Scoping review: longitudinal effects of the COVID-19 pandemic on child and adolescent mental health

Anxiety and depressive symptoms among youth in Italy, Spain, and Portugal: A three-year post-pandemic study

The COVID-19 pandemic disrupted the population's lives. Stressful conditions during the lockdown and the reintroduction to a changed social environment emotionally affected children and adolescents. The aim of this work was to study anxiety and depressive symptoms in Italian, Spanish, and Portuguese children and adolescents aged 3 to 18 years at different moments of the COVID-19 pandemic: April 2020 (during confinement), September 2020 (with the schools' reopening), and September 2023 (with the situation restored). Parents of 1,097 children participated in at least one assessment, completing measures of child emotional symptoms online. Cases with subclinical symptoms of anxiety and depression were higher compared to pre-pandemic studies. Overall, anxiety increased from April 2020 to September 2020, decreasing in September 2023 with no differences compared to the first assessment. Depression was high in April 2020 but decreased in September 2020, with no significant differences three years later, in September 2023. Cross-country comparisons at each point are discussed. Moreover, boys showed higher levels of depression during the pandemic compared to girls. Older children, compared to younger ones, had more anxiety and depressive symptoms throughout all the moments. These findings highlight the emotional impact of the pandemic and its conditions on children and adolescents.

[The COVID-19 pandemic in Germany: mental health trajectories, resilient and vulnerable groups]

BACKGROUND

The COVID-19 pandemic has probably been the biggest health crisis of the twenty-first century to date. For many people it meant prolonged exposure to psychologically relevant stressors and simultaneously limited coping possibilities.

AIM OF THE STUDY

The aim of this review is to present a summary of the current state of knowledge on the course of mental health in Germany during the COVID-19 pandemic.

MATERIAL AND METHODS

Using longitudinal and repeated cross-sectional surveys, key findings are summarized and vulnerability and resilience factors are identified.

RESULTS

Large proportions of the German population reported at least temporary effects on their mental well-being in the sense of increased anxiety and depression symptoms as well as reduced life satisfaction, particularly among women, children and adolescents. At the same time, resilient courses were observed in most cases, i.e., most people managed to maintain their mental health during the pandemic. Vulnerability factors included female gender, younger age and financial difficulties. In contrast, a positive appraisal style, cognitive flexibility, social support, self-efficacy beliefs and, at a societal level, social cohesion and institutional trust were reported as important resilience factors.

DISCUSSION

The vulnerability and resilience factors identified offer concrete starting points for promoting pandemic preparedness.

Neuropsychology practice guidance for the neuropsychiatric aspects of Long COVID

Objective: The coronavirus disease-2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has had a profound global impact on individual health and well-being in adults and children. While most fully recover from COVID-19, a relatively large subgroup continues to experience persistent physical, cognitive, and emotional/behavioral symptoms beyond the initial infection period. The World Health Organization has termed this phenomenon "Post-COVID-19 Condition" (PCC), better known as "Long COVID." Due to the cognitive and psychosocial symptoms, neuropsychologists often assess and recommend treatment for individuals with Long COVID. However, guidance for neuropsychologists' involvement in clinical care, policy-making, and research has not yet been developed. The authors of this manuscript convened to address this critical gap and develop guidance for clinical neuropsychologists working with patients presenting with Long COVID. Method: Authors include pediatric and adult neuropsychologists with expertise in Long COVID and behavioral health. All authors have been engaged in clinical and research efforts examining the impact of COVID-19. Authors summarized the literature-to-date pertinent to the neuropsychiatric sequelae of Long COVID and developed guidance for neuropsychologists working with individuals with Long COVID. Conclusions: Research findings regarding neuropsychiatric symptoms associated with Long COVID are mixed and limited by methodological differences. As they practice and conduct research, neuropsychologists should remain mindful of the evolving and tenuous nature of the literature.

Parenting stress and pandemic burden in families with crying, sleeping, and feeding problems during COVID-19: a case-control study

BACKGROUND

Families with child crying, sleeping, and feeding problems are a vulnerable group due to high levels of parenting stress and an increased risk for child abuse. However, little is known about their specific situation during the COVID-19 pandemic. The aim of our study was to assess parenting stress and pandemic burden / constraints in families with child crying, sleeping, and feeding problems (= clinical sample) compared to a non-clinical sample. First, we hypothesized that parenting stress during the pandemic would be higher in the clinical sample compared to the nonclinical sample. Moreover, we aimed to explore the extent to which pandemic-related burden / constraints were perceived as restrictive and whether they differed between the two groups. Last, we intended to explore which pandemic-related constraints were associated with parenting stress during the pandemic, controlled for demographic variables.

METHODS

Using a case-control matched design, standardized questionnaire data from N = 142 parents of children aged 0-24 months, drawn from two different studies (clinical sample: n = 71, nonclinical sample: n = 71) were analyzed. Groups were compared using paired sample t-tests and variables associated with parenting stress were analyzed using a multiple linear regression model.

RESULTS

Parenting stress (p <.001, dz=0.64) and overall pandemic burden (p =.034, dz=0.26) were higher in the clinical group compared to the nonclinical group, whereas groups did not differ significantly in terms of specific pandemic-related constraints. Both groups reported being burdened especially by restricted leisure activities (79.6%) and reduced family support services (74%). Parenting stress was associated with child age (β=-0.20, p =.024), the presence of siblings (β=-0.21, p =.034), overall pandemic burden (β = 0.25, p =.009), increased childcare responsibilities (β = 0.19, p =.046), and increased family conflicts (β = 0.29, p <.001).

CONCLUSIONS

Families with crying, sleeping, and feeding problems experienced high levels of parenting stress and were significantly burdened by the pandemic itself. Thus, as a double-risk group during the pandemic, they require targeted attention in prevention and intervention efforts, including access to professional support and opportunities for safe social connection and leisure activities.

TRIAL REGISTRATION

Clinical group: German Register of Clinical Studies DRKS00019001, registration date: 2020-01-28, nonclinical group: OSF, https://osf.io/tksh5 , registration date: 2021-01-15.

Three Years after the Pandemic: How has the Mental Health of Children and Adolescents Evolved? A Longitudinal Study in Italy, Spain, and Portugal

The COVID-19 pandemic significantly challenged the mental health of children and adolescents, with existing research highlighting the negative effects of restrictive measures to control the virus's spread. However, in the specific context of this pandemic, there is limited understanding of how these difficulties have persisted over time after the situation was fully restored. This study sought to evaluate the pandemic's impact on psychological symptoms in children from Italy, Spain, and Portugal across five-time points (2, 5, and 8 weeks, 6 months, and three and a half years after the pandemic's onset). A total of 1613 parents completed the Psychological Impact of COVID-19 and Confinement on Children and Adolescents Scale, reporting symptoms in their children aged 3-17 years (39.2% female). The findings reveal an initial surge in psychological difficulties-anxiety, mood, sleep, behavioral, eating, and cognitive disturbances-followed by improvements in these domains three and a half years later. By September 2023, Spanish children experienced more significant reductions in symptoms compared to their Italian and Portuguese peers. While the COVID-19 pandemic has been a prolonged crisis, with varying impacts over time and across regions depending on the strictness of restrictions, the trends suggest a gradual improvement in the psychological well-being of children and adolescents.

A Latent Profile Analysis of Psychological Functioning During the COVID-19 Pandemic: Adolescents' Perceived Social Support and Lifestyle Behaviours

Research highlights notable concerns about adolescents' psychological functioning during the COVID-19 pandemic, pointing to its association with overall adjustment. Identifying adolescent profiles based on psychological distress risk levels is crucial for developing effective support strategies. This study, conducted with N = 579 adolescents (Mage = 15.97, SD = 1.52), employed a person-centred approach, using the latent profile analysis (LPA) to identify distinct psychological functioning profiles during the pandemic. Three profiles emerged, including low-risk, mild-risk, and high-risk subgroups, characterised by varying configurations of psychological functioning. The high-risk subgroup (19.5% of participants) exhibited elevated levels of mental health problems, loneliness, fear of COVID-19, stress, and negative affect, alongside lower positivity and positive affect. The mild-risk subgroup (46.8%) demonstrated intermediate scores in the study variables, while the low-risk subgroup (33.7%) showed the most positive psychological functioning. Differences in perceived social support and lifestyle behaviours were explored among these subgroups. Results showed that the high-risk subgroup reported lower social support and greater sleep problems, smartphone addiction, and daytime spent on smartphones than the other subgroups. The study underscores the importance of considering the varying risk levels related to adolescents' psychological functioning during emergencies and tailoring interventions to support diverse psychological profiles.

Generational Shifts in Adolescent Mental Health: A Longitudinal Time-Lag Study

There is concern that adolescents today are experiencing a "mental health crisis" compared to previous generations. Research has lacked a longitudinal time-lag design to directly compare depressive symptoms and social anxiety of adolescents in two generations. The current study surveyed 1081 adolescents in the current generation (Mage = 14.60, SD = 0.31, 49% female) and 1211 adolescents in a previous generation (Mage = 14.40, SD = 0.51, 51% female) across the high school years (grades 9-12), 20 years apart. Mixed-effects analysis revealed that the Current-Sample reported higher and increasing mental health problems over time compared to the Past-Sample. Although most adolescents reported consistently low mental health problems, the Current-Sample had a higher proportion of adolescents who were consistently at risk across the high school years compared to the Past-Sample. These findings highlight while most adolescents in both generations do not report elevated mental health problems, there may be a small, yet growing, group of adolescents today at risk for experiencing a "mental health crisis".

