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Child and family factors associated with child mental health and well-being during COVID-19

DOI:10.1007/s00787-021-01849-9
Authors:
Brae Anne McArthur at The University of Calgary
Brae Anne McArthur
Nicole Racine at The University of Calgary
Nicole Racine
Sheila McDonald
Sheila McDonald
Sheila McDonald
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Suzanne C Tough at The University of Calgary
Suzanne C Tough
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Abstract and Figures

Understanding the implications of the COVID-19 pandemic on the current generation of youth is critical for post-pandemic recovery planning. This study aimed to identify the most salient child (i.e., connectedness to caregivers, screen time, sleep, physical activity, peer relationships, and recreational activities) and family (i.e., COVID-19 financial impact, maternal depression and anxiety) factors associated with children’s mental health and well-being during the COVID-19 pandemic, after controlling for pre-pandemic mental health. This study included 846 mother–child dyads (child age 9–11) from the All Our Families cohort. Mothers reported on the child’s pre-pandemic mental health at age 8 (2017–2019) and during COVID-19 (May–July 2020), the family’s financial impact due to COVID-19, and maternal depression and anxiety. During COVID-19 (July–August 2020), children reported on their screen time, sleep, physical activity, peer and family relationships, and recreational activities, as well as their happiness, anxiety and depression. After controlling for pre-pandemic anxiety, connectedness to caregivers (B − 0.16; 95% CI − 0.22 to − 0.09), child sleep (B − 0.11; 95% CI − 0.19 to − 0.04), and child screen time (B 0.11; 95% CI 0.04–0.17) predicted child COVID-19 anxiety symptoms. After controlling for pre-pandemic depression, connectedness to caregivers (B − 0.26; 95% CI − 0.32 to − 0.21) and screen time (B 0.09; 95% CI 0.02–0.16) predicted child COVID-19 depressive symptoms. After controlling for covariates, connectedness to caregivers (B 0.36; 95% CI 0.28–0.39) predicted child COVID-19 happiness. Fostering parent–child connections and promoting healthy device and sleep habits are critical modifiable factors that warrant attention in post-pandemic mental health recovery planning.
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European Child & Adolescent Psychiatry
https://doi.org/10.1007/s00787-021-01849-9
ORIGINAL CONTRIBUTION
Child andfamily factors associated withchild mental health
andwell‑being duringCOVID‑19
BraeAnneMcArthur1 · NicoleRacine1· SheilaMcDonald2· SuzanneTough3· SheriMadigan1
Received: 28 May 2021 / Accepted: 16 July 2021
© Springer-Verlag GmbH Germany, part of Springer Nature 2021
Abstract
Understanding the implications of the COVID-19 pandemic on the current generation of youth is critical for post-pandemic
recovery planning. This study aimed to identify the most salient child (i.e., connectedness to caregivers, screen time, sleep,
physical activity, peer relationships, and recreational activities) and family (i.e., COVID-19 financial impact, maternal
depression and anxiety) factors associated with children’s mental health and well-being during the COVID-19 pandemic,
after controlling for pre-pandemic mental health. This study included 846 mother–child dyads (child age 9–11) from the
All Our Families cohort. Mothers reported on the child’s pre-pandemic mental health at age 8 (2017–2019) and during
COVID-19 (May–July 2020), the family’s financial impact due to COVID-19, and maternal depression and anxiety. During
COVID-19 (July–August 2020), children reported on their screen time, sleep, physical activity, peer and family relationships,
and recreational activities, as well as their happiness, anxiety and depression. After controlling for pre-pandemic anxiety,
connectedness to caregivers (B −0.16; 95% CI −0.22 to −0.09), child sleep (B −0.11; 95% CI −0.19 to −0.04), and child
screen time (B 0.11; 95% CI 0.04–0.17) predicted child COVID-19 anxiety symptoms. After controlling for pre-pandemic
depression, connectedness to caregivers (B −0.26; 95% CI −0.32 to −0.21) and screen time (B 0.09; 95% CI 0.02–0.16)
predicted child COVID-19 depressive symptoms. After controlling for covariates, connectedness to caregivers (B 0.36; 95%
CI 0.28–0.39) predicted child COVID-19 happiness. Fostering parent–child connections and promoting healthy device and
sleep habits are critical modifiable factors that warrant attention in post-pandemic mental health recovery planning.
Keywords COVID-19· Child· Mental health· Screen time· Sleep· Parent–child connections
Introduction
Children have experienced significant life disruptions
as a result of theCOVID-19pandemic, including school
closures, social distancing, missed milestones, and family
stress (e.g., income loss and parent mental illness) [1, 2].
The potential for the COVID-19 pandemic to have signifi-
cant consequences for child mental health and well-being
has garnered considerable attention from parents, the media,
health practitioners, and policy makers, leading many to ask
“are the kids alright?” While empirical evidence is begin-
ning to suggest a significant increase in children’s mental
health symptoms [3–5], few studies have clearly identified
the socio-environmental factors associated with children’s
Suzanne Tough and Sheri Madigan sharesenior authorship.
