Children's psychological well-being and problem behavior during the COVID-19 pandemic: An online study during the lockdown period in Germany

Health-related quality of life and impact of socioeconomic status among primary and secondary school students after the third COVID-19 wave in Berlin, Germany

In the earlier phases of the COVID-19 pandemic, studies in Germany and elsewhere found an overall reduction in health-related quality of life (HRQoL) among students. However, there is little evidence on later pandemic stages as well as socioeconomic influencing factors. We aimed to (1) describe HRQoL in a Berlin student cohort at two time points in mid-2021, and to (2) analyze the effects of household income and education. We assessed HRQoL of students from 24 randomly selected primary and secondary schools in Berlin, Germany, with the KIDSCREEN-10 index in June and September 2021. To adjust for non-response bias, inverse probability weighting was applied. The potential effects of both household income and education (lower vs. higher) were estimated in generalized linear mixed models, based on prior assumptions presented in directed acyclic graphs. Our cohort comprised 660 students aged 7-19 years. In June 2021, 11.3% [95% CI = 9.0% - 14.0%] reported low HRQoL, whereas in September 2021, this increased to 13.7% [95% CI = 11.1% - 16.5%], with adolescent girls more frequently reporting low HRQoL at both time points (20% [95% CI = 17.1% - 23.3%] and 29% [95% CI = 25.5% - 32.5%]) compared to boys and younger children. While there was no statistically significant total effect of lower household income on HRQoL, a negative effect of lower household education was statistically significant (β = -2.15, SE 0.95, 95% CI = -4.01 to -0.29, p = 0.024). In summary, students' HRQoL in mid-2021 was better than that documented in other studies conducted at pandemic onset using KIDSCREEN-10. Female adolescents reported low HRQoL more often, and lower household education significantly reduced children's HRQoL. Support strategies for psychosocial wellbeing should consider socioeconomically disadvantaged children as important target groups.

Longitudinal prediction of primary school children's COVID-related future anxiety in the second year of the pandemic in Germany

Although research has confirmed that the first COVID-19-related lockdown has increased stress and mental health problems in children, less is known about the longer-term effects of the pandemic on children's COVID-related future anxiety (CRFA). Because of CRFA's potentially debilitating effects, risk and resilience factors against this anxiety were investigated. To this end, n = 140 children (49% female) in 3rd and 4th grade classrooms in Germany were asked to perform a working memory task and to self-report about their CRFA and emotion regulation in December 2020 and in May 2021. More maladaptive emotion regulation in December 2020 contributed to the explanation of a high CRFA score in May 2021, whereas a better performance on working memory updating contributed a lower CRFA score later when controls were in place. These results were confirmed when children's CRFA in December 2020 was included in the prediction of their later CRFA. They suggest that maladaptive strategies of emotion regulation, such as rumination, may explain higher or increasing levels of CRFA, whereas efficient working memory updating may be an indicator of processing information in a way which shields children from CRFA-related thoughts. The concepts underlying these variables should be included in prevention and intervention efforts.

Association between residential environment and emotional wellbeing among older adults in China: the mediating effect of health lifestyle

Introduction

The association between the residential environment and emotional wellbeing (EWB) in older adults has received extensive attention from gerontologists, especially during the COVID-19 pandemic; however, the mediating mechanism of how residential environment affects emotional wellbeing has not been fully explored. This study examined the effects of the residential environment on EWB and the mediating role of health lifestyle.

Methods

This study analyzed the survey data of 493 rural and 515 urban older adults from 2021 Chinese General Social Survey. General linear regression and structural equation models were used to examine the effects of residential environment and health lifestyle.

Results

Urban participants exhibited clear advantages in EWB, residential environment, and physical activity. Residential environment significantly affected the EWB of older adults, and health lifestyle played a mediating role in this relationship. The residential environment and health lifestyle did not significantly affect EWB in rural participants.

Discussion

This study revealed differences in the effects of health lifestyles and residential environments on EWB among older adults in rural and urban settings in China. This study provided empirical evidence of mental health disparities between older rural and urban Chinese residents.

Association between Family Functioning, Child Emotional and Behavioral Problems, and Parental Stress during the COVID-19 Pandemic in Thailand

The COVID-19 pandemic has had a huge impact on people of all ages, especially children. This is a cross-sectional study in Thailand to explore the emotional and behavioral problems of school-aged children and associated factors during the lockdown. An online survey was conducted with 942 parents of school-age children. Strengths and Difficulties Questionnaire (SDQ) scores showed that total difficulties and all subscale difficulties (hyperactivity, conduct problems, peer problems, and emotional problems) were increased, whereas prosocial behaviors were decreased in the pandemic period. The factors significantly associated with higher parental stress were higher emotional and peer problems after the COVID-19 outbreak, high family difficulty, and sleep problems. Sleep problems were associated with all children's difficulties, except prosocial behavior. High score in family difficulty subscale was associated with increased emotional problems, whereas poor family communication was associated with increased hyperactivity. Appetite change was negatively associated with parental stress and some children's difficulties. Higher household income, family time, physical activities, and recreational activities were associated with a decreased level of some difficulties and family functioning problems, but positively with an increase in the prosocial behavior of children. Additionally, higher screen time was associated with a higher level of hyperactivity, conduct problems, and poor family communication. This study demonstrated that Thai children were at high risk of developing mental health problems during the pandemic lockdown. We suggest that intervention to promote physical activities and reduce screen time is needed. Moreover, efficient monetary policy is urgently required. The limitations here include a recall bias with no baseline to compare and a potential selection bias due to parental selection and a webpage announcement.

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.

"I couldn't see my friends; the internet was bad, and I hardly went out" - insights into children's and adolescents' experiences of COVID-19 in Germany

PURPOSE

We explored children's experiences of COVID-19 in terms of proximity and distance to significant others.

METHODS

Our qualitative study with children in Germany (6-15 years of age) explored their views and experiences of COVID-19 times via drawings and face-to-face semi-structured interviews (n = 13). We analysed data thematically and used the socio-ecological model as the theoretical underpinning. Case studies contextualized how children dealt with the COVID-19 precautions.

RESULTS

Salient motives in children's drawings were school scenarios showing distance-keeping and mask-wearing as an expression of interpersonal distance; in the home-schooling context, loneliness was highlighted. Drawings also illustrated the impact of COVID-19 in terms of separation, illness and death. A dynamic perception of proximity and distance emerged from drawings and interviews. COVID-19 barred children from spending "real" time together with close friends. Bridging physical distance virtually was easier for adolescents than for children.

CONCLUSION

To bolster children's mental and social resilience in future epidemics, participants' plea for maintaining social and physical interactions with significant others and for keeping schools open should be heeded by policy-makers. Our study also highlights the benefits of conducting direct research with children and using non-verbal methods of data collection.