Helicopter Parenting and Youth Affective Well-Being: Need Satisfaction as a Within-Family Mediator

Parenting processes occur within families and unfold over time. According to Self-Determination Theory (SDT), helicopter parenting can threaten youth's psychological need satisfaction and undermine well-being. This study represents the first investigation of these theorized within-family, time-lagged processes. The research followed 350 late adolescents in Hong Kong (Mage = 18.2, SDage = 1.09, 39.7% male, 60.3% female, 98.9% Chinese) for an academic year, collecting 16 bi-weekly reports of maternal helicopter parenting, youth affective well-being, and youth psychological need satisfaction. Preregistered Dynamic Structural Equation Models showed that, within families, helicopter parenting predicted decreased autonomy and relatedness (but not competence) satisfaction, which subsequently predicted decreased positive affect and increased negative affect. Parenting effects were time-dependent, exhibiting differences in valence and statistical significance between concurrent and time-lagged associations. This meso-longitudinal study highlights the applicability of SDT to parenting contexts and underscores the significance of considering the timeframe in understanding parenting processes.

The complete mental health of Australia's adolescents and emerging adults: distress and wellbeing across 3 nationally representative community samples

AIMS

The high level of psychological distress in young people is a growing concern. However, there are few national surveys that describe the trajectories of mental health and wellbeing through adolescence into early adulthood. Further, existing research has largely focused exclusively on mental ill-health, with little focus on positive mental health. This study provides the first national profile of the mental health and wellbeing of Australians aged 12-25 years.

METHODS

Participants completed the National Youth Mental Health survey in 2018 (n1 = 3832), 2020 (n2 = 974) or 2022 (n3 = 961). We applied Keyes' Complete Mental Health (CMH) framework to derive categories of mental health and wellbeing, and examine rates of CMH over time, by age and gender.

RESULTS

While approximately half of those surveyed reported flourishing (high wellbeing without mental illness), rates of flourishing declined between 2018 and 2022. Rates of flourishing generally decreased with age, and flourishing was more prevalent amongst males than females.

CONCLUSIONS

The findings provide a unique contrast of youth mental health pre-, during and post- the COVID-19 pandemic. While rates of psychological distress are consistently high, the proportion of youth reporting flourishing highlights the need to consider all aspects of psychological functioning to accurately understand and respond to the mental health needs of young people.

Caregiving stress and maternal mental health during the COVID-19 pandemic

It has now been extensively documented that parental mental health has deteriorated since the beginning of the COVID-19 pandemic. Although pandemic-related stress has been widespread, parents faced the unique challenge of navigating remote schooling. Parental oversight of children's education, loss of access to school supportive resources, and the challenges of remote learning may have been most problematic for parents of children with or at elevated risk for mental health difficulties. In the current study, we examined interactive effects of parent-reported pandemic-related caregiving stress and child internalizing and externalizing problems on parental depressive symptoms in a community-based cohort (N = 115) in the Northeast of the United States. Results indicated that parents experiencing higher levels of pandemic-related caregiving stress whose children exhibited elevated externalizing behaviors reported heightened levels of depressive symptoms. Greater child internalizing problems were associated with higher parental depressive symptoms independent of caregiving stress. These findings point to conditions that might heighten risk for parent mental health challenges in the context of ongoing remote or hybrid learning and pandemic-associated restrictions. Further, the findings point to conditions and characteristics that may be screened to identify and intervene with vulnerable families to mitigate mental health problems.

The Psychosocial Burden of Pediatric Food Allergy in the United States: A Population-Based Survey

BACKGROUND

Food allergy (FA) affects approximately 1 in 12 US children, with prevalence increasing. Aside from considerable health care utilization, accumulating research suggests heightened psychosocial burden among this population.

OBJECTIVE

To characterize FA-related psychosocial burden among a large, nationally representative pediatric sample, and its correlates, including sociodemographic characteristics, comorbid conditions, allergy severity, allergic symptoms, number and type of allergens, and health care utilization.

METHODS

A survey was administered between October 2015 and September 2016 to a nationally representative sample of US households. Survey constructs included the Food Allergy Independent Measure (FAIM), which was developed to quantify adverse impacts of living with FA on psychosocial burden (range, 1-7; higher scores indicate greater burden). FAIM responses were analyzed from caregivers reporting current FA in their child (N = 4734). Linear regression models examined associations with sociodemographic and FA characteristics.

RESULTS

The overall estimated mean caregiver-proxy FAIM scores for the US pediatric population were 2.79 (SE, 0.03) for reported FA, 2.96 (SE, 0.04) for convincing FA, and 3.21 (SE, 0.05) for physician-confirmed, convincing FA. Significant differences in caregiver-reported burden (P < .05) were found for sociodemographic (ie, household income, birth country, child age) and clinical (ie, FA severity, physician diagnosis, specific allergens) factors.

CONCLUSIONS

Although heterogeneous to a degree, the psychosocial burden of children with FA was substantial irrespective of sociodemographic and clinical characteristics. FAIM norms can be used clinically, as well as be leveraged by other economic, epidemiological, and health efforts to understand the public health impact of FA.

Effects of the corona measures on the life of children and adolescents: Results of the German HBSC study 2022

Background

The containment measures of the COVID-19 pandemic have changed many people's daily lives. The study examines how children and adolescents assess the impact of the coronavirus measures on various areas of life.

Methods

Overall, N = 6,475 students (11 - 15 years) in Germany took part in the representative 'Health Behavior in School-aged Children (HBSC)' study in 2022. Logistic regressions were performed to investigate the relationships between the perceived impact of the coronavirus measures on various areas of their lives by age, gender and family wealth.

Results

Two years after the onset of the pandemic, children and adolescents reported both, positive and negative effects of the coronavirus measures. About a half of those surveyed perceived positive effects regarding social relationships. In contrast, approximately one in three respondents reported a deterioration in mental health and school performance. In particular, 11-year-olds, boys and wealthy students reported more often positive effects.

Conclusions

The positive effects of the pandemic on the lives of children and adolescents in individual areas and the resilience (resistance) that is emerging here, as well as the results on more negative assessments of adolescents, girls and respondents with lower family wealth, can be used as a starting point for a needs-oriented and target group-specific health promotion in times of crisis. Future research should focus on the pandemic's long-term effects on young people's development.

Scoping review: outpatient psychotherapeutic care for children and adolescents in Germany-status quo and challenges in assessment

Background

In the context of multiple global crises, including the COVID-19 pandemic, climate change, and global conflicts, children and adolescents worldwide are experiencing heightened psychological stress. As the foundation for lifelong mental health is established during childhood and adolescence, early prevention and treatment of mental health problems, such as through psychotherapy, are crucial. In Germany, current outpatient psychotherapeutic care capacities appear inadequate, while systematic evaluations of the care situation are lacking. This study investigates the state of statutory health insurance-funded outpatient psychotherapeutic care for children and adolescents in Germany and evaluates various methodological approaches for its assessment.

Methods

We conducted a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Publications from January 2018 to December 2023 were sourced from PubPsych, PubMed, APA PsycInfo, Google Scholar, and ProQuest. Included studies report quantitative primary data on the mental health of community samples of children and adolescents in Germany or their outpatient psychotherapeutic care.

Results

We included 41 publications comprising epidemiological studies, administrative data, and psychotherapist and patient reports. A lack of systematic and standardised research approaches resulted in significant variance in data. Nonetheless, qualitative analysis revealed that approximately one four children and adolescents in Germany is affected by mental health problems, while one in six to seven children and adolescents requires psychotherapeutic treatment. Yet, only up to one in 50 receives guideline-based psychotherapy. Most requests for initial psychotherapeutic consultations are unmet, with waiting times for guideline-based psychotherapy exceeding 6 months for at least half of the patients.

Conclusion

Overall, our findings suggest that outpatient psychotherapeutic care for children and adolescents in Germany is still insufficient. They advocate for a systematic, multimodal, and longitudinal assessment of statutory health insurance-funded outpatient psychotherapeutic care, along with an expansion of treatment capacities to enhance access for children and adolescents in Germany.

Supporting youths in global crises: an analysis of risk and resources factors for multiple health complaints in children and adolescents during the COVID-19 pandemic

Introduction

The number of global crises increased in recent years, significantly affecting the health and well-being of children and adolescents worldwide. Awareness of these global crises and their impact on health and well-being has risen since the COVID-19 pandemic. Research indicates that some children and adolescents are more vulnerable to the challenges resulting from these crises than others. This study examines the risk and resources factors for multiple health complaints (MHC) in children and adolescents in Germany during the COVID-19 pandemic.

