Child and adolescent mental health service provision and research during the Covid-19 pandemic: challenges, opportunities, and a call for submissions

The protective effects of Swedish COVID-19 pandemic strategies on adolescents' mental health: a longitudinal cohort study

AIM

The aim of this study was to investigate a cohort of Swedish eighth graders' mental health and experiences during the COVID-19 pandemic.

METHODS

Participants were 157 eighth graders recruited in junior high schools during 2020 who completed a depression questionnaire and a survey about their psychosocial health in relation to the COVID-19 pandemic, alongside a follow-up assessment in 2021. Analyses were conducted using latent change score and cross-lagged models.

RESULTS

Participants' depressive symptoms did not substantially increase during the COVID-19 pandemic. The level of depressive symptoms in 2020 was significantly associated with participants' perceptions of the pandemic in 2020 and spring 2021. Participants with higher depression scores reported worse experiences of the pandemic.

CONCLUSIONS

The stable level of depressive symptoms among this cohort of eighth graders suggested that keeping schools open during a nationwide lockdown could mitigate some mental health consequences. Adolescents in this study with higher self-assessed depressive symptoms were more likely to experience increased depression after 6 months and had worse experiences during the pandemic than others. This suggests that the pandemic may not immediately affect mental well-being, but those at risk may be affected over time.

Mental health among children with long COVID during the COVID-19 pandemic

A growing number of studies report that persons of all ages, infected with SARS-CoV-2, may experience long-term persistent symptoms, known as long COVID (LC) or post COVID-19 condition. This is one of the first studies examining the consequences of LC on children's mental health. In this case-control study, we compared select mental health aspects of 103 children diagnosed with LC to a control group of 113 children uninfected with SARS-COV-2; all 4-18 years old. Both groups were assessed via parents' questionnaires. In comparison to the control group, children with LC exhibited more memory difficulties. However, no group differences emerged in other functional aspects (connection with friends and engagement in physical activities), problems with concentration, or levels of emotional-behavioral problems (externalizing, internalizing, ADHD, and PTSD symptoms). We also found that children with LC had greater exposure to COVID-19-related stressors. Higher levels of parental worries regarding their children's functioning and economic difficulties at home significantly predicted higher levels of children's emotional-behavioral problems and were better predictors than the child's age, social functioning, or LC diagnosis.    Conclusion: LC was associated with impairments in some aspects of children's memory which may relate to academic functioning, but not with higher rates of emotional-behavioral problems, thus warranting interventional programs addressing school functioning and cognitive abilities in this population. Additionally, parents' economic stress and worries regarding their child's emotional adjustment during the pandemic, are important factors affecting pandemic-related emotional-behavioral problems among children, regardless of COVID-19 infection, that should be addressed. What is Known: • Children may have long COVID (LC) after being infected with SARS-COV-2. What is New: • LC may be associated to impairments in some aspects of children's memory, as reported by parents. • Parents' economic stress and worries concerning their children's emotional adjustment during the pandemic are associated with more distress in their children.

Are you alone? Measuring solitude in childhood, adolescence, and emerging adulthood

The goal of this review was to provide an overview of how solitude has been operationally defined and measured since the year 2000 in psychological studies of children, adolescents, and emerging adults. After applying exclusionary criteria, our review of the extant literature identified n = 19 empirical studies, which we grouped into three broad methodological categories: (1) experiments/manipulations (n = 5); (2) retrospective reports (n = 7); and (3) experience sampling measures (experience sampling methodology; n = 7). A review of these studies indicated considerable variation in how solitude is operationalized and measured. There is also a notable lack of studies measuring solitude in childhood. Implications for 'what matters' when assessing solitude are discussed, and we provide a series of suggestions for helping this research area move forward.

Changes in Lifestyle Behaviors of Children and Adolescents during the COVID-19 Pandemic and the Impact on the Development of Non-Communicable Diseases: A Narrative Review

Background: Quarantine restrictions have changed the usual lifestyle habits of children and adolescents. In this review, we summarize how the COVID-19 outbreak changed lifestyle during childhood and discuss potential short- and long-term effects of NCD high-risk behaviors on health outcomes. Methods: literature search was conducted in Medline database (PubMed), Scopus, Embase, Web of Science, and Google Scholar. All studies that assessed the relationship between COVID-19 outbreak and lifestyle changes were included. Results: NCD risk factors such as unhealthy diet, physical inactivity, prolonged screen time and sedentary behavior, disrupted sleep schedules and sleep quality, as well as mental disorders during COVID19 in childhood, may increase the susceptibility to NCDs in adulthood. These changes in lifestyle behaviors have short and long-term cardio-metabolic and psychological health outcomes. Since it is not clear when COVID-19 is completely controlled, assessment of the interactions between COVID-19 and lifestyle activities in the pediatric age group is critical. Conclusion: The pandemic of coronavirus disease 2019 (COVID-19) has greatly influenced all levels of health systems. During the COVID-19 pandemic, prevention and management of non-communicable diseases (NCDs) will need to be prioritized even further.

The impact of media on children during the COVID-19 pandemic: A narrative review

Although mobile technologies are a fundamental part of daily life, several studies have shown increased use of electronic devices, TV, and gaming during childhood in conjunction with the COVID-19 pandemic. The virus affected almost every country, causing uncertainty about the future, social isolation, and distress. This narrative review has searched the scientific literature in the field focusing on children. A non-systematic literature review was conducted in May 2022. Various databases were employed to conduct the document research for this paper, such as "Google Scholar", "PubMed", "Web of Science". Keywords for the search included "screen time", "media", "digital use", "social media", "COVID-19", "pandemic", "lockdown", "children", "effect of media on children during COVID". It was found that both children and adolescents seem to have used technologies to confront struggles provoked by COVID-19, such as the onset or exacerbation of symptoms of anxiety, depression, and attention-deficit/hyperactivity disorder. However, moreover, other studies have suggested that increased media use can have positive effects on children depending on usage and monitoring by the parents.

