Ontario COVID-19 and Kids Mental Health Study: a study protocol for the longitudinal prospective evaluation of the impact of emergency measures on child and adolescent mental health during the COVID-19 pandemic

Evaluation of an automated matching system of children and families to virtual mental health resources during COVID-19

BACKGROUND

Children and their families often face obstacles in accessing mental health (MH) services. The purpose of this study was to develop and pilot test an electronic matching process to match children with virtual MH resources and increase access to treatment for children and their families during COVID-19.

METHODS

Within a large observational child cohort, a random sample of 292 families with children ages 6-12 years were invited to participate. Latent profile analysis indicated five MH profiles using parent-reported symptom scores from validated depression, anxiety, hyperactivity, and inattention measures: (1) Average Symptoms, (2) Low Symptoms, (3) High Symptoms, (4) Internalizing, and (5) Externalizing. Children were matched with virtual MH resources according to their profile; parents received surveys at Time 1 (matching process explanation), Time 2 (match delivery) and Time 3 (resource uptake). Data on demographics, parent MH history, and process interest were collected.

RESULTS

128/292 families (44%) completed surveys at Time 1, 80/128 families (63%) at Time 2, and a final 67/80 families (84%) at Time 3, yielding an overall uptake of 67/292 (23%). Families of European-descent and those with children assigned to the Low Symptoms profile were most likely to express interest in the process. No other factors were associated with continued interest or uptake of the electronic matching process. Most participating parents were satisfied with the process.

CONCLUSIONS

The electronic matching process delivered virtual MH resources to families in a time-efficient manner. Further research examining the effectiveness of electronically matched resources in improving children's MH symptoms is needed.

The Distinction Between Social Connectedness and Support When Examining Depressive Symptoms Among Children and Adolescents During the COVID-19 Pandemic

Childhood depression is associated with significant social and functional impairment, suicide risk, and persistence throughout adulthood. Recent evidence demonstrates that social connectedness and social support may serve as protective factors against the development of depression. The current study aimed to examine the effect of change in social connectedness and social support on depressive symptoms among children and adolescents during the COVID-19 pandemic. Hierarchical regression was performed. Results indicated that parent-reported measures of change in social connectedness were inversely associated with depressive symptom severity, and could significantly predict future depressive symptom severity. In contrast, parent-reported measures of social support (i.e., from family and friends) did not significantly predict future depressive symptom severity. The presence of a pre-COVID psychiatric and/or neurodevelopmental diagnosis and baseline depressive symptom severity were also important factors associated with future depressive symptom severity. The findings suggest that an awareness of the presence of social supports (i.e., family or friends) is not sufficient for children to feel connected, but rather the mechanisms of social relationships are crucial. As our approach to public health restrictions evolves, the risk transmission of COVID-19 should be carefully balanced with the risks associated with decreased connectedness among youth.

The role of parenting practices in parent and child mental health over time

BACKGROUND

Parent and child mental health has suffered during the pandemic and transition phase. Structured and shared parenting may be intervention targets beneficial to families who are struggling with parent or child mental health challenges.

AIMS

First, we investigated associations between structured and shared parenting and parent depression symptoms. Second, we investigated associations between structured and shared parenting and depression, hyperactivity/inattention and irritability symptoms in children.

METHOD

A total of 1027 parents in two-parent households (4797 observations total; 85.1% mothers) completed online surveys about themselves and their children (aged 2-18 years) from April 2020 to July 2022. Structured parenting and shared parenting responsibilities were assessed from April 2020 to November 2021. Symptoms of parent depression, child depression, child hyperactivity and inattention, child irritability, and child emotional and conduct problems were assessed repeatedly (one to 14 times; median of four times) from April 2020 to July 2022.

RESULTS

Parents who reported higher levels of shared parenting responsibilities had lower depression symptoms (β = -0.09 to -0.32, all P < 0.01) longitudinally. Parents who reported higher levels of shared parenting responsibilities had children with fewer emotional problems (ages 2-5 years; β = -0.07, P < 0.05), fewer conduct problems (ages 2-5 years; β = -0.09, P < 0.01) and less irritability (ages 13-18 years; β = -0.27, P < 0.001) longitudinally. Structured parenting was associated with fewer conduct problems (ages 2-5 years; β = -0.05, P < 0.05).