Methods

We analyzed data from the German population-based longitudinal COPSY (COvid-19 and PSYchological Health) study. A total of 1,673 children and adolescents aged 11 years and older and their parents participated in at least one of the five survey waves between 2020 and 2022. We assessed MHC using the international Health Behavior in School-aged Children Symptom Checklist (HBSC-SCL), which includes four somatic complaints (e.g., headache, abdominal pain) and four psychological complaints (e.g., feeling low, sleeping difficulties). We conducted a mixed model panel regression analysis to examine longitudinal changes in MHC and identified sociodemographic, psychosocial, and pandemic-related risk factors and resources.

Results

Our results revealed increased MHC throughout the COVID-19 pandemic. Girls, single-parent children and adolescents, as well as children and adolescents of mentally ill or highly burdened parents, were at particular risk. A higher subjective perceived burden of the pandemic and COVID-19-related worries were significantly associated with a higher level of MHC. Personal resources, a positive family climate, and more perceived social support were significantly associated with a lower level of MHC.

Discussion

This paper highlights the vulnerability of children and adolescents in a global crisis, such as the COVID-19 pandemic. The results provide a scientific foundation for targeted health promotion and intervention strategies to protect and maintain the health and well-being of young people in future crises.

Changes in Internet Activities and Influencing Factors for Problematic Internet Use During the COVID-19 Pandemic in Korean Adolescents: Repeated Cross-Sectional Study

BACKGROUND

As adolescents increasingly engage with digital experiences, the internet serves as a platform for social interaction, entertainment, and learning. The COVID-19 pandemic accelerated this trend, with remote learning and restricted physical interactions driving changes in internet behavior. Adolescents spent more time on gaming and social media, reflecting a notable shift in use patterns.

OBJECTIVE

We hypothesized that the COVID-19 pandemic changed internet use patterns among Korean adolescents, including content types, time spent on web-based activities, and pathological use prevalence. Additionally, we anticipated that these changes would correlate with shifts in adolescents' psychological status during the pandemic.

METHODS

Data from 827 adolescents aged 12 to 15 years (n=144 in 2018, n=142 in 2019, n=126 in 2020, n=130 in 2021, n=143 in 2022, and n=142 in 2023) were gathered over 6 years from 43 middle schools across 16 regions and 1 hospital in South Korea. The demographic data collected included age, sex, and school year. Participants also provided information on their internet use patterns and levels of internet addiction. Additionally, psychological status, including mood, anxiety, attention, and self-esteem, was assessed.

RESULTS

There were significant differences in the depression scale (Patient Health Questionnaire 9). The Patient Health Questionnaire 9 scores for 2018, 2019, and 2023 decreased compared to those in 2020, 2021, and 2022 (F5=3.07; P=.007). Regarding changes in internet use behavior, game playing among adolescents decreased after the pandemic compared to before, while watching videos increased. Additionally, the rate of problematic internet use was highest for games before COVID-19, but after COVID-19, it was highest for videos, and this trend continued until 2023 (χ23=8.16, P=.04). Furthermore, this study showed that the Young's Internet Addiction Scale (YIAS) score was highest in the game group in 2018 compared to other groups before COVID-19 (F5=14.63; P<.001). In 2019, both the game and video groups had higher YIAS scores than other groups (F5=9.37; P<.001), and by 2022, the YIAS scores among the game, video, and Social Network Service groups did not differ significantly. The degree of influence on the severity of internet addiction was also greatest for games before COVID-19, but after COVID-19, the effect was greater for videos than for games.

CONCLUSIONS

During the COVID-19 pandemic, internet use for academic and commercial purposes, including remote classes and videoconferences, increased rapidly worldwide, leading to a significant rise in overall internet use time. The demand for and dependence on digital platforms is expected to grow even further in the coming era. Until now, concerns have primarily focused on the use of games, but it is now necessary to consider what types of internet behaviors cause problems and how to address them.

The Role of Sports in Building Resilience: A Machine Learning Approach to the Psychological Effects of the COVID-19 Pandemic on Children and Adolescents

(1) Background: This study evaluated whether physical activity and sports serve as a protective factor in mitigating COVID-19 pandemic long-term consequences. (2) Methods: A survey of 1702 participants (8-18 years) used the Impact of Event Scale (IES), Generalized Anxiety Disorder Scale (GAD-7), and Center for Epidemiological Studies Depression Scale for Children (CES-DC). Participants were categorized based on their engagement in sports, cultural activities, or sedentary behaviors. Statistical analysis included non-parametric tests, CHAID models, and clustering. (3) Results: In total, 65.5% of participants experienced minimal to mild anxiety, and 34.5% reported moderate to severe anxiety. The main predictor of depression is the sample age, followed by the training experience. Depressive symptoms were identified in 71.3% of participants (75.7% adolescents; 64% children). Adolescents with longer training experience (67.6%) showed lower depression compared to those with shorter experience (77.2%). For post-traumatic stress, 38% of children and 46% of adolescents exceeded cut-off scores for significant symptoms, with age and training level identified as key predictors. Among children, sport experience with low weekly frequency was associated with the lowest depression rates (59.5%). (4) Conclusions: Four years after the pandemic, a high percentage of anxiety and depression disorders is observed in the youth population, particularly among adolescents. Sports appear to slightly alleviate this serious condition.

Voices from the Rainbow: Exploring Participants' Experiences in an Online LGBTIQ+-Affirmative Psychoeducation Program

Background/Objectives: This article highlights the importance of addressing the mental health of LGBTQ people, specifically through psychoeducation/intervention programs. The primary objective was to understand the effects of participating in an online affirmative program. The theoretical frameworks of the minority stress model and the concept of decompensation were used to understand and address disparities with the general population. Methods: A detailed protocol was designed to understand the participants' experiences. An analysis of the results was carried out using a content analysis of the data collected from a convenience sample of participants from two groups. Results: The findings show that the participants' experiences were satisfactory, especially with developing coping skills and changing their attitudes towards homophobia, also showing improvements in mental health indicators. Conclusions: This study concludes that online LGBTQ-affirmative psychoeducation programs can be positive in enhancing the mental health and well-being of the LGBTQ population. The research highlights the importance of extending these programs to LGBTQ family members. It is also important to acknowledge the specificities of each subgroup.

Feasibility, satisfaction, and goal attainment in routine telemedicine consultation in child and adolescent psychiatry and psychotherapy

Telehealth services were rapidly adopted during the COVID-19 pandemic, but evidence regarding the effectiveness and feasibility of telehealth services in child and adolescent mental healthcare is sparse. This study aims to investigate feasibility, satisfaction, and goal attainment in video-delivered consultations in routine care child and adolescent psychiatry and psychotherapy. A total of 1046 patients from four university child and adolescent outpatient psychiatric clinics and one university outpatient unit for child and adolescent psychotherapy were screened for study participation. We examined a) the percentage of patients considered eligible for video-delivered consultation, b) clinicians', parents' and patients' satisfaction with video consultation, c) clinicians' ratings of goal attainment in video consultation, and d) factors associated with satisfaction and goal attainment. 59% of the screening sample (n = 621) fulfilled eligibility criteria and were considered eligible for video consultation. A total of 267 patients consented to participate in the study and received a video consultation. Clinicians reported high levels of satisfaction with video consultation and high levels of goal attainment in video consultations, especially for patients scheduled for initial patient assessments. Parents and patients were also highly satisfied with the video consultations, especially if patients had less severe emotional and behavioral problems. The present findings suggest that video consultations are a feasible and well-accepted alternative to in-person consultations in child and adolescent mental health care, especially for children with less severe symptoms and for children in early phases of assessment and treatment. Limitations include the lack of a control group. The study was registered at the German Clinical Trials Registry (DRKS00023525).

Temporal trends and social inequities in adolescent and young adult mental health disorders in Catalonia, Spain: a 2008-2022 primary care cohort study

BACKGROUND

The prevalence of mental health disorders in children, teens, and young adults is rising at an alarming rate. This study aims to explore time trends in the incidence of mental disorders among young people in Catalonia, Spain from 2008 to 2022, focusing on the effects of the COVID-19 pandemic and from the perspective of social inequities.

METHODS

A cohort study using primary care records from the SIDIAP database was conducted. It included 2,088,641 individuals aged 10 to 24 years. We examined the incidence of depressive, anxiety, eating, and attention deficit/hyperactivity disorders, stratified by sex, age, deprivation, and nationality.

RESULTS

All disorders reflected an increasing trend throughout the study period: depressive disorders (IRR: 2.44, 95% CI: 2.31-2.59), anxiety disorders (IRR: 2.33, 95% CI: 2.27-2.39), ADHD (IRR: 2.33, 95%CI: 2.17-2.50), and eating disorders (IRR: 3.29, 95% CI: 3.01-3.59). A significant increase in incidence was observed after the outbreak of the COVID-19 pandemic. In 2022, anxiety disorders were most frequent, with an incidence rate (IR) of 2,537 per 100,000 persons-year (95% CI: 2,503-2,571). Depressive disorders followed with an IR of 471 (95% CI: 458-486), ADHD with an IR of 306 (95% CI: 295-317) and eating disorders with an IR of 249 (95% CI: 239-259). Significant associations were reported with sex, age, deprivation, and nationality.

CONCLUSION

The incidence of all studied disorders has steadily increased, reaching unprecedented levels during the pandemic. Understanding these trends is essential for an appropriate healthcare response, while addressing the non-medical determinants, requires action across all sectors of society.

