Longitudinal increases in childhood depression symptoms during the COVID-19 lockdown

Abstract

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.

Keywords: adolescent health; psychology.

Figure 1

Correlations between mental health variables and patterns of missing data. Below diagonal: Pearson correlations between SDQ Emotional Problems (SDQ), RCADS anxiety subscale (generalised anxiety disorder (GAD)) and RCADS depression subscale (major depressive disorder (MDD)), before and during lockdown. On diagonal: number of observations for each variable. Above diagonal: number of observations with data on two given variables and 95% CIs for correlations. RCADS, Revised Child Anxiety and Depression Scale; SDQ, Strengths and Difficulties Questionnaire.

Figure 2

Change in mental health ratings from before to during the lockdown measures. Panels A–C display changes in mental health ratings for all three outcomes, respectively. Dark purple lines indicate changes in only parent-reported mental health scores. Dashed lines indicate changes in mental health scores from either teacher or child reports (before lockdown) to parent report (during lockdown). In each plot, we report the number of responses before and during lockdown, by teachers, children or parents. Panel D plots the same data as panel C, however with age at assessment on the horizontal axis and lines showing individual changes in depression symptoms. This shows a relatively sharp increase in depression symptoms from before to during lockdown, compared with the relatively weak effect of age on depression symptoms (shown in the black, dashed line) estimated from the mixed linear model. In panel D, child-reported mental health measures are reduced by ~1.3 to aid visualisation, as the model estimated that children reported higher depression compared with parents on by this amount on average. RCADS, Revised Child Anxiety and Depression Scale; SDQ, Strengths and Difficulties Questionnaire.

Figure 3

Mean standardised change score and CIs for each mental health question, comparing during to before lockdown, using solely caregiver reported mental health at both time points. Positive numbers indicate worsening of symptom during lockdown. Results support the interpretation that RCADS depression items have increased during lockdown, with more minor changes in other symptoms. RCADS, Revised Child Anxiety and Depression Scale; SDQ, Strengths and Difficulties Questionnaire.