Impact of COVID-19 on the Mental Health of Children and Adolescents

Lived experiences of adolescents with major depressive disorder during the COVID pandemic: A qualitative study from a tertiary care center

Objectives

Depression is a leading cause of global disease burden and morbidity among adolescents. Studies have reported higher rates of depression and anxiety secondary to the COVID pandemic and the psychosocial impact of social distancing measures. There is a paucity of literature on the subjective experiences of depressed adolescents in such pandemic circumstances. The objective of this study was to explore the lived experiences of adolescents with major depressive disorder (MDD) during the COVID pandemic, and the impact of the pandemic, and pandemic-related circumstances on adolescents' mental health and coping.

Materials and Methods

In-depth interviews with eight adolescents diagnosed with MDD were analyzed using interpretative phenomenological analysis.

Results

The analysis revealed three major themes; "The pandemic was arduous," "Negativity in family interactions," and "Effects on depression." Most adolescents coped using excessive screen time as a distraction, and their families perceived them as indolent.

Conclusion

The study found that adolescents' experience of depression during the pandemic was extremely overwhelming because, on the one hand, they had to deal with immediate COVID infection-related worries and were not able to adjust to the new routine, not able to concentrate during online classes while also dealing with greater interpersonal discord with their parents and limited social resources for coping. The findings expand the clinical understanding of adolescents' experience of depression during pandemic circumstances and would aid in better management planning.

Long-term pulmonary and extra-pulmonary consequences of COVID-19: A comprehensive review of current evidence and future perspectives

The global impact of the coronavirus disease 2019 (COVID-19) pandemic has been significant, affecting countless individuals worldwide. The existence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to considerable levels of illness and mortality. While considerable attention has been devoted to the immediate handling of COVID-19, there is a growing concern about the long-term effects of this disease. The recent studies have brought to light various complexities associated with COVID-19, encompassing both respiratory and non-respiratory problems such as lung scarring, heart diseases, neurological effects, and psychological consequences. The purpose of this review is to provide a comprehensive understanding of the persistent repercussions of COVID-19. It presents a summary of recent studies that have examined the frequency and severity of these complications, as well as an exploration of the potential mechanisms that contribute to their development. Specifically, it delves into the role of immune dysregulation, prolonged inflammation, and dysfunction of blood vessel linings in the origin of these complications. Moreover, the clinical significance of these long-term consequences is discussed, including their potential impact on healthcare systems and society as a whole. Our review highlights the necessity for continuous monitoring and management of patients diagnosed with COVID-19, along with the importance of conducting follow-up studies over an extended period to determine the most effective strategies for prevention and treatment of these complications.

Child self-report and child-parent agreement regarding health-related quality of life under COVID-19 lockdown in the French Grand Est area

Nearly 1.6 billion of children and young people in more than 190 countries have been affected by school closures under the first lockdown due to the coronavirus disease. This study aimed to investigate child-reported and parent-rated health-related quality of life among 8- to 18-year-olds and the agreement between the children's assessments and those of their parents during lockdown. A cross-sectional study was conducted among French children living in the Grand Est area. An online survey was used to collect data on the children's sociodemographics, living environments, education and HRQoL. The latter was assessed with KIDSCREEN-27, which consists of five domains. Sex and age differences in parent ratings and child-reported data were analyzed using Mann-Whitney tests. Child-parent agreement was analyzed using the intraclass correlation coefficient (ICC). In total, 471 child-parent pairs from 341 households were included. Compared to European norms, children scored lower on all dimensions during the first lockdown: physical well-being (45.9/49.94 EU), psychological well-being (48.8/49.77 EU), parent relations and autonomy (47.7/49.99 EU), social support and peers (36.4/49.94 EU) and school (48.2/50 EU). Significant child-reported sex and age differences were identified for both psychological and physical well-being dimensions. Moderate to good agreement existed between children's and parents' ratings on all KIDSCREEN dimensions (ICC ranged from 0.60 to 0.76). The study suggests the need to focus on children's social support and peers during epidemics and to consider the children's self-reported HRQoL. Additional research should be conducted to identify ways of minimizing the gap between mental health needs and the services available and to help more children maintain their physical and mental health during the current crisis.

Successes, challenges, and opportunities in providing evidence-based teletherapy to children who have experienced trauma as a response to Covid-19: A national survey of clinicians

While teletherapy is not a new phenomenon, most clinicians have not been trained and do not routinely practice it. The current study was designed to ascertain challenges and opportunities presented by the widescale usage of teletherapy especially for traumatized children, which was necessitated by the COVID-19 pandemic. Two hundred and fifty clinicians across the United States providing teletherapy to traumatized children completed an online survey. Results revealed that many logistical aspects of treatment were perceived to be easier when implemented remotely. Some clinical aspects of care were also perceived to be easier, notably engagement with caregivers. Developing rapport, assessing emotions, and keeping children's attention, however, were perceived as more challenging. Child characteristics such as age, attention span, and screen fatigue were viewed as creating challenges. Most clinicians had not received training in relevant topics for teletherapy and were eager to receive such training. These results suggest many avenues for refining and fine-tuning remote mental health services especially for children.

A Scoping Review of the Psychological and Emotional Impact of the COVID-19 Pandemic on Children and Young People

BACKGROUND

The COVID-19 pandemic has resulted in many changes to the lives of children and young people. Our aim is to explore the impact of the pandemic on the mental health of children and young people (ages 5-21).

METHODS

The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines was used to report the findings of this rapid review.

RESULTS

Children and young people are potentially very vulnerable to the emotional impact of traumatic events that disrupt their daily lives. Key areas of concern include: Death Anxiety and Fear of Infection; lack of social interaction and loss of routine.

CONCLUSIONS

Despite some early and responsive studies, the evidence base for pandemic impact on children and young people is very limited. Such evidence is urgently needed if adequate and responsive services, that can mitigate the long-term impact of the pandemic for children and young people can be established.

The Investigation of Major Predictors of Well-Being in a Sample of Romanian University Students in the Post-Covid-19 Period

"The Coronavirus-induced pandemic has had a significant impact on the physical and psychological functioning of the entire world’s population. Research has indicated that besides the physical threat to health itself, the implications of constant uncertainty, separation from and/or loss of loved ones, loss of freedom to travel, shortage of food and financial resources, disruptions of usual life-routines, changing work and learning habits, further aggravate the effect of initial stressors, leading to increased levels of depressive symptoms, anxiety, PTSD, insomnia, lowered levels of well-being, and confusion. Unfortunately, just as the two-years long pandemic ended, the Ukrainian war started, and the Romanian population, since our country borders Ukraine, has experienced a novel type of stress, that of the possibility of being attacked, affected economically. Almost simultaneously, the online education has returned to classical form of teaching, amidst semester, being another stress factor for students. Our results indicated that the two-year long pandemic was considered as having the greatest impact by almost two-thirds of the students. Furthermore, the lack of self-efficacy component of perceived stress was a constant and strong predictor of all components of well-being (subjective and psychological), and perceived helplessness for subjective well-being. Regarding emotion regulation strategies refocus on planning, positive reevaluation, self- and other blame, withdrawal and actively approaching the source of stress proved to be the most important predictors. The results of our investigation may be beneficial for the tailoring of future prevention and intervention programs that would target the enhancement of psychological adaptation of students. Keywords: stress, depressive symptoms, uncertainty, emotion regulation strategies, subjective and psychological well-being, post COVID-19. "

Rural Children's Well-Being in the Context of the COVID-19 Pandemic: Perspectives from Children in the Midwestern United States

Children in rural areas are more likely to experience a variety of risk factors that increase their vulnerability to physical and mental health disparities. Bronfenbrenner's ecological model (1986) was used as a framework for understanding rural children's perceptions and well-being within multiple interactive contexts during the COVID-19 pandemic. This phenomenological study was designed to explore rural children's perceptions of their well-being and the impact of the COVID-19 pandemic on their contexts and well-being. This sub-study of the Children's Understandings of Well-Being project followed the standard qualitative interview protocol with additional prompts related to the pandemic. Rural children (age 8 to 18, N = 72) from the Midwestern United States participated from March 2020 to November 2021 via teleconferencing. Phenomenological analyses of transcripts focused on the essence of children's understanding of well-being and their perception of the impact of the pandemic on their contexts and well-being. Each transcript was coded by author 1 and verified by author 2, and discrepancies were identified, discussed, and resolved. The third author served as an external auditor to enhance trustworthiness. First-cycle coding focused on children's specific references to well-being experiences during COVID-19. Second-cycle selective coding focused on specific well-being experiences and contexts that were impacted by COVID-19. These codes were used to develop two broad themes, "Well This Kinda Stinks, But We Just Adapt" and "Safety Means Something Different to Me Now." The meaning of themes and subthemes are explored, with implications for researchers, practitioners, and policymakers.