Going beyond competencies: Building blocks for a patient- and population-centered medical curriculum

INTRODUCTION

Changing health care requires changing medical education. In this position paper it is suggested that subsequent innovations in medical education each had their specific strengths and shortcomings. What they have, however, in common is that they place the medical student and their competencies at their center. Innovation in medical education is inward looking.

DISCUSSION

The authors propose a perspective on the medical curriculum in which the patient, their family, and the surrounding community take center stage. They argue that present medical education cannot adequately respond to the great challenges to population health: an aging population, the obesity epidemic, and future pandemics of new diseases due to population growth, urbanization, and antimicrobial resistance, particularly because these challenges cannot be dealt with by the medical sciences alone but need deep understanding of the social sciences as well. In addition, the practice of health care is changing: effective health care demands a close partnership between the health care system and the medical school which is mostly lacking, cooperation with other health professions is becoming more and more necessary in response to the increasing complexity of health care, patients and their families are required to play a more active role in their health, medical error threatening patient safety is becoming to be seen as a huge problem, and the emergence of artificial intelligence in education and practice, all requiring transformation of medical education.

CONCLUSION

The present contribution suggests eight such transformations necessary to create a truly patient- and population-centered medical curriculum.

Intensifying Substance Use Trends among Youth: A Narrative Review of Recent Trends and Implications

PURPOSE OF REVIEW

Substance use among adolescents and young adults remains a critical public health concern, with patterns shifting dramatically in recent years. This narrative review examines trends in substance use behaviors during and following the COVID-19 pandemic.

RECENT FINDINGS

Epidemiologic evidence shows declines in the proportion of youth who are using most substances but intensified consumption patterns with rising levels of disorder among adolescents who use substances. This picture may reflect the greater potency, availability and accessibility of substances, vulnerabilities related to poor mental health, minoritization, as well as social factors including pandemic stressors, commercial and regulatory forces - in short, features of the agent (substance), host (person), and environment (context), consistent with a public health formulation. Understanding trends in youth substance use and related problems, especially in the context of contributing factors, is critical for informing clinical care strategies and public health interventions to improve outcomes for youth across diverse populations.

Trends in changes of family functioning during different phases of the pandemic - findings across four population-based surveys between 2020 to 2023 in Germany

BACKGROUND

The COVID-19 pandemic and the associated measures have had a significant impact on millions of individuals and families worldwide. Although cross-sectional studies have demonstrated the considerable burden placed on families during the pandemic, trends over different phases of the pandemic including later stages and using population-based samples is scarce.

OBJECTIVE

In this study, we aimed to assess trends in family functioning across four population-based surveys between December 2020 and March 2023 using a repeated cross-sectional design. The surveys were conducted using a similar sampling strategy and measures. We included individuals residing in a household with at least one minor below the age of 16.

RESULTS

The most notable changes across surveys over time were related to quality of life. While 54.3% of respondents reported a decline in quality of life during the winter of 20/21 compared to pre-pandemic levels, this was observed in only 22.6% of participants during the spring of 23. The proportion of respondents who indicated a deterioration in their relations with their children also decreased during the pandemic. While 9.9% of respondents reported a deterioration in their relationship with their children during the winter of 20/21 in comparison to the initial phase of the pandemic, this was reported by only 5.2% in the spring 23. The relationship with one's partner and health status exhibited minimal fluctuations. Mental health problems were associated with a decline in quality of life, health status and relationships with children and partners compared to pre-pandemic levels at all time points. Moreover, lower income levels were associated with poorer relationship quality with the partner in the most recent wave.

CONCLUSIONS

Our findings demonstrate significant improvements in family functioning since the onset of the pandemic, indicating that individuals and families in our sample were generally adapting well. However, a subgroup of the population still reports suboptimal family functioning compared to before the pandemic. Psychosocial care and social policy support for families are needed.

The impact of neighborhood deprivation on mental health and quality of life in children and adolescents during the COVID-19 pandemic: Findings from the COPSY Hamburg study

INTRODUCTION

Socioeconomic inequalities have been associated with poorer mental health outcomes in children and adolescents during the COVID-19 pandemic. Despite numerous studies on individual risk factors, the impact of societal environment, such as neighborhood characteristics, on changes in mental health has rarely been investigated. This study investigates the effect of neighborhood deprivation on mental health problems and health-related quality of life (HRQoL) in children and adolescents during the COVID-19 pandemic in Hamburg, Germany.

METHODS

Data were derived from the prospective German COPSY Hamburg study. Children and adolescents aged between 11-20 years and their parents participated in the study, which took place in summer 2020 (T1) and summer 2022 (T2). Neighborhood deprivation was assessed by a neighborhood status index. Mental health problems and HRQoL were assessed using internationally validated and established instruments. The prevalence of mental health problems and impaired HRQoL was reported. Analysis of covariance was conducted to examine the effect of neighborhood deprivation of the districts in Hamburg on the (changes in) mental health problems and HRQoL while controlling for social individual-level indicators.

RESULTS

The total sample included in the statistical analysis consisted of N = 2,645 families. Children and adolescents living in more deprived areas had higher levels of general mental health problems and depressive symptoms during the COVID-19 pandemic. However, differences in neighborhood deprivation did not relate to the HRQoL and the averaged changes in children and adolescents' mental health problems and HRQoL from summer 2020 to summer 2022.

DISCUSSION

Neighborhood deprivation is associated with impaired mental health in youth during the COVID-19 pandemic. Children and adolescents' mental health and overall well-being should be addressed by health promotion measures to create a health-promoting living environment, including diverse neighborhoods. Future research should focus on uniform assessment methods and addressing additional neighborhood factors.

Adolescents' Daily Lives (ADL) project: an intensive longitudinal design study protocol examining the associations between physical literacy, movement behaviours, emotion regulation and mental health

INTRODUCTION

Adolescence represents a critical developmental period, with changes in emotional regulation capacities influencing physical and mental health. With less than 6% of Canadian youth currently meeting the 24-hour movement guidelines for physical activity, sleep and sedentary behaviour, there is an urgent need to understand the potential association between movement behaviours, physical literacy, emotional regulation and mental health during adolescence. Additionally, there is a need to better understand these associations among equity-deserving groups. We developed the Adolescents' Daily Lives (ADL) project to identify how, when, under what contexts and to whom to promote healthy engagement in movement behaviours to optimise youth mental health.

METHODS AND ANALYSIS

For the ADL project, we will employ a 14-day intensive longitudinal design to investigate the associations between physical literacy, movement behaviours, emotion regulation and mental health among a diverse sample of 120 adolescents (ages 13-17 years) living in the Greater Victoria Area, British Columbia, Canada. A comprehensive baseline survey and movement competence test, assessing physical and mental well-being, 24-hour movement behaviours (ie, physical activity, sleep and sedentary behaviours) and physical literacy, will be accompanied by daily diary surveys and accelerometer-based movement tracking (ie, Fitbit Inspire 3) to assess daily fluctuations in movement behaviour, emotional regulation and mood. Multivariate analyses, including multilevel modelling, multilevel structural equation modelling and Bayesian hierarchical continuous-time SEM, will be used to model the repeated measures data and understand the simultaneous variations in daily movement behaviours, emotion regulation and mental health.

ETHICS AND DISSEMINATION

The ADL project received ethical approval from the University of Victoria Behavioural Research Ethics Board (protocol #22-0262). Study participation is voluntary, and data collection will be anonymised to protect participant privacy and confidentiality. Research findings will be shared through academic publications and conference proceedings. Through knowledge mobilisation resources, cocreated with the youth community advisory board, relevant findings will be shared directly with the wider community of adolescents.

Reframing prolonged negative mental health effects of COVID-19: cognitive restructuring promotes posttraumatic growth

OBJECTIVE

The study aimed to investigate the level of peritraumatic distress in relation to possible traumatic outcomes in university personnel and students across three pandemic waves.

METHODS

Three cross-sectional surveys were conducted to investigate university students and staff (n = 1426). An online survey including the COVID-19 Peritraumatic Distress Index (CPDI), Ways of Coping, Impact of Events Scale (IES), and Posttraumatic Growth Inventory (PTGI) were administered across three waves. Psychometric properties of the Hungarian version of CPDI were assessed and associations between peri/posttraumatic stress and coping were explored. Cluster analysis based on posttraumatic stress and growth was used to identify subgroups.

RESULTS

An increasing trend of peritraumatic stress over the waves was found. Regression analyses revealed that two coping styles, cognitive restructuring and problem analysis were negatively and positively associated, respectively, with both peritraumatic and posttraumatic stress. Two-step cluster analysis conducted on PTGI and IES scores yielded three clusters of posttraumatic changes: IES-low/PTGI-low, IES-high/PTGI-low and IES moderate/PTGI-high. Multinomial regression showed that cognitive restructuring and peritraumatic stress were significant predictors of cluster membership.

CONCLUSION

Our findings point out that cognitive restructuring may be effective for dealing with longer-term psychological results of traumatic life events, such as the COVID-19 pandemic, even in highly exposed groups of the society.