Exploring changes in children's well-being due to COVID-19 restrictions: the Italian EpaS-ISS study

BACKGROUND

While existing research has explored changes in health behaviours among adults and adolescents due to the COVID-19 outbreak, the impact of quarantine on young children's well-being is still less clear. Moreover, most of the published studies were carried out on small and non-representative samples. The aim of the EpaS-ISS study was to describe the impact of the COVID-19 pandemic on the habits and behaviours of a representative sample of school children aged mainly 8-9 years and their families living in Italy, exploring the changes in children's well-being during the COVID-19 pandemic compared to the immediately preceding time period.

METHODS

Data were collected using a web questionnaire. The target population was parents of children attending third-grade primary schools and living in Italy. A cluster sample design was adopted. A Well-Being Score (WBS) was calculated by summing the scores from 10 items concerning the children's well-being. Associations between WBS and socio-demographic variables and other variables were analysed.

RESULTS

A total of 4863 families participated. The children's WBS decreased during COVID-19 (median value from 31 to 25; p = 0.000). The most statistically significant variables related to a worsening children's WBS were: time of school closure, female gender, living in a house with only a small and unliveable outdoor area, high parents' educational level and worsening financial situation.

CONCLUSIONS

According to parents ' perception, changes in daily routine during COVID-19 negatively affected children's well-being. This study has identified some personal and contextual variables associated with the worsening of children's WBS, which should be considered in case of similar events.

Religious coping, care burden and psychological distress among informal caregivers of COVID-19 patients: Results of a cross-sectional survey in Pakistan

BACKGROUND

There is a complex relationship between health and religiosity. People may use religion to cope with difficulties and uncertainties in their life - such as induced by the COVID-19 pandemic.

AIMS

The purpose of this study is to investigate the relationship between religious coping, care burden and psychological distress among caregivers during COVID-19 in Pakistan.

METHOD

We conducted a cross-sectional survey in Pakistan. We used the Religious Coping Scale (RCOPE), Care Burden Scale (CB), and Depression, Anxiety and Stress Scale (DASS-21) to measure psychological stress from 303 caregivers. Data were analyzed using a hierarchical linear regression model for each of the three outcome variables, which are depression, anxiety, and stress. This analysis allows to investigate whether adding variables significantly improves a model's ability to predict the criterion variable.

RESULTS

The findings reveal that emotional care burden, physical care burden, negative religious coping, and social care burden explain a significant amount of the variance of three components of psychological distress among caregivers.

CONCLUSIONS

Health experts, psychologists, and policymakers can make better strategies to combat pandemics like COVID-19 by incorporating religious coping methods.

FAMIly Physical Activity, Sedentary behaviour and Sleep (FAMIPASS) study: protocol for a cross-sectional study

INTRODUCTION

The development of children's healthy and active lifestyles, including habit formation for optimal 24-hour movement behaviour, is associated with their family environment. A whole-family study collecting comprehensive data that can evaluate family lifestyle behaviours in different settings in depth has the potential to provide the evidence-based information needed for national guidelines, for designing interventions and for supporting policy-makers' decisions.

METHODS AND ANALYSIS

The FAMIly Physical Activity, Sedentary behaviour and Sleep (FAMIPASS) study is a nationally representative cross-sectional study that will recruit 500 families (with at least 1 child aged between 3 and 8 years) from the urban and rural parts of all three regions of the Czech Republic. To examine the relationship between family environment and children's healthy development (eg, healthy weight) and children's active lifestyle behaviour, anthropometric measures, parents' health-related behaviour (including dietary habits, alcohol and tobacco use, screen time and bedtime rules and 24-hour movement behaviour), socioeconomic data and data about the characteristics of the home and neighbourhood will be collected from parents and children. The 24-hour movement behaviour (eg, sleep, sedentary behaviour and physical activity) will be monitored using wGT3X-BT and GT9X Link ActiGraph accelerometers placed on the non-dominant wrist of the children and their parents for 7 consecutive days. The accelerometers will be set up for each family separately, using the group proximity mode, allowing proximity tagging between devices and establishing the time spent together and parent-child coactivities.

ETHICS AND DISSEMINATION

The overarching methodological protocol of the FAMIPASS project was approved by the Ethics Committee of the Faculty of Physical Culture, Palacký University Olomouc, Czech Republic (reference number: 25/2021). The results and findings will be reported to: (1) the participating families and (2) school representatives and will be (3) presented at national and international conferences and (4) disseminated via peer-reviewed publications.

Cognitive-Behavioral Play Therapy and COVID-19 Pandemic Trauma in Preschool Children

Traumatic life events, such as the ongoing COVID-19 pandemic, can be a challenging health emergency, among others. The pandemic can also affect young preschoolers. They can experience negative emotions and behavioral and social difficulties. It can be hard for children to understand on their own what is going on, as well as for their families. This narrative review summarizes the role of psychotherapeutic approaches in working with trauma and aims to manage trauma, such as COVID-19, in preschool children. It focuses on the possibilities of applying cognitive-behavioral play therapy (CBPT) in preschool children who suffer from trauma during the COVID-19 pandemic period. The therapeutic approaches are tailored to specific development in preschoolers. Furthermore, the article provides insights into the relationship between negative emotions, thinking, and behavior, and COVID-19 as a threat, by describing a cognitive model in preschool-aged children. Finally, the article offers possible ways of applying play-based cognitive-behavioral therapy programs in preschool children who are victims of trauma.

Risk factors for the population's mental health amidst the COVID-19 pandemic

OBJECTIVE

To identify risk factors for mental health in the population in times of COVID-19 through the analysis of levels of socio-cognitive mindfulness and perception of stress in individuals.

METHOD

This is a cross-sectional observational study with a quantitative approach, carried out through online data collection using the Perceived Stress Scale and the Langer Mindfulness Scale in a sample of 955 individuals from different regions of Brazil.

RESULTS

Women, younger people and individuals with low socioeconomic conditions had higher levels of perceived stress; on the other hand, older men and individuals with high socioeconomic status had higher levels of mindfulness.

CONCLUSION

Socio-cognitive mindfulness was not a protective factor for perceived stress in the context of the COVID-19 pandemic.

Three years into the pandemic: results of the longitudinal German COPSY study on youth mental health and health-related quality of life

Purpose

For the past three years, the German longitudinal COPSY (COVID-19 and PSYchological Health) study has monitored changes in health-related quality of life (HRQoL) and the mental health of children and adolescents during the COVID-19 pandemic.

Methods

A nationwide, population-based survey was conducted in May-June 2020 (W1), December 2020-January 2021 (W2), September-October 2021 (W3), February 2022 (W4), and September-October 2022 (W5). In total, n = 2,471 children and adolescents aged 7-17 years (n = 1,673 aged 11-17 years with self-reports) were assessed using internationally established and validated measures of HRQoL (KIDSCREEN-10), mental health problems (SDQ), anxiety (SCARED), depressive symptoms (CES-DC, PHQ-2), psychosomatic complaints (HBSC-SCL), and fear about the future (DFS-K). Findings were compared to prepandemic population-based data.