Life under lockdown for children with autism spectrum disorder: Insights from families in South Africa

BACKGROUND

Children with Autism Spectrum Disorder (ASD) remain vulnerable during the Covid-19 outbreak due to significant changes to their daily routines, social interactions and diets. In addition, these challenges may be exacerbated for children living in low- and middle-income countries (LMIC) such as South Africa where there are already barriers such as poverty, access to resources and availability of support. Understanding the impact of the Covid-19 outbreak on children with ASD is imperative in order to create awareness as well as provide equitable services and support to both children with ASD and their families.

PURPOSE

The study aimed to explore family-reported changes for children with ASD and their reactions and responses to the Covid-19 restrictions in South Africa.

METHOD

A qualitative research design was employed. Twelve families consisting of different family compositions with a total of 21 family members (mothers, fathers and grandmothers) participated in the current study using semistructured interviews. Data were transcribed and analysed using a framework method for thematic analysis.

RESULTS

Findings indicated that children with ASD present with unique challenges related to Covid-19. Negative themes such as children's obstructive reactions due to the immediate changes to their routines, increases in emotional dysregulation as well as loss of previously acquired skills as a result of lack of access to services during lockdown were reported. However, families also reported on positive changes such as improved social interactions as children became more accustomed to their new lockdown routines.

IMPLICATIONS

The Covid-19 response has had a negative impact on children with disabilities, specifically around access to services and support for both children with ASD and their families. While the future of the virus and impending lockdown measures is unknown, clinicians, providers and educators need to ensure that provisions are made for children's current adjustments as well as further adjustments to their current routines both during and after the pandemic.

'The world somehow stopped moving': impact of the COVID-19 pandemic on adolescent psychiatric outpatients and the implementation of teletherapy

BACKGROUND

The COVID-19 pandemic results in disproportional consequences for psychiatric patients. Due to restraints in physical contacts, providers switched from face-to-face contacts to teletherapy, but prior experiences were mostly limited. The study aimed at assessing symptom dynamics, potentially increased adversities and factors influencing a successful transition into teletherapy in adolescent psychiatric outpatients during the COVID-19 pandemic.

METHOD

Thirty adolescent psychiatric outpatients participated in an interview-based study. The differential impact of the COVID-19 pandemic was measured by integrating patients' and psychiatrists' judgements.

RESULTS

Patients who reported deteriorated symptoms and patients who showed (partial) improvement of symptomatology could be separated by feelings of isolation (specific to deterioration) and perceived reduction in school-associated stress (unique to improvement). Patients with worsening symptomatology showed a significantly higher degree of psychosocial disability before lockdown and at the first interview. Patients who deteriorated in their level of psychosocial functioning also reported negatively on teletherapy. These patients were verbally less differentiated concerning emotions and affect, reported introspection and rumination, and stated distinctly lower levels of perceived social support. Concerning adversities, no clear trend could be identified, but some patients reported increased domestic violence and neglect.

CONCLUSIONS

Patients with a higher degree of psychosocial disability suffer disproportionally from the crisis, so that an assessment of functioning should serve as a triage tool. Also, a screening of the perceived level of social support should be established before offering teletherapy. Additionally, the provision of strategies to enhance verbalisation and differentiation of emotions and affect might be beneficial.

Evaluating the Implementation of a Multi-Technology Delivery of a Mental Health and Wellbeing System of Care Within a Youth Sports Development Program During the COVID-19 Pandemic

The COVID-19 pandemic presents challenges to the provision of community programs and access to mental health services for young people. We examined the feasibility, reach, and acceptability of multi-technology delivery of an integrated system that assesses and provides feedback on youth mental health and wellbeing and connects them to care within the context of a youth sports development program. The system was delivered via computer, telephone, and teleconference with 66 adolescent boys participating in a rugby league development program in three communities in Australia. Young people completed online wellbeing and mental health measures (Assess step), parents were provided with telephone feedback on results, support, and referral options (Reflect step), and youth received teleconferenced workshops and online resources (Connect step). The multi-technology delivery was feasible to implement, and reach was high, with barriers experienced at the Assess step but minimally experienced at the Reflect and Connect steps. Delivering the system via multiple forms of technology was rated as highly beneficial and enjoyable by young people. Players improved in self-reported prosocial behaviour, gratitude, and anxiety symptoms from pre- to post-program. Strong collaboration between researchers, organisational personnel, and community members is important for achieving these outcomes.

Impact of COVID-19 on Pediatric Mental and Behavioral Health Visits to the Emergency Department

OBJECTIVES

This study aimed to describe changes in pediatric emergency department (ED) mental and behavioral health (MBH) visits before and during the early COVID-19 pandemic.

METHODS

We retrospectively reviewed medical records of patients aged from 5 to 17 years presenting to the pediatric ED of a major tertiary care hospital with MBH-related concerns from March 2017 to September 2020. We evaluated trends in MBH ED visits over the study period, specifically comparing patient demographics, diagnosis categories, and ED disposition between the pre-COVID (2019) and COVID (2020) periods using pairwise Pearson χ 2 analyses with reported odds ratios (ORs) in SAS statistical software version 9.4 (SAS Institute Inc, Cary, NC).