Mindfulness supports emotional resilience in children during the COVID-19 Pandemic

An important aspect of mental health in children is emotional resilience, the capacity to adapt to, and recover from, stressors and emotional challenges. Variation in trait mindfulness, one’s disposition to attend to experiences with an open and nonjudgmental attitude, may be an important individual difference in children that supports emotional resilience. In this study, we investigated whether trait mindfulness was related to emotional resilience in response to stressful changes in education and home-life during the COVID-19 pandemic in the United States. We conducted a correlational study examining self-report data from July 2020 to February 2021, from 163 eight-to-ten-year-old children living in the US. Higher trait mindfulness scores correlated with less stress, anxiety, depression, and negative affect in children, and lower ratings of COVID-19 impact on their lives. Mindfulness moderated the relationship between COVID-19 child impact and negative affect. Children scoring high on mindfulness showed no correlation between rated COVID-19 impact and negative affect, whereas those who scored low on mindfulness showed a positive correlation between child COVID-19 impact and negative affect. Higher levels of trait mindfulness may have helped children to better cope with a wide range of COVID-19 stressors. Future studies should investigate the mechanisms by which trait mindfulness supports emotional resilience in children.

Social networking use, mental health, and quality of life of Hong Kong adolescents during the COVID-19 pandemic

Background

During the COVID-19 pandemic, adolescents' use of social networking sites/apps has surged, and their mental health and quality of life have also been significantly affected by the pandemic and its associated social-protection measures. The present study first examined the prevalence of social networking sites/apps use and social networking addiction, the mental health status, and the health-related quality of life among Hong Kong adolescent students. We further investigated the associations of the youths' daily use of social networking sites/apps and their social networking addiction with their mental health and quality of life during the pandemic.

Methods

A total of 1,147 students (age = 15.20 ± 0.53 years) recruited from 12 randomly selected local secondary schools in Hong Kong participated in a questionnaire survey in classroom settings between January and June, 2020, right after the COVID-19 outbreak. The questionnaire includes demographic characteristics and scales that measure social networking sites/apps use and social networking addiction, mental health, and quality of life.

Results

Approximately 46.4% of the participants reported using social networking sites/apps often or very often, and 7.8% met the criteria for social networking addiction using Bergen's Social Media Addiction Scale. The prevalence of mild to extremely severe depression, anxiety, and stress among the adolescents stood at 39.6, 37.5, 48.8%, respectively, and the participants' physical, social, and school functioning were lower than the norms of healthy adolescents before the pandemic. Participants who used social networking sites/apps but for <3 h per day (excluding students who never used social networking sites/apps) showed significantly fewer problems of depression, anxiety, and stress than did those who spent more than 3 h per day on social networking sites/apps. Social networking addiction was found to be consistently associated with poor mental health and health-related quality of life.

Conclusion

This study provides important evidence supporting the potential protective effect of guiding adolescents to use social networking sites/apps appropriately in order to mitigate their negative emotions during contexts such as that of the pandemic; it further points to the need to provide extra support to promote the well-being of young people, especially those in disadvantaged situations (e.g., non-intact family) during and after the pandemic.

Can ResilienceNHope, an evidence-based text and email messaging innovative suite of programs help to close the psychological treatment and mental health literacy gaps in college students?

There is a high prevalence of stress, anxiety, depression, and substance use disorders in college students globally. Financial stressors, course workload, peer pressure, and other personal, family, and societal stressors contribute to the high incidence of mental disorders among college students. Despite the high prevalence of mental disorders in college students, barriers such as lack of mental health literacy, stigma of mental health, inadequate numbers of mental health counselors and clinical psychologists supporting students in colleges in both low- and high-income countries, and financial and geographical barriers often hinder college students from accessing the needed mental supports. There is increasing evidence on the effectiveness and feasibility of mobile technology in health promotion and closing psychological treatment gaps. College students are well adapted to the use of mobile technology, particularly text and email messaging daily, which presents a unique opportunity for an innovative way to offer support for their mental health. In this article, we provide a perspective on the ResilienceNHope program, an evidence-based text and email messaging innovation, to close the psychological treatment gap and improve the mental health literacy of college students.

The Effect COVID Has Had on the Wants and Needs of Children in Terms of Play: Text Mining the Qualitative Response of the Happen Primary School Survey with 20,000 Children in Wales, UK between 2016 and 2021

Play is central to children's physical and social development. This study examines changes in children's response to questions on play opportunities between 2016 and 2021. Primary school children aged 8-11 in Wales participated in the HAPPEN survey between 2016 and 2021. The survey captures a range of information about children's health and wellbeing, including open-ended questions about what could make them happier. Text mining methods were used to examine how open-ended responses have changed over time in relation to play, before and, after the COVID enforced school closures. A total of 20,488 participant responses were analysed, 14,200 pre-school closures (2016 to pre-March 2020) and 6248 after initial school closures (September 2020-December 2021). Five themes were identified based on children's open-ended responses; (a) space to play (35%), (b) their recommendations on play (31%), (c) having permission to play (20%), (d) their feelings on health and wellbeing and play (10%) and (e) having time to play (4%). Despite differences due to mitigation measures, the predominant recommendation from children after COVID is that they would like more space to play (outside homes, including gardens), more time with friends and protected time to play with friends in school and at home.

COVID-19-Induced Seizures: A Meta-Analysis of Case Series and Retrospective Cohorts

The adverse events and complications of coronavirus disease 2019 (COVID-19) continue to challenge the medical profession despite the worldwide vaccination against the severe acute respiratory coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19. Other than typical respiratory manifestations, COVID-19 also presents a wide range of neurological manifestations. This article underlines the pooled incidence of COVID-19-induced seizures in patients with epilepsy and without epilepsy. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocols, we conducted a bibliographical search, and an initial search revealed 1,375 articles. In total, 21 articles were included in the final analysis by following the inclusion criteria. A total of 11,526 patients from 21 published articles that met the predetermined search criteria were included. The median age of the patients was 61.9 years, of whom 51.5% were males. A total of 255 patients presented with seizures as the first manifestation of COVID-19 with a prevalence of 2.2% (95% confidence interval = 0.05-0.24, p < 0.01) (I² = 97%), of which 71 patients had previously been diagnosed with epilepsy. Among patients with epilepsy, 49 patients had seizures as an initial presentation of SARA-CoV-2 with an incidence of 72% (0.54-0.85, p = 0.1) (I² = 34). Although the incidence of COVID-19-induced seizures is not high compared to other neurological manifestations, seizure incidence in epileptic patients with COVID-19 is remarkably high. New-onset seizures in any patient should be considered a presentation of COVID-19 in the absence of other causative factors.