Results

While the prevalence of low HRQoL increased from 15% prepandemic to 48% at W2, it improved to 27% at W5. Similarly, overall mental health problems rose from 18% prepandemic to W1 through W2 (30-31%), and since then slowly declined (W3: 27%, W4: 29%, W5: 23%). Anxiety doubled from 15% prepandemic to 30% in W2 and declined to 25% (W5) since then. Depressive symptoms increased from 15%/10% (CES-DC/PHQ-2) prepandemic to 24%/15% in W2, and slowly decreased to 14%/9% in W5. Psychosomatic complaints are across all waves still on the rise. 32-44% of the youth expressed fears related to other current crises.

Conclusion

Mental health of the youth improved in year 3 of the pandemic, but is still lower than before the pandemic.

[The COVID-19 pandemic-How did it affect the mental health of children?]

Background

The COVID-19 pandemic has had a substantial impact on the daily life of children and adolescents due to lockdowns, contact restrictions, closings of childcare, schools and leisure facilities.

Objective

This article examines the impact of the pandemic on the mental health of children and adolescents in Germany.

Material and methods

In the population-based longitudinal COPSY study (COVID-19 and Psychological Health) 1600 parents of children aged 7-17 years old and 1000 children and adolescents aged 11-17 years old completed established questionnaires at 5 online survey points (t1: May and June 2020 to t5: September and October 2022). For comparison, pre-pandemic data were obtained from the representative BELLA study.

Results

During the pandemic the portion of children and adolescents, who reported a low health-related quality of life, increased from pre-pandemic 15% to 48% in the first year of the pandemic and improved in year 3 to 27%. This is still substantially above pre-pandemic levels. Similar trajectories were found for mental health problems which rose from 18% (pre-pandemic) to 31% and improved in year 3 to 23%. For anxiety and depression, the changes were similar except that depressive symptoms returned to pre-pandemic levels in year 3. The physical activity of almost one third of the youth was still very low in year 3.

Conclusion

The mental health of children and adolescents was ignored during the pandemic for a long time. Now support and allocation of funding is urgently needed to mitigate the negative mental health effects and prevent further impairment by new crises.

Changes in social behavioral developmental risks in preschool children after the first COVID-19 wave: a prospective longitudinal cohort study

The impact of the COVID-19 pandemic on social-emotional developmental risks (SE-DR) of preschool children is largely unknown. Therefore, the aim of this prospective longitudinal dynamic cohort study was to assess changes in preschoolers' SE-DR from before the pandemic to after the first COVID-19 wave. SE-DR were assessed annually with the instrument "Dortmund Developmental Screening for Preschools" (DESK). Longitudinal DESK data from 3- to 4-year-old children who participated both in survey wave (SW) three (DESK-SW3, 2019) and SW four (DESK-SW4, 2020) from August 1 to November 30 were used, respectively. Additionally, data from previous pre-pandemic SW were analyzed to contextualize the observed changes (SW1: 2017; SW2: 2018). A total of N = 786 children were included in the analysis. In the pre-pandemic DESK-SW3, the proportion of children with SE-DR was 18.2%, whereas in DESK-SW4 after the first COVID-19 wave, the proportion decreased to 12.4% (p = 0.001). Thus, the prevalence rate ratio (PRR) was 0.68. Compared to data from previous SW (SW1-SW2: PRR = 0.88; SW2-SW3: PRR = 0.82), this result represents a notable improvement. However, only short-term effects were described, and the study region had one of the highest preschool return rates in Germany. Further studies are needed to examine long-term effects of the pandemic on preschoolers' SE-DR.

Parents' Perceptions of Children's Behavioral Difficulties and the Parent-Child Interaction During the COVID-19 Lockdown

The study examined parents' perceptions of their children's behavioral difficulties (CBD) and positive parent-child interaction (PCI) during the first COVID-19 lockdown in Israel, as well as the associations among parents' psychological distress, parents' COVID-19-related worries, parents' coping, and parents' resilience. Participants were 437 parents of minor children. Parents reported more behavioral and emotional difficulties alongside with more quality time with their children. Parents' distress and COVID-19-related worries were positively related to CBD. Emotion-focused coping mediated the association between psychological distress and CBD, while resilience mediated the association between distress and PCI. The study results indicated that parents perceived their children as having greater difficulties, but they also perceived more positive parent-child interactions, during the lockdown. Parents' distress appears to have been a significant variable in perceived child's difficulties during the lockdown.

Social Policies and Theories on Quality of Life under COVID-19: In Search of the Missing Links

COVID-19 has generated many negative impacts on the family, including impaired psychological well-being of family members (parents and children) and family processes (such as parenting and family functioning). Regarding social policies to support families under the pandemic, there are several missing links. First, COVID-19 related policies mainly focus on physical well-being with a relatively weaker emphasis on psychological well-being. Second, with social policies primarily aiming at stabilizing the "financial capital" of the public, human capital (particularly personal resilience) and social capital (particularly family resilience) are relatively neglected. Third, while "general" social policies may help "averaged" individuals and families, there is a need to take pre-existing family vulnerabilities (such as poverty and caregiving burdens) and inequalities into account when formulating "down to earth" social policies. Fourth, while social science knowledge and theories have important potential contributions to help develop relevant policies and services to promote quality of life under COVID-19, explicit utilization is not strong. With reference to these missing links, we proposed several research and practice directions for the promotion of quality of life under the pandemic.

Impact of preschool attendance, parental stress, and parental mental health on internalizing and externalizing problems during COVID-19 lockdown measures in preschool children

BACKGROUND

Internalizing problems are common in young children, often persist into adulthood, and increase the likelihood for subsequent psychiatric disorders. Problematic attachment, parental mental health problems, and stress are risk factors for the development of internalizing problems. COVID-19 lockdown measures have resulted in additional parental burden and especially their impact on preschool children has rarely been investigated as of now. The current study examined the impact of sustained preschool attendance, parental stress, and parental mental health on internalizing and externalizing problems during COVID-19 lockdown measures in a sample of preschool children in Germany.

METHODS AND FINDINGS

N = 128 parents of preschool children filled out a one-time online survey about children's internalizing problems, externalizing problems, and attachment for three time points: before a nation-wide lockdown (T1), during the most difficult time of the lockdown (T2) and after the lockdown (T3). Additionally, parents answered questions about their own depressive and anxious symptomatology for the three time points and parental stress for T1 and T2. Linear-mixed effect models were computed to predict children's internalizing / externalizing behavior. Preschool children showed a significant increase in internalizing and externalizing problems over time, highest at T2 with small decreases at T3. Parental depressive and anxious symptomatology increased significantly from T1 to T2, but also remained high at T3. Parental stress levels were comparable to community samples at T1, but attained average values reported for at-risk families at T2. Linear-mixed effect models identified higher parental stress, parental anxiety, attachment problems, parental education, and less preschool attendance as significant predictors for internalizing and externalizing problems in preschoolers with more specific associations shown in separate models. A limitation is the retrospective assessment for the times T1 and T2.