* Sheri Madigan
sheri.madigan@ucalgary.ca
Brae Anne McArthur
braeanne.mcarthur@ucalgary.ca
Nicole Racine
nicole.racine2@ucalgary.ca
Sheila McDonald
sheila.mcdonald@albertahealthservices.ca
Suzanne Tough
stough@ucalgary.ca
1 Department ofPsychology, Faculty ofArts, Alberta
Children’s Hospital Research Institute, University
ofCalgary, 2500 University Dr. NW., Calgary, ABT2N1N4,
Canada
2 Department ofPediatrics, Cumming School ofMedicine,
University ofCalgary, 2500 University Dr. NW., Calgary,
ABT2N1N4, Canada
3 Department ofPediatrics andCommunity Health Sciences,
Cumming School ofMedicine, Alberta Children’s Hospital
Research Institute, University ofCalgary, 2500 University
Dr. NW., Calgary, ABT2N1N4, Canada
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... In the general population, with the progression of the pandemic, negative changes of the children's mental health have been documented, especially as regards increased anxiety and depressive symptoms (1)(2)(3)(4)(5). Several factors, such as gender, social isolation, difficult parent-child relationships, socioeconomic disadvantage, and increased media information seeking about COVID have been related to negative emotions (6). ...
... On the other side, as expected, half of children had elevated mental health symptoms during the lockdown, with significant scores of behavioral problems and hyperactivity/inattention. In fact, prior mental health is one of the most prominent predictors of child mental health difficulties (7). A recent study from Canada suggested that children who struggled with mental health symptoms prior to COVID-19 were also struggling during the pandemic (6). Furthermore, a meta-analysis showed high levels of anxiety and depression in children during the COVID-19 pandemic, exacerbated by older age of the child and the duration of the pandemic (3). ...
Mental Health of Children With Attention Deficit and Hyperactivity Disorder and Their Parents During the COVID-19 Lockdown: A National Cross-Sectional Study
Article
Full-text available
  • Jun 2022
The coronavirus disease 2019 (COVID-19) pandemic has caused a real disruption of children's lives. Children with neurodevelopmental disorders and their parents seem to be particularly vulnerable to adverse mental health effects due to lockdown policies. This study explores the psychological state of children with Attention Deficit Hyperactivity Disorder (ADHD) and their parents during the first lockdown in France. A national prospective cross-sectional parent-reported study was conducted using an online survey disseminated through different social networks of French ADHD associations during the first lockdown. The survey consisted of open-ended, multiple-choice questions and standardized questionnaires such as the Strengths and Difficulties Questionnaire (SDQ), the coping self-report questionnaire (Brief COPE) and the Patient Health Questionnaire-2 (PHQ-2). A total of 538 parents completed the online survey between the 6th and the 15th of April 2020. These results suggest that most children (65.29%) did not experience a worsening of their behavior but still had pathological levels of hyperactivity (56.47%) and behavioral (57.60%) symptoms at the time of the first lockdown. In addition, some parents (26.27%) showed responses indicating possible major depressive disorder. Positive parental coping strategies were associated with both improved child behavior and fewer parental depressive symptoms. Strengthening parents' coping strategies may be an effective intervention to protect both parents and children with ADHD from the negative psychological effects of lockdown. In times of pandemic, psychological care modalities must evolve to provide quality online interventions for families of children with ADHD.
... These multiple, unexpected challenges may have eroded parents' emotional well-being and mental health, compromising their childrearing skills (Brown et al., 2020;Russell et al., 2020). Yet, these same conditions also may have afforded parents novel opportunities to foster positive family connections that could bolster their own and their children's well-being (Chu et al., 2021;McArthur et al., 2021). Families evincing good parent and child mental health, positive parent-child relationship quality, and parent efficacy in the context of the pandemic could be seen as thriving despite the challenges. ...
... conditions on children's mental health (Bignardi et al., 2021;Creswell et al., 2021), there is growing need to examine the factors that may buttress children's well-being and healthy adjustment . Effective family functioning during the first few weeks of shelter-in-place has been associated with children's concurrent positive adjustment (Chu et al., 2021;McArthur et al., 2021), with benefits for children's adjustment potentially persisting for several months (Hastings et al., 2021). How families initially responded to and coped with COVID-19 may have had persisting influences on children's emotional and behavioral trajectories as the pandemic continued. ...
