Sonal Jain, D.O.,
Former APAF SAMHSA Minority Psychiatry Fellow,
Boston University Medical Center
On March 11, 2020, The World Health organization (WHO) declared COVID-19 a global pandemic. Since then, the world has been negatively impacted from exposure to novel stressors. Children, specifically have faced many pandemic-related hardships, including social isolation, school closures, increased screen time, stressed caregivers, financial difficulties, reduced access to health care, and loss of loved ones. Furthermore, racial and ethnic minority youth experience an uneven load of psychosocial risks such as poverty and food insecurity, that can be associated with impairing mental health concerns. Here, I would like to highlight some of the social and emotional effects that have occurred during COVID-19 that have affected school-age children.
Depression and Anxiety
Child mental health has worsened since the start of the pandemic. Multiple studies have shown that anxiety and depression have been the most commonly reported symptoms that have resulted since the beginning of the pandemic. In comparing mental health data pre-pandemic and mid-pandemic, depression and/or anxiety increased to 18% in school-age children during the pandemic from 5% prior to the pandemic. Children who had not been scoring for mental health symptoms on scales used in primary care settings such as the Pediatric Symptom Checklist-17 (PSC-17) prior to pandemic, are now scoring positively. Most presented with worry about COVID-19.
Factors Contributing to Worsening Mental Health
Remote Learning
Remote learning has been one of the major factors for worsening mental health. It was found that less remote assignment completion was correlated with increased mental health symptoms and that parents felt remote learning has negatively impacted their child’s health as it lends itself to further social isolation.
What can be done: School engagement and success may have a protective role in mental health and may be a focus of intervention to improve child-well-being. For example, teachers may be able to support children returning to school by openly creating a designated time and space during the day to discuss the pandemic and hold regular check-ins regarding re-adjustments back to in person schooling. Here is an additional resource of techniques that can be used to re-engage students both virtually or in person: Returning to School Mentally Healthy (.pdf).
Increased Screen Time
Due to remote learning, children are being exposed to prolonged screen times that were not as persistent pre-pandemic. Additionally, organized, in-person extra-curricular activities had been on hold lending itself to children relying more on screens for entertainment. However, given the increase in social isolation, the internet allowed for maintenance of social connections which alternatively proved to be beneficial.
What can be done: More effort in recognizing the internet can be helpful to building social connections with attention to length of screen time will be important going forward. For example, families can work on implementing a “media blackout” for the household where all screens are turned off for a designated amount of time in the day. This will limit length of screen time and emphasize social connections/quality time with one another. Here is a resource for more ideas on how to approach screen time: It's Time to Reconnect (.pdf).
Caregiver Depression
Given stressors of the pandemic, caregivers’ mental health has declined as well. Worse parent functioning can have a correlation with parent and child physical and mental health conditions.
What can be done: Going forward, it would be important to intervene on the caregiver level to assist with mental health problems in children during the pandemic. Some methods to assist in supporting caregiver mental health are staying connected with friends and family, setting boundaries to emphasize a work and life balance, and sticking to a regular schedule. Schools can offer mental health resources to parents as well as children who attend school.
Meeting the needs for child mental health pre-pandemic was already a concern. Given how COVID-19 continues to affect the world, the access to child mental health care will be further limited in the current mental health system. Public health efforts to mitigate this will be most important. This may in the form of school-based, family-based, or community-based programs that can help reach vulnerable families and decrease the burden of the current system.
Reference
- Spencer AE, Oblath R, Dayal R, Loubeau JK, Lejeune J, Sikov J, Savage M, Posse C, Jain S, Zolli N, Baul TD, Ladino V, Ji C, Kabrt J, Mousad L, Rabin M, Murphy JM, Garg A. Changes in psychosocial functioning among urban, school-age children during the COVID-19 pandemic. Child Adolesc Psychiatry Ment Health. 2021 Dec 2;15(1):73. doi: 10.1186/s13034-021-00419-w. PMID: 34857026; PMCID: PMC8637516.