Longitudinal trajectories of mental health and loneliness for Australian adolescents with-or-without neurodevelopmental disorders: the impact of COVID-19 school lockdowns

The Impact of COVID-19 on the Language Skills of Preschool Children: Data from a School Screening Project for Language Disorders in Greece

Background/Objectives: The COVID-19 pandemic has significantly affected children's lives, particularly preschool-aged children who undergo rapid biological and psychosocial development. This study aimed to investigate the effects of the COVID-19 pandemic on the language skills of preschool children in Greece. Methods: To that end, a widely used screening tool was applied in a screening project involving 213 preschoolers. Language skills were assessed in three groups of children aged 2-4 years old before, during and after the pandemic. Results: A significant increase in the number of children with atypical language skills profile was identified in relation to the preschoolers after the pandemic versus those before or during the pandemic period. A higher prevalence of atypical profiles was observed in girls than in boys. Interestingly, an increase in the number of successfully produced or repeated words and pseudowords, along with enhanced expressive abilities, was observed during the pandemic compared to the periods before and after. Conclusions:Our findings suggest that post-pandemic preschool children exhibit higher rates of atypical language skill profiles compared to those assessed before and during the pan-demic. Given the importance of language development as a critical aspect of children's overall personality and well-being, further research is needed to explore the impact of specific pandemic-related factors on language competency. These factors include mask-wearing, increased screen time, reduced social interaction and exposure to language-rich environments, as well as impaired mental health and parental distress. Additionally, personalized interventions should be developed to support healthier developmental outcomes.

The impact of COVID-19 on the peer relationships of adolescents around the world: A rapid systematic review

The main objective of this rapid systematic review was to examine how the COVID-19 pandemic impacted peer relationships for adolescents (10-25 years of age) around the globe. We focused on four indices of peer relationships: (1) loneliness, (2) social connectedness, (3) social support, and (4) social media use. In addition, we examined gender and age differences. Four databases (APA PsychInfo, PubMed, Scopus, and Web of Science) were searched for articles published from January 2020 to November 2022. A total of 96 studies (cross-sectional: n = 66, longitudinal: n = 30, quantitative: n = 67, qualitative: n = 12, mixed-methods: n = 17) met our inclusion criteria (empirical observational studies with data on at least one of the indices of interest, cross-sectional data on COVID-19-related experiences or longitudinal data collected during the pandemic, age range of 10-25 years, typically developing adolescents). We extracted data and conducted a narrative synthesis. Findings suggest that COVID-19 disruptions negatively impacted peer relationships for youth. Most studies reported either an increase in loneliness over the course of the pandemic or a positive association between loneliness and COVID-19-related experiences. Similar findings were observed for increased social media use as a means of continued communication and connection. Fewer studies focused on social support but those that did reported a decrease or negative association with COVID-19-related experiences. Lastly, findings suggest a mixed impact on social connectedness, which might be due to the strengthening of closer ties and weakening of more distant relationships. Results for gender differences were mixed, and a systematic comparison of differences across ages was not possible. The heterogeneity in measures of COVID-19-related experiences as well as timing of data collection prevented a more nuanced examination of short and more long-term impacts.

Research Review: The impact of the COVID-19 pandemic on the mental health of children and young people with pre-existing mental health and neurodevelopmental conditions - a systematic review and meta-analysis of longitudinal studies

BACKGROUND

Systematic reviews have suggested mixed effects of the COVID-19 pandemic on the mental health of children and young people. However, most included studies focused on the general population and were cross-sectional. The long-term impact on those with pre-existing mental health and/or neurodevelopmental conditions remains unclear. Thus, we conducted a systematic review and meta-analysis to examine the longitudinal impact of the pandemic on the mental health of this clinical population and potential explanatory factors.

METHODS

Ovid Medline, Embase, APA PsycInfo and Global Health databases were searched between 1 January 2020 and 3 August 2023 (PROSPERO CRD42022383546). We included longitudinal studies that compared mental health symptoms between pre- and during pandemic and/or during pandemic timepoints in children and young people (≤18 years old) with pre-existing mental and/or neurodevelopmental conditions. Outcomes included internalising, externalising and other symptoms. Risk of bias was rated using an adapted tool. Included studies were narratively synthesised and multi-level meta-analyses were conducted where the number of studies was sufficient.