Family Thriving During COVID-19 and the Benefits for Children’s Well-Being
Article
Full-text available
  • May 2022
Although the COVID-19 pandemic has raised deserved concern regarding adverse impacts on parents’ and children’s mental health, regulations like “sheltering-in-place” may have afforded parents novel opportunities to foster positive family connections, thereby bolstering well-being. Using latent profile analysis (LPA), we (a) distinguished family thriving during shelter-in-place (May-June 2020) from other patterns of family functioning, (b) tested potential predictors of family functioning profiles, and (c) examined if family thriving predicted subsequent child adjustment (September–October 2020). 449 parents in two-parent U.S. families with children aged 2–18 years completed online surveys assessing (a) parent–child relationship quality, parents’ positive psychological adjustment, children’s emotional well-being, and parenting efficacy and satisfaction as family functioning indicators, (b) financial, marital, parental psychosocial assets, and child (age, gender, and temperament) predictors of family functioning, and (c) child adjustment. LPA identified four family functioning profiles: Thriving, Managing, Struggling, and Distressed. Thriving families evinced higher scores on all functioning indicators. Logistic regressions revealed that parents in Thriving families reported significantly lower financial anxiety, less dissatisfaction with partner’s help, less child emotionality, and greater use of cognitive reappraisal, as well as more positive child adjustment in Fall 2020. These findings underscore the multidimensional nature of coping and well-being during COVID-19. Utilizing these levers to promote mental health in families languishing during comparable future crises could promote resilience, thereby protecting children’s well-being.
... During the pandemic, adolescents ages 13 to 18 years-old who reported spending more time with family also reported less loneliness and depression (34). Similarly, among younger adolescents ages 9 to 11 years-old, connectedness to adults at home was associated with lower depression and anxiety during the pandemic as well as greater happiness (35). Interestingly, in this same study, connectedness to peers was not associated with mental health and well-being outcomes, which was explained as potentially resulting from the limited opportunities students had to interact with peers during the study period. ...
... Furthermore, related to relationships with adults at home, 29% of our sample reported that spending time with family inperson and virtually had helped them deal/cope with worries and stress related to the COVID-19 pandemic. This aligns with other COVID-19 pandemic research that has identified maintaining a predictable and supportive structure at home to be an important factor in maintaining children's and adolescents' mental health in times of stress (35,(57)(58)(59). Specifically, eating meals together, creating family routines, maintaining good communication, engaging in shared activities, and creating a sense of belonging within families have been identified as resilience-building supports for children and adolescents during the pandemic (57)(58)(59). ...
Early Adolescents' Experiences During the COVID-19 Pandemic and Changes in Their Well-Being
Article
Full-text available
  • May 2022
Background Early adolescence is a time of psychological and social change that can coincide with declines in mental health and well-being. This study investigated the psychological and social impacts of the COVID-19 pandemic from the perspective of students who responded to a survey in Grades 7 and 8 (ages 12–14) in British Columbia (BC), Canada. The objectives of this study were (i) to provide an overview on early adolescents' experiences and social-emotional well-being during the pandemic; and (ii) to examine whether changes in social experiences as well as feeling safe from getting COVID-19 at school were associated with changes in well-being outcomes over the course of a year. Methods A sample of n = 1,755 students from a large public school district self-reported on their life satisfaction, optimism, and symptoms of sadness across two time points: First, in their Grade 7 year (pre-pandemic; January to March, 2020) and then 1 year later in their Grade 8 year (during the pandemic; January to March, 2021). In Grade 8, students also reported on pandemic-specific experiences, including changes in mental health, social relationships, and activities, as well as coping strategies and positive changes since the pandemic. Data were collected online using the Middle Years Development Instrument (MDI), a population-based self-report tool that assesses children's social-emotional development and well-being in the context of their home, school, and neighborhood. Multivariable linear regression analyses were used to examine associations between pandemic-related changes in relationships and perceived safety from getting COVID-19 at school with changes in well-being outcomes. Results Students reported a range of experiences, with a large proportion reporting moderate concerns and impacts of the pandemic, including worries about their mental health and missing school activities. Students reported significantly lower optimism, lower life satisfaction, and higher sadness compared to the previous year. Within the sample, improvements in relationships with parents and other adults at home was associated with higher well-being during the pandemic. Implications Results from this study can inform decision making of policy-makers, educators, and practitioners working with youth, by providing information on students' experiences during the pandemic and identifying factors that may be protective for students' mental health during and beyond the pandemic.
... Mental health challenges are a major global concern at present (World Health Organization) and may be particularly salient for emerging adults (ages 18-25 years) due to developmental characteristics of this time period that increase risk (Arnett, 2015;Arnett et al., 2014). Recent research points to the possibility that COVID-19 could exacerbate these already disturbing trends (McArthur et al., 2021;Rogers et al., 2021;Thakur & Jain, 2020). Thus, it becomes important to understand what might help individuals and families to be resilient, or to cope, in the midst of crisis. ...
... Recent literature is beginning to capture how the pandemic is negatively impacting the mental health of individuals globally (Kwong et al., 2020;McArthur et al., 2021;Rossi et al., 2020;Sabato et al., 2021;Thakur & Jain, 2020), including emerging adults (Evans et al., 2021;Halliburton et al., 2021;Parola et al., 2020;Solomou & Constantinidou, 2020). For instance, research has found a significant increase in depressive symptoms among students from the United Kingdom (Evans et al., 2021) and increases in anxiety, depression, withdrawal, internalizing, and externalizing problems among Italian emerging adults (Parola et al., 2020). ...
