Trajectories and Associations Between Maternal Depressive Symptoms, Household Chaos and Children's Adjustment through the COVID-19 Pandemic: A Four-Wave Longitudinal Study

Contribution of an under-recognized adversity to child health risk: large-scale, population-based ACEs screening

Background and Objectives

Whereas adverse early life experiences (ACEs) correlate with cognitive, emotional and physical health at the population level, existing ACEs screens are only weakly predictive of outcomes for an individual child. This raises the possibility that important elements of the early-life experiences that drive vulnerability and resilience are not being captured. We previously demonstrated that unpredictable parental and household signals constitute an ACE with cross-cultural relevance. We created the 5-item Questionnaire of Unpredictability in Childhood (QUIC-5) that can be readily administered in pediatric clinics. Here, we tested if combined screening with the QUIC-5 and an ACEs measure in this real-world setting significantly improved prediction of child health outcomes.

Methods

Leveraging existing screening with the Pediatric ACEs and Related Life Events Screener (PEARLS) at annual well-child visits, we implemented QUIC-5 screening in 19 pediatric clinics spanning the diverse sociodemographic constituency of Orange County, CA. Children (12yr+) and caregivers (for children 0-17years) completed both screens. Health diagnoses were abstracted from electronic health records (N=29,305 children).

Results

For both screeners, increasing exposures were associated with a higher probability of a mental (ADHD, anxiety, depression, externalizing problems, sleep disorder) or physical (obesity abdominal pain, asthma, headache) health diagnosis. Across most diagnoses, PEARLS and QUIC provided unique predictive contributions. Importantly, for three outcomes (depression, obesity, sleep disorders) QUIC-5 identified vulnerable individuals that were missed by PEARLS alone.

Conclusions

Screening for unpredictability as an additional ACE in primary care is feasible, acceptable and provides unique, actionable information about child psychopathology and physical health.

Effects of the COVID-19 Pandemic on Early Childhood Development and Mental Health: A Systematic Review and Meta-Analysis of Comparative Studies

From 2020 to 2023, the coronavirus-19 (COVID-19) pandemic exposed children to a variety of adverse childhood events, including parental loss, abuse, and disruption in services, and it exacerbated societal inequities. Studies evaluating the mental health of older children and adolescents reported increases in depression and anxiety symptoms, but no reviews have addressed the effects of the pandemic on preschool children. This systematic review and meta-analysis is the first to explore these effects. The goal was to analyze and synthesize longitudinal cohort studies to determine impact of the COVID-19 pandemic on the development and mental health of young children. Searches of multiple databases were performed for studies published between 2018 and 2023 with pre- and post-pandemic evaluations of the mental health or development of preschool children (aged 0-6 years) using objective measures and according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Cohen's d effect sizes were calculated for each study that utilized the Strengths and Difficulties Questionnaire (SDQ), Ages and Stages Questionnaire (ASQ), or the Child Behavior Checklist (CBCL). Random-effects mixed models combined the estimates of effect sizes to calculate the overall mean effect size. The meta-analyses included 22,348 children from 16 countries. The analyses showed small increases in emotional symptoms and conduct problems, as well as increases in emotional reactivity, anxiety/depression, withdrawal symptoms, attention problems, and aggressive behaviors. A decrease in fine motor and personal-social skills was noted. Studies not included in these meta-analyses also showed negative effects on language and executive function. This systematic review characterizes the detrimental effects of the COVID-19 pandemic on the mental health and development of preschool children across the world. Our results suggest the vulnerability of early childhood to pandemic-related disruptions, although the heterogeneity in study design and child characteristics may limit some of these conclusions.

[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.

Annual Research Review: The power of predictability - patterns of signals in early life shape neurodevelopment and mental health trajectories

The global burden of early life adversity (ELA) is profound. The World Health Organization has estimated that ELA accounts for almost 30% of all psychiatric cases. Yet, our ability to identify which individuals exposed to ELA will develop mental illness remains poor and there is a critical need to identify underlying pathways and mechanisms. This review proposes unpredictability as an understudied aspect of ELA that is tractable and presents a conceptual model that includes biologically plausible mechanistic pathways by which unpredictability impacts the developing brain. The model is supported by a synthesis of published and new data illustrating the significant impacts of patterns of signals on child development. We begin with an overview of the existing unpredictability literature, which has focused primarily on longer patterns of unpredictability (e.g. years, months, and days). We then describe our work testing the impact of patterns of parental signals on a moment-to-moment timescale, providing evidence that patterns of these signals during sensitive windows of development influence neurocircuit formation across species and thus may be an evolutionarily conserved process that shapes the developing brain. Next, attention is drawn to emerging themes which provide a framework for future directions of research including the evaluation of functions, such as effortful control, that may be particularly vulnerable to unpredictability, sensitive periods, sex differences, cross-cultural investigations, addressing causality, and unpredictability as a pathway by which other forms of ELA impact development. Finally, we provide suggestions for prevention and intervention, including the introduction of a screening instrument for the identification of children exposed to unpredictable experiences.

