Mental health of kids, teens compromised during pandemic

Poor health-related quality of life (HRQoL), along with high levels of anxiety and other mental health problems, has become more common among children and adolescents during the COVID-19 pandemic, according to a recent German study.

“As one of the first longitudinal population-based studies during the COVID- 19 pandemic, the COPSY [COVID-19 and Psychological Health] 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 prepandemic data,” the researchers said.

The nationwide, population-based survey included 2,097 children and adolescents aged 7–17 years. Questionnaires were administered in three waves: between May and June 2020 (wave 1), December 2020 and January 2021 (wave 2), and September and October 2021 (wave 3).

Outcomes were measured using validated scales, including 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.

Survey results showed that from 15.3 percent before the pandemic, the proportion of children and adolescents reporting low HRQoL shot up to 39.8 percent at wave 1 and to 48.1 percent at wave 2. While this eased down to 35.5 percent at wave 3, poor HRQoL was nevertheless significantly more common during vs before the pandemic (p<0.001 for all three time points). [J Adolesc Health 2022;doi:10.1016/j.jadohealth.2022.06.022]

Indeed, 70.3 percent of participants aged 11–17 years said that they felt burdened by the pandemic at wave 1, a rate that grew to 82.8 percent at wave 2, before dropping slightly to 82.0 percent at wave 3.

Similar patterns were reported for mental health problems in general, which grew in prevalence from 17.6 percent before the pandemic to 28.8 percent, 30.6 percent, and 28.0 percent during waves 1, 2, and 3, respectively. Anxiety spiked during the pandemic, too, jumping from 14.9 percent before COVID-19 to 23.6 percent, 30.1 percent, and 26.2 percent at waves 1, 2, and 3, respectively. The same was true for depressive symptoms.

“The level of mental health deterioration remains high and almost double that before the pandemic. The slight improvements in adolescent HRQoL and mental health in wave 3 could be explained by the low infection rates, vaccination, and the loosening of restrictions in Germany in autumn 2021,” the researchers said.

Who are most at risk of impaired HRQoL?

To identify subgroups of children and adolescents who are more likely to experience poor HRQoL during COVID-19, the researchers conducted logistic regression analyses, focusing on a subgroup of vulnerable participants based on known indicators (ie, parental factors, migration history, and living space).

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

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

Further studies could also focus on pandemic-related causes of poor mental health and wellbeing among children and teens, as well as explore the impacts of public health and policy interventions.