Association between Physical Fitness Index and Psychological Symptoms in Chinese Children and Adolescents

The aim of this study was to determine the relationship between different physical fitness indices (PFIs) and psychological symptoms and each dimension (emotional symptoms, behavioral symptoms, social adaptation difficulties) of Chinese children and adolescents. Methods: A total of 7199 children and adolescents aged 13−18 in Jiangxi Province, China, were tested for grip strength, standing long jump, sit-ups, sit and reach, repeated straddling, 50 m run, 20 m shuttle run test (20 m SRT) items. The physical fitness indicators were standardized, converted to Z score and added up to obtain the PFI, and the self-assessment of the psychological section of the multidimensional sub-health questionnaire of adolescents (MSQA) to test the psychological symptoms, using the chi-square test to determine the psychological symptoms of different types of children and adolescents and binary logistic regression analysis to determine the association between psychological symptoms and different PFI grades. Results: The higher the PFI of Chinese children and adolescents, the lower the detection rate of psychological symptoms, emotional symptoms and social adaptation difficulties, from 25.0% to 18.4%, 31.3% to 25.7% and 20.1% to 14.4%, respectively. These results were statistically significant (χ2 = 14.073, 9.332, 12.183, p < 0.05). Taking the high-grade PFI as a reference, binary logistic regression analysis was performed. Generally, compared with the high-grade PFI, children and adolescents with a low-grade PFI (OR = 1.476, 95% CI: 1.200−1.814) or medium-grade PFI (OR = 1.195, 95% CI: 1.010−1.413) had a higher risk of psychological symptoms (p < 0.05). Conclusions: The lower the PFI of Chinese children and adolescents, the higher the detection rate of psychological symptoms, showing a negative correlation. In the future, measures should be taken to improve the physical fitness level of children and adolescents in order to reduce the incidence of psychological symptoms and promote the healthy development of children and adolescents.

Challenges and Implications of the COVID-19 Pandemic on Mental Health: A Systematic Review

The measures put in place to contain the rapid spread of COVID-19 infection, such as quarantine, self-isolation, and lockdown, were supportive but have significantly affected the mental wellbeing of individuals. The primary goal of this study was to review the impact of COVID-19 on mental health. An intensive literature search was conducted using PsycINFO, PsyciatryOnline, PubMed, and the China National Knowledge Infrastructure (CNKI) databases. Articles published between January 2020 and June 2022 were retrieved and appraised. Reviews and retrospective studies were excluded. One hundred and twenty-two (122) relevant articles that fulfilled the inclusion criteria were finally selected. A high prevalence of anxiety, depression, insomnia, and post-traumatic stress disorders was reported. Alcohol and substance abuse, domestic violence, stigmatization, and suicidal tendencies have all been identified as direct consequences of lockdown. The eminent risk factors for mental health disorders identified during COVID-19 include fear of infection, history of mental illness, poor financial status, female gender, and alcohol drinking. The protective factors for mental health include higher income levels, public awareness, psychological counseling, social and government support. Overall, the COVID-19 pandemic has caused a number of mental disorders in addition to economic hardship. This strongly suggests the need to monitor the long-term impact of the COVID-19 pandemic on mental health.

The Lockdown Impact on the Relations between Portuguese Parents and Their 1- to 3-Year-Old Children during the COVID-19 Pandemic

Many countries have applied mandatory confinement measures in response to the COVID-19 pandemic, such as school and kindergarten closures, which confined families to their homes. The study concerns the impacts of the first COVID-19 lockdown on the relationships between Portuguese parents and their children, in a non-clinical population composed of fathers and mothers of children between the ages of 12 months and 3 years and 364 days. An online questionnaire (set by the research team) and the Parenting Daily Hassles Scale (PDHS) concerning the confinement period were applied between 17 June and 29 July 2020. To assess the impacts of the lockdown, outcomes regarding the impacts perceived by the parents, the potential regression in the development of children, and the willingness to promote changes in family routines in the future, were considered. Of the total sample (n = 1885), 95.4% of the parents (n = 1798) said that, after confinement, the relationship with their children had improved or remained similar to the pre-confinement period; 97.3% (n = 1835) noticed positive changes in the development of their children, and 63.7% (n = 1200) noted that the relationships with their children during the confinement period would lead to some changes in family routines in the future. Multivariate regression analyses showed that most of the sociodemographic variables chosen were not associated with the outcomes. However, significant levels of pressure over parenting and parental overload (reported by high scores in the PDHS intensity and frequency scales), challenging behaviors of the children, and the impacts they had on parental tasks had negative influences on the studied outcomes. On the contrary, the number of adults living with their children, the perceptions regarding the development of their children, and sharing new experiences with them were significant factors for positively-perceived impacts on the relationships between them or in the desire to bring about changes in family routines in the future. The impacts of the lockdown on the relationships between parents and children aged between 1 and 3 years old were more dependent on relational aspects and on the parents’ sense of competence in exercising parental functions. We conclude that, despite the increased demands imposed by the lockdown, nearly all of the parents evaluated the quality of the relationship with their children as positive after this period.

"It's All COVID's Fault!": Symptoms of Distress among Workers in an Italian General Hospital during the Pandemic

BACKGROUND

Since the outbreak of the COVID-19 pandemic, healthcare workers (HCWs) have been faced with specific stressors endangering their physical and mental health and their functioning. This study aimed to assess the short-term psychological health of a sample of Italian HCWs and the related influencing factors. In particular, the study focused on the differences related to HCWs' gender and to having been directly in charge of COVID-19 patients or not.

METHODS

An online survey was administered to the whole staff of the Modena General University Hospital three months after the onset of the pandemic, in 2020. Demographic data and changes in working and living conditions related to COVID-19 were collected; mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21) and the Impact of Event Scale-Revised (IES-R).

RESULTS

1172 out of 4788 members returned the survey (response rate = 24.5%), the male/female ratio was 30/70%. Clinically significant symptoms assessed according to the DASS-21 emerged among 21.0% of the respondents for depression, 22.5% for anxiety and 27.0% for stress. Symptoms suggestive of a traumatic reaction were reported by 19.0% of the sample. Symptoms of psychological distress were statistically associated with female gender, job role, ward, changes in lifestyle, whereas first-line work with COVID-19 patients was statistically associated with more stress symptoms. HCWs reported a significant level of psychological distress that could reach severe clinical significance and impact dramatically their quality of life and functioning.

CONCLUSIONS

Considering the persistence of the international emergency, effective strategies to anticipate, recognize and address distress in HCWs are essential, also because they may impact the organization and effectiveness of healthcare systems.

Association of Obesity With COVID-19 Severity and Mortality: An Updated Systemic Review, Meta-Analysis, and Meta-Regression

Background

Obesity affects the course of critical illnesses. We aimed to estimate the association of obesity with the severity and mortality in coronavirus disease 2019 (COVID-19) patients.

Data Sources

A systematic search was conducted from the inception of the COVID-19 pandemic through to 13 October 2021, on databases including Medline (PubMed), Embase, Science Web, and Cochrane Central Controlled Trials Registry. Preprint servers such as BioRxiv, MedRxiv, ChemRxiv, and SSRN were also scanned.

Study Selection and Data Extraction

Full-length articles focusing on the association of obesity and outcome in COVID-19 patients were included. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used for study selection and data extraction. Our Population of interest were COVID-19 positive patients, obesity is our Intervention/Exposure point, Comparators are Non-obese vs obese patients The chief outcome of the study was the severity of the confirmed COVID-19 positive hospitalized patients in terms of admission to the intensive care unit (ICU) or the requirement of invasive mechanical ventilation/intubation with obesity. All-cause mortality in COVID-19 positive hospitalized patients with obesity was the secondary outcome of the study.

Results

In total, 3,140,413 patients from 167 studies were included in the study. Obesity was associated with an increased risk of severe disease (RR=1.52, 95% CI 1.41-1.63, p<0.001, I2 = 97%). Similarly, high mortality was observed in obese patients (RR=1.09, 95% CI 1.02-1.16, p=0.006, I2 = 97%). In multivariate meta-regression on severity, the covariate of the female gender, pulmonary disease, diabetes, older age, cardiovascular diseases, and hypertension was found to be significant and explained R2 = 40% of the between-study heterogeneity for severity. The aforementioned covariates were found to be significant for mortality as well, and these covariates collectively explained R2 = 50% of the between-study variability for mortality.

Conclusions

Our findings suggest that obesity is significantly associated with increased severity and higher mortality among COVID-19 patients. Therefore, the inclusion of obesity or its surrogate body mass index in prognostic scores and improvement of guidelines for patient care management is recommended.

Depression among young adults - risks and protective factors in the COVID-19 pandemic

Purpose

The present study aimed to assess the depression symptoms and predictors of depression in Polish young adults during online learning in the COVID-19 pandemic.