RESULTS

Of 8093 MBH-related visits, 58.5% were females, 85.4% were adolescents, and 62.7% self-identified as non-Hispanic. The proportion of MBH-related ED visits increased from 3.8% to 7.5% over the study period ( P < 0.0001). Although total MBH visits decreased by 17.3% from 2019 to 2020, there was a proportionate increase in MBH-to-total-ED visits, representing a 42.8% increase through 2019. Compared with 2019, there was a proportionate increase in MBH-related ED visits by females (10.6%, P < 0.0001), older adolescents (18.2%, P < 0.0001), and non-Hispanic patients (6.1%, P = 0.017) in 2020. The MBH visits in 2020 were more likely related to suicidality/self-harm (OR, 1.2; confidence interval [CI], 1.1-1.4) or substance use (OR, 1.4; CI, 1.1-1.9). Compared with 2019, there were significantly higher odds of admission (OR, 1.6; CI, 1.3-2.1) or transfer for inpatient psychiatric care (OR, 1.8; CI, 1.6-2.1) in 2020.

CONCLUSIONS

Our data suggest that the early COVID-19 pandemic had a significant impact on MBH-related ED visits. Compared with 2019, we observed a significant increase in the proportion of MBH-to-total-ED visits primarily affecting older adolescent, non-Hispanic girls with suicidality/self-harm and substance-related disorders in 2020, despite an overall decrease in the number of MBH visits during this period. There was also an increase in the proportion of visits resulting in admission or transfer for inpatient psychiatric care in 2020.

Depressive risk among Italian socioeconomically disadvantaged children and adolescents during COVID-19 pandemic: a cross-sectional online survey

BACKGROUND

Children and adolescents and low-income individuals are considered particularly vulnerable for mental health implications during the current COVID-19 pandemic. Depression is a frequent negative emotional response during an epidemic outbreak and is also prone importantly to environmental risk like stressors derived from income inequality. We aimed to assess depressive symptomatology in a sample of Italian low-income minors during the COVID-19 outbreak. We hypothesized that the stronger were the negative effects of the pandemic on socioeconomic conditions, the higher would have been the risk for showing depressive symptoms.

METHODS

We performed a cross-sectional study during July 2020, at the end of the Italian first wave of COVID-19 pandemic. We recruited 109 Italian socioeconomically disadvantaged children and adolescents from 7 to 17 years. We used an online survey to collect socio-demographic and clinical data and information about pandemic-related stressors and to assess depressive symptoms with the Children's Depression Inventory 2 (CDI 2), Parent Version (Emotional Problems subscale) and Self-Report Short Form. We performed logistic regression analysis to assess the association between depressive symptoms and potential risk factors for mental health.

RESULTS

22% and 14% of participants showed depressive symptoms at the CDI 2 Parent Version and Self-Report, respectively. Participants coming from families experiencing a lack of basic supplies during the pandemic (34.9%) were more expected to show depressive symptoms at CDI 2 Parent Version. Participants with a pre-existing neuropsychiatric diagnosis (26.6%) were more likely to exhibit depressive symptoms measured by CDI 2 Parent Version.

CONCLUSIONS

The results of our study showed that a group of Italian socioeconomically disadvantaged children and adolescents were more vulnerable to depressive symptoms if they suffered from a paucity of essential supplies during the pandemic or had pre-existing neurodevelopmental disorders. The promotion of educational and child-care programs and activities could be crucial in sustaining the prevention of mental distress in those frail subjects who particularly need support outside the family. Further studies are needed to detect effective preventive and therapeutic strategies to adopt promptly in the case of another pandemic wave.

Parental Perceptions of Child and Adolescent Mental Health During the COVID-19 Pandemic in Argentina

Background

As a result of the COVID-19 pandemic, governments have implemented preventive measures towards reducing infections. These conditions can affect the mental health of children and adolescents; however, this has not yet been fully explored.

Objective

The aim of the study was to analyze changes in symptomatology and positive emotions in Argentine children and adolescents since the onset of isolation, based on parent/caregiver report. We analyzed differences based on gender, age, socioeconomic status (SS) and containment measure (and their interactions); their associations with symptomatology and positive affect of parents/caregivers; and the moderating effects of sociodemographic factors on these associations.

Method

A total of 1205 caregivers responded to a survey regarding the mental health of children and adolescents under their care. They also completed a set of anxiety, depression, and affect measures about themselves.

Results

A considerable proportion of parents/caregivers perceived changes in their children’s and adolescents’ mental health compared to before the pandemic. Increased levels of anxiety-depression, aggression-irritability, impulsivity-inattention, and dependence-withdrawal were reported, as well as alterations in sleeping and eating habits, and a reduction in positive affect. Differences were observed according to their age and containment measure. Finally, we found correlations between parents/caregivers’ symptomatology and that reported about their children or adolescents. Gender, age and SS moderated some of these relationships.

Conclusions

Continued monitoring of child and adolescent mental health is a fundamental necessity. We recommend the implementation of early intervention strategies to prevent the escalation of serious mental health problems, particularly in those groups that have been most adversely affected since the onset of the pandemic.

Radical Acceptance of Reality: Putting DBT®-A Skill Groups Online During the COVID-19 Pandemic: A Qualitative Study

INTRODUCTION

Emotion dysregulation is a common challenge pertaining to numerous psychiatric disorders in adolescence and is associated with increased morbidity and mortality. Dialectical Behavior Therapy for Adolescents (DBT®-A) has been shown to be an effective treatment, especially in the reduction of self-harm and suicidality. Measures in relation to the COVID-19 pandemic set strict limits on physical contacts with patients. In order to continuously provide evidence-based specialized care to patients suffering from emotion dysregulation, we offered two online DBT®-A skill groups in a video-group-call format.

