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. 2023 Dec;32(12):2657-2666.
doi: 10.1007/s00787-022-02115-2. Epub 2022 Dec 17.

Mental health in clinically referred children and young people before and during the Covid-19 pandemic

Kapil Sayal  1   2 , Christopher Partlett  3 , Anupam Bhardwaj  4 , Bernadka Dubicka  5 , Tamsin Marshall  6 , Julia Gledhill  7 , Colleen Ewart  3   8 , Marilyn James  3 , Alexandra Lang  9 , Kirsty Sprange  3 , Alan Montgomery  3
Affiliations

Mental health in clinically referred children and young people before and during the Covid-19 pandemic

Kapil Sayal et al. Eur Child Adolesc Psychiatry. 2023 Dec.

Abstract

The Covid-19 pandemic and mitigation approaches, including lockdowns and school closures, are thought to have negatively impacted children and young people's (CYP) mental health. However, the impact for clinically referred CYP is less clear. We investigated differences in the mental health of CYP referred to specialist Child and Adolescent Mental Health Services (CAMHS) before and since the onset of the pandemic. Using baseline data (self- and parent- completed Mood and Feelings Questionnaire and Strengths and Difficulties Questionnaire) from an ongoing RCT (STADIA; ISRCTN: 15748675) in England involving 5-17-year-olds with emotional difficulties recently referred to CAMHS (non-urgent referrals), with repeated cross-sectional comparisons of CYP (n = 1028) recruited during 5 different time periods: (1) Before schools were closed (Group 1 (pre-pandemic); n = 308; 27.08.2019-20.03.2020). (2) Early pandemic period until schools fully re-opened, which included the first national lockdown, its easing and the summer holidays (Group 2 (in-pandemic); n = 183; 21.03.2020-31.08.2020). (3) The following school-term-schools fully re-opened and remained open, including during the second national lockdown (Group 3 (in-pandemic); n = 204; 01.09.2020-18.12.2020). (4) Schools closed as part of the third national lockdown (Group 4 (in-pandemic); n = 101; 05.01.2021-07.03.2021). (5) Schools re-opened and remained open, until the school summer holidays (Group 5 (in-pandemic); n = 232; 08.03.2021-16.07.2021). Most CYP scored above cutoff for emotional problems and depression, with three-quarters meeting criteria for a probable disorder ('caseness'). The groups did not differ on parent-rated mental health measures. However, self-rated emotional problems, depression, functional impairment and caseness appeared to be higher amongst participants recruited in the two periods following school re-openings. In particular, functional impairment and caseness were greater in Group 5 compared with Group 2. Although symptom severity or impairment did not change in the initial pandemic period, self-reported difficulties were greater during the periods after schools re-opened. This suggests possible greater stresses in the adjustment to re-starting school following recurrent lockdowns and school closures.

Keywords: Children and young people; Covid-19; Lockdown; Mental health; STADIA; School closures; School re-openings.

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Conflict of interest statement

On behalf of all the authors, the corresponding author states that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
Timeline diagram: Covid-19 key dates in England with sample size of parent- and self-completed questionnaires during the different time periods. Group 1: pre-pandemic: 27.08.2019–20.03.2020. Group 2: early pandemic and schools closed: 21.03.2020–31.08.2020. Group 3: schools re-open: 01.09.2020–18.12.2020. Group 4: schools closed as part of the 3rd national lockdown: 05.01.2021–07.03.2021. Group 5: schools re-open, until summer holidays (mid-July): 08.03.2021–16.07.2021
Fig. 2
Fig. 2
Proportion of participants (with 95% confidence intervals) scoring above the cutoff on the MFQ and SDQ measures, based on parent-report
Fig. 3
Fig. 3
Proportion of participants (with 95% confidence intervals) scoring above the cutoff on the MFQ and SDQ measures, based on self-report
See this image and copyright information in PMC

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