Emerging adults’ cultural values, prosocial behaviors, and mental health in 14 countries during the COVID-19 pandemic
Article
  • Apr 2022
Evidence suggests an impact of the COVID-19 pandemic on mental health, particularly among emerging adults. However, theories on altruism born of suffering or adversarial growth suggest that we might also see prosocial behavior as a function of the pandemic, which may protect against mental health challenges. Because cultural values are central in determining prosocial behavior, the current study explored how cultural values were differentially associated with adaptive prosocial behaviors that might protect against mental health challenges. Participants for the current study included 5,682 young people aged 18–25 years from 14 different countries around the world (68% female, 62% college students). Path analyses suggested that there were few differences in patterns as a function of culture, but revealed that horizontal individualism and horizontal and vertical collectivism were indirectly associated with lower levels of depression via prosocial behavior toward family members. Discussion focuses on the importance of coping by strengthening family relationships via prosocial behavior during the pandemic.
... There have been multiple case studies reported in the US and all parts of the world demonstrating the worsening of mental health conditions, including depression, anxiety, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD) [2][3]. For children, in particular, social isolation, excessive screen time, and a lack of socialization were associated with profound effects, resulting in mental health conditions such as major depressive disorder, generalized anxiety disorder, PTSD, and OCD [4]. This is highlighted in a recent study by McArthur et al., where 846 mothers and children participated in a COVID-19 mental health questionnaire in Calgary, Canada [4]. ...
... For children, in particular, social isolation, excessive screen time, and a lack of socialization were associated with profound effects, resulting in mental health conditions such as major depressive disorder, generalized anxiety disorder, PTSD, and OCD [4]. This is highlighted in a recent study by McArthur et al., where 846 mothers and children participated in a COVID-19 mental health questionnaire in Calgary, Canada [4]. The study identified an increase in the reported number of anxiety and depression symptoms such as connectedness to caregivers, child sleep, and screen time duration. ...
Mental Health Consequences of the COVID-19 Pandemic Among Ontario's Youth: A Cross- Sectional Study
Article
Full-text available
  • Feb 2022
The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on the mental health and wellbeing of Ontario's youth. Our study investigated the psychological impacts of COVID-19 on the pediatric population of Ontario, using a survey derived from the Revised Children's Anxiety and Depression Scale (RCADS) system to identify children who may benefit from seeking professional help. Our cross-sectional study examined the potential risk factors that contributed to worsening mental health and wellbeing in children, including changes in sleep patterns, appetite, and physical activity levels, as well as the diagnosis of a family member with COVID-19. Our study found that 24%, 9.4%, and 15.5% of participants exhibited symptoms of depression, anxiety, and obsessive-compulsive disorder (OCD), respectively, according to the RCADS system. Furthermore, there were significant associations between the presence of symptoms and the diagnosis of a family member with COVID-19 or a frontline worker in the family. This suggests a need to create interventions to support the families of frontline workers and those directly affected by a COVID-19 diagnosis.
... The importance of parental stress for child wellbeing has been demonstrated, where a reduction in parental stress during the pandemic yield increased wellbeing among the children [25]. Further, connectedness to caregivers before the pandemic has predicted wellbeing among children during the outbreak [26]. Other family factors such as single-parent households and difficult work situation have been associated with worse mental and social health among children during this period [10]. ...
Quality of life among young people in Norway during the COVID-19 pandemic. A longitudinal study
Article
Full-text available
In this study, we aimed to examine health-related quality of life during the COVID-19 pandemic among a general sample of young people in Norway aged 11–19 years. More specifically, we examine: (1) Change over 2 time-points in five health-related quality of life dimensions, (2) Whether sociodemographic- and COVID-19-related factors contributed to change in these five dimensions, (3) Whether parental stress and socioeconomic status at T1 interacted with change in health-related quality of life across T1 and T2. Data collection lasted from April 27th to May 11th, 2020 (T1), and from December 16th, 2020, to January 10th, 2021 (T2). Youth aged 11–19 years ( N = 2997) completed the KIDSCREEN-27, COVID-19 related and sociodemographic items. Parents ( N = 744) of youth aged 15 years and younger completed the parental stress scale and sociodemographic items. Physical and psychological wellbeing declined significantly from March to December 2020. Subscale scores for social support and peers increased. Controlling for a broad number of sociodemographic and COVID-19-related factors did not make an overall impact on the estimates. Those worried about infection, older aged, girls, and youth born outside Norway had a steeper decline in health-related quality of life subdimensions from T1 to T2. In the wake of the COVID-19 pandemic, we warrant special attention to the recovery of youth's physical and psychological wellbeing.
... Other research has similarly identified the maintenance of family routines, adaptability, and family cohesion as factors of family resilience during the pandemic [30]. Children's perceived connectedness to caregivers has also been found to predict better mental health outcomes for children during the pandemic [38]. ...