RESULTS

We identified 21 studies (N = 2,617) from 6,083 records. Studies differed across countries, diagnoses, measures, informants and timepoints. All had overall moderate-to-high risk of bias. Narrative synthesis found mixed evidence of symptom change, with individual studies showing increase/reduction/no change. Factors such as diagnosis, baseline symptom severity, age and sex/gender may explain variation in outcomes. Multi-level meta-analyses were feasible for a limited number of outcomes and found no significant changes in internalising and externalising symptoms pre- versus during pandemic or internalising symptoms between 2020 pandemic phases, and high heterogeneity was noted.

CONCLUSIONS

The impact of the pandemic on the mental health of children and young people with pre-existing conditions varied according to individual and contextual vulnerabilities, which were not fully captured in pooled analyses. Further research needs to investigate longer-term impacts and better stratify this vulnerable population.

Understanding the Impact of Home Confinement on Children and Young People with ADHD and ASD During the COVID-19 Pandemic

To understand whether the mental health of children and young people (CYP) with and without attention-deficit/hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD) were differentially affected by COVID-19. We analysed data (n = 6507) from the Co-Space study, a UK web-based longitudinal survey. CYP with ADHD (n = 160;2.5%), ASD (n = 465;7%), and ADHD + ASD (n = 155;2.4%) were compared with a reference group (n = 5727;88%) using parent-completed questionnaires [Strengths and Difficulties Questionnaire (SDQ) & Pandemic Anxiety Scale (PAS)]. Baseline to 1-month follow-up differences were compared using linear regression models. CYP with ADHD and/or ASD had higher scores at baseline than other CYP. At follow-up, CYP with ASD showed small but significant improvements in symptoms (SDQ), compared with the reference group. CYP with ASD experienced a worsening of disease anxiety (PAS) and CYP with ADHD a deterioration in functional impairment. These findings indicate a mixed pattern of pandemic-related impact for CYP with ADHD and/or ASD.

Cultural Dimensions Moderate the Association between Loneliness and Mental Health during Adolescence and Younger Adulthood: A Systematic Review and Meta-Analysis

Cultural factors, such as country or continent, influence the relationship between loneliness and mental health. However, less is known about how cultural dimensions moderate this relationship during adolescence and younger adulthood, even if these dimensions manifest as country or continent differences. This study aims to examine the potential influence of Hofstede's cultural dimensions on this relationship using a three-level meta-analysis approach. A total of 292 studies with 291,946 participants aged 10 to 24 were included in this study. The results indicate that cultural dimensions, such as individualism vs. collectivism, indulgence vs. restraint, power distance, and long-term vs. short-term orientation, moderated the associations between loneliness and social anxiety, stress, Internet overuse, and negative affect. The association between loneliness and mental health was not moderated by cultural dimensions, such as masculinity and uncertainty avoidance. These findings suggest that culture's influence on the association between loneliness and mental health is based on a domain-specific mechanism.

Impact of COVID-19 pandemic on prescription of psychotropic medications in the Italian paediatric population during 2020

BACKGROUND

There is a global perception that psychotropic utilization in children and adolescents is increasing, especially with the onset of COVID-19 pandemic. Available literature data on paediatric psychotropic medication prescriptions in Italy are limited to one or few regions and not updated. The aim of this study was to provide updated data on psychotropic prescriptions referred to the whole Italian paediatric population, as overall and by subgroups of medications and to evaluate if the COVID-19 pandemic during 2020 had an impact on prescription rates.

METHODS

A descriptive study on psychotropic drug utilization in children and adolescents (< 18 years) resident in all Italian regions during 2020 was performed. Patients registered in the Pharmaceutical Prescriptions database with at least one prescription/dispensing of a psychotropic medication (antipsychotics-N05A), (antidepressants-N06A) and (psychostimulants-N06BA) during the study period were considered. The indicators used were the prescription rate (number of prescriptions per 1000 children) and prevalence of use (proportion of the paediatric population with at least one prescription in the relevant year).

RESULTS

During the 2020 the prevalence of psychotropic drug use in the paediatric population was 0.3%, increased of 7.8% if compared to 2019. The same trend was observed for the prescription rate, which recorded an average of 28.2 per 1000 children with an increase of 11.6% if compared to previous year, representing the 0.6% of the overall drug use in this age group. The data showed a growing trend prescription by age, reaching the peak in adolescents aged 12-17 years old, with a prescription rate of 65 per 1000 children and a prevalence of 0.71%. Considering the subgroups of psychotropic medications, the highest prevalence of use was found for antipsychotic drugs, received by the 0.19% of the paediatric population during 2020.

