Our children’s mental health in the wake of a pandemic.

​It’s hard to believe we’ve endured almost a year of one of the most challenging times in our world’s collective history. Among many of the prevailing concerns has been the issue of school closures and limited in-person instruction and the impact on our children’s mental health.

We examined some of the latest information to sort out what might be next for our youth and what we should be aware of as far as the impacts to their neuropsychological wellbeing.
 
The numbers.

Certainly there has been a rise in the incidence of mental health disorders associated with quarantine and related measures as school attendance and pre-COVID activities have been disrupted. There are additional concerns relevant to the diversion of healthcare, particularly for economically vulnerable populations whose access was already more limited. 
 
Children with preexisting mental health disorders are particularly at risk and there is data that supports an increase in the number of new mental health referrals. A report released by the U.S. Centers for Disease Control and Prevention (CDC) examined figures from hospital emergency departments (ED), which are “often the first point of care for children’s mental health emergencies.”
 
The November report noted that ED visits in the U.S. for persons of all ages declined during the early COVID-19 pandemic (March–April 2020). However “beginning in April 2020, the proportion of children’s mental health–related ED visits among all pediatric ED visits increased and remained elevated through October. Compared with 2019, the proportion of mental health–related visits for children aged 5–11 and 12–17 years increased approximately 24% and 31%, respectively.”
 
A recent study in BMC Psychiatry, “the immediate effect of COVID-19 pandemic on children and adolescents with obsessive compulsive disorder,” reported that all investigation participants had experienced a worsening of their OCD, anxiety, and depressive symptoms.1

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​In the United Kingdom (UK), the figures are equally concerning. A 2020 update to a survey conducted in 2017 by the National Health Service (NHS) examined experiences of family life, education and services, and worries and anxieties during the pandemic.2 Their review spotlighted multiple risks due to the inherent and unintended consequences of the general response measures. It also considers longer-term risks due to the ongoing fluid situation that impacts healthcare access and social inequities. 
 
When you look at several of these key takeaways it’s clear that children are reacting to changes not only surrounding school and lifestyle disruption, they also are at risk from the issues that affect the family such as financial and job difficulties. Some of the NHS report’s key takeaways:
 
In 2020, one in six (16.0%) children aged 5 to 16 years (both boys and girls) were identified as having a probable mental disorder, increasing from one in nine (10.8%) in 2017.  
 
Among those aged 5 to 22 years, 58.9% with a probable mental disorder reported having sleep problems. Young people aged 17 to 22 years with a probable mental disorder were more likely to report sleep problems (69.6%), than those aged 11 to 16 (50.5%) and 5 to 10 (52.5%).

Children aged 5 to 16 years with a probable mental disorder were more than twice as likely to live in a household that had fallen behind with payments (16.3%), than children unlikely to have a mental disorder (6.4%).

Yet another article published in the British Medical Journal (BMJ), “Priorities for the child public health response to the COVID-19 pandemic recovery in England” also addresses the growing concern related to the impacts of social isolation on emotional well-being and mental health that is a problem in all age groups, but particularly in youth. The report states there has been a marked rise in referral rates in many areas as well as a surge in the use of online mental health platforms and additionally noted that many impacts will be long term and take time to emerge, citing as yet known effects on obesity and mental health stemming from increased adversity in the early childhood years.3 We discussed back in April of last year the ramifications as well regarding post-COVID neuropsychiatric disorders in a previous blog – and now, many months later, we still don’t really know when “post-COVID” might be. 
 
A story in NPR additionally highlights examples worldwide of the reality of dealing with a crisis that is still unfolding. But we know that youth are self-reporting being significantly more depressed and unhappy as well as fearful of the future and its uncertainty. Teaching and reinforcing the concept of resilience seems paramount as far as lessons parents can impart to their children, which ideally will be supported by educational and community resources – and that all children will have better access than perhaps they’ve been afforded in the past.
 
Moving forward.

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At the current time, one thing we do know is that it doesn’t appear children spread COVID-19 in the same manner as adults, at least in communities without significant widespread infection. A recent cohort study published preprint findings stating “data indicate that schools can reopen safely if they develop and adhere to specific SARS-CoV-2 prevention policies.”4 Authors of the article also noted that following the mitigation policies in place “resulted in minimal clusters of SARS-CoV-2 infection and low rates of secondary transmission in schools, and did not cause a larger community infection burden.”
 
While the history is limited as far as this virus’ full impacts, we already have seen that youth on a global scale are suffering with a number of added mental health-related issues resulting from efforts to mitigate spread of the virus. And given that the youth population doesn’t appear to spread the virus in the same way as adults, it’s possible that isolation, masks and restriction of activities may continue to exacerbate mental health issues. Ideally children and their families should have access to appropriate care services to improve outcomes… and when at all possible, it is hoped that all youngsters can return to in-person learning and lifestyle normalcy without the burden of fear or anxieties. Our children’s mental and emotional wellbeing is best served by alleviating isolation and overly restrictive measures to give their developing brains the healthiest opportunities to thrive in the short and long term.
 
In health,
Dr. Suzanne Gazda
 
References:
 
1 Nissen, J.B., Højgaard, D. & Thomsen, P.H. The immediate effect of COVID-19 pandemic on children and adolescents with obsessive compulsive disorder. BMC Psychiatry 20, 511 (2020). https://doi.org/10.1186/s12888-020-02905-5
 
2 Mental Health of Children and Young People in England, 2020: Wave 1 follow up to the 2017 survey. https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and-young-people-in-england/2020-wave-1-follow-up#summary
 
3 Hefferon C, Taylor C, Bennett D, et al. Priorities for the child public health response to the COVID-19 pandemic recovery in England. Archives of Disease in Childhood. Published Online First: 09 December 2020. doi: 10.1136/archdischild-2020-320214
 
4 Zimmerman KO, Akinboyo IC, Brookhart A, et al. Incidence and secondary transmission of SARS-CoV-2 infections in schools. Pediatrics. 2021; doi: 10.1542/peds.2020- 048090
 
Additional reading:
 
COVID-19 Parent Resources Kit
https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/parental-resource-kit/index.html
 
National Institutes of Mental Health
https://www.nimh.nih.gov/health/education-awareness/shareable-resources-on-coping-with-covid-19.shtml