Trends in Childhood Behavioral, Mental, and Developmental Problems (2019-2022) Using the National Survey of Children's Health

BACKGROUND

This study examines nationwide prevalence of US childhood behavioral, mental, and developmental problems in the 6-11 age group category between 2019 and 2022, and several key metrics related to caregiver social determinants of health.

METHODS

We used NSCH data for 6-11-year-old children for the years 2019-2022. Summary statistics for the selected sample were generated and binary logistic regressions were conducted for each severity level binary variable for each study year with caregiver mental or emotional health as a covariate.

RESULTS

Our study found significant associations between severe childhood anxiety and "fair" or "poor" caregiver rankings of mental and emotional health for both the 2020 and 2022 survey years. Our study also found that caregiver mental and emotional health may play a role in childhood ADD and ADHD prevalence rates as caregivers who ranked their mental health as "fair" or "good" had significantly higher odds of having a child with severe ADD or ADHD than caregivers who reported "excellent" mental and emotional health.

CONCLUSION

These findings support prospects of an increase in the need for developmental health services, thus necessitating efforts towards effective allocation and focus of developmental treatment programs tailored to children and pediatric population groups.

Depression and anxiety in transgender and non-binary adolescents: prevalence and associations between adolescent and caregiver reports

Transgender/non-binary (TNB) adolescents are at increased risk for mental health concerns, and caregiver awareness is important to facilitate access to care. Yet, limited research has examined caregiver awareness of TNB mental health. Thus, we examined (1) the prevalence of internalizing symptoms (depression, generalized anxiety, separation anxiety, social anxiety) among TNB adolescents and (2) associations between adolescent and caregiver reports of adolescent mental health symptoms. TNB adolescents (N = 75) aged 12-18 and a caregiver were recruited from a multidisciplinary gender clinic in Ohio. Adolescents self-reported their mental health symptoms via the CDI and SCARED. Caregivers reported their perceptions of the adolescent's mental health symptoms via the CASI-5. Descriptive statistics assessed participant characteristics, adolescent self-reported mental health symptoms, and caregiver proxy reports of adolescent mental health symptoms. Pearson's correlations and scatterplots were used to compare adolescent and caregiver reports and McNemar tests assessed if the differences were statistically significant. Most TNB adolescents reported elevated symptoms of depression (59%), generalized anxiety (75%), separation anxiety (52%), and social anxiety (78%). Caregiver and adolescent reports were significantly correlated for depression (r = .36, p = .002), separation anxiety (r = .39, p < .001), and social anxiety (r = .47, p < .001). Caregiver and adolescent reports of generalized anxiety were not significantly correlated (r = .21, p = .08). McNemar tests were significant (all p < .001), such that adolescents' reports met clinical cutoffs far more than their caregivers' reports.

CONCLUSIONS

Though adolescent and caregiver reports were low to moderately correlated, youth reports were consistently higher, suggesting the importance of interventions to increase caregiver understanding of TNB adolescent mental health.

WHAT IS KNOWN

• Transgender/non-binary adolescents are at high risk for mental health concerns and caregivers are essential to coordinate care.

WHAT IS NEW

• This study expands the diagnostic mental health sub-categories examined in transgender/non-binary adolescents, noting elevated symptoms of separation and social anxiety. • Transgender/non-binary adolescents reported more symptoms of depression, generalized anxiety, separation anxiety, and social anxiety than caregivers.

Risk and protective factors for mental health problems in children and adolescents during the COVID-19 pandemic: results of the longitudinal COPSY study

The COVID-19 pandemic has had profound effects on the mental health of children and adolescents worldwide, exacerbating existing challenges and introducing new stressors. This paper explores the impact of risk and protective factors on the mental well-being of young individuals during the pandemic. Using data from the German nationwide, population-based, longitudinal COPSY study (n = 2,471, girls: 50.0%, age 7-17 years) spanning nearly three years, this study investigates how factors such as gender, age, parental education, parental depressive symptoms, family cohesion, and social support influence mental health. Mental health problems were assessed using the Strengths and Difficulties Questionnaire (SDQ). Latent growth analysis and structural equation modeling were employed to analyze cross-sectional and longitudinal data collected at five measurement points (initial response rate: 46.8%). Findings revealed that boys and younger children are at a higher risk for mental health problems. Additionally, low parental education, single parenthood, parental burden due to the pandemic and parental depressive symptoms were significantly linked with mental health problems in children. Conversely, personal resources, family cohesion, and social support were associated with less symptoms. Family cohesion additionally buffered against the negative impact of parental depressive symptoms. The study underscores the importance of multi-level interventions that consider individual, familial, and societal factors in promoting positive mental health outcomes among children and adolescents during challenging times. Continued research and collaborative efforts are needed to develop evidence-based strategies for supporting the resilience of young individuals in the face of future adversities.

Supporting young people through the COVID-19 pandemic and beyond: a multi-site qualitative longitudinal study

BACKGROUND

Throughout the COVID-19 pandemic, youth have experienced substantial stress due to abrupt changes in education, finances, and social life, compounding pre-existing stressors. With youth (ages 15-26) often at critical points in development, they are vulnerable to long-term mental health challenges brought on by pandemic trauma.

METHODS

To identify youth experiences throughout the pandemic and examine changes over time, we conducted semi-structured interviews among n = 141 youth in two Canadian provinces (Ontario and British Columbia) and across the country of Ireland at three time points over the course of more than one year (August 2020-October 2021). We conducted a qualitative longitudinal analysis using an inductive content approach.

RESULTS

Categories identified were (1) coping with hardship; (2) opportunities for growth; (3) adapting to new ways of accessing services; (4) mixed views on the pandemic: attitudes, behaviour, and perception of policy response; (5) navigating COVID-19 information; (6) transitioning to life after the pandemic; and (7) youth-led recommendations for government and service response. The findings also reveal trends in health and wellness in accordance with prolonged periods of lockdown, changes in weather, and return to normalcy after the availability of COVID-19 vaccines. Key recommendations from youth include incorporating youth voice into decision making, communicating public health information effectively to youth, enhancing service delivery post-pandemic, and planning for future pandemics.

CONCLUSIONS

These results provide insights into the extensive longitudinal impacts of the COVID-19 pandemic on young people across three geographical locations. Actively involving youth in decision making roles for future pandemics or public health emergencies is critical.

Resilience, emotions, and suicidal ideation in Mexican adolescents during COVID-19 pandemic: risk factors and protective mechanisms

Introduction

Suicide is the second leading cause of death among adolescents worldwide. Suicidal ideation (SI) in adolescents may be influenced by factors such as resilience, anxiety, and depressive symptoms. The COVID-19 pandemic served as a significant stressor with documented impacts, yet further research is needed to clarify its effects. While stressful events are known to be associated with increased SI, direct evidence linking COVID-19 specifically to elevated SI remains limited.

Objective

The aim of this study was to identify the risk and protective factors associated with SI in Mexican adolescents during the COVID-19 pandemic.

Method

A cross-sectional, correlational descriptive study was conducted between May and June 2022 with a sample of 2,194 high school students, with a mean age of 16.6 years (SD = 1.2). Among the participants, 58.9% were female and 41.1% were male. They completed inventories to assess stress, anxiety, depressive symptoms, and resilience.

Results

Of 2194 adolescents, 15.5% presented SI, with females showing a higher prevalence of SI, anxiety, and depressive symptoms compared to males. In contrast, resilience was lower in females. Furthermore, depressive symptoms were identified as a risk factor for SI (OR 1.212; 95% CI 1.186, 1.240), whereas social competence was highlighted as a protective factor (OR 1.046 95% CI 1.044, 1.078).

Conclusions

The findings underscore the importance of preventing SI in adolescents by addressing anxiety and depressive symptoms, which were identified as risk factors, and by promoting social competence as a protective factor. Therefore, an integrated approach that addresses both individual mental health and the social context must be considered for preventing SI in adolescents.

Secure base and mental health in children: a narrative review

Background and Objective

Childhood is a crucial period for the formation of an individual's attachment type. Previous studies focused more on how to directly intervene in children's mental health problems such as depression, and less on how to improve children's mental health from the perspective of attachment relationship. Secure base, as one of the core concepts of attachment theory, plays an important role in the whole process of children's psychological development. In this article, we review the concept of the secure base, describe current clinical practice and suggest future directions.

Methods

A literature search was performed within electronic databases such as Web of Science, PubMed, and CNKI. Chinese and English articles focusing on the secure base and attachment relationship among children were retrieved. Their publication dates were set from the inception of the database to August 6, 2024.

Key Content and Findings

While the secure base significantly impacts early childhood, a safe base may also be established through group and teacher-student relationships to activate individual secure attachment schemas. Most prior studies concentrated on the mother-child bond, with limited exploration of the father's role in the family dynamic. Furthermore, children's secure attachment development is not only influenced by parents' secure base script knowledge (SBSK) but also by intergenerational transmission. The underlying structure of secure base scripting knowledge plays a distinct role in middle childhood mental health.