OBJECTIVE

We aimed at assessing our online DBT®-A skills groups, collect according up- and downsides, and form a basis for advancement of this form of treatment provision. Also, the impact of the COVID-19 pandemic on patients was assessed.

METHODS

A physical DBT®-A skill group was switched to a video-group-call format and a second group was initiated de novo online. After five sessions, patients engaged in structured group discussions to reflect experiences. Discussion content was analyzed via Inductive Category Formation within the Framework of Qualitative Content Analysis.

RESULTS

Patients unanimously found the COVID-19 pandemic challenging, but also reported differentially on its impact. Downsides were balanced by subjective "gains" in time and a perceived reduction in stress. Technical problems of the online format were discussed, but did not limit the positive experience of still receiving treatment. Patients of both online DBT®-A skill groups valued the offer, felt connected, and reported benefits from the treatment. The transition group additionally discussed changes in structure and content of the group sessions after the switch to online meetings and reflected differential functions of the group.

DISCUSSION

Although the sample size is small, and conclusions are drawn from Inductive Qualitative Content Analysis, the presented results are of interest. In our investigation, video-group-calls were both safe and beneficial for patients. This alternative to physical meetings is not only interesting for further waves of the current pandemic but also for service provision in remote areas with limited access to specialized care. Further research is needed to challenge and refine our results and to explore extensions to "basic" video-group-calls, such as "break-out sessions," blended therapy, or real-time supervision within an online session.

Factors associated with preventive behaviors for COVID-19 among adolescents in South Korea

PURPOSE

COVID-19's infection rate among adolescents is increasing; hence, it is important to prevent it as it can spread in the community through transmission in schools. It is crucial to determine the extent to which adolescents follow COVID-19 preventive measures and identify factors relating to such behaviors to implement more effective health education. This study aimed to understand factors related to COVID-19 preventive behaviors using the theory of planned behavior (TPB) and the health belief model (HBM) among adolescents in South Korea.

DESIGN AND METHODS

A cross-sectional face-to-face questionnaire survey was conducted among 272 adolescents in South Korea. Structural equation modeling was used to examine the relationships between perceived susceptibility, perceived severity, attitude, subjective norms, perceived behavioral control, intention, and COVID-19 preventive behaviors.

RESULTS

Among adolescents' COVID-19 preventive behavior scores, wearing masks was the highest and distancing was the lowest. Adolescents' adherence to COVID-19 preventive behaviors was directly or indirectly associated with their perceived susceptibility, perceived severity, subjective norms, perceived behavioral control, and intention.

CONCLUSIONS

Attention to mitigate social isolation is important to improve compliance with COVID-19 preventive behaviors. Perceived susceptibility, perceived severity, subjective norms, perceived behavioral control, and intention explained 61.3% of adolescents' COVID-19 preventive behaviors, there is a need for education to promote relevant factors.

PRACTICE IMPLICATIONS

To increase adolescent awareness of COVID-19 and increase attitudes, subjective norms, and perceived behavior control, nurses need to provide education including the evidence for COVID-19 preventive behavior to increase adolescents' understanding and active implementation of those behaviors.

Risks and Resources for Depressive Symptoms and Anxiety in Children and Adolescents During the COVID-19 Pandemic - Results of the Longitudinal COPSY Study

BACKGROUND

Mental health during the COVID-19 pandemic is of particularly high relevance. Especially for children and adolescents, the pandemic and its restrictions represent a significant burden. The present study aims to identify risks and resources for depressive symptoms and anxiety in children and adolescents during the pandemic in Germany.

MATERIALS AND METHODS

Self-reported data from the first wave of the longitudinal COVID-19 and Psychological Health (COPSY) study were used to investigate risks and resources among n = 811 children and adolescents aged 11-17 years. Depressive symptoms and anxiety were measured at the first follow-up 6 months later. Multivariate linear regression analyses were performed to investigate the effects of risks and resources on depressive symptoms and anxiety.

RESULTS

Parental depressive symptoms predicted depressive symptoms and anxiety in children and adolescents 6 months later. Female gender was identified as a risk factor for anxiety during the pandemic. None of the potential resources were associated with depressive symptoms or anxiety at the follow-up.

CONCLUSION

The findings provide evidence of risk factors for depressive symptoms and anxiety during the COVID-19 pandemic. Children and adolescents who face risk factors need to be identified early and monitored during the pandemic. Family-based intervention programs are needed to help vulnerable children and adolescents cope with the challenges of the pandemic.

Mental health of children with neurodevelopmental disorders during COVID-19: A brief report of family experiences from a low and middle income country

COVID-19 has grossly impacted lives of people across the globe. In particular, children have also been affected due to closure of schools, therapy, and day care centers. Families have been challenged with new circumstances, and mental health professionals are coming up with novel ways to help these families who have children with mental health issues. This article describes experiences of families who have children with a diagnosed neurodevelopmental disorder with comorbid mental health difficulties and their ways of coping with the pandemic challenges. The series will throw light on ground level experiences of families during the pandemic, give insights into their ways of adapting, and brings out problem areas which healthcare professionals must work on, to design novel ways of care. The case series is novel and a similar report has probably not been presented from India or other low and middle income countries.

Challenges of routine diabetes care during COVID-19 era: A systematic search and narrative review

BACKGROUND

The world is facing the current COVID-19 pandemic. The pandemic response is affecting routine health care provision all over the world. We aimed to review the relevant literature and highlight challenges in the provision of routine care for patients with diabetes during the COVID-19 outbreak.

