Have the COVID-19 pandemic and lockdown affected children's mental health in the long term? A repeated cross-sectional study

Abstract

Objective: The study aimed to evaluate the impact of the COVID-19 pandemic on levels of anxiety and depressive symptoms in children and adolescents.

Design: Cross-sectional surveys were carried out on the mental health of children; one survey was conducted before the COVID-19 pandemic and one into the pandemic, 15 months after the school closures and implementation of lockdown and social distancing. Demographic data and COVID-19 pandemic-related data were collected from specific parent-report and self-report questionnaires.

Participants: Participants included children and adolescents between ages 6 and 16 years, attending a tertiary care hospital without any diagnosed major psychiatric or chronic disorder.

Analysis: Data were collected at two points (before the COVID-19 pandemic and during it) and compared. Levels of anxiety and depressive symptoms were compared and tested for statistically significant differences between these two points using appropriate statistical tests. Regression models were constructed to predict the factors affecting increased anxiety levels and depressive symptoms in the COVID-19 period.

Results: 832 and 1255 children/adolescents were included in the study during the pre-COVID-19 and COVID-19 times, respectively. The median age of the participants was 10 years (IQR=4 years). The median (IQR) Spence Children's Anxiety Scale score was 24 (12) at the pre-COVID-19 point and 31 (13) during the COVID-19 pandemic (p<0.001, r=-0.27). 11% and 16% of children reported being depressed at these two-time points, respectively (p=0.004, φ_c=-0.063). Regression analysis showed that many factors, including the duration of smartphone use, female gender and only child status, were associated with increased anxiety or depression levels.

Conclusion: A large proportion of children had elevated anxiety and depressive symptoms during the pandemic relative to before the pandemic, suggesting a need for measures to engage children in healthy habits to protect children's mental health and continuous monitoring of children during such scenarios.

Keywords: COVID-19; anxiety; depression; lockdown; mental health; pandemic.

Figure 1

Participants flow diagram of patients visiting a tertiary care centre.

Figure 2

(A) Scatterplot between SCAS scores and smartphone use per day (in hours). (B) Scatterplot between CES-DC scores and smartphone use per day (in hours). (C) Scatterplot between SCAS scores and CES-DC scores. CES-DC, Centre for Epidemiological Studies-Depression Scale for Children; SCAS, Spence Child Anxiety Scale.