Conclusions

The mechanism by which family structure, the functional division of family roles, and the potential structure of safe-base script knowledge influence children's secure attachment development at various stages warrants further elucidation, including investigating cross-gender and cross-cultural stability. To facilitate the development of children's secure attachment pathways, it is essential to consider different attachment styles within parents and diverse family structures (including those in lesbian, gay, bisexual). From a clinical psychotherapy perspective, this review offered novel insights and practical guidance on how the secure base mechanism impacts children's mental health, with the overarching goal of mitigating the risk of mental health problems.

Burden of the COVID-19 pandemic on adolescent mental health in the Lombardy Region, Italy: a retrospective database review

BACKGROUND

Previous research has assessed the impact of the COVID-19 pandemic on adolescent mental health (MH). How the pandemic changed healthcare resource utilisation for MH conditions was investigated less, however, in particular in Italy.

METHODS

Data concerning outpatient visits in child and adolescent mental health services (CAMHSs), access to emergency departments (EDs), hospital admissions and drug prescriptions collected in administrative databases of the Lombardy Region, Italy, concerning adolescents 12-17 years old and occurring in the 2016-2021 period were analysed.Annual and monthly prevalence of healthcare (CAHMS/ED visits/hospital admissions) use for MH conditions and of psychotropic drug prescriptions were estimated. A negative binomial regression model was used to model the pre-pandemic monthly number of prevalent cases by gender. The total number of pandemic (1 March 2020 to 31 December 2021) cases predicted from the model was compared with the number of observed cases.

RESULTS

The overall annual rate of healthcare service utilisation slightly increased in the 2016-2019 period (from 63.8‰ to 67.8‰), decreased in 2020 (57.1‰) and returned to values similar to 2016 (64.9‰) the following year. A 2% relative increase was observed in girls, and a 10% decrease in boys, when comparing the prevalence in 2021 with that in 2019. Differences between genders were particularly evident for ED attendance, with an observed/predicted cases ratio in 2021 of 0.81 (95% CI 0.79 to 0.83) in boys, and 1.18 (95% CI 1.16 to 1.20) in girls, and for psychotropic drug prescriptions (0.83 (95% CI 0.82 to 0.84) and 1.24 (95% CI 1.23 to 1.25), respectively).

CONCLUSIONS

The current study confirms that the use of health services for MH conditions during the COVID-19 pandemic increased among adolescent girls but decreased among boys, and that gender differences emerged in the MH impact of the pandemic.

Post-traumatic Reactions and Social-Emotional Competence Among Chinese High School Students Experiencing COVID-19 Lockdown: A Network Analysis

In the post-pandemic era, psychological traumas have emerged as major mental health issues. However, the post-traumatic reactions and their connections with social-emotional competence among high school students experiencing COVID-19 lockdown have not been adequately explored. This study aimed to reveal the characteristics of their positive and negative post-traumatic reactions, and their connections with social-emotional competence. Network analysis was used on data from 1096 Chinese high school students who experienced COVID-19 lockdown. Measures included the DSECS-S, the PTGI and the PC-PTSD-5. The results revealed that "Valuing life" and "Recalling unwillingly" were identified as core factors of post-traumatic reactions, while "Having close friendships", "Getting along well with others" and "Respecting others' emotions" played a bridging role in connecting the communities of social-emotional competence and post-traumatic reactions. This study enriches research on post-traumatic reactions, emphasizing the importance of implementing social-emotional competence programs to tackle mental health crises.

COVID-19 lockdown effects on adolescent brain structure suggest accelerated maturation that is more pronounced in females than in males

Adolescence is a period of substantial social-emotional development, accompanied by dramatic changes to brain structure and function. Social isolation due to lockdowns that were imposed because of the COVID-19 pandemic had a detrimental impact on adolescent mental health, with the mental health of females more affected than males. We assessed the impact of the COVID-19 pandemic lockdowns on adolescent brain structure with a focus on sex differences. We collected MRI structural data longitudinally from adolescents prior to and after the pandemic lockdowns. The pre-COVID data were used to create a normative model of cortical thickness change with age during typical adolescent development. Cortical thickness values in the post-COVID data were compared to this normative model. The analysis revealed accelerated cortical thinning in the post-COVID brain, which was more widespread throughout the brain and greater in magnitude in females than in males. When measured in terms of equivalent years of development, the mean acceleration was found to be 4.2 y in females and 1.4 y in males. Accelerated brain maturation as a result of chronic stress or adversity during development has been well documented. These findings suggest that the lifestyle disruptions associated with the COVID-19 pandemic lockdowns caused changes in brain biology and had a more severe impact on the female than the male brain.

Implications of Cash Transfer Programs for Mental Health Promotion among Families Facing Significant Stressors: Using Ecological Systems Theory to Explain Successes of Conditional and Unconditional Programs

The purpose of this paper is to apply Bronfenbrenner's ecological systems theory to explore the literature on how Conditional Cash Transfer (CCT) and Unconditional Cash Transfer (UCT) programs might support positive mental health outcomes. The paper begins with transnational considerations of stress, such as poverty and COVID-19, and their impact on mental health. Bronfenbrenner's theory is applied to better understand the mechanisms by which CCT and UCT programs can potentially lead to positive outcomes for children and families who face such stressors. The implications of cash transfer programs are subsequently discussed in terms of how they might promote positive mental health outcomes among families globally. This theoretical application paper concludes with a call for transnational research to explore connections between cash transfer programs and mental health outcomes for children/adolescents and their parents/caregivers.

[Psychological distress and mental health problems in children and their parents during the COVID-19 pandemic (2020-2022)]

INTRODUCTION

The COVID-19 pandemic and accompanying containment measures created major changes to everyone's daily life that had an impact on mental health and psychological burden.

METHODS

In five surveys of the COPSY study more than 1,500 parents of 7- to 17-year-olds and their children between the ages of 11 and 17 were interviewed using established mental health assessment tools and a self-developed item on the experience of mental burden. Pre-pandemic comparative data were drawn from the representative BELLA study (BEfragung zum seeLischen Wohbefinden und VerhAlten).

RESULTS

The majority of children and adolescents as well as their parents in Germany felt stressed by the pandemic between 2020 and 2022. There was an increase in both mental health problems and symptoms of anxiety and depression at the beginning of the COVID-19 pandemic and during the second nationwide lockdown. A slight decrease in the subjective experience of psychological burden and mental health problems among children and their parents was observed in the fall of 2022. However, the prevalence of mental health problems and anxiety remained above pre-pandemic levels.

DISCUSSION

The results illustrate the difficult situation of many children, adolescents and parents, even after 3 years of pandemic. Low-threshold counseling and support services as well as more therapy places and professional support services should be made available.

Acceptance of a French e-Mental Health Information Website (CléPsy) for Families: A Web-Based Survey

Background

Childhood mental health issues concern a large amount of children worldwide and represent a major public health challenge. The lack of knowledge among parents and caregivers in this area hinders effective management. Empowering families enhances their ability to address their children's difficulties, boosts health literacy, and promotes positive changes. However, seeking reliable mental health information remains challenging due to fear, stigma, and mistrust of the sources of information.

Objective

This study evaluates the acceptance of a website, CléPsy, designed to provide reliable information and practical tools for families concerned about child mental health and parenting.

Methods

This study examines user characteristics and assesses ease of use, usefulness, trustworthiness, and attitude toward using the website. Platform users were given access to a self-administered questionnaire by means of mailing lists, social networks, and posters between May and July 2022.

Results

Findings indicate that the wide majority of the 317 responders agreed or somewhat agreed that the website made discussions about mental health easier with professionals (n=264, 83.3%) or with their relatives (n=260, 82.1%). According to the ANOVA, there was a significant effect between educational level and perceived trust (F6=3.03; P=.007) and between frequency of use and perceived usefulness (F2=4.85; P=.008).

Conclusions

The study underlines the importance of user experience and design in web-based health information dissemination and emphasizes the need for accessible and evidence-based information. Although the study has limitations, it provides preliminary support for the acceptability and usefulness of the website. Future efforts should focus on inclusive co-construction with users and addressing the information needs of families from diverse cultural and educational backgrounds.

Hair steroid before and after COVID-19 in preschoolers: the moderation of family characteristics

BACKGROUND

Frequent or prolonged exposure to stressors may jeopardize young children's health. The onset of the COVID-19 pandemic, coupled with disruptions in daily routines and social isolation resulting from public health preventive measures, have raised concerns about its potential impact on children' experienced stress, particularly for young children and vulnerable families. However, whether the pandemic was accompanied by changes in physiological stress remains unknown as perceived stress is not a good proxy of physiological stress. This study examined if preschoolers showed increasing hair steroid concentrations following the onset of the COVID-19 pandemic and whether family characteristics may have exacerbated or buffered these changes.

METHODS

136 preschoolers (2-4 years) provided hair for steroid measurement (cortisol, dehydroepiandrosterone (DHEA), cortisone, cortisol-to-DHEA ratio, cortisol-to-cortisone ratio) in October-November 2019 (T0) and in July-August 2020 (T1). A 2-centimeter hair segment was analyzed, reflecting steroid production over the two months leading up to collection. Family income, conflict resolution and lack of cohesion, as well as parents' COVID-19 stress were reported by parents. Linear mixed models for repeated measures and Bayes factors were used.