Impacts of the COVID-19 Pandemic on Family Mental Health in Canada: Findings from a Multi-Round Cross-Sectional Study
Article
Full-text available
Pandemic-related disruptions, including school, child care, and workplace closures, financial stressors, and relationship challenges, present unique risks to families’ mental health. We examined the mental health impacts of the coronavirus disease 2019 (COVID-19) pandemic among parents with children <18 years old living at home over three study rounds in May 2020 (n = 618), September 2020 (n = 804), and January 2021 (n = 602). Data were collected using a cross-sectional online survey of adults living in Canada, nationally representative by age, gender, household income, and region. Chi-square tests and logistic regression compared outcomes between parents and the rest of the sample, among parent subgroups, and over time. Parents reported worsened mental health compared with before the pandemic, as well as not coping well, increased alcohol use, increased suicidal thoughts/feelings, worsened mental health among their children, and increases in both negative and positive parent–child interactions. Mental health challenges were more frequently reported among parents with pre-existing mental health conditions, disabilities, and financial/relationship stressors. Increased alcohol use was more frequently reported among younger parents and men. Sustained mental health challenges of parents throughout nearly a year of the pandemic suggest that intervention efforts to support family mental health may not be adequately meeting families’ needs. Addressing family stressors through financial benefit programs and virtual mental health supports should be further explored.
... Dissatisfaction with sharing of childcare duties may lead to increased parenting distress, which was shown to be associated to child abuse potential during the pandemic (Brown et al., 2020;Chung et al., 2020). In a recent study of over 800 mother-child dyads, connectedness to caregivers was an important predictor for child mental health (McArthur et al., 2021). ...
Predictors of Parental Coping During the Covid-19 Pandemic: A Survey in Germany
Article
Full-text available
  • Sep 2021
The Covid-19 pandemic has been profoundly affecting nearly everybody, but families with minors have been hit particularly. Closure of schools and kindergartens, home schooling, and working from home have led to a profound upheaval in family life. Parental adverse childhood experiences (ACEs) are an important determinant for parenting behavior. Importantly, ACEs can increase the vulnerability to stress and impair coping strategies. The current pandemic leads to increased parental stress, a risk factor for harsh parenting behavior, Therefore, we aimed to assess the role of ACEs and sociodemographic factors associated to parental coping during the current pandemic. In a cross-sectional online survey, 687 parents of minors in Germany were included. Demographic and psychosocial factors associated to parental coping during the first lockdown due to the Covid-19 pandemic were assessed. Results show that younger age of the respective child, income loss, dissatisfaction with the sharing of childcare duties, and ACEs were significantly associated with an increase of potential harmful parenting behavior during the Covid-19 pandemic. An increase of dissatisfaction with the sharing of childcare duties during the pandemic was predicted by working from home and taking care of the children mainly by oneself, while sharing childcare duties with the partner equally resulted even in an increase of satisfaction with sharing of childcare duties during the pandemic. These findings demonstrate that a history of childhood adversity in a parent is a risk factor for harmful parenting during the pandemic. Parental satisfaction with sharing of caregiving is an important factor for parental coping during the pandemic. Sharing of caregiving between partners should be encouraged.
Zašto neki političari, novinari i zdravstveni djelatnici zagovaraju cijepljenje djece protiv covid-19?
Preprint
Full-text available
  • Dec 2021
U hrvatskim je medijima sve više govora o cijepljenju djece protiv covid-19, unatoč maloj ulozi djece u prijenosu novog koronavirusa i njihovom malom riziku od teških simptoma, postojanju drugih oblika prevencije, činjenici da klinička ispitivanja nisu dovršena, raznih problema u provedenim ispitivanjima i rastućoj zabrinutosti oko sigurnosti cjepiva i mogućih štetnih učinaka. Cilj je ovog kratkog pregleda odabrane znanstvene literature potaknuti kvalitetnu javnu raspravu prije donošenja potencijalno ishitrenih odluka.
Impact of COVID-19 pandemic on mental health and health behaviors in Swedish adolescents
Article
Full-text available
  • Jun 2021
Aims: There is an urgent need to explore the impact of the COVID-19 pandemic on adolescent mental health and health behaviours. To date, there are no such studies on Swedish adolescents. As COVID-19 emerged in the middle of our ongoing 2-year follow-up examination of the Study of Adolescence Resilience and Stress, we had the unique opportunity to use the corona outbreak as a 'natural experiment' to study the impact of COVID-19 on 15-year-old adolescents in Sweden. Methods: Adolescents (baseline age 13.6±0.4 years) were recruited from schools in western Sweden (during the COVID-19 outbreak schools were kept open for those under 16 years of age). The COVID-19 pandemic reached Sweden on 31 January 2020. A total of 1316 adolescents answered the 2-year follow-up survey before (unexposed to COVID-19 pandemic, controls) and 584 after 1 February 2020 (COVID19-exposed). Data on stress, psychosomatic symptoms, happiness, relationships with parents and peers, school and health behaviours were collected. Results: Adolescents reported higher levels of stress and psychosomatic symptoms and lower levels of happiness at follow-up compared to baseline. These changes occurred to a similar extent in both the control and COVID-19-exposed groups. Likewise, the COVID-19-exposed group showed no deterioration in peer relations or relations with parents versus controls. We did not find any significant differences between groups regarding sleep duration and physical activity. Conclusions: Swedish adolescents exposed to COVID-19 during most of 2020 showed no differences in longitudinal changes in mental health, relationships with parents and peers, and health behaviours compared to those not exposed to COVID-19.
