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      Impact of COVID-19 and Lockdown on Mental Health of Children and Adolescents: A Narrative Review with Recommendations.

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          HIGHLIGHTS

          • We conducted a narrative review of articles on mental health aspects of children and adolescents during the COVID-19 pandemic and lockdown.

          • Most studies are cross-sectional in nature. Findings show that quality and magnitude of impact is determined by vulnerability factors like developmental age, educational status, pre-existing mental health condition, being economically underprivileged or being quarantined due to infection or fear of infection.

          • There is a crucial requirement for planning longitudinal and developmental studies, and evidence based elaborative strategies to cater to mental health needs of the vulnerable children and adolescents during and after the pandemic by mobilising direct and digital collaborative networks.

          Abstract

          Background

          COVID-19 pandemic and lockdown has brought about a sense of fear and anxiety around the globe. This phenomenon has led to short term as well as long term psychosocial and mental health implications for children and adolescents. The quality and magnitude of impact on minors is determined by many vulnerability factors like developmental age, educational status, pre-existing mental health condition, being economically underprivileged or being quarantined due to infection or fear of infection.

          Aims

          This paper is aimed at narratively reviewing various articles related to mental-health aspects of children and adolescents impacted by COVID-19 pandemic and enforcement of nationwide or regional lockdowns to prevent further spread of infection.

          Methodology

          We conducted a review and collected articles and advisories on mental health aspects of children and adolescents during the COVID-19 pandemic. We selected articles and thematically organized them. We put up their major findings under the thematic areas of impact on young children, school and college going students, children and adolescents with mental health challenges, economically underprivileged children, impact due to quarantine and separation from parents and the advisories of international organizations. We have also provided recommendations to the above.

          Conclusion

          There is a pressing need for planning longitudinal and developmental studies, and implementing evidence based elaborative plan of action to cater to the psycho social and mental health needs of the vulnerable children and adolescents during pandemic as well as post pandemic. There is a need to ameliorate children and adolescents’ access to mental health support services geared towards providing measures for developing healthy coping mechanisms during the current crisis. For this innovative child and adolescent mental health policies policies with direct and digital collaborative networks of psychiatrists, psychologists, paediatricians, and community volunteers are deemed necessary.

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          Most cited references 17

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          Impact of maternal stress, depression and anxiety on fetal neurobehavioral development.

          Although postnatal psychologic distress has been widely studied for many years, particularly with a focus on postpartum depression, symptoms of maternal depression, stress, and anxiety are not more common or severe after childbirth than during pregnancy. This paper reviews the newer body of research aimed at identifying the effects of women's antenatal psychologic distress on fetal behavior and child development, and the biologic pathways for this influence. These studies are in line with the growing body of literature supporting the "fetal origins hypothesis" that prenatal environmental exposures--including maternal psychologic state-based alterations in in utero physiology--can have sustained effects across the lifespan.
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            Protecting the psychological health of children through effective communication about COVID-19