Methods

The online questionnaire, including the Kutcher Adolescent Depression Scale, was distributed to young Poles through school principals. The final sample consisted of 1,500 students between the ages of 18 and 23 attending secondary schools. Multivariable logistic regression assessed the relationships between sociodemographic factors, pandemic stressors, coping behaviours and depressive symptoms.

Results

56% of young Polish adults are experiencing significant depressive symptoms (95% CI: 1.82-13.96). Social isolation was recognized as the main stressor. Many significant predictors of depression were captured. Being female, living in the countryside, talking to parents, and participating in sports and hobbies are found to be protective factors. The following sociodemographic factors are important predictors of depression in young adults: being male, attending a secondary school, living in a large city. Experiencing stress due to pandemic and online learning is one of the risk factors for depression.

Conclusions

The majority of young Poles met the criteria for depressive disorders. The initial findings of the presented study not only highlight the need to address mental health consequences for young people during online learning, but also provide the grounds for the development of post-pandemic interventions.

Lockdown in France: Impact on Families of Young Children With Special Needs

Background

Families with young children have faced serious challenges during the first lockdown as a result of the COVID-19 pandemic. In addition to remote working, parents have had to monitor their children’s schoolwork and manage their daily lives. When one of the children also has neuro-developmental disorders, this results in an increased burden. We can therefore wonder how these families with one or more young children (under 6 years old) with special needs have experienced and dealt with this lockdown.

Aim of the Study

In this context, the “COVJEUNENFANT” study focused more specifically on the subjective experience, as a parent, of those who cared for children with special needs (i.e., with developmental disorders, neurodevelopmental disorders, proven disabilities or chronic health conditions) compared to the general population. We wished to see if the consequences of the health crisis were significantly different from those perceived by respondents in the general population (n = 490) and if the sociodemographic structure of these families differed from those of other respondents.

Methods

Ninety three French families with at least one child under 6 years old and one with developmental difficulties or a chronic illness, from a cohort of 490 control families, participated in a web-based survey during the first lockdown, from the 28th April 2020 to 29th May 2020.

Results

After presenting the participants’ sociodemographic characteristics, the results show that these French families (n = 93) are less wealthy than the control population “without special needs” (n = 397), have felt more pressures originating from their environment (families, friends, colleagues, media, social networks…), have suffered from more health issues (other than COVID-19), have taken more measures to protect themselves (social-distancing), and were less likely to feel happy. A significantly larger number of them lamented the lack of free time and voiced a larger need for information regarding children’s education. However, their parental role was felt as being more satisfying and their family relations strengthened more than in the general population of participants.

Conclusion

It is apparent that urgent prioritisation is needed in order to support and care for these families by continuing to provide care for their children in one way or another, and by ensuring that their need to adapt again does not exceed their own abilities and resources, especially as young children, who have high levels of requirements, are present in the home.

Change of Disease Spectrum Characteristics of Psychiatric Inpatients Before and After Lockdown Lifted During the COVID-19 Pandemic - Wuhan City, Hubei Province, China, 2021

What is already known about this topic?

The coronavirus disease 2019 (COVID-19) pandemic poses a significant threat to mental health globally and may change the proportion of hospitalized patients.

What is added by this report?

This report analyzed and compared the disease characteristics of psychiatric inpatients one year before and after Wuhan lifted lockdown during COVID-19. About 50% of the inpatients were diagnosed with bipolar disorder; females and adolescents had a higher prevalence of mental disorders.

What are the implications for public health practice?

More attention should be paid to the mental health of children, adolescents, and females.

Mental health status of adolescents in-home quarantine: a multi-region, cross-sectional study during COVID-19 pandemic in Bangladesh

Background

The population's mental and physical health worldwide are currently at risk due to the coronavirus pandemic. We evaluated the mental health status of the adolescents trapped indoors because of the precautionary restrictions and prolonged closure of the educational institutions.

Method

A cross-sectional study was conducted on adolescents from multiple urban and semi-urban areas of Bangladesh from 22 January to 3 February 2021. A self-reported online questionnaire containing questions regarding sociodemographic factors, home quarantine-related factors and mental health symptoms was distributed to collect data. Descriptive analysis, bivariate and multivariable logistic regressions were performed to measure the association of the variables. Cronbach's alpha was estimated to present the internal consistency of the scales.

Results

A total of 322 adolescents (aged 12–19) with a mean age of 16.00 years (SD = 1.84) responded to the invitation. 54.97% (n = 177) of them were male, and the participants were predominantly urban residents (87.27%, n = 281). We observed varying degrees of depression in 67.08%, anxiety in 49.38% and stress in 40.68% of the participants according to DASS-21. Age, sex, education, mother's occupation, total monthly income, playing sports, doing household chores, going out of home, watching television, using the internet, attending online classes, changing food habits, and communicating with friends had a positive significant association with mental health burdens.

Conclusion

Home quarantine has a noticeable adverse impact on the mental health of teenagers. Psychological evaluations and counselling via online and offline programs are essential to improve adolescents' declining mental health conditions.

The gap between perceived mental health needs and actual service utilization in Australian adolescents

Despite being highly prevalent, adolescent mental health problems are undertreated. To better understand the mental health treatment gap, we assessed the prevalence and correlates of help-seeking, including perceived need for care and access to that care. Data were drawn from Young Minds Matter (YMM) survey-the second Australian child and adolescents survey of mental health and wellbeing. Parent-reported data and self-reported child data were combined into one dataset to analyse 2464 Australian adolescents aged 13-17 years. We employed bivariate and multivariate logistic regression models to assess the correlation between independent variables (professionally assessed with mental disorders only, self-reported self-harm/suicidality only and both) and their distribution over outcome variables (perceived need and service use). Mental disorders include depression, anxiety, ADHD and conduct disorder. Our study revealed 15.0%, 4.6% and 7.7% had professionally assessed with mental disorders only, self-reported self-harm/suicidality only and both, respectively. Overall, 47.4% and 27.5% of adolescents respectively perceived need for care and used services in the past-12-months. While among those only who perceived the need, only 53% of adolescents used any services. Professionally assessed with mental disorders only, self-reported self-harm/suicidality only and both were associated with higher likelihood of perceived need and service use (p < 0.001 for all). However, adolescents who self-reported self-harm/suicidality only were not found to be significantly associated with service use among those who perceived the need for care. Adolescents who perceived the need for mental health care but did not seek care represent a treatment gap. Our results suggest the importance of reducing the wide treatment gap that exists between need and care.

The Impact of COVID-19 Experiences on Adolescent Internalizing Problems and Substance Use Among a Predominantly Latinx Sample

Given the salience of socialization factors on adolescence and their role in vulnerability to disasters and trauma, this study examined whether COVID-19-associated fears and impacted quality of life mediated associations between pandemic-focused family conversations and media exposure and subsequent youth mental health. A primarily Latinx sample of adolescents (N = 167; Mage = 16.2 years, 44.9% female) participated in a longitudinal (summer 2020-winter 2020) COVID-19 study. COVID-19 media exposure predicted engagement in relevant safety behaviors, which negatively impacted quality of life, which in turn predicted increased internalizing problems. COVID-19 family conversations predicted social distancing fears, which negatively impacted quality of life, which then in turn also predicted increased internalizing problems. Targeting key socialization factors may minimize negative consequences following major community trauma among adolescents.