RESULTS

No significant changes were noted from before to after the onset of the COVID-19 pandemic for most hair steroids. However, a moderating role of family conflict resolution was noted. Children living with parents with a better ability to resolve conflicts had lower levels of DHEA compared to those who had more difficulty managing conflicts. Additionally, lower levels of family cohesion and income were linked to some steroids, especially DHEA, suggesting that these factors may relate to children's physiological stress. Finally, boys had higher DHEA levels than girls.

CONCLUSION

Our findings suggest that stress biomarkers were comparable from before to during the COVID-19 pandemic. This observation holds true despite the pandemic being perceived by many as a novel, unpredictable, and potentially threatening event. Findings further suggest that family characteristics are associated with hair steroid, especially DHEA, which deserves further investigation.

Longitudinal Changes in Youth Mental Health From Before to During the COVID-19 Pandemic

Importance

Robust longitudinal studies of within-child changes in mental health associated with the COVID-19 pandemic are lacking, as are studies examining sources of heterogeneity in such changes.

Objective

To investigate within-child changes, overall and between subgroups, in youth mental health from prepandemic to midpandemic.

Design, Setting, and Participants

This cohort study used longitudinal prepandemic and midpandemic data from the Environmental influences on Child Health Outcomes (ECHO) Program, collected between January 1, 2015, and March 12, 2020 (prepandemic), and between March 13, 2020, and August 31, 2022 (midpandemic). Data were analyzed between December 1, 2022, and June 1, 2024. The sample included 9 US-based observational longitudinal pediatric ECHO cohorts. Cohorts were included if they collected the Child Behavior Checklist (CBCL) School Age version before and during the pandemic on more than 20 participants of normal birth weight aged 6 to 17 years.

Exposure

The COVID-19 pandemic.

Main Outcomes and Measures

Prepandemic to midpandemic changes in CBCL internalizing, externalizing, depression, anxiety, and attention-deficit/hyperactivity disorder (ADHD) scores were estimated, and differences in outcome trajectories by child sociodemographic characteristics (age, sex, race, ethnicity, and poverty level) and prepandemic mental health problems were examined using established CBCL clinical score thresholds.

Results

A total of 1229 participants (mean [SD] age during the pandemic, 10.68 [2.29] years; 625 girls [50.9%]) were included. The sample was socioeconomically diverse (197 of 1056 children [18.7%] lived at ≤130% of the Federal Poverty Level; 635 (51.7%) identified as White, 388 (31.6%) as Black, 147 (12.0%) as multiracial, 40 (3.3%) as another race, and 118 (9.6%) as Hispanic). Generalized linear mixed-effects models revealed minor decreases in externalizing problems (β = -0.88; 95% CI, -1.16 to -0.60), anxiety (β = -0.18; 95% CI, -0.31 to -0.05), and ADHD (β = -0.36; 95% CI, -0.50 to -0.22), but a minor increase in depression (β = 0.22; 95% CI, 0.10 to 0.35). Youth with borderline or clinically meaningful prepandemic scores experienced decreases across all outcomes, particularly externalizing problems (borderline, β = -2.85; 95% CI, -3.92 to -1.78; clinical, β = -4.88; 95% CI, -5.84 to -3.92). Low-income (β = -0.76; 95% CI, -1.14 to -0.37) and Black (β = -0.52; 95% CI, -0.83 to -0.20) youth experienced small decreases in ADHD compared with higher income and White youth, respectively.

Conclusions and Relevance

In this longitudinal cohort study of economically and racially diverse US youth, there was evidence of differential susceptibility and resilience for mental health problems during the pandemic that was associated with prepandemic mental health and sociodemographic characteristics.

Antidepressant treatment initiation among children and adolescents with acute versus long COVID: a large retrospective cohort study

BACKGROUND

Child and adolescent antidepressant use increased post-pandemic, but it is unknown if this disproportionally affected those who develop post-acute sequelae of coronavirus disease 2019 (COVID) or long COVID. This study compared the risk of antidepressant initiation among children and adolescents with long COVID with those who had COVID but did not have evidence of long COVID.

METHODS

Our retrospective cohort study of children and adolescents aged 3-17 years at the first evidence of COVID or long COVID from October 1, 2021 through April 4, 2022 was conducted within Komodo's Healthcare Map™ database. The index date was the earliest date of a medical claim associated with a COVID (COVID comparators) or long COVID diagnosis (long COVID cases). The baseline period was six months before the index date. The outcome was antidepressant initiation within twelve months after the index date. Due to the large number of COVID relative to long COVID cases, COVID comparators were randomly selected with a ratio of 2 COVID to 1 long COVID. We used propensity score matching to control for confounding due to imbalances in the baseline covariates. Log-binomial models estimated the relative risk (RR) of antidepressant initiation in the propensity score matched sample. We conducted several sensitivity analyses to test the robustness of our findings to several assumptions.

RESULTS

Our child and adolescent sample included 18 274 with COVID and 9137 with long COVID. Compared with those with COVID, a larger proportion of long COVID children and adolescents had psychiatric disorders, psychotropic use, medical comorbidities, were previously hospitalized, or visited the emergency department. In the propensity score-adjusted analysis, the long COVID group had a statistically significant higher risk of antidepressant initiation relative to the COVID comparator (adjusted-RR: 1.40, 95% CI = 1.20, 1.62). Our findings were robust across sensitivity analyses.

CONCLUSIONS

The increased risk of antidepressant initiation following long COVID warrants further study to better understand the underlying reasons for this higher risk. Emerging evidence of long COVID's impact on child mental health has important implications for prevention and early interventions.

A longitudinal study of child adjustment during the COVID-19 pandemic: the protective role of the parent-child relationship in middle childhood

This longitudinal study assessed how parent-child relationship quality during the first COVID-19 lockdown was related to changes in internalizing, externalizing, and sleep problems during the first months of the pandemic: during lockdown, partial deconfinement, and total deconfinement. Participants included 167 children (9-12 year) and their parents recruited in the province of Quebec, Canada. Child behavior problems decreased between lockdown and the two deconfinement assessments, but more sleep and behavior problems were associated with lower levels of relationship quality (more conflict, less closeness, and more insecure attachment). Significant interaction effects showed that changes in externalizing and sleep problems varied as a function of parent-child relationship. Results support the critical importance of the parent-child relationship with regard to child adjustment in middle childhood in times of crisis such as a pandemic. They also highlight resilience in children aged 9 to 12, with a decrease in problems over time.

Adolescents perception of the COVID-19 pandemic restrictions and associated mental health and well-being: gender, age and socioeconomic differences in 22 countries

BACKGROUND

The COVID-19-pandemic has had a profound impact on the lives of adolescents worldwide. This study examined the subjective perception of the COVID-19 pandemic measures and its association with mental health and well-being (i.e., loneliness, life satisfaction and multiple health complaints) among 13- and 15-years-old adolescents from 22 countries.

METHODS

Data from the cross-national Health Behaviour in School-aged Children (HBSC) 2021/22 study were used from representative samples of 22 countries (N = 67,544; 51.9% girls). The self-perceived impact of COVID-19 measure comprised 10 items asking about the impact on several dimensions of adolescent lives (e.g., relationships with family and friends, health, or eating behaviours). Measures of loneliness, multiple health complaints, and life satisfaction were included as indicators of mental health and well-being. A non-parametric multilevel latent class analysis considering individual and country-levels was conducted to identify classes of self-perceived impact of the COVID-19 measures. Multilevel logistic regression models adjusted by age and socioeconomic status were applied to assess the association between COVID-19 measure impact classes and mental health.

RESULTS

Three classes were identified on individual level encompassing a neutral (51%), positive (31%), or negative (18%) perception of COVID-19 measures. A third of the adolescents reported a positive impact of the pandemic measures. The distribution of classes was heterogeneous within and across countries. Within the positive COVID-19 measure impact class, social relationships were the most important dimension, whereas mental health problems were mostly represented within the negative COVID-19 measure impact class. Girls with a negative perception of pandemic measures showed higher levels of loneliness and multiple health complaints and lower life satisfaction. 15-year-old adolescents and those with a low socioeconomic status reported higher levels of loneliness and lower life satisfaction.

CONCLUSIONS

The majority of adolescents perceived the pandemic measures as neutral or positive. Girls, 15-year-old adolescents, and those with low socioeconomic status were at higher risk of suffering from pandemic measures and associated problems of loneliness, multiple health complaints, and low life satisfaction. We conclude that adolescent's mental health and well-being should be considered in the decision-making process by ensuring that the unique challenges of adolescents are adequately addressed in policies.

Trajectories of mental health in children and adolescents during the COVID-19 pandemic: findings from the longitudinal COPSY study

BACKGROUND

Mental health and health-related quality of life (HRQoL) in children and adolescents deteriorated during the COVID-19 pandemic. The aim of this population-based longitudinal study was to explore whether distinct mental health trajectories in youths can be identified over the course of the pandemic.

METHODS

Mental health problems (MHP), psychosomatic symptoms and HRQoL were assessed at five time points between May 2020 and October 2022 in 744 children and adolescents aged 7 to 20 years using established instruments. We used generalized mixture modeling to identify distinct mental health trajectories and fixed-effects regressions to analyse covariates of the identified profiles of change.

