seven reported that physical activity improves psychological health. The impact of psychologically stressful situations such as COVID-19 on children and adolescents has been experienced worldwide. Physical activity has been correlated with psychological health, and it may improve psychological status; physical activity should be recommended to better support the psychological health of children and adolescents under the influence of COVID-19.

Don't Think That Kids Aren't Noticing: Indirect Pathways to Children's Fear of COVID-19

The present study is couched within Rachman's three-pathway theory of fear acquisition (Rachman, 1977, 1991). Besides the direct contact with the objects of fear, this model also includes two indirect pathways to fear acquisition: negative information transmission and modeling. The study aims to explore the contribution of these three factors to the level of children's fear of COVID-19. The sample consisted of 376 children (59.6% girls), aged 7-19 (M age = 12.77, SDage = 3.57), and one of their parents (M age = 42.88, SDage = 6.00). The survey was conducted online during the COVID-19 national state of emergency in the Republic of Serbia. The children assessed their fear of COVID-19, general fearfulness, negative information transmission, and modeling by their parents, as well as the level of exposure to negative information outside their home. The parents assessed their own fear of COVID-19 and trait anxiety. Parents' anxiety, children's age, and children's general fearfulness were used as covariates. The results of our path analysis provide support for Rachman's notion of indirect pathways. The more the parents were afraid of COVID-19, the more they expressed this (either verbally or through their behavior), which in turn led to an increase in the children's fear of COVID-19. Furthermore, children's exposure to negative information related to COVID-19, provided by their teachers and peers or stemming from the media, directly contributed to the level of children's fear. The results of the study emphasize the importance of caregivers' behavior during global health crises and provide some clues as to what caregivers may do to protect their children's mental health in such circumstances.

Neurologic Care of COVID-19 in Children

Most children with SARS-CoV-2 infection have relatively mild clinical symptoms without fever or pneumonia, although severe cases with multiple-organ failure have been reported. Neurological symptoms, which have been mainly reported in adults, are very rare in children. This article will review 2 different aspects of neurological involvement related to this infection in children. In the first part, we will review the neurological abnormalities reported in children caused by this viral infection. Adults frequently report muscle pain, headache, anosmia, dysgeusia, and occasionally more severe central or peripheral nervous system damage. Neurological involvement seems infrequent in children, although some cases have been reported. In the second part, we will discuss the COVID-19 pandemic impact on the healthcare system of some countries, causing collateral damage to general pediatric care and in particular to those children affected with chronic diseases, mainly neurological conditions, including autism, intellectual disability, attention deficit and hyperactivity disorder (ADHD), neuromuscular disorders, cerebral palsy, and epilepsy, and patients needing neurosurgical procedures.

A Qualitative Study of Child and Adolescent Mental Health during the COVID-19 Pandemic in Ireland

Mitigating the adverse physical health risks associated with COVID-19 has been a priority of public health incentives. Less attention has been placed on understanding the psychological factors related to the global pandemic, especially among vulnerable populations. This qualitative study sought to understand the experiences of children and adolescents during COVID-19. This study interviewed 48 families during the COVID-19 pandemic restrictions, and a national lockdown, to understand its impacts. The study used an Interpretative Phenomenological Analysis (IPA) methodology. Parents and children discussed the negative impact of the restrictions on young people’s wellbeing. Children and adolescents experienced adverse mental health effects, including feelings of social isolation, depression, anxiety, and increases in maladaptive behaviour. Families with children with Autism Spectrum Disorders reported increased mental health difficulties during this period mostly due to changes to routine. The findings highlight the impact of severe restrictions on vulnerable populations’ wellbeing and mental health outcomes, including children, adolescents, and those with Autism spectrum disorder (ASD).

COVID-19 Anxiety-A Longitudinal Survey Study of Psychological and Situational Risks among Finnish Workers

Background: The COVID-19 crisis has changed the conditions of many all over the globe. One negative consequence of the ongoing pandemic is anxiety brought about by uncertainty and the COVID-19 disease. Increased anxiety is a potential risk factor for wellbeing at work. This study investigated psychological, situational, and socio-demographic predictors of COVID-19 anxiety using longitudinal data. Methods: A nationally representative sample of Finnish workers (N = 1308) was collected before and during the COVID-19 crisis. Eighty percent of the participants responded to the follow-up study (N = 1044). COVID-19 anxiety was measured with a modified Spielberger State-Trait Anxiety Inventory. Psychological and situational predictors included perceived loneliness, psychological distress, technostress, personality, social support received from the work community, and remote working. A number of socio-demographic factors were also investigated. Results: Perceived loneliness, psychological distress, technostress, and neuroticism were identified as robust psychological predictors of COVID-19 anxiety. Increase in psychological distress and technostress during the COVID-19 crisis predicted higher COVID-19 anxiety. A recent change in their field of work and decreased social support from work communities predicted COVID-19 anxiety. Women and young people experienced higher anxiety. Conclusions: Different factors explain workers' COVID-19 anxiety. Increased anxiety can disrupt wellbeing at work, emphasizing the organizations' role in maintaining an inclusive and caring work culture and providing technical and psychological support to workers during crisis.

Validation and Psychometric Properties of the Portuguese Version of the Coronavirus Anxiety Scale (CAS) and Fear of COVID-19 Scale (FCV-19S) and Associations with Travel, Tourism and Hospitality

The aim of this study is to determine the anxiety and fear related to coronavirus disease 2019 (COVID-19) and their associations with travel, tourism and hospitality, in the Portuguese population. The Coronavirus Anxiety Scale (CAS) and Fear of COVID-19 Scale (FCV-19S) were validated for the Portuguese population and correlations with issues related to travel, tourism and hospitality were established. CAS and FCV-19S presented a good adjustment model and solid reliability and validity. Correlations between CAS and FCV-19S and the perception of the impact of COVID-19 in travel, tourism and hospitality were found. Participants considered that COVID-19 mainly affected their holidays and leisure time. However, the strongest correlation established was between total FCV-19S and emotional fear FCV-19S and the fear of attending hotel facilities. The Portuguese versions of CAS and FCV-19S are reliable psychological tools to assess anxiety and fear in relation to COVID-19 for the general population. The use of hotel facilities is the most threatening issue related to travel, tourism and hospitality. The results suggest that hotels should invest in hygiene and safety measures that allow users to regain confidence in hotel equipment.

Noli Timere: The Role of Reassuring Adults in Dealing with COVID-19 Anxiety in Pediatric Age

Since the earliest stages of the Corona Virus Disease-19 (COVID-19) spread, the elderly has been identified as the most vulnerable and health authorities have rightly focused on that population. Minor attention was paid to pediatric populations and their emotional reactions. Actually, children and adolescents faced severe anxiety, fear and stress conditions. An efficient management of the pandemic, therefore, must take into account the pediatric population which cannot be neglected as a minor matter compared to the elderly, the economy and health care. Since the lockdown time is over, children and adolescents must recover sociality, return to living in the open air, rediscover playing, free time, aiming for the beauty of their everyday life. In order to mitigate the long-term impact of COVID-19, the key response is the reassuring presence of the adult as 'a secure base'. The current study aimed to collect an overview of the recent references that report evidence on the role of adults in containing pandemic anxiety COVID-19 in pediatric populations, suggesting the need to ensure a reassuring presence of the adult, an effective child-parent communication, a child-friendly day and a long-lasting shared time with parents.