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


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

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s00787-021-01744-3.

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              The Strengths and Difficulties Questionnaire: A Research Note


                Author and article information

                Eur Child Adolesc Psychiatry
                Eur Child Adolesc Psychiatry
                European Child & Adolescent Psychiatry
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                26 February 2021
                : 1-14
                [1 ]GRID grid.42327.30, ISNI 0000 0004 0473 9646, Department of Psychiatry, , Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, ; 686 Bay Street, 6th Floor, Toronto, On M5G 0A4 Canada
                [2 ]GRID grid.17063.33, ISNI 0000 0001 2157 2938, Department of Psychiatry, Faculty of Medicine, , University of Toronto, ; Toronto, Canada
                [3 ]GRID grid.17063.33, ISNI 0000 0001 2157 2938, Department of Pediatrics, Faculty of Medicine, , University of Toronto, ; Toronto, ON Canada
                [4 ]GRID grid.414294.e, ISNI 0000 0004 0572 4702, Holland Bloorview Research Institute, ; Toronto, ON Canada
                [5 ]GRID grid.42327.30, ISNI 0000 0004 0473 9646, Division of Paediatric Medicine, , Hospital for Sick Children, ; Toronto, ON Canada
                [6 ]GRID grid.410356.5, ISNI 0000 0004 1936 8331, Department of Psychology, , Queens University, ; Kingston, ON Canada
                [7 ]GRID grid.39381.30, ISNI 0000 0004 1936 8884, Department of Psychiatry, , University of Western Ontario, ; London, ON Canada
                [8 ]GRID grid.415502.7, MAP Centre for Urban Health Solutions, , Li Ka Shing Knowledge Institute, Unity Health Toronto, ; Toronto, Canada
                [9 ]GRID grid.22072.35, ISNI 0000 0004 1936 7697, Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, , University of Calgary, ; Calgary, AB Canada
                [10 ]GRID grid.22072.35, ISNI 0000 0004 1936 7697, Department of Psychiatry, Cumming School of Medicine, , University of Calgary, ; Calgary, AB Canada
                © Springer-Verlag GmbH, DE part of Springer Nature 2021

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                Funded by: FundRef http://dx.doi.org/10.13039/501100000024, Canadian Institutes of Health Research;
                Funded by: FundRef http://dx.doi.org/10.13039/501100000226, Ontario Ministry of Health and Long-Term Care;
                Funded by: University of Toronto (CA)
                Funded by: FundRef http://dx.doi.org/10.13039/501100006126, Hospital for Sick Children;
                Funded by: Leong Centre for Healthy Children
                Original Contribution

                Clinical Psychology & Psychiatry
                covid-19,child and adolescent psychiatry,neurodevelopmental disorders


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