RESULTS

We found five distinct linear latent trajectory classes each for externalising MHP and psychosomatic symptoms and four trajectory classes for internalising MHP. For HRQoL, a single-class solution that indicates a common development process proved to be optimal. The largest groups remained almost stable at a low internalising and externalising symptom level (64 to 74%) and consistently showed moderate psychosomatic symptoms (79%), while 2 to 18% showed improvements across the pandemic. About 10% of the youths had consistently high internalising problems, while externalising problems deteriorated in 18% of youths. Class membership was significantly associated with initial HRQoL, parental and child burden, personal resources, family climate and social support.

CONCLUSIONS

The mental health of most children and adolescents remained resilient throughout the pandemic. However, a sizeable number of youths had consistently poor or deteriorating mental health. Those children and adolescents need special attention in schools and mental health care.

The COVID-19 pandemic and wellbeing in Switzerland-worse for young people?

BACKGROUND

The key objective of our study was to describe the population-average trajectories of wellbeing, spanning the period of 2017-2022, comparing young people with other age groups. Moreover, we aimed to identify subgroups of young people who experienced disproportionate changes in wellbeing.

METHODS

We used longitudinal data from six waves (2017-2022) of the Swiss Household Panel. Participants were at least 14 years old in 2017 and had at least one valid composite measure of wellbeing between 2017 and 2022 (n individuals = 11,224; n observations = 49,032). The data were typically collected with telephone or web interviewing. The age of participants ranged from 14 to 102, with a roughly equal distribution of men (51.1%) and women (48.9%). We conceptualized wellbeing as positive affect and life satisfaction, negative affect, stress and psychosomatic symptoms. We described the trajectories of wellbeing using piecewise growth curve analysis. We included sociodemographic characteristics to further describe wellbeing trajectories across subgroups of young people. These comprised (1) gender, (2) migration status, (3) partnership status, (4) living with parents, (5) education/employment status, (6) household income.

RESULTS

Young people (age 14-25) experienced a steady decline in positive affect and life satisfaction throughout the entire period, with the greatest change occurring before the pandemic (2017-2019). The trajectories in this outcome were largely stable in other age groups. Moreover, young individuals showed a more pronounced increase in negative affect, particularly in the pre-pandemic years, compared to older groups. Negative affect increased during the pandemic, followed by a subsequent decline post-pandemic, observed similarly across all age groups. Among young people specifically, the trajectory of stress was similar to the one of negative affect. However, issues such as sleep problems, weakness, weariness, and headaches continued to increase in this population from 2017 to 2022. We also found evidence for a greater increase in negative affect during the pandemic in young women and those not in employment or education.

CONCLUSIONS

Given the fact that the decline in young people's wellbeing in Switzerland started two years before the pandemic, our study emphasises the importance of consideing their wellbeing within a broader systemic context beyond pandemic-related changes.

Effects of three prophylactic interventions on French middle-schoolers' mental health: protocol for a randomized controlled trial

Adolescence is a strategic developmental stage in terms of preventing later difficulties and ensuring good mental health. Prophylactic interventions, which are conducted before the onset, prolongation, or worsening of difficulties, and aim to prevent or reduce symptoms or to promote wellbeing, therefore appear particularly appropriate for adolescents. However, existing prophylactic interventions conducted with adolescents have several weaknesses, including sparse theoretical frameworks, ambivalent evidence of their efficacy, and implementation and dissemination difficulties. In addition, no data are currently available on the effectiveness of such interventions in France. To fill this gap, a four-arm randomized controlled trial will be performed to assess the effectiveness of three prophylactic interventions targeting reactive, proactive and interpersonal adaptation in fourth-grade middle-school students, together with participants' experience and perception of the interventions. Based on existing knowledge about adolescents, their learning mechanisms, and field constraints, these three interventions have been designed to promote their learning and receptiveness to interventions. Compared with baseline (i.e., before the intervention), we expect to observe a significant decrease in the level of distress (anxiety and depressive symptoms, functional impairment, and psychosocial difficulties) and a significant increase in the level of wellbeing after the intervention, across the three intervention groups, but not in the control group. In addition, we expect to observe post-intervention improvements in the processes targeted by the reactive adaptation intervention (operationalized as coping strategy use and flexibility), those targeted by the proactive adaptation intervention (operationalized as the tendency to engage in committed actions and general self-efficacy), and those targeted by the interpersonal adaptation intervention (operationalized as assertiveness in interactions), but only in the corresponding groups, with no change in any of these processes in the control group. The results of this research will not only enrich our knowledge of the processes involved in adolescents' distress and wellbeing, but also provide clues as to the best targets for intervention. Moreover, the material for these interventions will be freely available in French on request to the corresponding author, providing access to innovative and fully assessed interventions aimed at promoting adolescents' mental health in France.This clinical trial is currently being registered under no. 2023-A01973-42 on https://ansm.sante.fr/ . This is the first version of the protocol.

The change of psychosocial stress factors in families with infants and toddlers during the COVID-19 pandemic. A longitudinal perspective on the CoronabaBY study from Germany

Background

Over nearly three years, the COVID-19 pandemic has had a lasting impact on people's lives and mental health worldwide with its far-reaching restrictions and concerns about infections and other personal consequences. Families were particularly affected and showed increased stress and psychological problems. Long-term effects cannot be ruled out. So far, data on young families are sparse. The present longitudinal analysis (n = 932) of the CoronabaBY study investigated the development of parenting stress, parental affective symptoms, and child's mental health in young families with children aged 0-3 years in Germany as well as potential influencing factors.

Methods

The observational study includes two measurement points over the course of the pandemic (baseline and follow-up). Data was collected by app using standardized questionnaires.

Results

N = 932 participants, mainly mothers (94.7%) born in Germany (93.1%) with higher education (61.3% with at least high school diploma) and a comfortable financial situation participated in the longitudinal study. Children were on average 14.7 months old at baseline (SD: 12, range: 1-39 months). While the proportion of parents who perceived the pandemic as stressful decreased significantly from baseline (60%) to follow-up (52.3%), the proportion with parenting stress increased significantly (from 40.1% to 45.4%). Both parental and child mental health problems remained constant over time, with infants crying/feeding/sleeping problems ranging above pre-pandemic comparative data. Most predictive for high parenting stress at follow-up was high parenting stress at baseline. This was also true for parental affective symptoms (depression/anxiety) and child mental health problems.

Conclusions

Despite faded pandemic restrictions, parents remained burdened. Support services do not appear to have been sufficient to help families out of their stressful situation. Our results indicate a need for action regarding low-threshold services that effectively reach affected families.

Trial registration

The study was pre-registered in OSF (https://osf.io/search/?q=tksh5&page=1).

Risk factors associated with depression and anxiety among the Chinese general population after retracting the dynamic zero-COVID policy: A network analysis

BACKGROUND

Recent studies have evidenced the negative psychological consequences of the COVID-19 pandemic and sociodemographic vulnerability among the general population, while limited information was available on which factors make the greatest contribution to psychological distress when these factors were considered concurrently. Herein, we aimed to investigate the pathways that underlie psychological distress in the context of retracting dynamic zero-COVID policy.

METHODS

We employed the mixed graphical model to construct the network of depression (PHQ-9), anxiety (GAD-7), and pandemic-related factors in a general population sample (N = 1610). Then, we re-examined the network by adding sociodemographic variables to further explore the influence of sociodemographic factors. Additionally, we repeated the analyses in the second sample (N = 620) collected in the same period to assess the replicability.

RESULTS

The relationships between the pandemic factors and anxiety and depressive symptoms exhibited a tendency to decrease after adding demographic variables, and income became the most important node and shared edge weights with all anxiety and depressive symptoms. These findings were replicable with the second sample. No significant difference in the network properties was detected between the two samples.

LIMITATIONS

The cross-sectional design limits the ability to observe longitudinal changes in these risk factors and their relationship with psychological distress.

CONCLUSIONS

Income level, rather than the pandemic-related factors, acted as a vital role in the psychological distress of the general population, implying that livelihood issues may be the critical intervention targets for mental health during the post-pandemic period.

Subjective health and psychosomatic complaints of children and adolescents in Germany: Results of the HBSC study 2009/10 - 2022

Background

Subjective health and well-being are important health indicators in childhood and adolescence. This article shows current results and trends over time between 2009/10 and 2022.

Methods

The Health Behaviour in School-aged Children (HBSC) study examined subjective health, life satisfaction and psychosomatic complaints of N = 21,788 students aged 11 to 15 years in the school years 2009/10, 2013/14, 2017/18 and in the calendar year 2022. Multivariate regression analyses show the associations between sociodemographic characteristics and well-being in 2022, as well as trends since 2009/10.

Results

The majority of children and adolescents indicate a good subjective health and high life satisfaction. About half of the girls and one third of the boys report multiple psychosomatic health complaints, with a clear increase over time. Older adolescents, girls and gender diverse adolescents are at an increased risk of poor well-being. Subjective health and life satisfaction varied between 2009/10 and 2022, with a significant deterioration between 2017/18 and 2022.

Conclusions

The high proportion of children and adolescents with psychosomatic complaints, as well as the observed gender and age differences, underline the need for target group-specific prevention, health promotion and continuous health monitoring.