Low HRQoL, anxiety up in kids, teens during COVID-19 pandemic

The three-wave longitudinal COPSY* study has shown that poor health-related quality of life (HRQoL), increased levels of anxiety, and other mental health problems have become more common among children and adolescents throughout the COVID-19 pandemic.

“We found that reduced social contacts and school-closing or irregular schooling were associated with lower HRQoL,” said study authors led by Dr Ulrike Ravens-Siberer from the Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

“Hence, mental health promotion, prevention, and intervention strategies should be implemented to support adolescents, particularly those at risk,” they pointed out.

The COPSY study included 2,097 families with children and adolescents 7–17 years of age who were polled between May and June 2020 (wave 1 of the pandemic), December 2020 and January 2021 (wave 2), and September and October 2021 (wave 3). Of these, 1,531 children and adolescents aged 11-17 years completed the survey. [J Adolesc Health 2022;doi:10.1016/j.jadohealth.2022.06.022]

Outcomes were measured using the KIDSCREEN-10 for HRQoL, Strengths and Difficulties Questionnaire (SDQ) for general mental health problems, Screen for Child Anxiety Related Disorders (SCARED) for anxiety, Patient Health Questionnaire for depression, and Health Behaviour in School-aged Children tool (HBSC) for psychosomatic problems.

Worst outcomes at wave 2

The prevalence of low HRQoL increased from 15 percent prepandemic to 40 percent and 48 percent at waves 1 and 2, and improved slightly to 35 percent at wave 3, with significant differences.

In terms of gender differences, girls had a 1.2-to-2-fold higher risk of low HRQoL compared with boys. Girls were also more likely to report anxiety and depressive symptoms.

Similar patterns were reported for mental health problems which went up from 18 percent prepandemic to 29 percent at wave 1, 31 percent at wave 2, and slightly down to 28 percent at wave 3, but still more prevalent compared with the prepandemic level.

Anxiety also increased from 15 percent prepandemic to 24 percent and 30 percent at waves 1 and 2 and then down a bit to 27 percent at wave 3. The same was true for depressive symptoms which shot up from 10 percent prepandemic to 11 percent and 15 percent at waves 1 and 2 and then down to 11 percent at wave 3.

Results showed that the proportion of children and adolescents reporting low HRQoL shot up to 39.8 percent at wave 1 (from 15.3 percent before the pandemic) and to 48.1 percent at wave 2. While this eased down to 35.5 percent at wave 3, poor HRQoL was significantly more common during vs pre-pandemic (p<0.001 for all three time points).

Seventy percent of the participants aged 11–17 years reported being burdened by the pandemic at wave 1, which even grew to 82.8 percent at wave 2, then dropped slightly to 82.0 percent at wave 3.

“As one of the first longitudinal population-based studies during the COVID- 19 pandemic, the COPSY study reports a decline in mental health and HRQoL in the first year of the pandemic, followed by a slight improvement in autumn 2021, although the deterioration remains high compared to the pre-pandemic data,” Ravens-Siberer reiterated.

Teens and kids most at risk

The researchers conducted logistic regression analyses on these children and adolescents based on known indicators (ie, parental factors, migration history, and living space) to identify who among them are more likely to experience poor QoL and mental health impairments during the three waves of the pandemic.

Statistical models showed that vulnerable children and teenagers were at a significantly higher risk of poor HRQoL, mental health problems, and symptoms of anxiety and depression at all three waves. Feeling burdened by the pandemic was only significantly elevated at wave 3.

More research warranted

The researchers said more research that investigate the pandemic-related causes of low HRQoL and monitor mental health trajectories in detail are needed.

“It is likewise imperative that awareness for children and adolescents in need of mental support be increased in policy, educational, and healthcare settings,” the researchers said. “Policymakers also need to pave the way for better screening for at-risk children and adolescents and support them through prevention and intervention programmes that might mitigate the effects the pandemic appears to have on them.”