Children and adolescents experienced an increase in depression and anxiety during the COVID-19 pandemic compared with before the worldwide healthcare crisis, with females from higher income families having the most marked increased, Canadian researchers reported this month in JAMA Pediatrics.
Results of the systematic review and meta-analysis highlight “a need for government to develop urgent and strategic plans to address the mental health of youth and ensure the provision of accessible and equitable resources to support this,” lead author Sheri Madigan, PhD, told Medscape.
“We need to urge decision-makers to earmark funding for child and adolescent research and clinical services,” continued Madigan, a professor of psychology at the University of Calgary in Canada, adding that priority should be given to “investing in new models of care that can be adapted to increase scalability.”
The analysis included 53 longitudinal cohort studies from 12 countries that used validated measures to compare pre-pandemic and pandemic depression or anxiety symptoms in children and adolescents younger than age 19 years.
Standardized mean changes (SMC) in symptoms were estimated for 40,807 participants before and 33,682 during the pandemic. The data was analyzed according to age, sex, race, ethnicity, geographical location, medical condition, and family income.
In total, 51% of studies reported data from North America, 24% from Europe, 19% from Asia, 4% from Australia, and 2% from Israel.
Overall, there was evidence of a slight increase in anxiety symptoms (SMC, 0.10), and a stronger increase in depression symptoms (SMC, 0.26).
“The magnitude of this increase was more than what could be expected based on time trends, and can therefore likely be attributed to the disruptions, restrictions, and stress imposed on children and adolescents and their families during the pandemic,” write the researchers. They added that the difference in changes for anxiety vs depression is “consistent with research highlighting COVID-19–related impacts on social isolation and activity restrictions on children’s sadness, sense of purpose, and hopelessness, which mostly perpetuate depressed mood.”
The analysis also found that the increase in depression was seen mostly in females (SMC, 0.32), with only a slight increase in males. Again, this is consistent with previous research, and may be explained by a number of things, said Madigan.
“We tend to encourage girls to think and talk about their feelings more than we do for boys,” Madigan said. “They are also more likely to seek out help for mental health problems. As a result, they may feel less stigma about disclosing their depressive symptoms. Sadly, girls are more likely to experience sexual assault and teen dating violence, and victimization is a precipitant to mental distress.”
The researchers also noted larger pandemic-related increases in depression and anxiety symptoms among youth from higher vs lower income backgrounds. “This could be related to greater ownership of digital devices in kids from higher-income families…and their known association with depression,” Madigan suggested. She added it is also possible that youth from higher-income families had more disruptions to their routine and expectations “due to their more frequent engagement with extracurricular activities.”
Commenting on the findings, Jonathan Klein, MD, MPH, a professor of pediatrics at University of Illinois at Chicago, said that the research, “provides additional confirmation that young people experienced significant psychological stress during the COVID-19 pandemic.” Klein and co-authors published a similar meta-analysis last year (BMJ Glob Health. 2022;7:e010713).
He noted that since most of the studies included in the current analysis were from high-income areas, and were reported very early in the pandemic, they may reflect a bias of geographical location, since this is where high-quality COVID-related research was initially done. In addition, he suggested, the findings may also be influenced by differences in school closures, which “disproportionally happened in high-income countries” early in the pandemic.
“It would have been useful to present findings arrayed by date of data collection rather than date of publication, and to have examined school closure and/or lockdown status for each study’s population as another potential moderating factor,” he said.
Finally, Klein noted that the authors, whose analysis included only longitudinal studies, “go out of their way” to criticize cross-sectional studies.
“This is unnecessary,” he said, as cross-sectional studies “provide important insight into population needs, and surveillance tracking of population data are timely indicators of the need for additional mental health interventions. For example, current continued increases in suicidality presentations to emergency rooms by adolescents in many places reflect the continued stresses young people face in the post-pandemic period, and a continuing need for mental health services.”
Study co-author Tracy Vaillancourt, PhD, is chair of the COVID-19 Task Force for the Royal Society of Canada, and co-author Daphne Korczak, MD, is chair of the Mental Health Task Force of the Canadian Paediatric Society. The other study authors and Klein reported no relevant financial relationships.
JAMA Pediatr. Published online May 1, 2023. Abstract
Kate Johnson is a Montreal-based freelance medical journalist who has been writing for more than 30 years about all areas of medicine.
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