New Findings About Children’s Mental Health During COVID-19

CHILD & ADOLESCENT PSYCHIATRY

COVID-19 has brought about a complex array of factors (uncertainty, social isolation, and parental angst) that have an impact on the mental health of children and adolescents. Predictability is a stabilizing force for children and adolescents, but it has been disrupted since the COVID-19 outbreak.

Children have many worries related to the consequences of COVID-19 such as whether they will see their friends and relatives, go to school or get sick. It is often difficult for parents to calm their children’s anxieties because of the uncertainty in their lives. Parents are typically adept at making plans for their children, but future plans are currently on hold. The challenges facing parents may interfere with their usual ability to address their children’s emotional needs.

Research findings related to COVID-19

An online questionnaire survey was administered to 359 children and 3254 adolescents aged 7 to18 years during the spread of COVID-19 in China.¹ The questionnaire included a depression scale, an anxiety scale, and a coping style scale. It showed 22.3% of youth had scores indicative of clinical depressive symptoms, which is higher than the 13.2% estimated prevalence of youth depression in China. Anxiety symptom levels were also higher after COVID-19 than previously reported. Youth who had a family member or friend with COVID-19 had higher levels of anxiety than those who did not. A problem-focused coping style was associated with lower levels of clinical depressive symptoms, whereas an emotion-focused coping style was associated with higher levels of clinical depressive symptoms.

In another online survey, 8079 junior and senior high school students in China completed assessments about depressive and anxiety symptoms during the COVID-19 epidemic period. Using the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder (GAD -7) questionnaire.² The prevalence of depressive symptoms was 43.7%, anxiety symptoms 37.4%, and both depressive and anxiety 31.3%. Depressive and anxiety symptoms were higher in females, and with increasing grade level from junior to senior high. Students without depressive and anxiety symptoms had more knowledge about preventive and control measures, as compared to those students with depressive and anxiety symptoms.

Mental health of children was assessed during the lockdown in Bangladesh via an online survey of 384 parents with children aged 5 to15 years.³ Children’s depression, anxiety, and sleep disorder scores were grouped into severity categories. Severity and percentages of mental health problems in the children were as follows: subthreshold (43%), mild (30.5%), moderate (19.3%), and severe (7.2%).

The emotional impact of the COVID-19 quarantine was assessed for children and adolescents from Italy and Spain.⁴ Participants included 1143 parents of children aged 3 to 18 years who completed a survey about the effects of the quarantine on their children, compared to before the home confinement period. The study found 85.7% of parents reported changes in their children’s emotions and behaviors during the quarantine. The most frequently observed changes were difficulty concentrating (76.6%), boredom (52%), irritability (39%), restlessness (38.8%), nervousness (38%), loneliness (31.3%), uneasiness (30.4%), and worries (30.1%). About 75% of parents reported feeling stressed about the quarantine situation. Parental stress was associated with increased reports of emotional and behavioral symptoms in their children.

In a systematic review, Loades and colleagues examined the impact of social isolation and loneliness on mental health in children and adolescents.⁵ The relationship between loneliness and mental health problems in healthy children and adolescents was assessed to determine if quarantine and social isolation are predictive of future mental health problems. The review included 63 studies with a total of 51,576 participants. Social isolation and loneliness increased the risk of depression up to 9 years later. Duration rather than intensity of loneliness was more strongly associated with mental health symptoms. The findings from this literature review on loneliness and social isolation have potential implications for the current COVID-19 pandemic. These researchers suggest that loneliness for youth during the disease containment measures for COVID-19 may affect the future mental health of youth. They recommend preventive support and early intervention to address the mental health needs of children and adolescents during the COVID-19 pandemic.

Concluding thoughts

Overall, the research demonstrates that COVID-19 is affecting the mental health of children and adolescents and that depression and anxiety are prevalent. Additional research is needed, however, to assess the short- and long-term effects of COVID-19 on children’s overall mental health.

So, what can clinicians do for their patients? For clinicians who treat children and adolescents, talk with them about the impact of COVID-19 on their lives and assess its potential relationship to their current mental health. For some youths, the psychosocial impact of COVID-19 may be related to the onset or exacerbation of their current mental health problems. For other youths, particularly those with social anxiety disorders, remaining at home and doing online schooling may temporarily relieve their anxiety, but this is not a long-term solution and may result in overwhelming anxiety when it is necessary to return to school.

For clinicians who treat parents of children and adolescents, it is important to inquire about the mental health of their children during this pandemic. Parents’ mental health may be affected by their children’s mental health. Encourage parents to seek an evaluation for their children if they have any concerns about their children’s mental health. Early intervention may prevent long term mental health consequences from this COVID-19 pandemic.

Dr Wagner is professor and chair, Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, TX. She is immediate past president of the American Academy of Child and Adolescent Psychiatry.

References

1. Duan L, Shao X, Wang Y, et al. An investigation of mental health status of children and adolescents in china during the outbreak of COVID-19. J Affect Disord. 2020;275:112-118.

2. Zhou SJ, Zhang LG, Wang LL, et al. Prevalence and socio-demographic correlates of psychological health problems in Chinese adolescents during the outbreak of COVID-19. Eur Child Adolesc Psychiatry. 2020 Jun;29(6):749-758.

3. Yeasmin S, Banik R, Hossain S, et al. Impact of COVID-19 pandemic on the mental health of children in Bangladesh: A cross-sectional study. Child Youth Serv Rev. 2020;117:105277.

4. Orgilés M, Morales A, Delvecchio E, et al. Immediate psychological effects of the COVID-19 quarantine in youth from Italy and Spain. PsyArXiv. Accessed September 22, 2020. https://psyarxiv.com/5bpfz/

5. Loades ME, Chatburn E, Higson-Sweeney N, et al. Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19 [published online ahead of print, 2020 Jun 3]. J Am Acad Child Adolesc Psychiatry. 2020;S0890-8567(20)30337-3.