Anxiety and depressive symptomatology among children and adolescents exposed to the COVID-19 pandemic – A systematic review
Abstract
Background/Aim. Children and adolescents are sensitive groups for the development of mental disorders during the crisis. The aim of this systematic review was to assess the impact of the COVID-19 pandemic on anxiety and depressive symptomatology in the population of children and adolescents. Methods. The investigation was based on a systematic review followed by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol, including Ovid MEDLINE, Embase, Global Health, and APA Psyc Info databases, to identify relevant studies reporting anxiety and depressive symptoms among children and adolescents during the COVID-19 pandemic. A total of 27 articles were included. Results. Anxiety symptoms increased from 28.3% before the pandemic to 49.5% during confinement [General Anxiety Disorder (GAD)-7 ≥ 11)] (McNemar test, p < 0.0001). More depressive symptomatology was found, as well as weight and sleep disturbances which are the characteristics of children and adolescents’ mental health. Additionally, female teenagers were experiencing grater declines in mood disorders than male teenagers during the COVID-19 crisis. On the one hand, different positive correlations between anxiety and other variables, were found, such as clinical depressive symptoms and anxiety (3/14), smartphone and internet addiction (2/14), lower levels of family income (2/14), perceived threats (2/14), higher grades at school (2/14), and loneliness (1/14). On the other hand, positive correlations were reported between depression and children and adolescents that were socially disconnected (3/17). Finally, mothers with higher level of education and income were associated with higher level of happiness (2/17). Conclusion. COVID-19 has a strong impact on the mental health of children and adolescents regarding depression and anxiety symptoms. Prevention programs focused on coping strategies should be conducted in elementary schools, middle schools, and high schools. Mental health should become a priority matter for governments, and the current pandemic could be an opportunity to highlight the importance of mental well-being and to invest in the betterment of clinical trainings, treatments and mental health research.
References
Dukanac V, Ljubomirović N, Dukanac D. Specifics of the ado-lescent crisis during the corona vurus pademia. Health Protect 2020; 49(3): 33‒42. (Serbian, English)
Roser M, Ritchie H, Ortiz-Ospina E, Hasell J. Coronavirus Pan-demic (COVID-19). 2020 Published online at Our-WorldInData.org. Avalailbe from: https://ourworldin-data.org/
coronavirus [Online Resource].
Steiner A. COVID-19 pandemic Humanity needs leadership and solidarity to defeat the coronavirus. 10/12/2020, de United Nations Development Program [Internet]. 2020. Available from: https://www.undp.org/content/undp/en/home/
coronavirus.html
Coughlin SS. Anxiety and Depression: Linkages with Viral Dis-eases. Public Health Rev 2012; 34(2): 7.
Salazar de Pablo G, Vaquerizo-Serrano J, Catalan A, Arango C, Moreno C, Ferre F, et al. Impact of coronavirus syndromes on physical and mental health of health care workers: Systematic review and meta-analysis. J Affect Disord 2020; 275: 48‒57.
Luchini C, Stubbs B, Solmi M, Veronese N. Assessing the quality of studies in meta-analyses: Advantages and limitations of the Newcastle Ottawa Scale. World J Meta Anal 2017; 5(4): 80‒4.
Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quali-ty of nonrandomised studies in meta-analyses. 2000.
Abawi O, Welling MS, van den Eynde E, van Rossum EFC, Hal-berstadt J, van den Akker ELT, et al. COVID-19 related anxiety in children and adolescents with severe obesity: A mixed-methods study. Clin Obes 2020; 10(6): e12412.
Adıbelli D, Sümen A. The effect of the coronavirus (COVID-19) pandemic on health-related quality of life in children. Child Youth Serv Rev 2020; 119: 105595.
Asanov I, Flores F, McKenzie D, Mensmann M, Schulte M. Re-mote-learning, time-use, and mental health of Ecuadorian high-school students during the COVID-19 quarantine. World Dev 2021; 138: 105225.
Chen F, Zheng D, Liu J, Gong Y, Guan Z, Lou D. Depression and anxiety among adolescents during COVID-19: A cross-sectional study. Brain Behav Immun 2020; 88: 36‒8.
Garcia de Avila MA, Hamamoto Filho PT, Jacob FLDS, Alcantara LRS, Berghammer M, Jenholt Nolbris M, et al. Children's Anxie-ty and Factors Related to the COVID-19 Pandemic: An Ex-ploratory Study Using the Children's Anxiety Questionnaire and the Numerical Rating Scale. Int J Environ Res Public Health 2020; 17(16): 5757.
Duan L, Shao X, Wang Y, Huang Y, Miao J, Yang X, et al. An investigation of mental health status of children and adoles-cents in china during the outbreak of COVID-19. J Affect Disord 2020; 275: 112‒8.
Fazeli S, Zeidi IM, Lin CY, Namdar P, Griffiths MD, Ahorsu DK, et al. Depression, anxiety, and stress mediate the associa-tions between internet gaming disorder, insomnia, and quality of life during the COVID-19 outbreak. Addict Behav Rep 2020; 12: 100307.
