COVID-19 Pandemic Impact on Family Life and Exacerbated Emotional and Behavioral Health among Preschool Children: A Longitudinal Study

Inequalities in COVID-19 impact on preschool mental health in India: key moderators of adverse outcome

ABSTRACT

Introduction

Worldwide research suggests that the COVID-19 pandemic had little to no overall effect on preschool children's mental health, but that the impact is variable depending on pre-existing and COVID-19-related inequalities. Evidence from low- and middle-income country settings is sparse, yet effects may be more variable due to greater inequalities. We provide the first empirical evidence for the impact of the pandemic on emotional and behavioural problems in Indian preschool children, after accounting for normative age-related change, and test whether the impact varied depending on COVID-19-related inequalities.

Methods

Families participating in an Indian-based prospective longitudinal birth cohort (Bangalore Child Health and Development Study) provided data at age 2 years (before COVID-19) and again during COVID-19 (n=528). Mothers reported child emotional and behavioural problems and a range of COVID-19-related adverse experiences.

Results

There was a small overall pandemic effect on emotional (rate ratio (RR)=1.31, p=0.040), but not behavioural problems, after adjusting for age-related change. However, compared with the lowest risk level, emotional and behavioural problems rose higher compared with whole sample age-expected rates in families who reported the highest levels of perceived negative impact of COVID-19-related adversities (moderation p<0.001, RR=2.43 and p<0.001, RR=1.32), COVID-19 life events (p<0.001, RR=3.28, and p<0.001, RR=1.26) and time the child spent playing alone (p<0.001, RR=2.49). Emotional problems rose higher with high perceived COVID-19 maternal stress (p=0.013, RR=1.57) and with increased child mobile phone use (p<0.001, RR 1.48). Secondary analyses controlling for variation in age trends within moderator subgroups revealed these to be rarely significant. Where significant and accounted for, having more children living at home emerged as protective, whereas living below the poverty line emerged as a risk for adverse pandemic impact on child mental health.

Conclusion

A small overall increase in preschool mental health problems was evident. However, this masked substantial worsening of such problems in families with elevated COVID-19 adversities in India. These findings can inform the targeting of policy and practice initiatives to better mitigate adverse longer-term mental health outcomes arising from the pandemic response.

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.

Maternal autistic traits and anxiety in children with typical development in Chinese families: a moderated mediation model of mothers' negative emotional expressions and child gender

Background

Prior studies have focused on the effects of maternal autistic traits on children with autism, but little attention has been paid to the effects of maternal autistic traits on typically developing children, while the mechanisms of the effects are not clear.

Objective

Given that, a moderated mediation model was conducted to examine the association between maternal autistic traits and typically developing children's anxiety and the underlying mechanisms.

Methods and results

Participants were 648 mother-child dyads in which these children had no autistic siblings. Mothers reported their autistic traits and negative emotional expressions in the family and children's anxiety. The results indicated that children's anxiety was predicted by maternal autistic traits. Mediating analysis revealed that mothers' negative emotional expressions partially mediated the association between their autistic traits and children's anxiety. The findings also indicated that child gender moderated the relationship between maternal emotional expressions and children's anxiety. Specifically, anxiety in girls was more strongly predicted by negative emotional expressions from their mothers than in boys.

Conclusion

These results have important theoretical and practical implications for reducing the adverse effect of maternal autistic traits on children's anxiety, especially for girls. The present study also reveals that maternal negative emotional expression is an important mechanism. Causal conclusions cannot be drawn based on cross-sectional research design, so it is necessary to conduct longitudinal studies in the future.

The Global Landscape of Domestic Violence against Women during the COVID-19 Pandemic: A Narrative Review

The coronavirus disease (COVID-19) pandemic has led to an alarming increase in domestic violence against women owing to lockdown measures and limited access to support services. This article provides insights into the global prevalence of domestic violence, barriers to seeking help, its impact on women and children, and the best practices implemented worldwide. Domestic violence encompasses various forms of abuse; many young women experience partner violence. Barriers to seeking help include fear, financial constraints, lack of awareness of available services, and distrust among stakeholders. The consequences of domestic violence affect the mental health of both mothers and children. Countries have increased shelter funding and developed innovative protocols to reach survivors and address this issue. However, the healthcare sector's involvement in addressing domestic violence has been limited. This review advocates collaboration among healthcare institutions and government bodies. Key recommendations include utilizing telehealth services, implementing comprehensive training programs, establishing effective referral systems, enhancing health education, developing a domestic violence registry, improving the responses of law enforcement and justice systems through healthcare integration, promoting data sharing, and conducting further research. Healthcare systems should recognize domestic violence as a public health concern and detect, prevent, and intervene in cases to support survivors.

