Impact of mask-wearing on child and adolescent psychosocial development: a systematic review

Background

Wearing face masks in public is recommended under certain circumstances in order to prevent infectious diseases transmitted through droplets. The objective was to compile all German and English research results from peer-reviewed journal articles using a sensitive literature search on the effects of mask-wearing for preventing infectious diseases on the psychosocial development of children and adolescents.

Methods

A systematic review was conducted considering different study designs (search period up until 12 July 2021). The risk of bias in the studies was determined using a risk of bias procedure. A descriptive-narrative synthesis of the results was performed. A search update will be conducted shortly before the conference.

Results

Thirteen studies were included, and the overall risk of bias was estimated to be high in all primary studies. There are some indications from the included surveys that children, adolescents, and their teachers in (pre)schools perceived facial expression processing as impaired due to mask-wearing, which were confirmed by several experimental studies. Two studies reported psychological symptoms like anxiety and stress as well as concentration and learning problems due to wearing a mask during the COVID-19 pandemic. One survey study during the 2002/2003 SARS pandemic examined oral examination performance in English as a foreign language and showed no difference between the “mask” and “no mask” conditions. The results are preliminary and may be extended due to the search update.

Conclusions

Only little evidence can be derived on the effects of face masks on different developmental areas of children and adolescents based on the small number of studies. There is a lack of research data regarding the following outcomes: psychological development, language development, emotional development, social behaviour, school success, and participation. Further cluster-randomized controlled trials or longitudinal studies are required.

Key messages

• Empirical and experimental evidence shows that mask-wearing impairs facial expression among children, adolescents, and teachers in (pre)schools.

• Research on the following developmental areas is missing: psychological development, language development, emotional development, social behaviour, school success, and participation.

Elevated risk of depression and anxiety disorder by „high strain“ occupations: a systematic review

Background

Poor working conditions might lead to mental illness.

Methods

We performed a systematic review with meta-analyses as an update of a review published in 2013. We registered the study protocol with PROSPERO (registration number: CRD42020170032) and searched for epidemiological studies in MEDLINE, PsycINFO, and Embase. Two reviewers carried out independently all review steps including title-abstract screening, full-text screening, risk-of-bias assessment and data extraction. Discordances were solved by consensus. We determined the certainty of evidence using the GRADE-approach.

Results

Ten cohort studies with acceptable study quality examined the relationship between high job strain and the incidence of depression. In the “classic” demand-control-model, ‘high strain’ (combination of high demands and low control) is compared with ‘low strain’ (combination of low demands and high job control). For high strain, the risk of depression was elevated by 73%, the pooled effect estimate for the risk of depression was 1.73 (95% CI 1.32-2.27. In a dichotomous analysis (without dividing job strain into the four dimensions mentioned above), there was a doubled risk of depression with high job strain (pooled effect estimate=1.99, 95% CI 1.68-2.35). We found comparable risk estimates for men and women. The GRADE assessment revealed a high certainty of evidence of the association between job strain and depression. We also found a considerably increased risk of anxiety disorder among individuals prone to high job strain.

Conclusions

This systematic review finds a clear association between high job strain (high demands in combination with low control) and depression as well as anxiety disorders.

Acknowledgment: This study was financially supported by SUVA (Schweizerische Unfallversicherungsanstalt).

Key messages