Adolescents’ symptoms of anxiety and depression before and during the Covid-19 outbreak – A prospective population-based study of teenagers in Norway
Article
Full-text available
  • Jun 2021
Background Lockdown policies related to the Sars-Cov-2 pandemic has potential negative consequences for mental health in youths. Methods Anxiety and depressive symptoms were assessed in 3 572 adolescents, age 13 to 16 using the Hopkins Symptom Checklist (HSCL-10), in a representative longitudinal survey of Norwegian youths between February 2019 (T1) and June 2020 (T2). Predictors for symptom change were analysed with linear mixed-effects models. Findings Overall, clinical levels of anxiety and depression increased slightly from 5•5% at T1 to 6•3% at T2; Chi square 224•4 (df = 1), p<•001. However, the observed change was driven by the increase in age between assessments. Being a girl, having pre-existing mental health problems, and living in a single-parent household at T1, predicted higher levels of anxiety and depressive symptoms at T2 (p<•001). Living in a single-parent household was associated with a significant increase in symptoms, also when age was controlled for (p<•001). Living in a poor family however, or having a history of maltreatment, was associated with a significantly lower increase in symptoms (p<•001). Interpretation Anxiety and depressive symptoms increased slightly in Norwegian youths between 2019 and 2020, but this change seemed to be driven by increase in age rather than pandemic-related measures. Symptom levels were unevenly distributed across demographic groups both before and during the pandemic outbreak, indicating that health disparities persist for adolescents in risk groups during a pandemic . Health inequities related to living conditions need to be addressed in future action plans, and intensified measures to mitigate inequities are needed. Funding The study was funded by the Norwegian Directorate for Children, Adolescents and Family affairs (Bufdir).
Suicide Risk in Emerging Adulthood: Associations with Screen Time over 10 years
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Suicide rates have increased over the past decade, and screen media (and social media in particular) are often blamed for this marked increase. However, there is little longitudinal research on this topic. The current study examined the link between various types of screen media use over a 10-year period (from adolescence to emerging adulthood) to suicide risk in emerging adulthood. Participants included 500 adolescents (51% female) who were first surveyed in 2009, when they were an average of 13.82 years old (range 12-15 years). For girls, a high level of social media or television use in early adolescence followed by a marked increase over time was most predictive of suicide risk in emerging adulthood. Additionally, video game use that increased over time was also associated with a higher risk for developing suicide risk for girls. A passive sensing measurement was also included at the final wave of data collection to obtain a more accurate and complete picture of phone use in particular. The use of entertainment apps was risky for girls while reading apps were risky for boys. Additionally, video game use (for boys) was associated with suicide risk when cyberbullying was also high. Identifying nonnormative patterns of media during adolescence may be instructive in terms of suicide prevention efforts.
Changes in Healthy Behaviors and Meeting 24-h Movement Guidelines in Spanish and Brazilian Preschoolers, Children and Adolescents during the COVID-19 Lockdown
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Full-text available
  • Jan 2021
Background: The aim of this study was to assess changes in physical activity, screen time and sleep duration of preschoolers, children and adolescents and the prevalence of meeting the 24-h movement guidelines during the lockdown caused by COVID-19 in a sample from Spain and Brazil. Methods: A total of 1099 preschoolers, children and adolescents (aged 3-17 years) from Spain (12.1 ± 4.6 years) and Brazil (10.7 ± 4.3 years) were included. An online survey was created and distributed in each country using a snowball sampling strategy. This online survey was completed by parents (mother/father/responsible guardian). Results: The proportion of the sample who met the PA and ST recommendations decreased during the COVID-19 lockdown in both Spanish and Brazilian samples (p < 0.001), while sleep duration increased (p < 0.001). The proportion of the sample meeting the overall 24-h movement guidelines was very low before the lockdown (Spain 3.0%; Brazil 11.7%) and even worse during the lockdown (Spain 0.3%; Brazil 7.5%). Conclusions: The prevalence of preschoolers, children and adolescents in both the Spain and Brazil samples meeting the 24-h movement guidelines during COVID-19 restrictions was as low as previous studies in other countries. Efforts to protect and support healthy behaviors of young people during a period of pandemic restrictions need to be a priority.
