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

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Abstract

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.

Related collections

Most cited references 178

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The Fear of COVID-19 Scale: Development and Initial Validation

Daniel Ahorsu, Chung-Ying Lin, Vida Imani … (2020)

Background The emergence of the COVID-19 and its consequences has led to fears, worries, and anxiety among individuals worldwide. The present study developed the Fear of COVID-19 Scale (FCV-19S) to complement the clinical efforts in preventing the spread and treating of COVID-19 cases. Methods The sample comprised 717 Iranian participants. The items of the FCV-19S were constructed based on extensive review of existing scales on fears, expert evaluations, and participant interviews. Several psychometric tests were conducted to ascertain its reliability and validity properties. Results After panel review and corrected item-total correlation testing, seven items with acceptable corrected item-total correlation (0.47 to 0.56) were retained and further confirmed by significant and strong factor loadings (0.66 to 0.74). Also, other properties evaluated using both classical test theory and Rasch model were satisfactory on the seven-item scale. More specifically, reliability values such as internal consistency (α = .82) and test–retest reliability (ICC = .72) were acceptable. Concurrent validity was supported by the Hospital Anxiety and Depression Scale (with depression, r = 0.425 and anxiety, r = 0.511) and the Perceived Vulnerability to Disease Scale (with perceived infectability, r = 0.483 and germ aversion, r = 0.459). Conclusion The Fear of COVID-19 Scale, a seven-item scale, has robust psychometric properties. It is reliable and valid in assessing fear of COVID-19 among the general population and will also be useful in allaying COVID-19 fears among individuals.

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Mental health before and during the COVID-19 pandemic: a longitudinal probability sample survey of the UK population

Matthias Pierce, Holly F Hope, Tamsin Ford … (2021)

Summary Background The potential impact of the COVID-19 pandemic on population mental health is of increasing global concern. We examine changes in adult mental health in the UK population before and during the lockdown. Methods In this secondary analysis of a national, longitudinal cohort study, households that took part in Waves 8 or 9 of the UK Household Longitudinal Study (UKHLS) panel, including all members aged 16 or older in April, 2020, were invited to complete the COVID-19 web survey on April 23–30, 2020. Participants who were unable to make an informed decision as a result of incapacity, or who had unknown postal addresses or addresses abroad were excluded. Mental health was assessed using the 12-item General Health Questionnaire (GHQ-12). Repeated cross-sectional analyses were done to examine temporal trends. Fixed-effects regression models were fitted to identify within-person change compared with preceding trends. Findings Waves 6–9 of the UKHLS had 53 351 participants. Eligible participants for the COVID-19 web survey were from households that took part in Waves 8 or 9, and 17 452 (41·2%) of 42 330 eligible people participated in the web survey. Population prevalence of clinically significant levels of mental distress rose from 18·9% (95% CI 17·8–20·0) in 2018–19 to 27·3% (26·3–28·2) in April, 2020, one month into UK lockdown. Mean GHQ-12 score also increased over this time, from 11·5 (95% CI 11·3–11·6) in 2018–19, to 12·6 (12·5–12·8) in April, 2020. This was 0·48 (95% CI 0·07–0·90) points higher than expected when accounting for previous upward trends between 2014 and 2018. Comparing GHQ-12 scores within individuals, adjusting for time trends and significant predictors of change, increases were greatest in 18–24-year-olds (2·69 points, 95% CI 1·89–3·48), 25–34-year-olds (1·57, 0·96–2·18), women (0·92, 0·50–1·35), and people living with young children (1·45, 0·79–2·12). People employed before the pandemic also averaged a notable increase in GHQ-12 score (0·63, 95% CI 0·20–1·06). Interpretation By late April, 2020, mental health in the UK had deteriorated compared with pre-COVID-19 trends. Policies emphasising the needs of women, young people, and those with preschool aged children are likely to play an important part in preventing future mental illness. Funding None.

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Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19

Maria Loades, Eleanor Chatburn, Nina Higson-Sweeney … (2020)

Objective Disease containment of COVID-19 has necessitated widespread social isolation. We aimed to establish what is known about how loneliness and disease containment measures impact on the mental health in children and adolescents. Method For this rapid review, we searched MEDLINE, PSYCHINFO, and Web of Science for articles published between 01/01/1946 and 03/29/2020. 20% of articles were double screened using pre-defined criteria and 20% of data was double extracted for quality assurance. Results 83 articles (80 studies) met inclusion criteria. Of these, 63 studies reported on the impact of social isolation and loneliness on the mental health of previously healthy children and adolescents (n=51,576; mean age 15.3) 61 studies were observational; 18 were longitudinal and 43 cross sectional studies assessing self-reported loneliness in healthy children and adolescents. One of these studies was a retrospective investigation after a pandemic. Two studies evaluated interventions. Studies had a high risk of bias although longitudinal studies were of better methodological quality. Social isolation and loneliness increased the risk of depression, and possibly anxiety at the time loneliness was measured and between 0.25 to 9 years later. Duration of loneliness was more strongly correlated with mental health symptoms than intensity of loneliness. Conclusion Children and adolescents are probably more likely to experience high rates of depression and probably anxiety during and after enforced isolation ends. This may increase as enforced isolation continues. Clinical services should offer preventative support and early intervention where possible and be prepared for an increase in mental health problems.

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Author and article information

Contributors

Hasina Samji:

ORCID: https://orcid.org/0000-0002-4555-7609

Hasina_Samji@sfu.ca

Journal

Journal ID (nlm-ta): Child Adolesc Ment Health

Journal ID (iso-abbrev): Child Adolesc Ment Health

Journal ID (doi): 10.1111/(ISSN)1475-3588

Journal ID (publisher-id): CAMH

Title: Child and Adolescent Mental Health

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Print): 1475-357X

ISSN (Electronic): 1475-3588

Publication date (Electronic): 28 August 2021

Publication date PMC-release: 28 August 2021

Electronic Location Identifier: 10.1111/camh.12501

Affiliations

[ ¹ ] Faculty of Health Sciences Simon Fraser University Burnaby BC Canada

[ ² ] British Columbia Centre for Disease Control Vancouver BC Canada

[ ³ ] British Columbia Children’s Hospital Research Institute Vancouver BC Canada

[ ⁴ ] School of Population and Public Health University of British Columbia Vancouver BC Canada

[ ⁵ ] School of Population and Global Health McGill University Montreal QC Canada

[ ⁶ ] Division of Clinical and Behavioural Neurosciences Department of Psychiatry Faculty of Medicine University of British Columbia Vancouver BC Canada

[ ⁷ ] British Columbia Mental Health and Substance Use Research Institute Vancouver BC Canada

[ ⁸ ] Faculty of Medicine University of British Columbia Vancouver BC Canada

Author notes

[*] [* ] Correspondence

Hasina Samji, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada; Email: Hasina_Samji@ 123456sfu.ca

Author information

Hasina Samji https://orcid.org/0000-0002-4555-7609

Article

Publisher ID: CAMH12501

DOI: 10.1111/camh.12501

PMC ID: 8653204

PubMed ID: 34455683

SO-VID: 0a66b650-5fc4-414a-a75a-c56765652213

License:

This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.