Commentary: School closures, the pandemic, and pediatric mental health: Scrutinizing the evidence

Abstract

The COVID-19 pandemic arrived with significant hardship. The secondary impacts of the pandemic and our response with respect to pediatric mental health has been a subject of significant discussion in the lay public, media, and decision-maker groups. The initiatives to control SARS-CoV-2 have become politicized. A narrative emerged early that strategies to mitigate the spread of the virus were harming children's mental health. Position statements from professional organizations in Canada have been used to support this claim. The aim of this commentary is to provide a reanalysis of some of the data and research methodology used to support these position statements. Some of the direct claims such as "online learning is harmful," should be supported by a strong evidence base with significant consensus that speaks directly to causality. We find that the quality of the studies and the heterogeneity of the results does not support the strength of the unequivocal claims made by these position statements. In a sample of the current literature examining the issue, we find that outcomes range from improvements to deteriorations. Earlier studies relying on cross-sectional surveys typically have shown stronger negative effects than longitudinal cohort studies, which often have also shown groups of children experiencing no changes to measured mental health characteristics or groups that have experienced improvements. We argue it is imperative that policymakers use the highest quality evidence in making the best decisions. We as professionals must avoid discussing only one side of heterogeneous evidence.

Keywords: adolescent; children; mental health; moral panic; pandemic; psychiatry.

Figure 1

Survey of Parents and Children April 15-June 19, 2020 as reported by Cost et al, 2021. Dichotomization (“deteriorated” vs “not deteriorated”) and 95% confidence intervals were added to test the hypothesis of “worsening mental health domains.” Because the confidence intervals for both dichotomized positions are identical, they are overlapped and represented in the lighter shaded area.

Figure 2

Social, emotional, and academic well-being differences in high school students receiving in person versus remote learning as reported by Duckworth et al, 2021. The vertical axis has been adjusted to show the full range of scores from 0 to 100, to demonstrate the negligible effect sizes (Hedges g for Social 0.10, Emotional 0.08, Academic 0.07) reported. ES=Effect size.