Short-term and long-term effects of the COVID-19 pandemic on child psychological well-being: a four-wave longitudinal study

As the COVID-19 pandemic further unfolds, it becomes a key theoretical and practical question to identify trajectories of child psychological well-being and to explore risk and resilience factors for developmental adjustment. The current study addressed this research gap by means of an ecological design: A (lockdown)-B (relaxation)-B (relaxation)-A (lockdown). We collected parental reports via online questionnaires over four measurement occasions during the COVID-19 pandemic in Germany (non-probabilistic sample): from the first lockdown (T1-spring 2020, N = 1769) to the following period of relaxation (T2-summer 2020, n = 873; T3-fall 2020, n = 729) on to the second lockdown (T4-winter 2020/21, n = 748). Key measures at T1-T4 were child emotional and behavioral problems as well as hyperactivity, child emotional and family-related well-being, parental strain, and parent-child relationship quality. We found evidence for quadratic growth models. While child problem behaviors (b = 0.32, p < 0.001) and emotional well-being (b = - 0.33, p < 0.001) improved after the first lockdown during subsequent periods of relaxation before worsening again in the second lockdown, child family-related well-being steadily decreased over all four measurement points (T1-T2: p < 0.001; T2-T3: p = 0.045; T3-T4: p = 0.030). Importantly, parental stress emerged as a strong risk factor (ps < 0.11) and the parent-child relationship quality constituted a resilience factor (p = 0.049) for child psychological well-being. These findings have major implications for policies aiming to further child health during the COVID-19 pandemic.

Preschoolers' Self-Regulation and Behavior Problems in the Midst of Caregiver Depression and Chaos

OBJECTIVES

Preschoolers' self-regulation is partially developed through home and child care routines. COVID-19-related child care closures increased caregiver depressive symptoms, household chaos, and children's behavior problems. This longitudinal study examined how preschoolers' prepandemic self-regulation was related to behavior problems early in the pandemic, including buffering against the adverse effects of caregiver depressive symptoms and household chaos.

METHODS

A sample of 264 caregivers of preschoolers reported on their children's self-regulation (Behavior Rating Inventory of Executive Function-Preschool Version Inhibitory Self Control Index) before the pandemic and caregiver depressive symptoms (Center for Epidemiological Studies), household chaos (Confusion, Hubbub, and Order Scale), and children's behavior problems (Behavior Rating Index for Children) during the pandemic. We used linear mixed models to examine predictors of children's behavior problems, including prepandemic self-regulation, and further examined moderation by pandemic-related caregiver depressive symptoms and household chaos.

RESULTS

Children were 64% non-Hispanic White and 24% non-Hispanic Black, with mean pandemic age 5.9 years. Prepandemic self-regulation significantly predicted early pandemic behavior problems (β = -0.38 [95% confidence interval, -0.69 to -0.07]). This association was moderated by pandemic-related caregiver depressive symptoms and household chaos; the protective association was maintained at high levels of caregiver depressive symptoms or household chaos, although the association diminished when these co-occurred.

CONCLUSION

The protective association between prepandemic self-regulation and subsequent behavior problems suggests longitudinal benefits of preschoolers' inhibitory and emotional control. Despite reduced protection associated with co-occurring caregiver and household challenges, self-regulation continued to demonstrate protection against subsequent behavior problems, even in the midst of a pandemic.

Mental health and quality of life in children and adolescents during the COVID-19 pandemic: a systematic review of longitudinal studies

Background

The COVID-19 pandemic has significantly impacted the mental health of children and families, i.e., due to measures like social distancing and remote schooling. While previous research has shown negative effects on mental health and health-related quality of life (HRQoL), most studies have focused on pre-post comparisons in the early pandemic stages. This systematic review aims to examine longitudinal studies to understand the long-term impacts of the pandemic on children and adolescents.

Methods

This systematic review adhered to the PRISMA guidelines and was preregistered in the international prospective register of systematic reviews (Record ID: CRD42022336930). We systematically searched PubMed/MEDLINE, Web of Science, PsycINFO, PSYNDEX, and the WHO-COVID-19 database and included studies published up to August 30, 2022. Based on pre-defined eligibility criteria, longitudinal and prospective studies that assessed the mental health or quality of life of children or adolescents (0-19 years) in the general population over a longer time span (at two or more measurement points) during the COVID-19 pandemic were included in the review. The methodological quality of the included studies was assessed using an adapted version of the Effective Public Health Practice Project (EPHPP) checklist. Narrative data synthesis was used to summarize the findings.