METHODS

We systematically searched PubMed, ScienceDirect, and Embase databases up till August 13, 2020 and retrieved relevant articles published on difficulties on routine diabetes management during the COVID-19 pandemic.

RESULTS

Through our reading of the recent literature discussing the difficulties of routine healthcare provision for patients with diabetes amid the COVID-19 pandemic, we have identified nine themes as follows: lockdown of standard outpatient clinics, decreased inpatient capacity, staff shortage, medicine shortage, unaffordable medicine, delayed care seeking, limited self-care practice, transport difficulties, and undiagnosed cases/events.

CONCLUSION

Diabetes management during lockdown is particularly challenging. This review specified a summary of difficulties of diabetes care during COVID-19 pandemic. Healthcare policy makers as well as healthcare providers could take advantage of the results of this review to mitigate the adverse effect of the crisis on provision of routine care for diabetes as well as other chronic conditions.

Impact of COVID-19 on Children's and Adolescent's Mental Health in Saudi Arabia

Background COVID-19 outbreak was sudden and unexpected in most countries. It has spread globally between January and March 2020. The World Health Organization (WHO) first declared the outbreak as a global pandemic on 11 March 2020. While this lockdown has proven to be an important and successful method of social distancing to counter the growing spread of the highly contagious COVID-19 virus, it has also created a degree of psychological impact on the public. Children may be strongly exposed to pandemic-generated biopsychosocial stressors, and once the containment measures of the population are needed to minimize the spread of viruses, they may be negatively impacted by the disturbance of everyday life as a result of social isolation. During school closures, children's routines may change, and healthy behaviors, such as physical activity, adequate diet, or good sleeping habits, may be less likely to happen. Method A cross-sectional study was conducted in Saudi Arabia from 20 March 2021 to 30 March 2021, targeted at children's parents and adolescents. Our concentration was on the impact of COVID-19 on the psychiatric wellbeing of children and adolescents. The data was collected through an online self-administered questionnaire which contains 56 close-ended questions for parents of children and 46 close-ended questions for adolescents. Statistical analysis was performed using R v 3.6.3 (R Foundation, Vienna, Austria). Counts and percentages were used to summarize the distribution of categorical variables. Results The questionnaire was completed by 1141 respondents, 454 were < 18 years old. Thus, these respondents completed the questionnaire on behalf of themselves. The remaining 688 respondents were adults and completed the questionnaire on behalf of their children. Results showed that higher children's age was associated with less increase in worrying, restlessness, and a higher increase in sadness. Higher age was associated with a higher increase in the frequency of waking up, sleeping little, and uneasiness, and nervousness. Having relatives who were infected with COVID-19 was associated with higher increases in most of the negative behaviors such as anxiety, sadness, sleeping little, indecisiveness, and irritability. Punishment threats, screaming, and hitting were associated with a higher increase in negative behaviors during the pandemic compared to before the pandemic. Results showed that neither the gender of the parent nor the child was associated with any of the domains of the child's behavior. Children whose parents were divorced had higher scores on anxiety, restlessness, and sleep disorders than children whose parents were not divorced Conclusion COVID-19 has caused increased stress on families, especially children and adolescents who are vulnerable populations. Our results show that the COVID-19 pandemic can affect the mental health of children and adolescents in Saudi Arabia. We showed that parental stress is a predictor of psychiatric problems, which, if unaddressed, can cause child maltreatment and greater psychological distress.

Kidcope and the COVID-19 Pandemic: Understanding High School Students' Coping and Emotional Well-Being

The COVID-19 pandemic has resulted in social isolation, grief, and loss among many adolescents. As the pandemic continues to impact individuals and communities across the globe, it is critical to address the psychological well-being of youths. More studies are needed to understand the effective ways adolescents cope with pandemic-related psychological distress. In this study, 146 students from 1 high school in a U.S. midwestern state completed an adapted version of Kidcope, a widely used coping instrument in disaster research, and measures were taken on generalized distress and COVID-19-related worries. Findings indicated that most students experienced COVID-19-related fears and general emotional distress. Additionally, we found that disengagement coping strategies were associated with lower general distress (p ≤ 0.05) and COVID-19 worries (p ≤ 0.10). Active coping was not associated with general distress and COVID-19 worries. Overall, our findings highlight the need to develop tailored interventions targeting youth coping strategies to reduce and prevent emotional distress and amplify healthy coping skills as the pandemic persists.

Children's Sleep During COVID-19: How Sleep Influences Surviving and Thriving in Families

OBJECTIVE

The COVID-19 pandemic has the potential to disrupt the lives of families and may have implications for children with existing sleep problems. As such, we aimed to: (1) characterize sleep changes during the COVID-19 pandemic in children who had previously been identified as having sleep problems, (2) identify factors contributing to sleep changes due to COVID-19 safety measures, and (3) understand parents' and children's needs to support sleep during the pandemic.

METHODS

Eighty-five Canadian parents with children aged 4-14 years participated in this explanatory sequential, mixed-methods study using an online survey of children's and parents' sleep, with a subset of 16 parents, selected based on changes in their children's sleep, participating in semi-structured interviews. Families had previously participated in the Better Nights, Better Days (BNBD) randomized controlled trial.

RESULTS

While some parents perceived their child's sleep quality improved during the COVID-19 pandemic (14.1%, n = 12), many parents perceived their child's sleep had worsened (40.0%, n = 34). Parents attributed children's worsened sleep to increased screen time, anxiety, and decreased exercise. Findings from semi-structured interviews highlighted the effect of disrupted routines on sleep and stress, and that stress reciprocally influenced children's and parents' sleep.