CONCLUSIONS

Shared parenting is beneficial for parent and child mental health, even under chaotic or inflexible life conditions. Structured parenting is beneficial for younger children.

Disruption to Education During COVID-19: School Nonacademic Factors Are Associated with Children's Mental Health

OBJECTIVE

Few studies have examined aspects of the school environment, beyond modality, as contributors to child and youth mental health during the coronavirus pandemic. We investigated associations between nonacademic school experiences and children's mental health.

METHODS

Parents of children ages 6 to 18 years completed online surveys about school experiences (November 2020) and mental health (February/March 2021). Parent-reported and child-reported school experiences (i.e., nonacademic factors) included school importance, adapting to public health measures, and school connectedness. Children's mental health symptoms of depression, anxiety, inattention, and hyperactivity were collected using standardized parent-reported measures.

RESULTS

Children's (N = 1052) self-reported and parent-reported nonacademic factors were associated with mental health outcomes, after adjusting for demographics and previous mental health. Lower importance, worse adapting to school changes, and less school connectedness were associated with greater depressive symptoms ( B = -4.68, CI [-6.04, -3.67] to - 8.73 CI [-11.47, 5.99]). Lower importance and worse adapting were associated with greater anxiety symptoms ( B = - 0.83 , CI [-1.62, -0.04] to -1.04 CI [-1.60, -0.48]). Lower importance was associated with greater inattention (B = -4.75, CI [-6.60, -2.90] to -6.37, CI [-11.08, -7.50]). Lower importance and worse adapting were associated with greater hyperactivity (B = -1.86, CI [-2.96, -0.77] to -4.71, CI [-5.95, -3.01]).

CONCLUSION

Schools offer learning opportunities that extend beyond curriculum content and are a primary environment where children and youth develop connections with others. These aspects of school, beyond academics, should be recognized as key correlates of child and youth mental health.

School and learning contexts during the COVID-19 pandemic: Implications for child and youth mental health

Despite significant disruption to school during the COVID-19 pandemic, research on the impact on children is sparse. This study examines in-person and virtual learning contexts and the impact of school format on mental health (MH). Children and adolescents were recruited from community and clinical settings. Parents and children completed prospective online surveys about school experiences (November 2020) and MH symptoms (February/March 2021), including school format and activities. Standardized measures of depression, anxiety, inattention, and hyperactivity were collected. Hierarchical regression analyses tested associations between school format and MH. Children (N = 1011; aged 6-18 years) attending school in-person (n = 549) engaged in high levels of participation in COVID-19 health measures and low levels of social learning activities. Learning online in high school was associated with greater MH symptoms (B = -2.22, CI[-4.32,-.12] to B = -8.18, CI[-15.59,-.77]). Children with no previous MH condition that attended school virtually experienced a similar magnitude of MH symptoms as those with previous MH conditions. However, children who attended school in a hybrid in-person format, with no previous MH condition, experienced less hyperactivity as same-age peers with prior MH problems (B = -8.08, CI[1.58,14.58]). Children's learning environments looked very different compared to before the pandemic. Removing children from school environments and limiting opportunities that support their MH, such as social learning activities, is problematic. Efforts to address the learning contexts to protect the mental health of children are needed.

Participating in extracurricular activities and school sports during the COVID-19 pandemic: Associations with child and youth mental health

In Ontario, Canada, school extracurricular activities and sports were modified or canceled for a prolonged period due to public health restrictions resulting from the COVID-19 pandemic. The present study aims to examine the association of changes to extracurricular and sport participation and child and youth mental health. Data were collected on child and youth mental health symptoms (n = 908) and participation in extracurricular activities and sports in the 2019–2020 and 2020–2021 academic years. Results indicated that pre-COVID (2019–2020) participation in either extracurricular activities or sports was associated with reduced anxiety, inattention, and hyperactivity during the pandemic (β range −0.08 to −0.11, p < 0.05). Participation in either extracurricular activities or sports during-COVID (2020–2021) was associated with lower depressive symptoms (β range −0.09 to −0.10, p < 0.05). Findings suggest that participation in extracurricular activities and/or school sports both before or during the COVID-19 pandemic were associated with better mental health outcomes in children and youth. Implications of this work consider future situations where restrictions on extracurricular and sport participation are reinstated and the impact of child and youth mental health.