Results

A total of 5,099 results were obtained from literature searches, with 4,935 excluded during title/abstract screening. After reviewing 163 full-text articles, 24 publications were included in the review. Sample sizes ranged between n = 86 and n = 34,038. The length of the investigated time periods and the number of assessment points, as well as outcomes, varied. The majority of studies were of moderate methodological quality. Mental health outcomes were more frequently studied compared to measures of HRQoL. The findings from these studies mostly suggest that children and adolescents experienced heightened mental health problems, specifically internalizing symptoms like anxiety and depression. Further, there was a decline in their overall HRQoL over the course of the COVID-19 pandemic that did not necessarily subside when lockdowns ended.

Conclusion

It is crucial to continue monitoring the mental health and well-being of children and adolescents following the pandemic to identify groups at risks and plan interventions. This should ideally be conducted by large systematic studies, using validated instruments, and encompassing representative samples to obtain reliable and comprehensive insights with the aim of improving youth mental health care.

Empirical support for a model of risk and resilience in children and families during COVID-19: A systematic review & narrative synthesis

BACKGROUND.

The COVID-19 Family Disruption Model (FDM) describes the cascading effects of pandemic-related social disruptions on child and family psychosocial functioning. The current systematic review assesses the empirical support for the model.

METHODS.

Study eligibility: 1) children between 2-18 years (and/or their caregivers); 2) a quantitative longitudinal design; 3) published findings during the first 2.5 years of COVID-19; 4) an assessment of caregiver and/or family functioning; 5) an assessment of child internalizing, externalizing, or positive adjustment; and 6) an examination of a COVID-19 FDM pathway. Following a search of PsycINFO and MEDLINE in August 2022, screening, full-text assessments, and data extraction were completed by two reviewers. Study quality was examined using an adapted NIH risk-of- bias tool.

RESULTS.

Findings from 47 studies were summarized using descriptive statistics, tables, and a narrative synthesis. There is emerging support for bidirectional pathways linking caregiver-child functioning and family-child functioning, particularly for child internalizing problems. Quality assessments indicated issues with attrition and power justification.

DISCUSSION.

We provide a critical summary of the empirical support for the model, highlighting themes related to family systems theory and risk/resilience. We outline future directions for research on child and family well-being during COVID-19. Systematic review registration. PROSPERO [CRD42022327191].

Changes in mental health symptoms and sociocultural factors across the COVID-19 pandemic in mothers of Mexican descent

Latinos have been disproportionately affected by the COVID-19 pandemic in the US. Little is known about the lasting effects on mental health, particularly among mothers of young children, who historically report high levels of depression and anxiety. We examined if anxiety and depression symptoms worsened for mothers of Mexican descent across the pandemic and identified the role of sociocultural risk and protective factors on these changes. Mothers of Mexican descent (n = 141) with young children (ages 0-7) were administered surveys on mental health symptoms (anxiety and depression), stress-related sociocultural factors (perceived discrimination) before (pre-pandemic), within 3 months (early pandemic), and 18 months after the COVID-19 stay-at-home order (late pandemic). Another sociocultural factor, acculturative stress, was only measured pre-pandemic while during the later phase of the pandemic mothers reported their levels of loneliness, optimism, and coping styles. Repeated measures (RM) ANOVA demonstrated that depressive and anxiety symptoms as well as perceived discrimination increased from pre to early months of the COVID-19 pandemic and slightly lowered in late-COVID but did not return to pre-COVID levels. Two-way RM ANOVA showed that acculturative stress and perceived discrimination predicted worse mental health trajectories across the pandemic while moderations revealed that optimism buffered against, and avoidant coping increased the adverse effects of sociocultural factors on mental health. The effects of the COVID pandemic on mental health are lingering in mothers of young children; however, optimism may be a protective factor. The results also highlight the damaging effects of external factors, such as discrimination, on maternal mental health during times of crisis.

Screen media exposure and behavioral adjustment in early childhood during and after COVID-19 home lockdown periods

There is ample evidence that young children's screen media use has sharply increased since the outbreak of the novel 2019 coronavirus disease (COVID-19). However, the long-term impact of these changes on children's adjustment is currently unclear. The goals of the current study were to assess longitudinal trajectories of young children's screen media exposure through a series of national COVID-19 home lockdowns and to examine the predictive associations between different aspects of media exposure and post-lockdown behavioral adjustment. Data were collected at four timepoints during and after home lockdown periods in Israel. Longitudinal data measuring various aspects of media use, behavioral conduct and emotional problems were gathered from a sample of 313 Israeli children (54% females) between the ages two to five years (Mage at T1 = 3.6), by surveying their mothers at 5 points in time. Child overall screen time use, exposure to background television, use of media to regulate child distress and maternal mobile device use all changed throughout the lockdown periods. Moreover, during lockdowns children's behavior problems were concurrently and positively correlated with screen time, use of media to regulate child distress, and exposure to background television. However, these were not longitudinally related to child behavior problems in the post-lockdown period. Possible implications for family media use during a public health crisis are discussed.