Existing concerns about the adverse impact of COVID-19 on children’s mental health and services for this population may be supported in recent studies despite inconsistent reports, according to review findings published in The Journal of Child Psychology and Psychiatry.
More than half of the 2.36 billion children worldwide experienced pandemic lockdown, and almost all of the children live in countries that imposed movement restrictions. Approximately 1.6 billion children were out of school for extended time, and relationships, and family and community life have all been affected. Investigators sought to discover the impact of the pandemic on children and young people’s mental health.
They initiated a search of the PsychINFO, EMBASE, CINAHL, and Medline databases for studies in English of adolescents or children with a mean age of 18 years and younger at baseline reporting a change of mental health measures from prepandemic times to during the pandemic. They included 51 studies in their systematic review and meta-analysis, only 4 with a high-quality rating from more than 6900 identified records. Of the 51 included studies, 10 rated medium/high quality, 17 medium, 7 low/medium, and 12 low quality. Meta-analysis was limited by methodological heterogeneity across studies in choice of measure, length of follow-up, population, timing in relation to the pandemic, setting, and design.
Included studies were longitudinal cohort studies (initiated prepandemic with at least 1 follow-up during the pandemic) or cross-sectional studies (initiated prepandemic and followed-up during the pandemic). Prepandemic was defined as December 2014 through December 2019. Follow-up during the pandemic was defined as between January 2020 and February 2022. Included studies reported change on validated measures of mental health and were published in peer-reviewed journals. Editorials, reviews, commentaries, and nonprimary research were excluded.
Overall, investigators found mixed results with no emergence of a pattern, but a slight dip in some measures. Only 9 of the included studies used sampling strategies representative of school population or the general population. Investigators noted an increase in externalizing problems, internalizing symptoms, global severity scores, and total difficulty which they say is oversimplified from a contradictory body of evidence.
They observed the Mental Health of Children and Young People in England survey found an increase in the prevalence of probable disorder in children 5- to 16-years of age of 10.8% in 2017 to 16% in 2020. They noted anxiety showed little evidence of change, however timing of measurement vs changing levels of social interaction in many communities may have noticeably affected results.
They found studies using categorical measures of depression had little evidence of increases in symptoms. They noted several high-quality studies revealed symptoms of depression increased, 2 of 5 meta-analyses found significant increases in depressive symptoms, and 3 meta-analyses found little evidence of symptom change.
They noted that studies of children relied significantly on parental report, some of the studies adjusted for parental mental state and some did not. Meta-analysis showed evidence of improvement in child-reported conduct problems.
Review limitations include a preponderance of cross-sectional studies with single pandemic follow-up, lack of studies examining externalizing conditions, lack of studies including preschool or early primary-aged children, lack of high-quality studies, lack of global generalizability, and heterogeneity of studies limiting meta-analysis.
Investigators concluded their experience “highlighted the opportunistic and unfocussed approach that has often been taken to assessing the impacts of COVID-19 on children and young people’s mental health.” They wrote “Our findings suggest that the increase in difficulties may be of a relatively small ‘clinical’ magnitude, but this appears already to be translating to significantly increased demand at population level in terms of new presentations and presentations in crisis across various health systems.” They urge working together with funders and governments so a more cohesive approach can be developed, in particular strengthening research collaboration worldwide.
Newlove-Delgado T, Russell AE, Mathews F, et al. Annual research review: the impact of Covid-19 on psychopathology in children and young people worldwide: systematic review of studies with pre- and within-pandemic data. J Child Psychol Psychiatry. Published online November 24, 2022. doi:10.1111/jcpp.13716