CG REPORT 3: The Impact of Pandemic Restrictions on Childhood Mental Health
Restrictions affecting mental health and well-being can affect many children and adolescents, as about half of all mental health disorders start by the age of 14.
Eight out of ten children and adolescents report worsening of behaviour or any psychological symptoms or an increase in negative feelings due to the COVID-19 pandemic. School closures contributed to increased anxiety, loneliness and stress; negative feelings due to COVID-19 increased with the duration of school closures. Deteriorating mental health was found to be worse in females and older adolescents.
Mental well-being protective factors include increasing socialisation that includes positive interactions and benefits for other people (prosocial behaviours), along with social connectedness based on experiences of feeling close and connected to others.
The quality of the review evidence was judged to be moderate: future high-quality longitudinal studies are required to assess the long term impact of covid restrictions on child and adolescent mental health.
The evidence shows the overall impact of COVID-19 restrictions on the mental health and well-being of children and adolescents is likely to be severe.
We found 17 systematic reviews reporting child and adolescent mental health (three were preprints Robinson 2021, Viner 2021 and Sun 2021).
Overall, we rated the impact as SEVERE on mental health and well-being based on the following main ﬁndings:
- Anxiety, depression, irritability, boredom, inattention and fear of COVID-19 were predominant new-onset psychological problems in children during the pandemic (Panda 2020)
- Pandemics can cause stress, worry, helplessness, as well as social and risky behavioural problems among children and adolescents (Meherali 2021)
- Thirteen studies report a negative association between the COVID-19 pandemic and its impact on mental health (Jones 2021)
- Eight out of ten children and adolescents report worsening of behaviour/any psychological symptoms (Panda 2020)
- School closures as part of broader social distancing measures may be associated with considerable harm to the psychological health and wellbeing of children (Viner 2021)
- School closure contributed to increased anxiety and loneliness and stress, sadness, frustration, indiscipline, and hyperactivity (Chaabane 2021)
- Worsening mental health was more marked in females and older adolescents (Chawla 2021, Samji 2021)
- Stressors for adolescents included the inability to see friends, arguments with parents, unresolvable disputes via social media, academic stress and feelings of isolation (John 2021)
- Social connectedness (i.e., family connectedness, school connectedness, social support), self-esteem, and prosocial behaviours were the most common protective factors for social isolation. (Preston 2021)
- Parent-child communication is potentially protective for anxiety and depression (Panchal 2021)
- The overall impact on suicide rates in children and adolescents remains uncertain (Minoozi 2021, Viner 2021)
‘In all actions concerning children undertaken by public institutions, the child’s best interest shall be a primary consideration’ (Article 3.1 of the convention of human rights for children).
Mental health should be a crucial consideration in deciding whether to increase social isolation and reduce prosocial behaviours for children and adolescents.
Several studies highlight the essential need to monitor the ongoing impact of mental health in children and the requirement for further long term studies.
Quality of Evidence
Limitations in the evidence introduce uncertainty about the accuracy of the reported effects. There was considerable variation in outcome across studies, often due to the sampling methods, the outcome tools used to assess the psychological symptoms, and the timing of the studies in the pandemic. Ma 2021 documented 18 mental health-related scales used to assess anxiety or depression, which significantly contributed to the heterogeneity. No long-term follow-up data were available, and studies often used cross-sectional designs that limited causal inference. Chawla 2021 reported almost no studies attempting to address potential bias. In nearly half the included studies, the authors had no discrete objectives and neglected to comment upon the generalizability of their findings. The use of convenience samples also introduced other biases. Selection bias occurs when individuals in a study differ systematically from the population of interest, leading to a systematic error in the outcome. Future studies should thus consider the most appropriate scale, an appropriate length of follow-up and whether random sampling would be more acceptable to obtain generalisable population estimates.
German translation available here.