Have the COVID-19 Pandemic and Lockdown Affected Children’s Mental Health in the Long Term? A Repeated Cross-Sectional Study

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 implementation of lockdown, social distancing, and school closures. 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 6-16 years, attending a tertiary care hospital without any diagnosed major psychiatric disorder or chronic disorder.

Analysis

Data was 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 [Interquartile Range (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.

STRENGTHS AND LIMITATIONS

• With the availability of pre-pandemic data, the repeated cross-sectional study design allowed us to compare the anxiety symptoms and prevalence of depression in children and adolescents during and before the COVID-19 lockdown and school closures.

• The study is one of the few studies from low-to-middle income countries on this topic with large sample size.

• The data was collected hospital setting, and all of the participants were attending a hospital, which could have resulted in a sampling bias. Although it is a tertiary care hospital, all of the patients included in the study came to us for primary care and were not referred.

• We used standardised scales that are usually used for screening and evaluation purposes and not for diagnostic purposes.

• We were unable to perform a longitudinal study with a follow-up that would offer clear evidence of any fluctuation in mental health during the course of the pandemic.