The Effect of Socio-Demographic Factors in Health-Seeking Behaviors among Bangladeshi Residents during the First Wave of COVID-19

Background: Socio-demographic variability among nations and cultures highly influences health-seeking behavior (HSB) in managing endemic or pandemic diseases. The present study aimed to investigate the influence of socio-demographic factors on HSB among Bangladeshi residents during the first wave of COVID-19. Methods: A cross-sectional online survey was performed with Bangladeshi residents (60% male and 40% female; age range: 10−60 years or above) from May to July 2020. Information was collected from the participants who resided in slum areas or did not have internet access through face-to-face surveys, maintaining spatial distancing and proper preventive measures. A self-reported and structured questionnaire, including socio-demographic and HSB, was undertaken, and the data was analyzed using a convenience sampling method. Finally, among the 947 participants, 20 were selected using a stratified random sampling technique for in-depth-interview (IDI). The linear regression analysis was performed to determine the influence of socio-demographic factors on HSB. Results: Only about 4.2% of respondents did not wear masks, but nearly half of the participants (46.6%) did not use hand gloves. The mean score of HSB was 9.98 (SD = 2.01) out of 16, with a correct overall rate of 62.4%. As per regression analysis, higher HSBs were found among participants who reported older age (>50 years) (9.96 ± 2.45), educated unemployed students (10.1 ± 1.95), higher education (10.5 ± 1.76), and higher-income (10.4 ± 1.59); in contrast, participants living in slum areas (8.18 ± 2.34) and whose source of income was business (8.46 ± 2.04) exhibited lower HSBs. Females, compared to men, showed better HSB in every aspect, apart from online food ordering. Qualitative data showed that the younger generation is more aware because of their access to information and persuaded the older generations to follow health-seeking protocols. The results also showed that some lower-income slum-dwellers have access to information and healthcare through their employers. IDIs also found cultural, religious, and mental-health affect people’s adherence to health-seeking guidelines and regulations. Conclusions: The findings suggest that socio-demographic factors significantly influenced HSBs during COVID-19 in the Bangladeshi population. Authorities can use these observations to systematically manage future endemics or pandemics.

Exploring Deeper Causes Linking Adolescents' Mental Disorders to Mobile Phone Use Problems: Grounded Theory Approach

BACKGROUND

Evidence from a variety of studies link mobile phone use with an increase in mental health problems, with the situation being particularly prevalent in China and exacerbated by the COVID-19 quarantine.

OBJECTIVE

This study aims to reveal underlying connections between mobile phone use and mental disorders of adolescents, and to develop a theory to help parents and counseling psychologists better understand and intervene in future cases.

METHODS

A total of 37 teenagers having both mental health and mobile phone use problems, along with their parents, were included for individual interviews. These interviews were transcribed, coded, and analyzed using qualitative methods of grounded theory.

RESULTS

The grades-ranking-first mentality is one of the main factors causing problems such as defective family bonding and peer influences, pushing teenagers with mental disorders to seek comfort in the virtual world through their cellphones.

CONCLUSIONS

The idea proposed in this study is not only inspiring for psychological counseling and therapy on adolescents with mental problems but also beneficial for school educators and parents to better understand the adolescents. The findings of the study are also particularly noteworthy in the postpandemic age, where parents whose work locations and schedules are substantially affected due to any emergencies should try to build a relaxing and cozy atmosphere at home to avoid possible conflicts with adolescents.

Mortality and Severity in COVID-19 Patients on ACEIs and ARBs-A Systematic Review, Meta-Analysis, and Meta-Regression Analysis

Purpose: The primary objective of this systematic review is to assess association of mortality in COVID-19 patients on Angiotensin-converting-enzyme inhibitors (ACEIs) and Angiotensin-II receptor blockers (ARBs). A secondary objective is to assess associations with higher severity of the disease in COVID-19 patients. Materials and Methods: We searched multiple COVID-19 databases (WHO, CDC, LIT-COVID) for longitudinal studies globally reporting mortality and severity published before January 18th, 2021. Meta-analyses were performed using 53 studies for mortality outcome and 43 for the severity outcome. Mantel-Haenszel odds ratios were generated to describe overall effect size using random effect models. To account for between study results variations, multivariate meta-regression was performed with preselected covariates using maximum likelihood method for both the mortality and severity models. Result: Our findings showed that the use of ACEIs/ARBs did not significantly influence either mortality (OR = 1.16 95% CI 0.94-1.44, p = 0.15, I 2 = 93.2%) or severity (OR = 1.18, 95% CI 0.94-1.48, p = 0.15, I 2 = 91.1%) in comparison to not being on ACEIs/ARBs in COVID-19 positive patients. Multivariate meta-regression for the mortality model demonstrated that 36% of between study variations could be explained by differences in age, gender, and proportion of heart diseases in the study samples. Multivariate meta-regression for the severity model demonstrated that 8% of between study variations could be explained by differences in age, proportion of diabetes, heart disease and study country in the study samples. Conclusion: We found no association of mortality or severity in COVID-19 patients taking ACEIs/ARBs.

The Emotional Response to Pandemic of Middle- and High-School Students of an Italian Northern Province: The ERP Study

The COVID-19 outbreak variably affected people’s mental reactions worldwide but was only episodically investigated in healthy Italian teenagers. Our aim was to investigate the emotional responses of Italian middle and high school students to the pandemic. An anonymous 10-item questionnaire was distributed in pre-selected school samples. Responders had to score their perceived extent for each reaction from 0 (lowest perception) to 10 (highest perception). A group of adults was selected as control. Generalized linear models were used to estimate differences among adults and students, high school (HS) and middle school (MS) students, and urban (U) and rural (R) MS students. Comparisons were presented as mean difference (Δ) with a 95% confidence interval (CI). A total of 1512 questionnaires (635 adults, 744 HS, 67 UMS, and 66 RMS) were analyzed. Students appeared more indifferent (Δ = 1.97, 1.52–2.41), anxious (Δ = 0.56, 0.07–1.04), aggressive (Δ = 2.21, 1.72–2.70), and depressed (Δ = 1.87, 1.40–2.34) than adults did, and claimed a higher loss of interest in their activities (Δ = 1.21, 0.72–1.70). Students were less disbelieving (Δ = −0.93, −1.50–0.35) and feared for their loved ones (Δ = −0.89, −1.40–0.39). MS students were less affected by the outbreak than HS students were. Furthermore, R-MS students were significantly less aggressive and depressed, but more indifferent and disbelieving than U-MS. Female sex was an independent factor associated to almost all the questionnaire domains. The pattern of the psychological responses to the pandemic in Italian students proved multifaceted. In addition to anxiety, loss of interest in activities, and depression, aggressiveness emerged as the most characterizing mental attitude in response to the pandemic.

Efficacy and Safety of Dapagliflozin versus Liraglutide in Patients with Overweight or Obesity and Type 2 Diabetes Mellitus: A Randomised Controlled Clinical Trial in Tianjin, China

OBJECTIVE

We aimed to clarify the efficacy of dapagliflozin versus liraglutide in patients with overweight or obesity and type 2 diabetes mellitus (T2DM) at the beginning of the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

T2DM patients with overweight or obesity who visited the Metabolic Disease Management Center at Tianjin Fourth Central Hospital from October 2019 to January 2020 were recruited and randomised to receive dapagliflozin or liraglutide for 24 weeks. Changes in blood glucose and lipid levels, blood pressure, and body weight, as well as the occurrence of hypoglycaemia and other adverse events, were compared.

RESULTS

309 patients completed the study (143 in liraglutide group and 166 in dapagliflozin group). After 24 weeks, HbA1c, fasting blood glucose (FPG), and 2 h postprandial blood glucose (2hPG) levels significantly decreased from 8.80% ± 1.41% to 7.02% ± 1.05%, 10.41 ± 3.13 to 7.59 ± 2.16 mmol/L, and 17.90 ± 4.39 to 10.12 ± 2.47 mmol/L, respectively, in the dapagliflozin group, and from 8.92% ± 1.49% to 6.78% ± 1.00%, 10.04 ± 2.99 to 7.20 ± 1.63 mmol/L, and 17.30 ± 4.39 to 10.13 ± 4.15 mmol/L, respectively, in the liraglutide group. Changes in HbA1c, FPG, and 2hPG levels between groups were not significantly different. Systolic blood pressure (SBP) and low-density lipoprotein cholesterol (LDL-C) level significantly decreased from 144.1 ± 19.1 to 139.7 ± 16.2 mmHg (p = 0.001) and from 3.21 ± 0.94 to 2.98 ± 0.89 mmol/L (p = 0.014), respectively, in the dapagliflozin group. After COVID-19 outbreak, the number of patients taking sleep-promoting drugs increased from 4.9% to 9.4% (p = 0.029).