CONCLUSIONS

The sleep of many Canadian children was affected by the first wave of the COVID-19 pandemic, with the disruption of routines influencing children's sleep. eHealth interventions, such as BNBD with modifications that address the COVID-19 context, could help families address these challenges.

Effects of Long-Duration Home Isolation Linked to the COVID-19 Pandemic on Mental Health of Adolescent Athletes

PURPOSE

To assess whether adolescent athletes were affected or not in terms of mental health by the long duration at home linked to isolation enforced during the COVID-19 pandemic.

METHOD

The study included 940 team athletes, 274 individual athletes, and 131 nonathlete controls aged 12-17 years. Demographic data were obtained with a form including questions about age, sex, sports type, and physical activity status (type, duration, and frequency) during the isolation period. Participants completed the Children's Revised Impact of Event Scale-13, Center for Epidemiological Studies Depression Scale for Children, and State-Trait Anxiety Inventory for Children.

RESULTS

Among participants, 88% did not meet the physical activity recommendations for children and adolescents, while 42.8% felt depressed. Depressive symptoms were present in 38.1% of boys and 59.7% of girls, with girls (6.4%) having higher posttraumatic stress symptoms than boys (3.5%). Among athletes, depressive and anxiety symptoms were lower compared with nonathlete controls (P < .01). Posttraumatic stress symptoms were lower among athletes than nonathlete controls for girls (team vs control, P = .006; individual vs control, P = .002) but similar for boys (P > .05). The depression (P = .518), state (P = .866), and trait anxiety (P = .507) symptoms were similar between team athletes and individual athletes.

CONCLUSION

Though adolescent athletes' depression, anxiety, and posttraumatic stress symptoms were significantly lower than nonathlete controls, athletes also had high depression levels. These findings show the need to take precautions to protect the psychological health of not only nonathletes, but also athletes in the pandemic period.

CoCo20 protocol: a pilot longitudinal follow-up study about the psychiatric outcomes in a paediatric population and their families during and after the stay-at-home related to coronavirus pandemic (COVID-19)

INTRODUCTION

In the context of a viral outbreak and the stay-at-home measures, a significant increase in psychological distress, such as stress or fear behaviours, has previously been reported in adult and paediatric population. Children and adolescents seem to be particularly at risk of developing psychiatric disorders during and after the stay-at-home but evidences are lacking. The main objective of this article is to present the methodology of Coronavirus Confinement 2020 (CoCo20) Study, which aims to assess the impact of the coronavirus pandemic (COVID-19) and stay-at-home on the development of psychiatric disorders, including post-traumatic stress disorder (PTSD), in children and adolescents.

METHODS AND ANALYSIS

We describe a longitudinal and multicentre study in the paediatric population during and after stay-at-home related to COVID-19 pandemic. Inclusions started on 30 March 2020 for 6 months. This study is proposed to all consecutive paediatric outpatients consulting during and after stay-at-home related to COVID-19 pandemic in medical-psychological centres and in a paediatric psychotrauma centre and/or calling the emergency COVID-19 hotline. We perform standardised and internationally validated psychiatric assessments (Diagnosis Infant and Preschool Assessment, Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version) together with anxiety, attention deficit hyperactivity disorder, PTSD, parenting stress and somatic symptoms scales during five visits (baseline, 1 week after baseline, 1 month after baseline, 1 week after the end of the containment and 1 month after the end of the containment) in patients and their families enrolled during the containment and during three visits in case of enrolment after the containment. The inclusion period will end in 30 November 2020.

ETHICS AND DISSEMINATION

The protocol has been approved by the Ethics Committee of Cote d'Azur University « CERNI » (number 2020-59). All patients and their legal caregivers provide a written informed consent on enrolment in the study. We will submit the results of the study to relevant journals and offer national and international presentations. This study will enable better characterisation of the impact of the stay-at-home (related to COVID-19 pandemic) on the mental health of children and adolescents.

TRIAL REGISTRATION NUMBER

NCT04498416.

Viral time capsule: a global photo-elicitation study of child and adolescent mental health professionals during COVID-19

OBJECTIVE

To examine, through photo-elicitation, the personal and professional impact of the COVID-19 pandemic on mental health professionals working with children and adolescents around the globe.

METHODS

We invited the submission of images collected about the pandemic between May and August 2020. We encouraged participants to yoke personal reflections or voice memos to their images. Using snowball sampling, we began with two invitations, including one to the graduates of a mentorship program continuously hosted since 2004 by the International Association of Child and Adolescent Psychiatry and Allied Professions (IACAPAP). We analyzed de-identified images and anonymized transcripts through iterative coding using thematic analysis informed by rich picture analysis and aided by NVivo software.

RESULTS

We collected submissions from child and adolescent mental health professionals (n = 134) working in 54 countries spread across the five continents. We identified four overarching domains with component themes that revealed both the commonality and the uniqueness of the pandemic experience around the globe: (1) Place (adjusting to emptiness and stillness; shifting timeframes; blending of spaces); (2) Person (disruption to life rhythms; emotional toll; positives of the pandemic); (3) Profession (changing practices; outreach efforts; guild pride-and guilt); and (4) Purpose (from pandemic to syndemic; from lamenting to embracing; planning toward a better tomorrow).

CONCLUSIONS

Photo-elicitation provided a disarming and efficient means to learn about individual, regional, and global similarities and differences regarding the professionals charged with addressing the mental health needs of children and adolescents around the globe. These findings may help inform practice changes in post-pandemic times.