CONCLUSIONS

Preschool children's mental health is strongly and negatively influenced by the ongoing COVID-19 pandemic and its lockdown measures. Sustained preschool attendance may serve as a protective factor.

Risk factors of orphan and vulnerable children in a children's home during the COVID-19 pandemic

Orphans and vulnerable children in children's homes are exposed to multiple psychosocial risks. This study aimed to explore the risks facing orphans and vulnerable children in a children's home in a township setting during COVID-19. Qualitative data was thematically analysed for this study. Fifty-eight female Black African children (n = 58) in a children's home were individually interviewed to ascertain the psychosocial risks that they experienced during COVID-19. The participants were orphans and vulnerable children residing in a children's home located in Johannesburg in South Africa. All children were enrolled in either primary or secondary schools located nearby the children's home. Boys were not included because the children's home only caters for females. The study found that unhealthy coping mechanisms, non-compliance with COVID-19 safety protocols, disruptive behaviour, fear of being infected and abuse by caregivers emerged as risks. We recommend that children be offered life skills such as coping mechanisms when faced with adversity, be constantly monitored to ensure adherence to safety rules and be given therapeutic interventions to deal with their fears. Furthermore, caregivers need to be psycho-educated on the giving of care to orphans and vulnerable children. The physical environment of the children's homes should be made conducive to allow healthy interactions with factors that impact on them.

Changes in mental health in the German child and adolescent population during the COVID-19 pandemic - Results of a rapid review

Background

This rapid review examines changes in the mental health of the German child and adolescent population during the COVID-19 pandemic.

Methods

The basis are 39 publications, which were identified by means of systematic literature search (until 19.11.2021) and manual search. The databases of the included publications were systematized with regard to their representativeness for the general population, and the indicators used were categorized with regard to the depicted constructs and their reliability.

Results

The large majority of the studies took place at the beginning of the pandemic until the summer plateau 2020. Representative studies mainly reported high levels of pandemic-related stress, increases in mental health problems, and negative impacts on the quality of life. Non-representative studies showed mixed results. Vulnerable groups could only be identified to a limited extent. Both routine and care-related data showed declines in the outpatient and inpatient service utilisation during the various waves of the pandemic followed by catch-up effects. Children and adolescents turned out to be more vulnerable during the pandemic compared to adults, but their stress levels varied with the waves of the pandemic and the related containment measures.

Conclusions

A future forward-looking crisis and pandemic management requires a close-knit and continuous surveillance of the mental health of children as well as an improved identification of risk groups.

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

The COVID-19 pandemic and associated public health measures have adversely affected the lives of people worldwide, raising concern over the pandemic's mental health consequences. Guided by a systemic model of family functioning during the COVID-19 pandemic (Prime et al., 2020), the current study aimed to examine how caregiver well-being (i.e., maternal depressive symptoms) and family organization (i.e., household chaos) are related to longitudinal trajectories of children's emotional and behavioral problems. Data were collected at four time points during and after home lockdown periods. Mothers of children (N = 230; 55% male) between the ages of two to five years were asked to complete questionnaires via an Israeli online research platform. Results indicated that emotional and behavioral problems, household chaos, and maternal depressive symptoms were the highest during the first lockdown assessment and dropped in the post-lockdown periods. Multilevel models further revealed that at the between-participants level, maternal depressive symptoms and household chaos positively predicted children's emotional and behavioral problems. At the within-participants level, household chaos fluctuations positively predicted fluctuations in child behavioral but not emotional problems. Our findings suggest that lockdowns have adverse effects on both maternal and child mental health. Screening for depressive symptoms among mothers of young children and maintaining household structure are important targets for future interventions to assist parents in navigating the multiple challenges brought upon by the COVID-19 pandemic.

What Mediates the Effect of Family Disruption in the COVID-19 Pandemic on Children’s Prosocial Behavior

Abstract. At the start of the COVID-19 pandemic, unprecedented social distancing rules (including mass school closures) dramatically constrained children’s social lives, jeopardizing human connections that foster prosocial development. This study of 2,516 families of 3–8-year-olds from six countries (China, Sweden, Australia, Italy, the USA, and the United Kingdom) examined whether children’s understanding or feelings about COVID-19 regulations mediated the expected association between COVID-19-related family disruption and children’s prosocial behavior, as indexed by parental ratings. For all six sites, family disruption indirectly predicted reduced prosocial behavior. Negative feelings about COVID-19 regulations mediated this association in all sites except China. Contrariwise, understanding of COVID-19 regulations was not implicated in the link between family disruption and reduced prosocial behavior.

School resources, self-control and problem behaviors in Chinese adolescents: a longitudinal study in the post-pandemic era

The outbreak of COVID-19 has brought many challenges to youth development. During this specific period, adolescents have suffered from numerous behavioral problems, which will lead to more maladaptive consequences. It is necessary to explore several protective factors to prevent or reduce the occurrence of problem behaviors in adolescence. The current study combined school resources and self-control to evaluate the multiple protective effects on adolescents' problematic behaviors in a two-wave longitudinal study. A sample of 789 Chinese adolescents (Mage = 14.00 years, SD = 2.05, 418 boys) were recruited via the random cluster sampling method to participate in the survey. The results confirmed the assumptions about the multiple protective effects of school resources and self-control on adolescents' problem behaviors. Specifically, school resources could negatively predict IGD and victimization, and self-control mediated these associations. Moreover, one problematic behavior could also mediate the associations between self-control and another problematic behavior. This is the first study to focus on the multiple protective effects of positive factors on adolescents' problem behaviors during the post-pandemic period, which has made several contributions to the literature and practice.

COVID-19-related future anxiety is associated with the health-related quality of life in school-aged children and adolescents-A cross-sectional study

Background

Over the course of the COVID-19 pandemic, previous studies have shown that the physical as well as the mental health of children and adolescents significantly deteriorated. Future anxiety caused by the COVID-19 pandemic and its associations with quality of life has not previously been examined in school children.

Methods

As part of a cross-sectional web-based survey at schools in Mecklenburg-Western Pomerania, Germany, two years after the outbreak of the pandemic, school children were asked about COVID-19-related future anxiety using the German epidemic-related Dark Future Scale for children (eDFS-K). Health-related quality of life (HRQoL) was assessed using the self-reported KIDSCREEN-10. The eDFS-K was psychometrically analyzed (internal consistency and confirmatory factor analysis) and thereafter examined as a predictor of HRQoL in a general linear regression model.