CONCLUSIONS

Liraglutide and dapagliflozin had strong hypoglycaemic effects in patients with overweight or obesity and T2DM at the beginning of the COVID-19 pandemic. Dapagliflozin may be beneficial in improving SBP and LDL-C levels; however, further research is warranted.

Physical Distancing and Mental Well-Being in Youth Population of Portugal and Brazil during the COVID-19 Pandemic

<b><i>Background:</i></b> The COVID-19 pandemic may affect youth’s physical and mental well-being, partially because of the countries’ rules to contain the virus from spreading. However, there is still uncertainty about the impact of physical distancing on youth’s mental health. We aimed to estimate the prevalence of feeling agitated, anxious, down, sad, or low mood (FNF) due to physical distance measures and verify which factors are associated with young Portuguese and Brazilian people. <b><i>Methods:</i></b> We used cross-sectional data from the instrument “COVID-19 Barometer: Social Opinion” in Portugal (March 2020 and September 2021) and from “COVID-19 Social Thermometer” in Brazil (August 2020 to April 2021); these surveys included data regarding the health and socioeconomic impact on the population. The health and sociodemographic variables of the two countries were summarized as absolute and relative frequencies. A multivariable logistic regression model was fit by country to estimate the relation between FNF and selected variables of interest. <b><i>Results:</i></b> Approximately 36% of the sample studied reported anxiety, agitation, sadness, or low mood almost every day in Portugal and 52% in Brazil due to physical distancing. In Portugal, having more than two comorbidities represented a greater chance of experiencing FNF every day or almost every day (odds ratio [OR] = 1.51 [CI: 1.22–1.87]) than those without comorbidities. In contrast, having a university education level represented a protector factor (OR = 0.76 [CI: 0.67–0.88]). In Brazil, being unemployed increased the chance of FNF compared to students (OR = 11.2). <b><i>Conclusions:</i></b> Physical distancing measures have impacted the mental well-being of the young population in Portugal and Brazil. The countries must make a quick effort to attend to and protect young people’s well-being and mental health in the changing context of the current pandemic.

Challenges With Long-Term Care Placement in Pediatric Psychiatry During COVID-19: A Case Series From Inpatient Unit

A large number of children and youth have been affected worldwide during the coronavirus disease 2019 (COVID-19) pandemic. Apart from the obvious medical and financial impacts of the COVID-19 pandemic, there has been an immense amount of psychosocial impact specifically on children and adolescents ranging from parents losing their jobs leading to financial hardships to school closure leading to not having significant interaction with their peers and having to spend more time at home which often leads to psychosocial conflicts. According to the literature review, in recent times, there has been worsening of mental health illnesses, increased suicide attempts, and severity of suicide attempts which has led to more visits to the hospitals and clinics with psychiatric concerns. There has been a pattern of increasing patient acuity in inpatient psychiatric units, more specifically in the pediatric units. The average length of stay for inpatient units has been increasing in the pediatric psychiatric units and an unfortunate downside of which has been noted to be increased lag time for placements in foster care systems or residential treatment centers in recent times. Here, we present cases of three teenagers who faced significant challenges in obtaining placement to foster care systems or residential treatment centers in the context of longer wait times experienced for intensive-out-of-home treatment services during the COVID-19 pandemic and discuss potential solutions to this issue.

Clinical practice during the COVID-19 pandemic: a qualitative study among child and adolescent psychiatrists across the world

BACKGROUND

The COVID-19 pandemic has directly impacted the field of child and adolescent psychiatry, affecting all aspects of the lives of children and their families and increasing their risk of distress and mental health issues, especially among children with preexisting psychiatric disorders. Child and adolescent psychiatrists (CAPs) across the world have had to adapt their practice, due to lockdown and social distancing measures. This study aimed to explore how CAPs experienced their clinical practice in these singular conditions.

METHODS

This exploratory international qualitative study used the Inductive Process to analyse the Structure of lived Experience (IPSE) approach, which is a five-stage inductive process used to explore the lived experience of participants in depth and to analyze their structure of lived experience. This study took place from March through July 2020 through individual in-depth video interviews. The sample size was determined according to the principles of theoretical sufficiency.

RESULTS

39 CAPs from 26 countries participated (age range 32-70 years; 23 women). Data analysis produced a structure of lived experience comprising three central axes of experience: (1) lost in space, lost in time, describing CAPs' experience of disorganization of their clinical practice in the dimensions of lived time and lived space, (2) the body-of CAPs and patients-underlining their disconcerting experience of both sensory aspects and the non-embodied encounter during clinical practice, and (3) unpleasant emotions, with angst and loneliness the two main feelings coloring their clinical practice experience.

CONCLUSIONS

This analysis of the structure of lived experience of CAPs went beyond the sole context of the pandemic and revealed key aspects of what usually organizes CAP clinical practice. It identified two blind spots or conceptual voids within the child and adolescent psychiatry field: first, the intrinsic therapeutic function of a CAP clinical practice and, second, the important diagnostic and therapeutic function of the embodied encounter during CAP consultations. Beyond the context of COVID-19, further research should investigate these aspects to better define what a CAP does in practice and to increase both attractiveness and recruitment in this specialty.

Phased Return of Students to 77 Transitional Kindergarten-8th Grade Schools With Cohesive Mitigation Strategies Serving as Protective Factors Against the Increase of COVID-19 Cases in Marin County: September 2020-January 2021

Background and objective Earlier uncertain implications of the coronavirus disease 2019 (COVID-19) pandemic on the pediatric population prompted the authorities to close schools worldwide under the premise that school settings would serve as drivers of an increase in the cases of COVID-19. Safe and equitable full-in-person school instruction is a critical factor in the continued educational gains of children and for their general well-being. The objective of this study was to report epidemiological trends related to the increasing percentage of students returning to in-person instruction, the suspected in-school transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, and countywide COVID-19 case rates during the first 21 weeks of school reopening in Marin County, CA, in the fall of 2020. Materials and methods The institutional review board (IRB) approval was waived for this study as it did not involve any identifiable human subjects data. Retrospective electronic reviews of countywide COVID-19 daily case count and COVID-19-related reports associated with in-person school participants from 77 schools in Marin County, CA, from September 8, 2020, to January 29, 2021, were conducted. The data were made available in collaboration with the Marin County Office of Education (MCOE) and Marin County Department of Health and Human Services (Marin HHS). Descriptive trends analyses were performed to determine whether the phased increase of students attending in-person learning was a significant contributor to countywide COVID-19 incidence rate, crude rate, and in-school COVID-19 viral transmission. This is the first long retrospective study of COVID-19 data among the reopened school population during the second half of the first pandemic year. It was conducted in a 21-week surveillance period involving an immense collaboration between Marin County's public health officials and school administrators. Results Over the 21-week observational period involving 17,639 students, 4,938 school staff, and 899,175 student days, the countywide COVID-19 crude rate decreased (from 89.9 to 35.89 per 10,000) as more students returned to in-person learning. The schools' strict adherence to public health guidance and site-specific safety plans against COVID-19 yielded a significantly reduced incidence rate of 0.84% among in-person learning participants; only nine cases were traced to suspected in-school SARS-CoV-2 transmission by way of rigorous contact tracing. The countywide COVID-19 incidence rate was 2.09%. Conclusions It is possible to minimize COVID-19 transmissions in in-person learning settings with cohesive mitigation strategies, specifically strict adherence to proper masking by students and staff while on school grounds. There is no clear correlation that the increasing phased return of students to in-person school drove an increase in countywide COVID-19 cases in Marin County, CA. Our findings revealed that schools were capable of safely resuming operations by following public health orders and recommendations. The increasing percentage of students returning to in-person school did not drive an increased COVID-19 case rate in the community. On the contrary, this analysis revealed that there was a drop in countywide COVID-19 cases as the phased student return percentage increased.