[Impact of social distancing on reports of violence against children and adolescents in Rio Grande do Sul, Brazil]

This study aimed to analyze the rates of reports of violence against children and adolescents in the state of Rio Grande do Sul, Brazil, from 2015 to 2020, and the changes in trends by period due to the novel coronavirus pandemic (COVID-19). This is an ecological time series study with secondary data obtained from the Bi Saúde Portal in the panel on Interpersonal Violence and Suicide. The study collected reports on violence in individuals 0 to 19 years of age in the months of March and April each year, stratified by sex, age bracket, race/color, and type of violence. Prais-Winsten regression was used to analyze the time trend. Of the 7,718 reports analyzed, there was a drop of 54% in the year 2020 compared to the same period in 2019. The analysis of the trend until 2019 indicated an increase in the reporting rates (2.04, 95%CI: 1.01; 3.07, p = 0.002), but with the inclusion of the year 2020 in the time series, the direction of the trends in reporting rates was reversed to negative, losing statistical significance (-0.39, 95%CI: -1.16; 2.14, p = 0.632). The study concludes that social distancing due to the pandemic reduced the reporting rates of violence against children and adolescents due to underreporting, thus requiring strategies to improve the identification of suspected cases of violence during the pandemic. This highlights the need for inter-sector planning and rapid and specific actions (health, social protection, justice, and public security) in order to guarantee the rights of children and adolescents.

The Effects of COVID-19 on Early Childhood Education and Care: Research and Resources for Children, Families, Teachers, and Teacher Educators

The COVID-19 world health crisis has profound implications for the care and education of young children in homes and schools, the lives of preservice and inservice teachers, and the work of college/university faculty. This article begins by discussing the implications of a world health pandemic for education and the challenges of conducting a literature review on such a rapidly evolving topic. The next four sections categorize the COVID-19 literature into themes: (1) threats to quality of life (QoL) and wellness, (2) pressure on families and intensification of inequities, (3) changes in teaching methods and reliance on technology, and (4) restructuring of higher education and scholarship interrupted. Each of the four themes is introduced with a narrative that highlights the current context, followed by the literature review. Next is a compilation of high-quality, online resources developed by leading professional organizations to support children, families, and educators dealing with the COVID crisis. The article concludes with changes that hold the greatest potential to advance the field of early childhood education and care.

Collaboration of Child Protective Services and Early Childhood Educators: Enhancing the Well-Being of Children in Need

This paper examines the role of interprofessional collaboration in the identification and reporting of a child in need. Such collaboration is especially important in the context of the global pandemic caused by the novel Coronavirus disease of 2019, known as COVID-19. The child protection system must have the capacity and resources to respond to increased demands during this time, and early childhood educators serve as an essential link for child protective services in identifying and reporting a child in need. As an effective system to accomplish these two aims requires a working collaboration among its participants, Bronstein's interdisciplinary collaboration model was used as a framework to interpret this practice. A small-scale qualitative study was conducted that included principals of nursery schools and child protection workers from one region in Estonia. Findings indicate that effective collaboration was believed to require communication and ongoing systematic relationship building. Collaboration in practice varied, as principals reported a high turnover rate for the child protection workers, which hindered the development of a working relationship and support for the process of noticing and thereby identifying a child in need. In contrast, child protection workers assessed collaboration more positively, recognizing the need to have a supportive system in place for nursery schools. Both groups of collaborators acknowledged the need to train teachers, particularly to conduct joint training exercises to foster a common understanding of the child in need and of the intervention process itself.

Young Hispanic fathers during COVID-19: Balancing parenthood, finding strength, and maintaining hope

OBJECTIVES

This study examined how the effects of the COVID-19 crisis has impacted young Hispanic fathers.

DESIGN/SAMPLE

Using qualitative description, in-depth interviews were conducted among Hispanic fathers between the ages of 18 and 24 years, from community-based fatherhood program. The interviews of seven young Hispanic fathers were analyzed using qualitative content analysis.

RESULTS

The participants' initial and ongoing fears about COVID-19 resulted from not having adequate information about the severity of the disease and how easily one can contract and transmit it to others. They also expressed concerns about the threat of the pandemic on their family's well-being, finances, and employment status. Providing for their families was their main priority, with some continuing to work, despite the risks of becoming infected with COVID-19. Despite their many hardships, fathers found strength in their families and remained hopeful in overcoming the challenges during the pandemic.

CONCLUSIONS

The pandemic has presented difficulties and loss for many. Nurses in the community are well positioned to serve young Hispanic fathers to ensure their needs are met. A family-centered approach is ideal for young fathers to provide them equal opportunity to be actively involved in promoting health for themselves and their families during the pandemic.

Longitudinal increases in childhood depression symptoms during the COVID-19 lockdown

OBJECTIVE

There has been widespread concern that so-called lockdown measures, including social distancing and school closures, could negatively impact children's mental health. However, there has been little direct evidence of any association due to the paucity of longitudinal studies reporting mental health before and during the lockdown. This present study provides the first longitudinal examination of changes in childhood mental health, a key component of an urgently needed evidence base that can inform policy and practice surrounding the continuing response to the COVID-19 pandemic.

METHODS

Mental health assessments on 168 children (aged 7.6-11.6 years) were taken before and during the UK lockdown (April-June 2020). Assessments included self-reports, caregiver reports, and teacher reports. Mean mental health scores before and during the UK lockdown were compared using mixed linear models.

RESULTS

A significant increase in depression symptoms during the UK lockdown was observed, as measured by the Revised Child Anxiety and Depression Scale (RCADS) short form. CIs suggest a medium-to-large effect size. There were no significant changes in the RCADS anxiety subscale and Strengths and Difficulties Questionnaire emotional problems subscale.