Results

A total of N = 840 8-18-year-old children and adolescents were included in the analysis. The eDFS-K demonstrated adequate internal consistency reliability (Cronbach's α = 0.77), and the confirmatory factor analysis further supported the one-factor structure of the four-item scale with an acceptable model fit. Over 43% of students were found to have low HRQoL. In addition, 47% of the students sometimes to often reported COVID-19-related fears about the future. Children with COVID-19-related future anxiety had significantly lower HRQoL (B = - 0.94, p < 0.001). Other predictors of lower HRQoL were older age (B = - 0.63, p < 0.001), and female (B = - 3.12, p < 0.001) and diverse (B = - 6.82, p < 0.001) gender.

Conclusion

Two years after the outbreak of the pandemic, school-aged children continue to exhibit low HRQoL, which is further exacerbated in the presence of COVID-19-related future anxiety. Intervention programs with an increased focus on mental health also addressing future anxiety should be provided.

Child and Adolescent Mental Health During the COVID-19 Pandemic: Results of the Three-Wave Longitudinal COPSY Study

PURPOSE

The German population-based longitudinal COVID-19 andPsychological Health study monitors changes in health-related quality of life (HRQoL) and mental health of children and adolescents during the COVID-19 pandemic and identifies vulnerable groups.

METHODS

A nationwide, population-based survey was conducted in May 2020 to June 2020 (Wave 1), December 2020 to January 2021 (Wave 2), and September 2021 to October 2021 (Wave 3). In total, n = 2,097 children and adolescents aged 7-17 years were investigated using measures to assess HRQoL (KIDSCREEN-10), mental health problems (SDQ), anxiety (SCARED), depressive symptoms(PHQ-2), and psychosomatic complaints(HBSC-SCL).

RESULTS

The prevalence of low HRQoL increased from 15% prepandemic to 40% and 48% in Waves 1 and 2 and improved slightly to 35% in Wave 3 (all differences significant). Similarly, overall mental health problems increased from 18% prepandemic to 29% in Wave 1 and 31% in Wave 2 to 28% in Wave 3 (all differences significant, except Wave 3 vs. 2), anxiety increased from 15% prepandemic to 24% and 30% in Waves 1 and 2 and was still 27% in Wave 3. Depressive symptoms increased from 10% prepandemic to 11% and 15% in Waves 1 and 2 and were 11% in Wave 3. A group with low parental education, restricted living conditions, migration background, and parental mental health problems was at significantly increased risk of HRQoL and mental health impairments.

DISCUSSION

The prevalence of low HRQoL, mental health problems, and anxiety has been elevated throughout the pandemic. Thus, mental health promotion, prevention, and intervention strategies need to be implemented to support adolescents-particularly those at risk.

Impact of the COVID-19 lockdown on gifted and non-gifted primary school students' well-being and motivation from a self-determination perspective

This study examined the impact of the COVID-19-induced school lockdown on need satisfaction, well-being and motivation in both gifted and non-gifted primary school students in the Netherlands. A total of 312 parents (122 from gifted children) participated. The lockdown had mainly negative effects on students' need satisfaction, well-being and motivation. However, the impact of the lockdown was less negative for gifted students. There was also a levelling effect: Before the lockdown, gifted students had lower need satisfaction, well-being and motivation than their non-gifted peers, but these differences decreased during the lockdown due to (stronger) declines in the non-gifted. Changes in non-gifted students' well-being and motivation, because of the lockdown, were negatively mediated by autonomy and relatedness with classmates. Among the gifted, this was positively mediated by competence. Only before the lockdown, the effects of giftedness on well-being and motivation were mediated by autonomy and relatedness satisfaction.

SARS-CoV-2 surveillance by RT-qPCR-based pool testing of saliva swabs (lollipop method) at primary and special schools—A pilot study on feasibility and acceptability

Background

Since the onset of the COVID-19 pandemic, children have been mentally and physically burdened, particularly due to school closures, with an associated loss of learning. Therefore, efficient testing strategies with high sensitivity are necessary to keep schools open. Apart from individual rapid antigen testing, various methods have been investigated, such as PCR-based pool-testing of nasopharyngeal swabs, gargle, or saliva samples. To date, previous validation studies have found the PCR-based saliva swab pool testing method to be an effective screening method, however, the acceptability and feasibility of a widespread implementation in the school-setting among stakeholders has not been comprehensively evaluated.

Methods

In this pilot study, SARS-CoV-2 saliva swab pool testing of up to 15 swabs per pool was conducted in ten primary and special schools in Mecklenburg-Western Pomerania, Germany, over a period of one month. Thereafter, parents, teachers and school principals of the participating schools as well as the participating laboratories were surveyed about the feasibility and acceptability of this method, its large-scale implementation and challenges. Data were analyzed quantitatively and qualitatively.

Results

During the study period, 1,630 saliva swab pools were analyzed, of which 22 tested SARS-CoV-2 positive (1.3%). A total of N = 315 participants took part in the survey. Across all groups, the saliva swab pool testing method was perceived as more child-friendly (>87%), convenient (>82%), and easier (>81%) compared to rapid antigen testing by an anterior nasal swab. Over 80% of all participants favored widespread, regular use of the saliva swab method.

Conclusion

In school settings in particular, a high acceptability of the test method is crucial for a successful SARS-CoV-2 surveillance strategy. All respondents clearly preferred the saliva swab method, which can be used safely without complications in children six years of age and older. Hurdles and suggestions for improvement of an area-wide implementation were outlined.

COVID-19 Vaccine Effectiveness against Omicron Variant among Underage Subjects: The Veneto Region's Experience

Even if most of the complications due to COVID-19 are observed in the elderly, in Italy the impact of COVID-19 among young people has not been negligible. Furthermore, their contribution to SARS-CoV-2 circulation is still unclear. These reasons have driven policy makers to involve subjects aged 5 to 17 years in the COVID-19 vaccination campaign. However, the trade-off of vaccinating this age-group should be further investigated, especially in view of the rise of new immunologically evasive variants of concern (VOCs). We used regional databases to retrospectively estimate vaccine effectiveness over time of each approved vaccination schedule among children (5–11) and adolescents (12–17). Our findings suggest that COVID-19 vaccines were highly effective and their protection levels lasted longer during a period of Delta variant predominance, whereas they offered just mild to moderate levels of protection—apparently affected by a rapid waning effect—in a period of Omicron variant predominance. Considering these results, it is plausible to evaluate a reformulation of possible future COVID-19 vaccination campaigns among underage subjects. However, effectiveness against serious complications due to COVID-19, as well as indirect benefits of underage vaccinations, should first be addressed. Furthermore, vaccine effectiveness should be kept monitored, as new VOCs may arise, but also new adapted vaccines may start being administered.