Mental Health Issues During and After COVID-19 Vaccine Era

The COVID-19 pandemic has persisted for more than a year, and post-COVID-19 sequelae of neurological complications, including direct and indirect effects on the central nervous system (CNS), have been recognized. There is a plethora of evidence for neurological, cognitive, and emotional deficits in COVID-19 patients. Acute neurological symptoms like neuroinflammation, cognitive impairment, loss of smell, and brain stroke are common direct effects among SARS-CoV-2 infected individuals. Work-associated stress, lockdowns, social distancing, and quarantine in response to contain SARS-CoV-2 have also affected the mental health of large populations, regardless of age. Public health emergencies have affected individuals and communities, resulting in emotional reactions and unhealthy behaviors. Although vaccines have been widely distributed and administered among large populations, vaccine hesitancy still exists and may be due to apprehension about vaccine efficacy, preliminary trials, and associated side effects. This review highlights the impact of COVID-19 on the CNS by outlining direct and indirect effects and factors contributing to the decline in people's mental health throughout the COVID-19 pandemic both during and after vaccine administration. Furthermore, we also discuss reasons for vaccine hesitancy and why some groups of people are deprived of vaccines. Finally, we touched upon the social determinants of mental health and their impact on disadvantaged populations during times of crisis which may help policymakers set up some action plans to mitigate the COVID-19 mental health turmoil during this ongoing pandemic.

Impact on Mental Health of Families during Covid-19: A Cross-Sectional Survey

Background

The global pandemic of novel coronavirus outbreaks threatens the general public and health care workers' physical, social and mental well-being. Therefore, the current study is aimed to highlight the status of mental health of families suffering from the COVID-19 pandemic.

Methods

An online cross-sectional survey was conducted on 560 families through Google Form distributed via email, Whatsapp groups, Facebook, and LinkedIn from November 2020 to January 2021 during the pandemic period in Karachi through the snowball sampling technique. The status of COVID-19 patients was assessed through demographics information and contextual factors questions whereas impact on mental health was assessed through Depression Anxiety Stress Scale (DASS-21).

Results

A total number of 536 participated in the study. The prevalence of depression, anxiety and stress was found to be 38.99%, 26.67%, and 15.48% respectively included 31% of males and 69% where the highest number of respondents belonged to district Central (37.8%). Chi square estimation was found to be significant among both the gender and in between all the age group ranges from 20 to 60 years. Moreover, significant association among categorical division of demography and DASS-21 p<0.05 was observed.

Conclusion

The results of our study indicated high rate of depression and anxiety in majority of families; in particular females. Consistent with these symptoms, significant association was found between gender and age from high to low socioeconomic status.

COVID-19 pandemic: Is teenagers' health in crisis? An investigation into the effects of COVID-19 on self-reported mental and physical health of teenagers in secondary education

Objectives

To evaluate the effects of the COVID-19 lockdown on the self-reported perception of physical and mental health, in a cohort of teenagers. To assess the extent to which these effects are perceived as detrimental.

Non-directional Hypothesis - the perception of physical and mental health will change over the duration of the eight weeks, due to the effects of the lockdown, as a result of COVID-19.

Design

This was a prospective longitudinal study evaluating the effects of the COVID-19 lockdown in the UK over the eight week period, against the political timeline during which the study was conducted (April 08, 2020–June 04, 2020).

Setting

Participants were all in secondary education, ranging from years 10–13 (ages 15–18).

Participants

55 volunteers have taken part in the study, the group of participants was mixed-sex and of different ethnic groups. Participants were chosen via an opportunity sampling method. All participants stem from a middle to high socioeconomic background. The target demographic of the study was teenagers in secondary education, so participants have been selected from a volunteer sample that is representative of this population.

Main outcome measures

Physical health and Mental health.

Results

Data obtained was synchronised with the political timeline over the eight week period, in order to provide specific interpretations for the findings of the study.

Measures of physical health: Sleep with a median length of 8 ​h in comparison to seven before lockdown (SD between 1.236 and 1.835); 70.00% of participants experienced a decline in their physical health; Productivity amongst participants slightly decreased (76.70%–62.90%). The measures of mental health: Length of screen time, with a median length of 6 ​h in comparison to four before lockdown (SD between 1.48 and 3.3), however, it remained stagnant over the study period and participants did not experience a further increase; The number of hours spent on social media also increased, with an increasing number of participants spending over 4 ​h on social media; Conflicts increased in their family environment (from 25.60% to 37.10% of participants reporting more conflicts). During virtual school, conflict was at its lowest point (18.40%) and harmony in the family environment was at its highest peak (65.80%). 51.00% of participants relayed a decline in their mental health. A statistically significant correlation was found between exercise and creativity, both of which decreased over the study period (r_s ​= ​0.42 is bigger than the critical value ​= ​0.22 when p ​= ​0.05).

Conclusions

Despite certain positive effects, the overall impact of lockdown during the COVID-19 pandemic has been negative, regarding both physical and mental health, for this cohort of young people.

COVID-19 and eating disorder and mental health concerns in patients with eating disorders

BACKGROUND

The Coronavirus (COVID-19) pandemic dramatically transformed daily life for adolescents and young adults, altering social and physical environments. Previous research has shown such shifts in daily life to be especially challenging for people living with eating disorders (ED). However, the extent of this environmental change on ED symptoms and mental health (MH) has been relatively unexplored in patients with EDs. This study examines how young people with EDs feel the COVID-19 pandemic has affected their living environments as well as their ED and MH symptoms and motivation for ED recovery.

METHODS

Participants were enrollees in the Registry of Eating Disorders and their Co-morbidities OVER time in Youth (RECOVERY) who responded to an additional survey (n = 89) in July 2020 to assess their perceptions of the impact of the COVID-19 pandemic. Participants reported on concerns of their ED worsening due to increased time living in a "triggering environment" due to the pandemic as well as perceived COVID-related changes in intrusive ED thoughts, depression, anxiety, isolation, and motivation to recover. Logistic regression models, adjusted for age and ED diagnosis, examined the association of triggering environment with ED and MH symptoms.

RESULTS

The majority of respondents reported concern for worsening of their ED due to a "triggering environment" (63%). Most reported an increase in ED thoughts (74%), feelings of anxiety (77%), depression (73%), and isolation (80%) they perceived to be related to the pandemic. Nearly one-third reported decrease in motivation to recover (29%) they perceived to be related to the pandemic. After adjusting for age and ED diagnosis, participants who reported concern for worsening of their ED due to a triggering environment had nearly 18 times the odds of decreased motivation to recover (OR 18.1; 95% CI 3.37-97.4, p = 0.003) and nearly 24 times the odds of increased ED thoughts (OR 23.8; 95% CI 4.31-131.6, p < 0.001) compared to those who did not report concern for worsening of their ED due to a triggering environment.

CONCLUSIONS

Our findings demonstrate the perceived negative impact the COVID-19 pandemic has had on the self-reported ED and MH symptoms in patients with EDs, particularly in those who report concern for a negative environmental change. These results underscore the need for heightened monitoring of patients with EDs during the pandemic.

Addressing the Clinical Impact of COVID-19 on Pediatric Mental Health

The COVID-19 pandemic impacts daily lives of families globally. Sequelae are not limited to physical consequences of medical complications but extend into social, emotional, spiritual, and psychological health. Interventions including mask-wearing and physical distancing are intended to prevent viral spread, but have unintended negative effects on mental health and child development. Although it is too early to know the full impact, practicing pediatric clinicians are well-positioned to help young people recover and thrive despite challenges presented. This article will review the impact of COVID-19 on child mental health and give practical interventions to foster resilience in youth and their families.