CONCLUSIONS

Psychotropic drug utilization in children and adolescents has grown during 2020 in Italy and worldwide, raising alarms from health care clinicians and patient advocates about the increase of burden of mental diseases in paediatric population during the COVID-19 pandemic. A more systematic monitoring of the use of psychotropic medications should be implemented in all countries for collecting relevant information about children and adolescents taking psychotropic drugs, in order to address the present and the future of the mental health of the paediatric population.

Loneliness in Young People with ADHD: A Systematic Review and Meta-Analysis

Many studies focus on problematic peer functioning in attention deficit/hyperactivity disorder (ADHD) but loneliness has been studied less. This paper examined (1) The loneliness level differences between young people (below 25 years old) with ADHD and those without ADHD, and (2) The association between loneliness and mental health difficulties in young people with ADHD. Six electronic databases were searched and 20 studies were included. A random effects meta-analysis was carried out in RStudio using the metafor package for the first question, while a narrative synthesis summarized the findings for the second question. The meta-analysis (n = 15) found that young people with ADHD reported significantly higher loneliness than those without ADHD, with a small-to-medium weighted pool effect (Hedges' g = 0.41) and high heterogeneity (I2 = 75.1%). For the second question (n = 8), associations between loneliness and mental health difficulties in ADHD was found (r = 0.05-0.68). Targeted research and interventions on loneliness in young people with ADHD is needed.

Parents' perceptions: Participation patterns and desires for change for children and adolescents with autism spectrum disorder-A descriptive population-based study from Switzerland

BACKGROUND

Low participation in youth with autism spectrum disorder (ASD) has been reported, but age-related and contextual information is rare.

OBJECTIVE

This study aimed to describe, from parental perspectives, two patterns of participation and parental desires for change of children (age: 5-11) and adolescents (age: 12-17) with ASD in Switzerland.

METHOD

A cross-sectional design used the German version of the Participation and Environment Measure-Child and Youth to describe and juxtapose the participation results of 60 children and 55 adolescents with ASD in 45 activities at home, school and in the community and parental desires for change.

RESULTS

Participation patterns differed between settings and age groups. Both groups were found to participate most at home, followed by school, whereas community participation was either low or nonexistent. Children were more involved at home than adolescents, while school involvement was higher than participation frequency in both age groups. Community participation frequency was generally low but higher in children than in adolescents, while involvement was similarly low in both groups. Half the parents expressed desire for change with three tendencies: (1) widespread desire for change at home due to high support needs, (2) parents of adolescents expressed more desire for change in all settings than those of children and (3) all parents mainly desired to increase participation frequency and involvement.

CONCLUSIONS

This study informs research and social, health and community service providers to further reshape their programmes to meet parental needs and increase the participation of youth with ASD.

Mental health during the COVID-19 pandemic in children and adolescents with ADHD: A systematic review of controlled longitudinal cohort studies

Prior studies reported mixed effects of the COVID-19 pandemic on the mental health of children and adolescents with ADHD, but they were mainly cross-sectional and without controls. To clarify the impact, we searched Web of Science, EMBASE, Medline, and PsychINFO until 18/11/2023 and conducted a systematic review of controlled longitudinal cohort studies (Prospero: CRD42022308166). The Newcastle-Ottawa scale was used to assess quality. We identified 6 studies. Worsening of mental health symptoms was more evident in ADHD or control group according to symptom considered and context. However, those with ADHD had more persistent elevated symptoms and remained an at-risk population. Sleep problems deteriorated more significantly in those with ADHD. Lower pre-COVID emotion regulation skills and greater rumination were associated with worse mental health outcomes, and longer screen time with poorer sleep. Quality was rated as low in most studies, mainly due to self-report outcome measures and no information on attrition rates. Despite these limitations, results suggest a predominantly negative impact on youths with ADHD and may guide clinical practice and policy.