Caregivers' everyday moral reasoning predicts young children's aggressive, prosocial, and moral development: Evidence from ambulatory assessment

Developmental theories have proposed caregiver reactions, in particular caregivers' moral reasoning with their children, as crucial factors in children's developing morality. Yet, empirical evidence is scarce and mainly restricted to laboratory contexts. Here, we used the ambulatory assessment method to investigate how caregiver responses to moral transgressions longitudinally relate to children's emerging moral agency. On the first measurement point, mothers (N = 220) reported on nine consecutive evenings on a moral transgression of their 5- to 46-month-olds', their emotional and verbal reactions, and how in turn their child reacted. Five months later, mothers reported on their child's aggressive and prosocial (helping, sharing, comforting) behavior. Our results demonstrated that (1) caregiver reasoning supported children's sharing and comforting behavior and was related to lower levels of children's aggressive behavior half a year later, that (2) caregiver reasoning reactions supported children's negative evaluations of their own transgressions while compliance-based caregiver reactions (e.g., physical interventions, reprimands) were predictive of children's subsequent emotional distress and anger, and that (3) caregiver social conformity and reflective functioning abilities emerged as determinants of caregiver negative moral emotions. Thus, this study uses an innovative methodological approach to uncover key characteristics of caregiver moral reactions supporting the development of morality.

Comparing parental distress and children's difficulties between parents of children with rheumatic diseases and parents of healthy children in families facing the COVID-19 pandemic

The COVID-19 pandemic could be a threat for the health status of children with a chronic condition. The present study aimed to explore parents' and children's psychological adjustment during the current pandemic, pursuing a triple objective: to compare the psychological adjustment of parents of children with pediatric rheumatic diseases (PRDs) and parents of healthy children; to analyze children's psychological symptoms (emotional problems and hyperactivity) before and during the COVID-19 pandemic, and with or without a PRDs diagnosis; to explore the associations of children's emotional problems and hyperactivity with parents' psychological adjustment, parent-child interactions and belonging or not to families with PRDs. This cross-sectional study involved 56 parents of children with PRDs and 53 parents of healthy children. Self-report questionnaires about parents' depression, anxiety, parenting stress, and children's emotional symptoms and hyperactivity-inattention were administered. No differences were detected on psychological adjustment between parents of children with PRDs and parents of healthy children. Parents of children with PRDs reported statistically significant higher levels of children's emotional problems and hyperactivity before the pandemic, compared to parents of healthy children; during COVID-19 pandemic, emotional symptoms increased for both groups, while hyperactivity-inattention symptoms increased only in the group of healthy children. Children's emotional difficulties were associated with higher levels of parental anxiety, worse parent-child interaction and having PRDs; children's hyperactivity symptoms were related to parent-child difficult interaction and higher levels of parental depression. Findings suggest the importance to target the children in relation to their parents, when approaching the psychological aspects of PRDs.

Child emotional and behavioral difficulties and parent stress during COVID-19 lockdown in Sri Lankan families

Introduction

Understanding parents’ and children’s mental health issues would help design population-specific intervention programs. The present study explored parents’ perceived stress and child emotions and behavior during the COVID-19 lockdown among Sri Lankan families.

Methods

A cross-sectional survey was conducted among Sri Lankan parents of children aged 11 to 17 years. Validated instruments (Perceived Stress Scale-PSS and Strengths and Difficulties Questionnaire-SDQ) evaluated parental stress, child emotions, and hyperactivity/inattention. Multiple linear regression assessed the predictors of mental health issues, including the interaction between age and gender.

Results

Three hundred fifty-five parents responded to the survey (mothers:76%). One-third of parents experienced difficulties with their children during the pandemic. Emotions and hyperactivity-inattention problems measured via the SDQ scale were high among 38% of children, while the perceived stress was high in 79.2% of parents. Overall, child emotions and hyperactivity-inattention increased with decreasing age, increasing parent stress, having middle-income compared to high-income, and having a family member/close relative tested positive for COVID-19. Hyperactivity-inattention (29.3%) was more than the emotional problems (22%) among children. The emotional problems were reported more with increasing parent stress, while child hyperactivity-inattention alone was reported more with decreasing age, middle-income compared to high-income families, and increasing parent stress. Also, the interaction effect of age and gender indicated that higher age was related to greater parent-reported hyperactivity-inattention problems in males.

Conclusions

The findings highlight how the COVID-19 crisis and social isolation have contributed to increased parental stress and child emotional and hyperactivity-inattention problems. In addition to cautioning the healthcare workers, socio-culturally appropriate preventive and supportive mental health programs may help deal with further waves of COVID-19 or any other adverse circumstances.

Perspectives and experiences of Covid-19: Two Irish studies of families in disadvantaged communities

The Covid-19 pandemic has been recognised to affect families’ socio-emotional well-being. Collecting the views of families in diverse socio-economic contexts can contribute to understanding their specific needs and resources in relation to the Covid-19 pandemic. The overarching objective of the current research was to explore the views and experiences of families in relation to the Covid-19 pandemic, who were living in the Republic of Ireland, including in areas designated as disadvantaged. In Study 1, the objective was to explore changes, difficulties, and concerns experienced by parents of children up to six years old during the pandemic, and related associations with socio-demographic characteristics. Data were collected from 168 parents/carers via an online questionnaire, and examined using conceptual content analysis. The most frequently identified experiences related to restrictions, social isolation, negative impacts on parents’ emotional and psychological well-being, negative impacts on children’s emotional well-being and development, concerns with physical health, uncertainty about the future, and positive changes regarding family time and activities. Associations were found with parents’ age and work situation, and family’s income and composition. In Study 2, the objective was to explore the views of children, parents, and service providers about the impact of the Covid-19 pandemic on families’ life, and relevant supports. Data were collected from 50 children aged between eight and 17 years old, 17 parents, and 20 service providers through focus group discussions, and examined using thematic analysis. The participants reported experiences related to challenges with online education, uncertainty regarding children’s education, food poverty, and children’s socio-emotional health. The findings of both studies reinforced the importance of implementing measures to promote parents’ and children’s socio-emotional well-being, combat educational inequalities, and ensure economic and employment security.

On What Tasks Did Children between the Ages of 3 and 12 Years Spend Their Time during the COVID-19 Pandemic? An International Comparative Study between Ibero-America and Europe

The pandemic caused by COVID-19 meant, in many countries, the establishment of a period of confinement in which families were forced to restrict movement and social contacts with the consequent risk of inactivity. Our objective as to analyze the degree of psychosocial well-being, sociodemographic aspects and use of technological means depending on the educational level of the parents. The sample consisted of 2316 children aged between 3 and 12 years (M = 7.70; SD = 2.86). For the analysis and treatment of the data, the statistical software SPSS 25.0 (IBM Corp, Armonk, NY, USA) was used. We found that the European participants used more video consoles (M = 0.89 ± 1.33) and tablets (M = 1.30 ± 0.95), while the Ibero-Americans obtained higher values in the use of TV (M = 2.28 ± 1.10) and levels higher in a negative state of psychosocial well-being (M = 7.29 ± 1.07) and in tiredness/fatigue (M = 4.34 ± 2.44). We concluded that, during the period of confinement in European areas, higher values were obtained in the time dedicated to Physical Activity (PA), use of tablets, school task performance, artistic activities, family games, reading, free play and hours of sleep; while in Ibero-America, there were longer times in the use of technological devices and performing domestic tasks.