CONCLUSIONS

During the UK lockdown, children's depression symptoms have increased substantially, relative to before lockdown. The scale of this effect has direct relevance for the continuation of different elements of lockdown policy, such as complete or partial school closures. This early evidence for the direct impact of lockdown must now be combined with larger scale epidemiological studies that establish which children are most at risk and tracks their future recovery.

A child's right to protection during the COVID-19 crisis: An exploratory study of the child protective services of Estonia

In 2019 the novel Coronavirus COVID-19 was discovered, and the following year the World Health Organization declared a pandemic. This pandemic is unprecedented in human history and affects all aspects of life. In this article, we explore the pandemic's impact on child protective services in Estonia and survey a representative sample of child protection workers (n = 81), asking three open-ended questions designed to explore child protection practice. These questions concern the impact on organisational design, the workers' ability to conduct a diagnosis of a child's care context, and what knowledge they could draw upon, as well as the decision itself. The overall findings indicate that the organisational design left practice unprepared; there was a general lack of ability to act upon referrals and also to conduct investigations to evaluate care contexts. Furthermore, there is a general lack of knowledge of how to deal with protective practices and conduct decision-making during crisis situations.

How is COVID-19 pandemic impacting mental health of children and adolescents?

The coronavirus disease (COVID-19) affected virtually all countries. Uncertain about the health risk and an increasing financial loss will contribute to widespread emotional distress and an increased risk of psychiatric disorders shortly. Posttraumatic, anxiety, and depression disorders are expected during and aftermath of the pandemic. Some groups, like children, have more susceptibility to having long term consequences in mental health. Herein, we made a comprehensive and non-systematic search in four databases (PubMed, Scopus, SciELO, and Google Scholars) to answer the question: What are children's and adolescents' mental health effects of the pandemic? Furthermore, which features are essential for mental health in a pandemic? Results: Seventy-seven articles were selected for full text read, and 51 were included. Children answer stress differently, depending on the development stage. High rates of anxiety, depression, and post-traumatic symptoms were identified among children. Discussion: Symptoms were as expected. New supportive strategies have appeared during this pandemic, but there is no measure of its effectiveness. Some groups seem to be more vulnerable to the mental health burden of the COVID-19 pandemic, and the mitigation actions should prioritize them. The school's role appears to be revalued by society. This review seems to pick good targets to prioritize mitigation actions aiming to spare children not only from the severe cases of COVID-19 but also to help them to deal with the mental health burden of the pandemics.

Psychological and psychiatric impact of COVID-19 pandemic among children and adolescents

Background:

COVID-19 outbreak and the unprecedent measures imposed by the government, including quarantine and social distancing, cause psychological distress in children and adolescents.

Methods:

we review literature about mental health effects of COVID-19 pandemic by using the keywords “COVID-19”, “coronavirus”, “pandemic”, “mental health”, “psych*”, “adolescent” and “child”.

Results:

early evidence show high prevalence of anxiety and depressive symptoms in children and adolescents, due to the pandemic itself, to social isolation and to parents’ stress. High grade students, females and low-income families are at higher risk to develop psychiatric symptoms. Psychological distress can be reduced by maintaining contact with peers through social networks and by accurate updates provided by the government through the mass media. Online resources such as information about mental health education and preventive measure, video-counselling, telemedicine and telepsychiatry services, can be useful to reduce the psychosocial effects of the novel coronavirus.

Conclusion:

there is urgent need to plan new strategies for early psychological interventions in order to reduce the impact of COVID-19 pandemic on children and adolescents mental health status. (www.actabiomedica.it)

Teaching Theory of Probability and Statistics during the Covid-19 Emergency

The state of emergency caused by the covid-19 pandemic has shown that teaching at this time is not easy. Teachers have to make more use of distance education and students have to adapt to that. Classic face-to-face study is not possible but asymmetric communication between the teacher and his students may be replaced by greater student independence and greater student effort. Within the subject theory of probability and statistics, a questionnaire was created to find how students manage distance education. It has been found out that they use the prepared tutorial videos and online assignments (in WeBWork platform) the most. They expressed that distance education prepared by the teacher can replace face-to-face study, but this form of learning is much more demanding and therefore they prefer classic face-to-face study.

Current and Future Challenges in the Delivery of Mental Healthcare during COVID-19

The USA is in the midst of the COVID-19 pandemic. We assess the impact of COVID-19 on psychiatric symptoms in healthcare workers, those with psychiatric comorbidities, and the general population. We highlight the challenges ahead and discuss the increased relevance of telepsychiatry. We analyzed all available literature available as of March 25, 2020, on PubMed, Ovid Medline, and PsychInfo. We utilized the MeSH term "covid AND (psychiatry OR mental health)" and included all articles. Duplicates were removed resulting in 32 articles, of which 19 are cited. Four additional references are included to examine suicide data. During the review process, an additional 7 articles were identified which are also included. Frontline healthcare workers are currently experiencing increased psychiatric symptoms and this is more severe in females and nurses. Non-frontline healthcare workers, as well as the general population, are experiencing vicarious traumatization. People with psychiatric comorbidities, and the general population, face increased psychiatric symptom burden. Migrant workers, the elderly, children, and the homeless may be disproportionately impacted. Suicide rates may be impacted. The COVID-19 pandemic has resulted in a severe disruption to the delivery of mental healthcare. Psychiatric facilities are facing unprecedented disruptions in care provision as they struggle to manage an infected population with comorbid psychiatric symptoms. Telepsychiatry is a flawed but reasonable solution to increase the availability of mental healthcare during COVID-19.