The gender gap in adolescent mental health: A cross-national investigation of 566,829 adolescents across 73 countries
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Full-text available
  • Jan 2021
Mental ill-health is a leading cause of disease burden worldwide. While women suffer from greater levels of mental health disorders, it remains unclear whether this gender gap differs systematically across regions and/or countries, or across the different dimensions of mental health. We analysed 2018 data from 566,827 adolescents across 73 countries for 4 mental health outcomes: psychological distress, life satisfaction, eudaemonia, and hedonia. We examine average gender differences and distributions for each of these outcomes as well as country-level associations between each outcome and purported determinants at the country level: wealth (GDP per capita), inequality (Gini index), and societal indicators of gender inequality (GII, GGGI, and GSNI). We report four main results: 1) The gender gap in mental health in adolescence is largely ubiquitous cross-culturally, with girls having worse average mental health; 2) There is considerable cross-national heterogeneity in the size of the gender gap, with the direction reversed in a minority of countries; 3) Higher GDP per capita is associated with worse average mental health and a larger gender gap across all mental health outcomes; and 4) more gender equal countries have larger gender gaps across all mental health outcomes. Taken together, our findings suggest that while the gender gap appears largely ubiquitous, its size differs considerably by region, country, and dimension of mental health. Findings point to the hitherto unrealised complex nature of gender disparities in mental health and possible incongruence between expectations and reality in high gender equal countries.
Longitudinal increases in childhood depression symptoms during the COVID-19 lockdown
Article
Full-text available
  • Dec 2020
Objective There has been widespread concern that so-called lockdown measures, including social distancing and school closures, could negatively impact children’s mental health. However, there has been little direct evidence of any association due to the paucity of longitudinal studies reporting mental health before and during the lockdown. This present study provides the first longitudinal examination of changes in childhood mental health, a key component of an urgently needed evidence base that can inform policy and practice surrounding the continuing response to the COVID-19 pandemic. Methods Mental health assessments on 168 children (aged 7.6–11.6 years) were taken before and during the UK lockdown (April–June 2020). Assessments included self-reports, caregiver reports, and teacher reports. Mean mental health scores before and during the UK lockdown were compared using mixed linear models. Results A significant increase in depression symptoms during the UK lockdown was observed, as measured by the Revised Child Anxiety and Depression Scale (RCADS) short form. CIs suggest a medium-to-large effect size. There were no significant changes in the RCADS anxiety subscale and Strengths and Difficulties Questionnaire emotional problems subscale. Conclusions During the UK lockdown, children’s depression symptoms have increased substantially, relative to before lockdown. The scale of this effect has direct relevance for the continuation of different elements of lockdown policy, such as complete or partial school closures. This early evidence for the direct impact of lockdown must now be combined with larger scale epidemiological studies that establish which children are most at risk and tracks their future recovery.
Estimation of US Children’s Educational Attainment and Years of Life Lost Associated With Primary School Closures During the Coronavirus Disease 2019 Pandemic
Article
Full-text available
  • Nov 2020
Importance United States primary school closures during the 2020 coronavirus disease 2019 (COVID-19) pandemic affected millions of children, with little understanding of the potential health outcomes associated with educational disruption. Objective To estimate the potential years of life lost (YLL) associated with the COVID-19 pandemic conditioned on primary schools being closed or remaining open. Design, Setting, and Participants This decision analytical model estimated the association between school closures and reduced educational attainment and the association between reduced educational attainment and life expectancy using publicly available data sources, including data for 2020 from the US Centers for Disease Control and Prevention, the US Social Security Administration, and the US Census Bureau. Direct COVID-19 mortality and potential increases in mortality that might have resulted if school opening led to increased transmission of COVID-19 were also estimated. Main Outcomes and Measures Years of life lost. Results A total of 24.2 million children aged 5 to 11 years attended public schools that were closed during the 2020 pandemic, losing a median of 54 (interquartile range, 48-62.5) days of instruction. Missed instruction was associated with a mean loss of 0.31 (95% credible interval [CI], 0.10-0.65) years of final educational attainment for boys and 0.21 (95% CI, 0.06-0.46) years for girls. Summed across the population, an estimated 5.53 million (95% CI, 1.88-10.80) YLL may be associated with school closures. The Centers for Disease Control and Prevention reported a total of 88 241 US deaths from COVID-19 through the end of May 2020, with an estimated 1.50 million (95% CI, 1.23-1.85 million) YLL as a result. Had schools remained open, 1.47 million (95% credible interval, 0.45-2.59) additional YLL could have been expected as a result, based on results of studies associating school closure with decreased pandemic spread. Comparing the full distributions of estimated YLL under both “schools open” and “schools closed” conditions, the analysis observed a 98.1% probability that school opening would have been associated with a lower total YLL than school closure. Conclusions and Relevance In this decision analytical model of years of life potentially lost under differing conditions of school closure, the analysis favored schools remaining open. Future decisions regarding school closures during the pandemic should consider the association between educational disruption and decreased expected lifespan and give greater weight to the potential outcomes of school closure on children’s health.