Well-Being Perception during COVID-19 Pandemic in Healthy Adolescents: From the Avatar Study

The COVID-19 pandemic provided an extraordinary and naturalistic context to observe young people’s psychosocial profiles and to study how a condition of environmental deprivation and lack of direct social contact, affects the well-being and health status of adolescents. The study explored whether the COVID-19 outbreak changes, in the short term, the acute well-being perception in adolescents, as measured by a Personalized Well-Being Index (PWBI) and the four components affecting health (i.e., lifestyle habits, social context, emotional status, mental skills), in a sample of early adolescent students. Data from 10 schools were collected on 1019 adolescents (males 48.3%, mean age 12.53 ± 1.25 y). Measurements were obtained at two time points, in September/October 2019, (baseline condition, BC) as part of the “A new purpose for promotion and eVAluation of healTh and well-being Among healthy teenageRs” (AVATAR) project and during the Italian Lockdown Phase (mid–late April 2020, LP), with the same students using an online questionnaire. During COVID-19 quarantine, adolescents showed a lower PWBI (p < 0.001) as compared to the BC. Considering the four health-related well-being components, lifestyle habits (p < 0.001), social context (p < 0.001), and emotional status (p < 0.001), showed significantly lower values during LP than BC. However, mental skills, in LP, displayed a significant increase as compared to BC (p < 0.001). In this study, we have provided data on the personalized well-being index and the different components affecting health in adolescents during the COVID-19 lockdown, showing a general decrease in well-being perception, expressed in lifestyle habits, social, and emotional components, demonstrating detrimental effects in the first phase of quarantine on adolescents’ psychosocial profiles. Our results shed new light on adolescence as a crucial period of risk behavior, especially when social support is lacking.

Mental Health and Physical Activity among Children and Adolescents during the COVID-19 Pandemic

Coronavirus disease 2019 (COVID-19) is causing disruptions in the global social system. Japanese children and adolescents have had their schools closed, government-mandated activity restrictions imposed, and interactions outside the home reduced. These restrictions can have a considerable psychological impact on children and adolescents. This review aims to describe the impacts of COVID-19 pandemic on physical activity and psychological status of this population. The review was conducted by searching PubMed for information on the impact of COVID-19-related activity restrictions on children and adolescents. The search identified 11 articles, three of which contained data on anxiety and psychological problems due to physical inactivity. Next, a PubMed search was conducted about physical activity and psychological status in children and adolescents under psychological stress. The search identified 368 articles, 28 of which were included in the review. For children, data that revealed a correlation between physical activity and psychological health and sedentary time leading to mood disorders were included. For adolescents, there were nine studies that reported a correlation between physical activity and psychological health and four studies that reported no correlation between physical activity and psychological health. Of the studies that reported a correlation, seven reported that physical activity improves psychological health. The impact of psychologically stressful situations such as COVID-19 on children and adolescents has been experienced worldwide. Physical activity has been correlated with psychological health, and it may improve psychological status; physical activity should be recommended to better support the psychological health of children and adolescents under the influence of COVID-19.

A multi-tiered systems of support blueprint for re-opening schools following COVID-19 shutdown

The COVID-19 pandemic will create enormous disruptions for youth and families with respect to economic and health status, social relationships, and education for years to come. The process of closing and intermittently reopening schools adds to this disruption and creates confusion for parents and school officials who must balance student educational progress with health and safety concerns. One framework that may serve as a roadmap in this regard is a multi-tiered systems of support (MTSS) model. This article briefly addresses four main domains of functioning (adjustment, traumatic stress, academic status, health and safety) across three tiers of support (universal, targeted, intensive). Each section draws on existing literature bases to provide specific recommendations for school officials who must address various and changing logistical, academic, and health-based challenges. The recommendations are designed to be flexible given fluctuations in the current crisis as well as focused on maximum-value targets. An MTSS approach adapted for contemporary circumstances can also be used to help address longstanding disparities that have been laid bare by the pandemic.

School-Based Approaches to Prevent Depression in Adolescents

Depression is one of the highest prevalent mental illnesses and is one of the common illnesses that can have its onset during childhood or adolescence. It is estimated that up to 20% of children experience mental illness worldwide. Preventing the onset of depression in children and adolescents should be a vital public health goal that will improve public health and decrease health care costs. We reviewed literature that described school-based interventions to prevent the onset of depression, reduce the severity of depressive symptoms, and enhance global functioning in adolescents. Our research also provides strategies for school-based intervention programs that are mainly categorized into three main subtypes. We also discussed each subtype and its advantages and limitations. The goal is to bring the readers an understanding of the importance of preventing depression on a community level, beginning at schools.

The Many Faces of Covid-19 at a Glance: A University Hospital Multidisciplinary Account From Milan, Italy

In March 2020, northern Italy became the second country worldwide most affected by Covid-19 and the death toll overtook that in China. Hospital staff soon realized that Covid-19 was far more severe than expected from the few data available at that time. The Covid-19 pandemic forced hospitals to adjust to rapidly changing circumstances. We report our experience in a general teaching hospital in Milan, the capital of Lombardy, the most affected area in Italy. First, we briefly describe Lombardy's regional Covid-19-related health organizational changes as well as general hospital reorganization. We also provide a multidisciplinary report of the main clinical, radiological and pathological Covid-19 findings we observed in our patients.

Mental Health in Children in the Context of COVID-19: Focus on Discharged Children

Introduction: To date, the mental health consequences of children hospitalized with COVID-19 remain unclear. We aimed to assess mental health status in children in the context of COVID-19, with a focus on discharged children. Methods: We recruited discharged children who recovered from COVID-19 and healthy controls between July and September 2020 in Wuhan Children's Hospital. Post-traumatic stress disorder (PTSD), anxiety, depression, and sleep problems were assessed in these children using questionnaires. Univariable and multivariable logistic and linear regressions were conducted to identify risk factors. Results: Totally, there were 152 children (61 discharged children and 91 healthy controls) aged 7-18 years old in our study. An increasing trend in the prevalence of PTSD, anxiety, and depression was observed in the discharged children compared with healthy controls (PTSD: 8.20 vs. 2.20%, anxiety: 22.95 vs. 13.19%; depression: 47.54 vs. 32.97%). Discharged children tended to report more depressive symptoms (β = 0.39) and less sleep problems (β = -0.37). Discharged children who lived in nuclear families and had longer hospital stays were more likely to report depression [odds ratio (OR) = 3.68 and 1.14, respectively]. Anxiety symptoms and the severity of sleep problems of discharged children were positively associated with caregivers' depression and PTSD symptoms (OR = 21.88 and 31.09, respectively). Conclusion: In conclusion, PTSD, anxiety, and depression symptoms were common among recovered children 4 months after COVID-19 hospitalization. Children from nuclear family and those had longer hospital stays need special attention. In addition, parental mental health had a significant impact on their children's mental resilience and recovery.

Online Learning Performances of Children and Adolescents With Attention Deficit Hyperactivity Disorder During the COVID-19 Pandemic

To investigate attention deficit hyperactivity disorder (ADHD) core symptoms that impair executive function (EF), emotional state, learning motivation, and the family and parenting environment of children and adolescents with ADHD, both with and without severe difficulties. This will be explored within an online learning environment during the period of COVID-19 pandemic. A total of 183 ADHD children diagnosed using DSM-V criteria were selected and divided into 2 groups high difficulties during online learning (HDOL) and low difficulties during online learning (LDOL) according to the answer of Home Quarantine Investigation of the Pandemic (HQIP). The participants filled out a set of questionnaires to assess their emotional state and learning motivation, and their parents also filled out the questionnaires about ADHD core symptoms, EF, and family and parenting environment. Compared with ADHD children in the LDOL group, the children in the HDOL group had significant symptoms of inattention, hyperactivity, oppositional defiant, behavioral and emotional problems according to the Swanson, Nolan, and Pelham Rating Scale (SNAP). They also had more severely impaired EF according to the Behavior Rating Inventory of Executive Function (BRIEF), more difficulties and disturbances in the family by the Chinese version of Family Environment Scale (FES-CV), and lower parenting efficacy and satisfaction by Parenting Sense of Competence (PSOC). With regard to the self-rating questionnaires of children and adolescents, the HDOL group reported lower learning motivation according to the Students Learning Motivation Scale (SLMS). By Screening for Child Anxiety-Related Emotional Disorders and Depression Self-Rating Scale for Children (DSRSC), those in HDOL presented more negative emotions. The HDOL group spent significantly more time on both video games and social software per day and significantly less time on multiple activities per week, when compared to those in the LDOL group. This study demonstrated that ADHD children and adolescents with HDOL had more inattention-related behaviors, more severe emotional problems and EF impairment, weaker learning motivation, and poorer family and parenting environment. Meanwhile, digital media use should be supervised and appropriate extracurricular activities should be encouraged by parents and schools.