Mental Health in Children in the Context of COVID-19: Focus on Discharged Children

Abstract

Introduction: To date, the mental health consequences of children hospitalized with COVID-19 remain unclear. We aimed to assess mental health status in children in the context of COVID-19, with a focus on discharged children. Methods: We recruited discharged children who recovered from COVID-19 and healthy controls between July and September 2020 in Wuhan Children's Hospital. Post-traumatic stress disorder (PTSD), anxiety, depression, and sleep problems were assessed in these children using questionnaires. Univariable and multivariable logistic and linear regressions were conducted to identify risk factors. Results: Totally, there were 152 children (61 discharged children and 91 healthy controls) aged 7-18 years old in our study. An increasing trend in the prevalence of PTSD, anxiety, and depression was observed in the discharged children compared with healthy controls (PTSD: 8.20 vs. 2.20%, anxiety: 22.95 vs. 13.19%; depression: 47.54 vs. 32.97%). Discharged children tended to report more depressive symptoms (β = 0.39) and less sleep problems (β = -0.37). Discharged children who lived in nuclear families and had longer hospital stays were more likely to report depression [odds ratio (OR) = 3.68 and 1.14, respectively]. Anxiety symptoms and the severity of sleep problems of discharged children were positively associated with caregivers' depression and PTSD symptoms (OR = 21.88 and 31.09, respectively). Conclusion: In conclusion, PTSD, anxiety, and depression symptoms were common among recovered children 4 months after COVID-19 hospitalization. Children from nuclear family and those had longer hospital stays need special attention. In addition, parental mental health had a significant impact on their children's mental resilience and recovery.

Keywords: COVID-19; PTSD; adolescent; children; mental health.

Figure 1

Factors associated with mental health symptoms in children (n = 152). Initial variables in the multivariate linear regression model for PTSD included gender, age group, COVID-19 diagnosis, stressful events before the pandemic, resilience, social support, and caregivers' PSS and PHQ-9 scores. Initial variables in the multivariate linear regression model for PTG included gender, age group, COVID-19 diagnosis, stressful events before the pandemic, resilience, social support, and caregivers' PSS and PHQ-9 scores. Initial variables in the multivariate linear regression model for anxiety included gender, age group, COVID-19 diagnosis, stressful events before the pandemic, resilience, social support, and caregivers' PHQ-9 scores. Initial variables in the multivariate linear regression model for depression included gender, age group, COVID-19 infection, nuclear family, stressful events before the pandemic, resilience, and social support. Initial variables in the multivariate linear regression model for sleep problems included gender, age group, COVID-19 diagnosis, being an only child, stressful events before the pandemic, and caregivers' PSS and PHQ-9 scores. Independent variables in the final model were determined using forward selection. *p < 0.05, **p < 0.01.

Figure 2

Factors associated with mental health symptoms in discharged children (n = 61). Initial variables in the multivariate linear regression model for PTSD included gender, age group, stressful events before the pandemic, and caregivers' GAD-7 and PHQ-9 scores. Initial variables in the multivariate linear regression model for PTG included gender, age group, resilience, social support, and caregivers' PHQ-9 and PSQI scores. Initial variables in the multivariate linear regression model for anxiety included gender, age group, and caregivers' PHQ-9 scores. Initial variables in the multivariate linear regression model for depression included gender, age group, being an only child, nuclear family, length of hospitalization, and social support. Initial variables in the multivariate linear regression model for sleep problems included gender, age group, being an only child, resilience, and social support. Independent variables in the final model were determined using forward selection. *p < 0.05, **p < 0.01.