Giannopoulou I, Efstathiou V, Triantafyllou G, Korkoliakou P, Douzenis A. Adding stress to the stressed: Senior high school students’ mental health amidst the COVID-19 nationwide lockdown in Greece. Psychiatry Res 2021; 295: 113560.
Guo J, Fu M, Liu D, Zhang B, Wang X, van IJzendoorn MH. Is the psychological impact of exposure to COVID-19 stronger in adolescents with pre-pandemic maltreatment experiences? A survey of rural Chinese adolescents. Child Abuse Negl 2020; 110(Pt 2): 104667.
Hou TY, Mao XF, Dong W, Cai WP, Deng GH. Prevalence of and factors associated with mental health problems and sui-cidality among senior high school students in rural China dur-ing the COVID-19 outbreak. Asian J Psychiatr 2020; 54: 102305.
Kılınçel Ş, Kılınçel O, Muratdağı G, Aydın A, Usta MB. Factors affecting the anxiety levels of adolescents in home‐quarantine during COVID‐19 pandemic in Turkey. Asia Pac Psychiatry 2021; 13(2): e12406.
Li Y, Duan W, Chen Z. Latent profiles of the comorbidity of the symptoms for posttraumatic stress disorder and general-ized anxiety disorder among children and adolescents who are susceptible to COVID-19. Child Youth Serv Rev 2020; 116: 105235.
McGuine TA, Biese KM, Petrovska L, Hetzel SJ, Reardon C, Kliethermes S, et al. Mental Health, Physical Activity, and Quality of Life of US Adolescent Athletes During COVID-19–Related School Closures and Sport Cancellations: A Study of 13 000 Athletes. J Athl Train 2021; 56(1): 11‒9.
Metwally AM, El-Sonbaty MM, Abdellatif GA, El-Etreby LA, Elsayed H, Elsheshtawy E, et al. Common phobias among Egyp-tian primary schoolchildren: an emergency trigger for panic disorder due to corona pandemic. Open Access Maced J Med Sci 2020; 8(T1): 3–11.
Oosterhoff B, Palmer CA, Wilson J, Shook N. Adolescents' Moti-vations to Engage in Social Distancing During the COVID-19 Pandemic: Associations With Mental and Social Health. J Ad-olesc Health 2020; 67(2): 179‒85.
Qi M, Zhou SJ, Guo ZC, Zhang LG, Min HJ, Li XM, et al. The Effect of Social Support on Mental Health in Chinese Adoles-cents During the Outbreak of COVID-19. J Adolesc Health 2020; 67(4): 514‒8.
Seçer İ, Ulaş S. An Investigation of the Effect of COVID-19 on OCD in Youth in the Context of Emotional Reactivity, Experiential Avoidance, Depression and Anxiety. Int J Ment Health Addict 2021; 19(6): 2306‒19.
Smirni P, Lavanco G, Smirni D. Anxiety in Older Adolescents at the Time of COVID-19. J Clin Med 2020; 9(10): 3064.
Tang S, Xiang M, Cheung T, Xiang YT. Mental health and its correlates among children and adolescents during COVID-19 school closure: The importance of parent-child discussion. J Affect Disord 2021; 279: 353‒60.
Xie X, Xue Q, Zhou Y, Zhu K, Liu Q, Zhang J, et al. Mental Health Status Among Children in Home Confinement During the Coronavirus Disease 2019 Outbreak in Hubei Province, China. JAMA Pediatr 2020; 174(9): 898‒900.
Zhang L, Zhang D, Fang J, Wan Y, Tao F, Sun Y. Assessment of Mental Health of Chinese Primary School Students Before and After School Closing and Opening During the COVID-19 Pandemic. JAMA Netw Open 2020; 3(9): e2021482.
Ellis WE, Dumas TM, Forbes LM. Physically isolated but so-cially connected: Psychological adjustment and stress among adolescents during the initial COVID-19 crisis. Can J Behav Sci 2020; 52(3): 177‒87.
Magson NR, Freeman JYA, Rapee RM, Richardson CE, Oar EL, Fardouly J. Risk and Protective Factors for Prospective Changes in Adolescent Mental Health during the COVID-19 Pandemic. J Youth Adolesc 2021; 50(1): 44‒57.
Ougrin D, Wong BH, Vaezinejad M, Plener PL, Mehdi T, Roma-niuk L, et al. Pandemic-related emergency psychiatric presen-tations for self-harm of children and adolescents in 10 coun-tries (PREP-kids): a retrospective international cohort study. Eur Child Adolesc Psychiatry 2021; 1–13.
Alves JM, Yunker AG, DeFendis A, Xiang AH, Page KA. BMI status and associations between affect, physical activity and anxiety among U.S. children during COVID-19. Pediatr Obes 2021; 16(9): e12786.
Rogers AA, Ha T, Ockey S. Adolescents' Perceived Socio-Emotional Impact of COVID-19 and Implications for Mental Health: Results From a U.S.-Based Mixed-Methods Study. J Ado-lesc Health 2021; 68(1): 43‒52.
Dilek TD, Boybay Z, Kologlu N, Tin O, Güler S, Saltık S. The impact of SARS-CoV2 on the anxiety levels of subjects and on the anxiety and depression levels of their parents. Mult Scler Relat Disord 2021; 47: 102595.