Attitudes toward Coronavirus Protection Measures among German School Students: The Effects of Education and Knowledge about the Pandemic

This article addresses the question of what attitudes school students in Germany hold regarding the Coronavirus protection measures taken by policymakers. Based on this, it investigates to what extent the students’ assessment of the pandemic is impacted by a better understanding of the spread of the virus, as well as their objective knowledge and their self-perceived subjective knowledge about the pandemic. Using a sample of 563 German school students (ages: 12–26), Part I of our analysis shows that after more than 2 years of the COVID-19 pandemic, (1) a significant exponential growth bias (EGB) (i.e., a systematic underestimation of the speed at which COVID-19 spreads) still exists, and (2) this bias can be reduced by giving simple educational nudges, but (3) this treatment has neither a major effect on the general approval of anti-COVID-19 measures nor on the willingness of the participants to apply specific protective measures themselves. Furthermore, Part II of our study illustrates that both subjective and objective knowledge increase the approval of or willingness for most protective measures. The same holds true for fear of infection. Therefore, an educational approach that combines rational, cognitive, and emotional elements is likely to be best suited to raising young people’s awareness of the dangers of a pandemic such as COVID-19.

A Narrative Review on Prevention and Early Intervention of Challenging Behaviors in Children with a Special Emphasis on COVID-19 Times

Background

COVID-19 and the measures stemming from efforts to control it have affected the psychosocial wellbeing of children and adolescents. The increasing trend of challenging behavior has exerted further pressure on parents and schools. Understanding socioemotional development and interrelating triggers is the key to management. Early interventions prevent the future threat of mental illness and risky acts. Effective strategies are ones that primarily focus on strengthening parent-child interactions.

Aim

The purpose of this paper is to review the literature on the (i) psychosocial and behavioral impacts of COVID-19 on children/adolescents and (ii) approaches to identify determinants of challenging behaviors as a principal guide to effective interventional strategies for children and their families.

Methodology

Electronic database searches of PubMed, ScienceDirect, Medline, and Scopus were conducted to identify studies meeting the inclusion criteria that address the impact of COVID-19 on behaviors, contributing factors, and management in the context of families/schools. The content of the selected articles was themed under five categories, namely the developmental milestones, the Pyramid Model, the Positive Behavioral Support, the management strategies, and the impact of COVID-19 on children/adolescents' behavior.

Results

The present review demonstrates considerable influence of COVID-19 on children and adolescents' behavior and mental wellbeing. It stresses the importance of early family-based interventions focusing on the triggers of challenging behavior. Functional Behavioral Assessment and Behavioral Intervention Plan provide a systematic analysis with a strategic plan that support children's self-regulation and socioemotional intelligence. Regular behavioral screening is vital to promote prevention and early management.

Conclusion

Managing behavioral difficulties remains an area of deficit for parents, teachers, and health care providers. With a quality support, parents and schools will be able to clearly characterize the challenging behavior, understand the causes, reinforce parent-child interactions, and consequently, gain the strategic skills required to apply it within natural settings. Timely interventions will limit the risk of future misconduct and mental disorders.

Disinfection behavior for COVID-19 in individuals with Down syndrome and caregivers' distress in Japan: a cross-sectional retrospective study

The COVID-19 outbreak affected the daily lives of individuals with Down syndrome, who were considered to have a higher risk of severe infection. While several studies have reported mental health issues in children and/or parents in the general population, no study has focused on people with Down syndrome and their caregivers. This study investigated the disinfection behaviors of individuals with Down syndrome and their caregivers' stress. A cross-sectional retrospective survey was conducted in October 2020. Caregivers of children and adults with Down syndrome were administered questionnaires including measures for practiced disinfection behavior in children, caregiver's child-related stress, and psychological distress. About half of the respondents' children practiced hand hygiene and mask-wearing behaviors, while physical distancing was performed less frequently. Habitual practices in physical distancing are affected by intellectual function. Logistic regression showed that caregivers' stress was associated with the irritability of individuals with the disorder (adjusted odds ratio [OR] = 8.44, 95% confidence interval [CI] 1.69-42.09) and the burden of infection-prevention behaviors for people with Down syndrome (adjusted OR = 4.26, 95% CI 1.88-9.65). This study showed the characteristics of disinfection behaviors in individuals with Down syndrome and associated factors for serious caregiver stress.

Lifestyle changes, mental health, and health-related quality of life in children aged 6-7 years before and during the COVID-19 pandemic in South Germany

BACKGROUND

The measures against the COVID-19 pandemic are challenging for children and parents, and detrimental effects on child health are suggested especially from lock-down measures and school closings.

METHODS

We conducted a cross-sectional analysis using a population based longitudinal (birth-) cohort study (SPATZ study) conducted in the South of Germany. Data included all 6 or 7 year old children for whom a questionnaire was completed during first grade of school. Consequently, we were able to analyze children being in first grade before the first lockdown in Germany (≤ 15th March 2020), as well as children being in first grade during the pandemic (> 15th March 2020). We conducted descriptive statistics and estimated the associations between the two time periods, before and during the pandemic, and various outcomes of child health using multivariable adjusted linear or logistic regression modeling. The analysis was stratified by gender.

RESULTS

Results among n = 362 children aged six or seven years showed substantially lower mean scores of health-related quality of life (difference in means: - 5.5, 95% confidence interval (CI) - 9.0, - 2.0), and higher mean scores in total emotional and behavioral difficulties (difference in means: 2.0, 95% CI 0.2, 3.8) in girls during vs. before the COVID-19 pandemic using multivariable linear regression modeling. In addition, weekly screen-time was increased in boys by 3.5 h (95% CI 0.6, 6.4). We did not find substantial differences in sleep quality, physical activity, and time spent with books, neither in boys nor in girls, however, the limited sample size has to be considered.

CONCLUSION

Child health (and behavior) of first grade school children is possibly impacted by the COVID-19 pandemic with adverse consequences possibly differing by gender.