            The attention of the world is rightly focused on measures to mitigate the transmission and economic effect of the 2019 novel coronavirus disease (COVID-19) pandemic. In this rapidly changing situation, media and social conversations are entirely dominated by the outbreak, and children are exposed to large amounts of information and high levels of stress and anxiety in the adults around them. Simultaneously, children are experiencing substantial changes to their daily routine and social infrastructure, which ordinarily foster resilience to challenging events. 1 Parents would do anything to protect their children from distress and might avoid talking about difficult feelings and events. However, research shows that even children as young as 2 years are aware of the changes around them. 2 Children's understanding evolves throughout childhood and adolescence. Thus, when adults talk to children, the information provided needs to take into account the child's age and level of understanding. Sensitive and effective communication about life-threatening illness has major benefits for children and their family's long-term psychological wellbeing. 2 Children need honest information about changes within their family; when this information is absent, children attempt to make sense of the situation on their own. 3 Consideration of the child's developmental stage is crucial to ensure that communication is effective and neither underestimates or overestimates their understanding. 4 Communicating with younger children should not solely rely on simplification of the language or concepts used, but must also take into account children's comprehension of illness and causality. Between the ages of approximately 4 and 7 years, understanding is substantially influenced by magical thinking, a concept that describes a child's belief that thoughts, wishes, or unrelated actions can cause external events—eg, an illness can be caused by a particular thought or behaviour. The emergence of magical thinking occurs around the same time children are developing a sense of conscience, while still having a poor understanding of how illness is spread. Adults need to be vigilant that children are not inappropriately blaming themselves or feeling that the illness is a punishment for previous bad behaviour. 5 Therefore, listening to what children believe about COVID-19 transmission is essential; providing children with an accurate explanation that is meaningful to them will ensure that they do not feel unnecessarily frightened or guilty. The uncertainty about the personal and global effects of COVID-19 is creating great concern, in addition to the specific psychological effect of quarantine. 6 Adults' preoccupation with the implications of COVID-19 might compromise their ability to sensitively recognise and respond to children's cues or distress. 7 Children are well attuned to adults' emotional states; exposure to unexplained and unpredictable behaviour is perceived by children as a threat, resulting in a state of anxiety. Even children younger than 2 years will notice the absence of regular caregivers (eg, grandparents) and become unsettled and upset, seeking their return. Conversely, children and adolescents' anxiety can also manifest in challenging externalising behaviours, such as acting out or arguing, rather than more typically assumed tearful, sad, or worried responses. Although adults often want to know how children are feeling, adults often do not set an example by sharing some of their own feelings, and conversations might well be dominated by the practical aspects of illness. 2 Research has highlighted that parents sometimes specifically use technical or factual language to try and minimise their children's distress. 8 An absence of emotion-focused conversations might leave children anxious about the emotional state of the adults around them. This anxiety can inadvertently result in children's avoidance of sharing their own concerns in an attempt to protect others, leaving children to cope with these difficult feelings alone. 2 Adults need to be authentic about some of the uncertainty and psychological challenges of the pandemic, without overwhelming children with their own fears. This honesty not only offers a coherent explanation for what children are observing, but also grants permission for children to safely talk about their own feelings. Normalising their emotional reactions and reassuring children about how the family will look after each other helps to contain anxiety and provides a shared focus. Mental health responses to previous emergencies and disasters have included widespread psychological first aid, focusing on psychoeducation about normative reactions and coping strategies. 1 Providing information 9 and prioritising communication with children about COVID-19 is an essential component of any universal, community-led response to the pandemic. Health-care workers are experiencing unprecedented demands caring for a predominantly adult patient population, magnifying the invisibility of children's urgent psychological needs. However, ignoring the immediate and long-term psychological effects of this global situation would be unconscionable, especially for children and young people, who account for 42% of our world's population. 10 © 2020 Peter Berglund/iStock 2020 Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
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              Adolescents’ Motivations to Engage in Social Distancing during the COVID-19 Pandemic: Associations with Mental and Social Health

              Purpose Reducing the spread of infection during the COVID-19 pandemic prompted recommendations for individuals to socially distance. Little is known about the extent to which youth are socially distancing, what motivations underlie their social distancing, and how these motivations are connected with amount of social distancing, mental health, and social health. Using a large sample of adolescents from across the US, this study examined adolescents’ motivations for social distancing, their engagement in social distancing, and their mental and social health. Methods Data were collected March 29th and 30th 2020, two-weeks after COVID-19 was declared a national emergency in the US. The sample consisted of 683 adolescents recruited using social media. A series of multiple linear regressions examined unique associations among adolescents’ motivations to engage in social distancing, perceived amount of social distancing, anxiety symptoms, depressive symptoms, burdensomeness, and belongingness. Results Almost all respondents (98.1%) reported engaging in at least a little social distancing. The most commonly reported motivations for social distancing concerned social responsibility and not wanting others to get sick. Motivations concerning state or city lockdowns, parental rules, and social responsibility were associated with greater social distancing, whereas motivations concerning no alternatives were associated with less social distancing. Specific motivations for social distancing were differentially associated with adolescents’ anxiety symptoms, depressive symptoms, burdensomeness, and belongingness. Conclusions Understanding adolescents’ motivations to engage in social distancing may inform strategies to increase social distancing engagement, reduce pathogen transmission, and identify individual differences in mental and social health during the COVID-19 pandemic.
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                Author and article information

                Contributors
                Role: Writing- Reviewing and Editing; Software; Validation; Supervision; Data curation; Writing- Original draft preparation; Conceptualization; Methodology
                Role: Writing- Reviewing and Editing; Software; Validation; Visualization; Investigation; Data curation; Writing- Original draft preparation; Software
                Role: Visualization; Investigation; Data curation; Writing- Original draft preparation
                Role: Visualization; Investigation
                Role: Visualization; Investigation; Data curation; Writing- Original draft preparation
                Role: Visualization;Investigation; Data curation; Writing- Original draft preparation
                Journal
                Psychiatry Res
                Psychiatry Res
                Psychiatry Research
                Published by Elsevier B.V.
                0165-1781
                1872-7123
                24 August 2020
                24 August 2020
                Affiliations
                [a ]Additional Professor, Department of Psychiatry, KGMU Lucknow. India.
                [b ]Psychiatric Nursing, Department of Psychiatry, King George's Medical University, Lucknow, India.
                [c ]Department of Psychiatry, King George's Medical University, Lucknow, India.
                Author notes
                [* ]Corresponding Author. Tel.: +919475866875 roydeblina001@ 123456gmail.com
                Article
                S0165-1781(20)31725-X 113429
                10.1016/j.psychres.2020.113429
                7444649
                © 2020 Published by Elsevier B.V.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                Categories
                Article

                Clinical Psychology & Psychiatry

                adolescents, covid-19, children, mental health, lockdown

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