Total cortisol output during an acute stressor predicts youths' internalizing symptoms during the COVID-19 pandemic

Individual differences in cortisol output may influence adolescents' adjustment to the COVID-19 pandemic; however, boys and girls may differ in terms of associations between cortisol output and internalizing symptoms in the context of COVID-19-related stress. We examined whether pre-pandemic cortisol output during an acute stressor, assessed approximately three years prior to the pandemic, predicted change in adolescents' internalizing symptoms early during the COVID-19 pandemic. Consistent with previous work on other life stressors, girls' cortisol output was positively associated with anxious and somatic symptoms early in the pandemic. Conversely, cortisol output and depressive symptoms were negatively associated for boys; boys with higher cortisol had depressive symptoms which significantly decreased over time. Findings suggest that hypothalamic-pituitary-adrenal axis stress functioning plays a role in shaping differences between adolescent boys' and girls' adjustment during the experience of a ubiquitous chronic stressor.

Factors associated with mental health symptoms among UK autistic children and young people and their parents during the COVID-19 pandemic

LAY ABSTRACT

What is already known about the topic: The COVID-19 pandemic and the associated restrictions impacted all of society. There is emerging evidence showing a range of impacts on autistic children and young people and their families. Further research that looks at how individuals coped during the pandemic while considering how they were doing before the pandemic is needed.What this paper adds: This article explores whether how well autistic youth were doing before the pandemic influenced how they coped during the pandemic. It also looked at how well their parents were doing during the pandemic and whether any pre-pandemic factors influenced how they coped. Samples of both primary-school-aged autistic children and autistic teenagers and their parents were surveyed to answer these questions. More engagement and enjoyment in education provision during the pandemic and getting outside more were linked with better child and parental mental health during the pandemic. More attention deficit hyperactivity disorder before the pandemic was linked with more attention deficit hyperactivity disorder and behavioural problems during the pandemic in primary-school-aged autistic children, and more emotional problems during the pandemic in autistic teenagers. Parents with more mental health problems during the pandemic had more mental health problems before the pandemic.Implications for practice, research or policy: Encouraging engagement and enjoyment in education and promoting physical exercise are key intervention targets. Ensuring access to attention deficit hyperactivity disorder medication and support is important, especially if this is managed jointly across school and home.

Psychological impact of six weeks of strict home confinement in Spanish families having school-aged children with attention-deficit/hyperactivity disorder

After the COVID-19 outbreak, early publications reported worsening symptoms and increased caregiver burden in families having children with Attention-Deficit/Hyperactivity Disorder (ADHD). In the present study, we launched an online survey to examine the psychological impact of the 41 days of strict home confinement implemented in Spain in families having children with ADHD compared to families having children with typical development (TD). We achieved a representative sample of 190 school-aged children (NADHD =100 and NTD=90) from 181 families. Respondents were mainly mothers (≈96%). We found that mother reports of hyperactive-impulsive symptoms significantly increased during home confinement regardless of ADHD diagnosis. During the lockdown, we also found that perceived stress significantly increased in mothers of ADHD and TD children, but, unexpectedly, this increase was much more noticeable for the latter group. Moreover, our study suggests that children having parents working in frontline jobs or living in families with higher household conflicts might display increased ADHD symptoms during the lockdown, irrespective of ADHD diagnosis. Our results highlight the need to provide psychological support to families most exposed to the pandemic and target household problems and mothers' well-being at intervention processes, in both ADHD and TD families.

Life satisfaction in the context of the COVID-19 pandemic among middle school adolescents in France: findings from a repeated cross-sectional survey (EnCLASS, 2012-2021)

Background and aims

Since the COVID-19 pandemic, several studies have reported a decrease in adolescents' well-being. We aim to describe life satisfaction over the last decade and examine the factors associated with its variations between 2020 and 2021 among French students in their last year of middle school (around 14-15 years old).

Methods

Data were drawn from a repeated biennial cross-sectional national survey conducted in French schools over the last decade (EnCLASS study), using a self-administered questionnaire. After describing life satisfaction trends between 2012 and 2021 using the Cantril ladder, we examined individual changes in life satisfaction between 2020 and 2021 and their associations with housing and studying conditions during the COVID-19 lockdown, using multinomial logistic regression analysis (decrease, increase, no change as reference).

