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. 2025 Feb;97(2):586-597.
doi: 10.1038/s41390-024-03364-4. Epub 2024 Jul 10.

Caregiver-reported emotional-behavioral symptoms in Spanish youth during the COVID-19 pandemic: a longitudinal study

Xavier Estrada-Prat  1   2 , Eduardo Estrada  3 , Jordina Tor  4   5 , Marcela Mezzatesta  1 , Aritz Aranbarri  1   2 , Alazne Aizpitarte  1   2 , Anna Butjosa  1   2   6 , Natalia Albiac  1 , Marina Fabrega  1 , Josep Maria Haro  6   7 , Immaculada Insa Pineda  1 , Jose A Alda  1   2 , Carles Virgili  8 , Ester Camprodon  1   2 , Montserrat Dolz  1   2   6   9 , Charlotte Keating  8 , Esther Via  10   11
Affiliations

Caregiver-reported emotional-behavioral symptoms in Spanish youth during the COVID-19 pandemic: a longitudinal study

Xavier Estrada-Prat et al. Pediatr Res. 2025 Feb.

Abstract

Background: COVID-19 pandemic stressors affected youth's mental health. This longitudinal study aims to explore these effects while considering predictive factors such as age and sex.

Methods: An initial sample of 1502 caregivers answered a longitudinal survey evaluating their youths' (4-17 years of age) emotional/behavioral symptoms using the Pediatric Symptom Checklist (PSC) screening tool. First assessment in May-July 2020 included the prior year's retrospective (TR) and since-lockdown-start (T0) PSC, followed by monthly evaluations until February 2021.

Results: A positive screening PSC (PSC+) was reported in 13.09% of cases at TR and 35.01% at T0, but the likelihood of PSC+ quickly decreased over time. At T0, a more pronounced impact was found on children (39.7%) compared to adolescents (25.4%); male children exhibited higher risk for a PSC+ at T0 and longitudinally than females. Adolescents presented a weaker effect of time-improvement. PSC+ at TR, experienced stressors, and caregiver's stress/depressive symptoms positively predicted PSC+ at T0 and longitudinally; adolescents' unproductive coping style predicted PSC+ at T0. CONCLUSION: The study shows a caregiver-reported increase in emotional/behavioral symptoms in youths during the COVID-19 pandemic, affecting predominantly younger children in the early stages and showing gradual improvement over time, albeit possibly slower in adolescents.

Impact: The results show the anticipated surge in emotional and behavioral symptoms during the COVID-19 lockdown in youth reported by caregivers, followed by subsequent amelioration. Of greater significance, the study reveals a heightened impact on young children initially, yet it suggests a slower improvement trajectory in adolescents. The study also identifies risk factors linked to emotional and behavioral symptoms within each age group. Alongside the longitudinal approach, the authors underscore the remarkable inclusion of a significant representation of young children, an unusual feature in such surveys.

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Conflict of interest statement

Competing interests: The authors declare no competing interests. Ethics approval: The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board and the Ethics Committee of Institut de Recerca Sant Joan de Déu (protocol code PIC-73-20, approved on the 23 of April 2020). Informed consent: Informed consent was obtained from all subjects involved in the study.

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