Have the COVID-19 pandemic and lockdown affected children’s mental health in the long term? A repeated cross-sectional study

  1. Manas Pustake
  2. Sushant Mane
  3. Mohammad Arfat Ganiyani
  4. Sayan Mukherjee
  5. Misba Sayed
  6. Varada Mithbavkar
  7. Zaid Memon
  8. Abdus Samad Momin
  9. Krishna Deshmukh
  10. Ayush Chordia
  11. Sabyasachi Parida
  12. Alan Johnson
  13. Sanket Warghade
  14. Deepankar Varma
  15. Ajit Bhagwat

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Abstract

The study aimed to evaluate the impact of the COVID-19 pandemic on levels of anxiety and depressive symptoms in children and adolescents.

Design

Cross-sectional surveys were carried out on the mental health of children; one survey was conducted before the COVID-19 pandemic and one into the pandemic, 15 months after the school closures and implementation of lockdown and social distancing. Demographic data and COVID-19 pandemic-related data were collected from specific parent-report and self-report questionnaires.

Participants

Participants included children and adolescents between ages 6 and 16 years, attending a tertiary care hospital without any diagnosed major psychiatric or chronic disorder.

Analysis

Data were collected at two points (before the COVID-19 pandemic and during it) and compared. Levels of anxiety and depressive symptoms were compared and tested for statistically significant differences between these two points using appropriate statistical tests. Regression models were constructed to predict the factors affecting increased anxiety levels and depressive symptoms in the COVID-19 period.

Results

832 and 1255 children/adolescents were included in the study during the pre-COVID-19 and COVID-19 times, respectively. The median age of the participants was 10 years (IQR=4 years). The median (IQR) Spence Children’s Anxiety Scale score was 24 (12) at the pre-COVID-19 point and 31 (13) during the COVID-19 pandemic (p<0.001, r=−0.27). 11% and 16% of children reported being depressed at these two-time points, respectively (p=0.004, φ c =−0.063). Regression analysis showed that many factors, including the duration of smartphone use, female gender and only child status, were associated with increased anxiety or depression levels.

Conclusion

A large proportion of children had elevated anxiety and depressive symptoms during the pandemic relative to before the pandemic, suggesting a need for measures to engage children in healthy habits to protect children’s mental health and continuous monitoring of children during such scenarios.

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  1. Version published to 10.1136/bmjopen-2021-058609
  2. ScreenIT

    SciScore for 10.1101/2022.05.10.22272976: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsField Sample Permit: The initial data collection was carried out in the context of another cross-sectional study designed in similar settings.
    IRB: Ethical Declaration: The study was approved by the institutional ethics committee of Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai (Document Nos.
    Consent: Children were recruited for the study only after their guardian gave written informed consent, and the children themselves gave assent for participation in the study.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Data Analysis: After collecting data, the data was entered into a spreadsheet using Microsoft Office Excel 2019 (Microsoft Corporation, WA, USA).
    Microsoft Office Excel
    suggested: (Microsoft Excel, RRID:SCR_016137)
    Statistical analysis was performed using the IBM SPSS Statistics software (v26.0; IBM, Armonk, NY, USA).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Every study has its own set of limitations, and ours is no exception. Because the data was collected in a hospital setting, not all of the individuals included in the study were healthy. The children who participated were visiting the hospital the mild sickness, immunisation or refilling of medications. Enrolling healthy children was impractical because schools and playgroups were closed, and we wanted to conduct an offline study, considering the sampling limitations of the other online studies. There was no way to overcome this limitation, so we included the available population. Another major limitation of the study is the lack of psychometric validation and the subjective nature of the COVID-19 pandemic-related questionnaire. Studies are necessary to develop and validate such questionnaires, which assess the general status of children within the context of the pandemic. Moreover, our study did not have a pre-considered hypothesis or study design, and there was an ad-hoc change in the pandemic according to the circumstances. However, because we compared this data to children who visited the same settings before the pandemic, we believe that these biases were eliminated. Also, CES-DC assesses the depressive symptoms in the past week, and as many of the children were attending hospital, the underlying disease may have caused the depressive symptoms in the past week. Despite these limitations, this study provides invaluable information on the psychological status of the childr...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2022.05.10.22272976v1 on medRxiv