Families' Worries during the First and Second COVID-19 Wave in Germany: Longitudinal Study in Two Population-Based Cohorts

This study aimed to compare worries related to the Coronavirus disease 2019 (COVID-19) in families with young children in two regions in Germany differently affected by the pandemic (Regensburg in Southeast Germany, Leipzig in Eastern Germany) during the first and the second waves of the COVID-19 pandemic. 720 parents participating in the KUNO Kids health study in Regensburg (n = 507) or the LIFE Child study in Leipzig (n = 213) answered questions regarding COVID-19-related worries and trust in anti-pandemic policy measures during the first wave (spring 2020) and during the second wave (winter 2020/2021) of the pandemic. Ordinal mixed-effects models were performed to assess differences depending on region and time, adjusting for education and migration background. Participants worried most about the general economic situation and their family and least about their own health or financial situation. Worries about oneself, family, friends, hometown, and country were stronger during the second than during the first wave. In regional comparisons, worries about family, friends, and hometown increased more pronouncedly from wave 1 to wave 2 in Leipzig (OR ranging from 2.67 (95% CI 1.71−4.19) to 3.01 (95% CI 1.93−4.71), all p < 0.001) than in Regensburg (OR ranging from to 1.38 (95% CI 1.08−1.78) to 1.72 (95% CI 1.33−2.21), all p < 0.05), running parallel with the increase in SARS-CoV-2 infections. Trust in anti-pandemic policy measures, in contrast, decreased significantly between wave 1 and wave 2, with a stronger decrease in Regensburg (OR = 0.30 (95% CI 0.22−0.39), p < 0.001) than in Leipzig (OR = 0.91 (95% CI 0.59−1.41), n.s.). The degree of families’ COVID-19-related worries differs by region and time, which might be related to differences in infection rates and public interest. Regional differences should be taken into account when developing communication strategies and policy measures during the COVID-19 pandemic.

Impact of the COVID-19 pandemic on children's mental health: A systematic review

BACKGROUND

The outbreak of COVID-19 in December 2019 has caused unprecedented disruption to the structure of children's daily lives due to school closures, online learning, strict social distancing measures, limited access to outdoor activities and many other restrictions. Since children are more susceptible to stress than adults and there is a growing concern about the potential debilitating consequences of COVID-19 for children's mental health, the present review aims to provide empirical evidence on the groups who are most at risk of mental health problems and uncover the risk and protective factors of children's mental health.

METHODS

A systematic search was performed, in accordance with PRISMA guidelines, in the electronic databases Web of Science (including SSCI and A&HI) and EBSCOhost (including ERIC, MEDLINE and APA PsycArticles and APA PsycINFO), for any empirical studies published between January 2020 and February 2022 that focused on children ≤ 12 years old.

RESULTS

An initial search identified 2,133 studies. A total of 30 studies fulfilled the inclusion criteria and were analyzed. The evidence showed that many children were affected by the COVID-19 pandemic and experienced internalizing and externalizing behaviors. Worsened child mental health outcomes reflected socioeconomic inequalities as most at-risk children had parents with low educational attainment, were from families of low socioeconomic status and lived in small homes. Key risk factors were identified, including unhealthy lifestyle behaviors (extended screen time, sleep disturbances and less physical activity), increased pandemic-related stressors among parents and deteriorated mental health of parents, which were directly or indirectly associated with the pandemic safety measures, such as home confinement or social distancing. Protective factors including parents' resilience, positive parent-child relationship and school connectedness in relation to children's mental health were reported.

CONCLUSION

The overall results highlight the urgent need for the implementation of tailor-made interventions for children with signs of internalizing and externalizing behaviors. Health promotion and prevention strategies by the government to maintain the mental health of children, particularly those from lower SES families who are at higher risk of worsened mental health are essential for post-pandemic policies.

Child behavior problems during COVID-19: Associations with parent distress and child social-emotional skills

The COVID-19 pandemic and associated government-mandated shutdowns disrupted schooling, socialization, and family life for school-aged children during spring 2020. These disruptions may have contributed to increased child behavior problems. Thus, we examined behavior problems in 247 children aged 7 to 9 years during Ohio's shutdown period. We investigated whether differences in parent-reported child behavior problems were associated with concurrent parent distress during spring 2020 and/or children's social-emotional skills measured via teacher-reports from the previous year (spring 2019). Parent distress significantly predicted behavior problems, such that more distressed parents also reported more child behavior problems. Child pre-pandemic peer social skills also significantly predicted behavior problems, such that more skilled children exhibited fewer behavior problems. There were no interaction effects between parent distress and children's social-emotional skills on child behavior problems. Further research is needed to understand how children's social-emotional skills impact their ability to cope during times of epidemiological crisis.

SARS-CoV-2 Transmissibility Within Day Care Centers-Study Protocol of a Prospective Analysis of Outbreaks in Germany

Introduction: Until today, the role of children in the transmission dynamics of SARS-CoV-2 and the development of the COVID-19 pandemic seems to be dynamic and is not finally resolved. The primary aim of this study is to investigate the transmission dynamics of SARS-CoV-2 in child day care centers and connected households as well as transmission-related indicators and clinical symptoms among children and adults. Methods and Analysis: COALA ("Corona outbreak-related examinations in day care centers") is a day care center- and household-based study with a case-ascertained study design. Based on day care centers with at least one reported case of SARS-CoV-2, we include one- to six-year-old children and staff of the affected group in the day care center as well as their respective households. We visit each child's and adult's household. During the home visit we take from each household member a combined mouth and nose swab as well as a saliva sample for analysis of SARS-CoV-2-RNA by real-time reverse transcription polymerase chain reaction (real-time RT-PCR) and a capillary blood sample for a retrospective assessment of an earlier SARS-CoV-2 infection. Furthermore, information on health status, socio-demographics and COVID-19 protective measures are collected via a short telephone interview in the subsequent days. In the following 12 days, household members (or parents for their children) self-collect the same respiratory samples as described above every 3 days and a stool sample for children once. COVID-19 symptoms are documented daily in a symptom diary. Approximately 35 days after testing the index case, every participant who tested positive for SARS-CoV-2 during the study is re-visited at home for another capillary blood sample and a standardized interview. The analysis includes secondary attack rates, by age of primary case, both in the day care center and in households, as well as viral shedding dynamics, including the beginning of shedding relative to symptom onset and viral clearance. Discussion: The results contribute to a better understanding of the epidemiological and virological transmission-related indicators of SARS-CoV-2 among young children, as compared to adults and the interplay between day care and households.

Sympathetic nerve-adipocyte interactions in response to acute stress

Psychological stress predisposes our body to several disorders. Understanding the cellular and molecular mechanisms involved in the physiological responses to psychological stress is essential for the success of therapeutic applications. New studies show, by using in vivo inducible Cre/loxP-mediated approaches in combination with pharmacological blockage, that sympathetic nerves, activated by psychological stress, induce brown adipocytes to produce IL-6. Strikingly, this cytokine promotes gluconeogenesis in hepatocytes, that results in the decline of tolerance to inflammatory organ damage. The comprehension arising from this research will be crucial for the handling of many inflammatory diseases. Here, we review recent advances in our comprehension of the sympathetic nerve-adipocyte axis in the tissue microenvironment.