Results

Among the 17,686 survey respondents, an overall slight decrease in the prevalence of adolescents reporting high life satisfaction (i.e., Cantril score ≥6) was observed since 2012 with the lowest proportion reported in 2021 (77.4%). Between 2020 and 2021, 16.3% of French adolescents experienced an improvement in life satisfaction, while 17.7% experienced the opposite. Decrease in life satisfaction between 2020 and 2021 was more likely experienced by adolescents living in reconstructed families [aOR 2.09 (95%CI, 1.58-2.77)], those who did not have their own room [aOR 1.58 (1.16-2.15)], nor access to the Internet to interact with their friends during the lockdown [aOR 1.47 (1.09-1.98)]. Interestingly, more girls than boys were represented in both those reporting increase and decrease in life satisfaction [aOR 1.82 (1.40-2.37) and 1.43 (1.14-1.79), respectively].

Conclusions

This study shows that the way adolescents experienced the first 2020 lockdown in France was not uniform, and that one must consider sex as well as housing and studying conditions when interpreting adolescents' life satisfaction decrease during the COVID-19 pandemic.

Loneliness During the School Years: How It Affects Learning and How Schools Can Help. THE JOURNAL OF SCHOOL HEALTH 2023;93:428-435. [PMID: 36861756 DOI: 10.1111/josh.13306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

BACKGROUND

Substantial evidence links loneliness to poor academic outcomes and poor employment prospects. Schools have been shown to be places that mitigate or aggravate loneliness, suggesting a need to consider how schools can better support youth experiencing loneliness.

METHODS

We conducted a narrative review on loneliness in childhood and adolescence to examine the literature on how loneliness changes over the school years and how it influences learning. We also examined whether there were increases in loneliness because of the COVID-19 pandemic and associated school closures, and whether schools can be places for loneliness interventions/prevention.

FINDINGS

Studies describe how loneliness becomes more prevalent during the adolescent years and why that is the case. Loneliness is associated with poor academic outcomes and poor health behaviors that impact learning or turn students away from education. Research shows that loneliness increased during the COVID-19 pandemic. Evidence suggests that creating positive social classroom environments, where teacher and classmate support are available, is crucial in combatting youth loneliness.

CONCLUSIONS

Adaptations to the school climate can be made to meet the needs of all students, reducing loneliness. Investigation of the impacts of school-based loneliness prevention/intervention is crucial.

Mental-health before and during the COVID-19 pandemic in adults with neurodevelopmental disorders

The COVID-19 pandemic negatively impacted mental health globally. Individuals with neurodevelopmental disorders (NDDs), including autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), are at elevated risk of mental health difficulties. We investigated the impact of the pandemic on anxiety, depression and mental wellbeing in adults with NDDs using data from the Avon Longitudinal Study of Parents and Children (n = 3058). Mental health data were collected pre-pandemic (age 21-25) and at three timepoints during the pandemic (ages 27-28) using the Short Mood and Feelings Questionnaire, Generalized Anxiety Disorder Assessment-7, and Warwick Edinburgh Mental Wellbeing Scale. ADHD and ASD were defined using validated cut-points of the Strengths and Difficulties Questionnaire and Autism Spectrum Quotient, self-reported at age 25. We used multi-level mixed-effects models to investigate changes in mental health in those with elevated ADHD/ASD traits compared to those without. Prevalences of depression, anxiety and poor mental wellbeing were higher at all timepoints (pre-pandemic and during pandemic) in those with ADHD and ASD compared to those without. Anxiety increased to a greater extent in those with ADHD (β = 0.8 [0.2,1.4], p = 0.01) and ASD (β = 1.2 [-0.1,2.5], p = 0.07), while depression symptoms decreased, particularly in females with ASD (β = -3.1 [-4.6,-1.5], p = 0.0001). On average, mental wellbeing decreased in all, but to a lesser extent in those with ADHD (β = 1.3 [0.2,2.5], p = 0.03) and females with ASD (β = 3.0 [0.2,5.9], p = 0.04). To conclude, anxiety disproportionately increased in adults with NDDs during the pandemic, however, the related lockdowns may have provided a protective environment for depressive symptoms in the same individuals.