Longitudinal association of nighttime sleep duration with emotional and behavioral problems among rural preschool children

This study aimed to examine the association between nighttime sleep duration and emotional and behavioral problems (EBPs) among rural preschool children. This longitudinal study including 1595 preschool children aged 3-6 years from 26 kindergartens in four counties was conducted in Anhui Province rural areas. Cross-lagged panel models and multivariable logistic regressions were performed to examine the bidirectional association between nighttime sleep duration and EBPs and further explore the predictive effect of nighttime sleep duration on EBPs. Compared to baseline, preschool children at follow-up had significantly more nighttime sleep duration (10.01 ± 0.68 vs. 10.15 ± 0.69) and lower EBPs (total difficulties: 15.8% vs. 11.2%; prosocial behavior problems: 12.4% vs. 7.0%). Results of cross-lagged panel models indicated that nighttime sleep duration was a predictor for EBPs, but not vice versa. Results of logistic regression analysis showed that each 1-h increase in nighttime sleep duration at T1 was associated with a 0.77-fold reduction in the risk of total difficulties at T2 (the most adjusted OR = 0.774, 95% CI 0.607-0.988, P = 0.040), but not with the prosocial behavior. Interestingly, the predictive effect of nighttime sleep duration at T1 on EBPs at T2 was only found in girls, children aged 3 years and children with lower maternal education. The decreased nighttime sleep duration may predict future EBPs, especially in girls, younger preschool children and children with lower maternal education. Extending sleep duration may improve EBPs in preschool children.

Health-Related Quality of Life in Kindergarten Children with Developmental Language Disorder: Child-Mother Agreement

Language disorders are associated with difficulties in various aspects of life, such as academic and social functioning, resulting in impaired health-related quality of life (HRQoL). Most studies use a parent proxy method to assess HRQoL. Since HRQoL refers to the subjective experience of an individual, it is necessary to assess children's perspectives along with their mothers'. The aim of the current study is to explore HRQoL rating agreement between children and their mothers, since the literature on other conditions suggests that discrepancies seem to reflect their different perspectives. Thus, 53 Greek-speaking children diagnosed with DLD attending kindergarten and their mothers completed, respectively, self-report and parent proxy PedsQLTM questionnaires. Mothers reported significantly better HRQoL than their children with developmental language disorder (DLD) in all HRQoL domains (p < 0.001). Poor agreement was revealed after comparing the scores from both responders, both in abstract domains, such as emotional functioning, as well as in more observable ones, such as physical health (ICC ranged from -0.05 to 0.07). Bland-Altman plots also showed poor agreement on HRQoL. Our results expand on the already known, from other conditions, importance of evaluating children's subjective experience of their HRQoL in kindergarten children with DLD. A multi-informant approach is ideal, and clinicians should prioritize children's view about their lives even when they are kindergarten-age. This approach could inform interventions focusing not only on language skills but also on other areas where it is necessary, depending on the child's subjective experience combined with the maternal perspective.

Changes in UK pre-schooler's mental health symptoms over the first year of the COVID-19 pandemic: Data from Co-SPYCE study

Background

The COVID-19 pandemic caused significant disruption to the lives of children and their families. Pre-school children may have been particularly vulnerable to the effects of the pandemic, with the closure of childcare facilities, playgrounds, playcentres and parent and toddler groups limiting their opportunities for social interaction at a crucial stage of development. Additionally, for parents working from home, caring for pre-school aged children who require high levels of support and care, was likely challenging. We conducted an intensive longitudinal, but not nationally representative, study to examine trajectories of pre-schoolers' mental symptoms in the United Kingdom during the first year of the COVID-19 pandemic.

Methods

UK-based parents and carers (n = 1520) of pre-school-aged children (2-4 years) completed monthly online surveys about their pre-schoolers' mental health between April 2020 and March 2021. The survey examined changes in children's emotional symptoms, conduct problems and hyperactivity/inattention.

Results

In our final mixed-effects models, our predictors (fixed effects) accounted for 5% of the variance in each of conduct problems, emotional symptoms and hyperactivity/inattention symptoms scores, and the combined random and fixed effects accounted for between 64% and 73% of the variance. Pre-schoolers' emotional problems and hyperactivity/inattention symptoms declined from April through summer 2020 and then increased again during the autumn and winter 2020/2021 as lockdowns were re-introduced. Pre-schoolers who attended childcare showed greater decline in symptom severity than those who did not. Older children, compared to younger, showed greater lability of emotion symptom severity. Attending childcare predicted lower symptom severity across all three domains of conduct problems, emotional symptoms, and hyperactivity/inattention, while the opposite pattern was observed for children whose parent had a mental health problem.

Conclusions

Our findings reinforce the importance of examining pre-schoolers' mental health in the context of micro and macro-level factors. Interventions focussing on family factors such as parent mental health, as well as continued provision of childcare, may have most potential to mitigate the impact of COVID-19 on young children's mental health.