Maternal depressive and anxiety symptoms before and during the COVID-19 pandemic in Canada: a longitudinal analysis
Article
  • Mar 2021
Background Parents have faced substantial social and economic challenges during the COVID-19 pandemic. Preliminary cross-sectional research has demonstrated increases in mental health problems in mothers during the COVID-19 pandemic compared with pre-pandemic estimates. We aimed to study an existing longitudinal cohort of mothers to assess changes in the prevalence of maternal depression and anxiety symptoms as a result of the COVID-19 pandemic over time and at the individual level. Methods In this longitudinal observational study, women who took part in the All Our Families pregnancy cohort in Canada were invited to complete a COVID-19 impact survey between May 20 and July 15, 2020. Women who had not agreed to additional research, had discontinued, were lost to follow-up, or who were not contactable via email were excluded. Maternal depression and anxiety symptoms during the COVID-19 pandemic were compared with three previous estimates collected at 3, 5, and 8-year timepoints (between April, 2012, and October, 2019). Depression symptoms were assessed using the 10-item Center for Epidemiological Studies Depression scale and anxiety symptoms were assessed using the short form of the Spielberger State-Trait Anxiety Inventory. Repeated cross-sectional analyses were done to assess temporal trends and fixed-effects regression models were fitted to assess within-person change over time. Findings Of the 3387 women included in the All Our Families study, 2445 women were eligible and were invited to participate in the COVID-19 impact study, of whom 1333 consented to participate, and 1301 were included in the longitudinal analysis. At the COVID-19 impact survey timepoint, a higher proportion of mothers had clinically significant depression (35·21%, 95% CI 32·48–38·04) and anxiety symptoms (31·39%, 28·76–34·15) than at all previous data collection timepoints. The mean depression score (8·31, 95% CI 7·97–8·65) and anxiety score (11·90, 11·66–12·13) at the COVID-19 pandemic timepoint were higher than previous data collection waves at the 3-year timepoint (mean depression score 5·05, 4·85–5·25; mean anxiety score 9·51, 9·35–9·66), 5-year timepoint (mean depression score 5·43, 5·20–5·66; mean anxiety score 9·49, 9·33–9·65), and 8-year timepoint (mean depression score 5·79, 5·55–6·02; mean anxiety score 10·26, 10·10–10·42). For the within-person comparisons, depression scores were a mean of 2·30 points (95% CI 1·95–2·65) higher and anxiety scores were a mean of 1·04 points (0·65–1·43) higher at the COVID-19 pandemic timepoint, after controlling for time trends. Larger increases in depression and anxiety symptoms were observed for women who had income disruptions, difficulty balancing home schooling with work responsibilities, and those with difficulty obtaining childcare. White mothers had greater increases in anxiety scores than non-white mothers and health-care workers had smaller increases in depressive symptoms than non-health-care workers. Interpretation Compared with previous estimates, the prevalence of maternal depression and anxiety among mothers in a Canadian cohort increased during the COVID-19 pandemic. Financial support, childcare provision, and avoiding the closure of schools, might be key priorities for preventing future increases in maternal psychological distress. Funding Alberta Innovates Health Solutions Interdisciplinary Team, Canadian Institutes of Health Research, Alberta Innovates, and Alberta Children's Hospital Foundation.
Paternal Sensitivity and Children’s Cognitive and Socioemotional Outcomes: A Meta‐Analytic Review
Article
  • Jan 2021
In a series of meta-analyses, paternal sensitivity was associated with children's (age range: 7 months-9 years) overall cognitive functioning (N = 3,193; k = 23; r = .19), including language skills (k = 9; r = .21), cognitive ability (k = 9; r = .18), and executive function (k = 8; r = .19). Paternal sensitivity was not associated with children's overall socioemotional functioning (N = 2,924; k = 24; r = -.03) or internalizing problems, but it was associated with children's emotion regulation (k = 7; r = .22) and externalizing problems (k = 19; r = -.08). In the broad cognitive functioning, executive function, broad socioemotional functioning, and externalizing problems meta-analyses, child age was a significant moderator.
Family Media Use Planning With Teens—Is It Time for Shared Decision-making?
Article
  • Jan 2021
Managing screen use in an ever-evolving media landscape is a challenge for many families, particularly families with adolescents. Whereas with younger children, parents can more readily restrict access to screens and monitor screen use,¹ adolescents are often in situations without direct parental oversight.²,3 The heightened role of screens in adolescent socialization and schoolwork further complicates the use of media-related strategies that require a high degree of parental control. Moreover, and consistent with self-determination theory,⁴ highly controlling parenting may thwart emergent adolescent needs for autonomy, limit the development of intrinsic motivation, and lead to noncompliance with parent-desired behaviors.⁵ Autonomy-supportive parenting is distinct from permissive or uninvolved parenting in that it includes a developmentally appropriate amount of parental involvement, with the goal of fostering increasing independence and self-regulation.⁶ Evidence suggests that autonomy-supportive parent communication about media use is associated with less media use concealment by adolescents.⁷ In sum, parent-identified and enforced rules alone are likely not sufficient for adolescents to gain the buy-in necessary for consistent implementation of limits on media use and may constrain the development of important self-determined motivation and skills necessary for self-regulation in the transition to independent living (eg, college).