Loneliness and Well-Being in Children and Adolescents during the COVID-19 Pandemic: A Systematic Review

Concerns have been raised about the loneliness and well-being of children and adolescents during the COVID-19 pandemic. The extent to which the ongoing pandemic has impacted loneliness and the association between loneliness and well-being is unclear. Therefore, a systematic review of empirical studies on the COVID-19 pandemic was conducted to examine the (1) prevalence of loneliness in children and adolescents, (2) associations between loneliness and indicators of well-being, and (3) moderators of these associations. Five databases (MEDLINE, Embase, PsycInfo, Web of Science, ERIC) were searched from 1 January 2020 to 28 June 2022 and 41 studies met our inclusion criteria (cross-sectional: n = 30; longitudinal: n = 11; registered on PROSPERO: CRD42022337252). Cross-sectional prevalence rates of pandemic loneliness varied, with some finding that over half of children and adolescents experienced at least moderate levels of loneliness. Longitudinal results reflected significant mean increases in loneliness compared to pre-pandemic levels. Cross-sectional results indicated that higher levels of loneliness were significantly associated with poorer well-being, including higher depression symptoms, anxiety symptoms, gaming addiction, and sleep problems. Longitudinal associations between loneliness and well-being were more complex than cross-sectional associations, varying by assessment timing and factors in the statistical analyses. There was limited diversity in study designs and samples, preventing a thorough examination of moderating characteristics. Findings highlight a broader challenge with child and adolescent well-being that predates the pandemic and the need for future research to examine underrepresented populations across multiple timepoints.

Emerging Materials, Wearables, and Diagnostic Advancements in Therapeutic Treatment of Brain Diseases

Among the most critical health issues, brain illnesses, such as neurodegenerative conditions and tumors, lower quality of life and have a significant economic impact. Implantable technology and nano-drug carriers have enormous promise for cerebral brain activity sensing and regulated therapeutic application in the treatment and detection of brain illnesses. Flexible materials are chosen for implantable devices because they help reduce biomechanical mismatch between the implanted device and brain tissue. Additionally, implanted biodegradable devices might lessen any autoimmune negative effects. The onerous subsequent operation for removing the implanted device is further lessened with biodegradability. This review expands on current developments in diagnostic technologies such as magnetic resonance imaging, computed tomography, mass spectroscopy, infrared spectroscopy, angiography, and electroencephalogram while providing an overview of prevalent brain diseases. As far as we are aware, there hasn't been a single review article that addresses all the prevalent brain illnesses. The reviewer also looks into the prospects for the future and offers suggestions for the direction of future developments in the treatment of brain diseases.

Commentary: A longitudinal exploration of the effects of the COVID-19 lockdowns for adolescents both with and without neurodevelopmental disorders - a reflection on Houghton et al. (2022)

The lockdowns during the COVID-19 pandemic had and continue to have severe and wide-ranging effects worldwide on mental health and loneliness. In this commentary, I summarise Houghton et al. (2022) who explored these effects longitudinally in adolescents in Western Australia, with and without a Neurodevelopmental Disorder (NDD), considering the strengths and weaknesses of the article and its importance to the field. Adolescents with NDD, who already had a high baseline rate of loneliness and mental health difficulties, did not find that this increased during COVID-19 lockdowns. However, adolescents without NDD, who began with a much lower baseline rate, found that this was elevated. There was variability in terms of different types of NDD, with adolescents who had ADHD reporting some positive effects of the COVID-19 lockdowns. These findings highlight the importance of support for adolescents both with NDD and those without as the world emerges out of the pandemic.

Mental health problems among Dutch adolescents of the general population before and 9 months after the COVID-19 outbreak: A longitudinal cohort study

The aim of the present study is to examine whether the COVID-19 pandemic has increased the risk of mental health problems (MHP) in adolescents nine months post-outbreak. For this purpose, a longitudinal cohort study was conducted based on a probability sample of the Dutch population. We compared the prevalence and incidence of MHP in 16-20 year-old adolescents in November-December 2020 (N = 251) with the prevalence and incidence in adolescents in November-December 2012 (N = 346) and November-December 2016 (N = 253). Results showed a higher prevalence of moderate anxiety and depression symptoms in the 2020 than in the 2012 and 2016 cohorts, but differences in mean scores were absent or small. The prevalence of sleep problems, fatigue, use of medicines for symptoms did not differ between the three cohorts. The use of mental health services was more prevalent in the 2020 than in 2016 cohort, but there was already a statistical trend of higher use in the 2016 compared to the 2012 cohort. No differences in the incidence of any MHP, based on data of the previous year (2011, 2015, and 2019, respectively) were found. Results suggest a very limited negative effect of this pandemic on MHP among Dutch adolescents 9 months post-COVID-19 outbreak.