Understanding and Capturing the Impact of COVID-19 on Children

By Iris Smith, Ph.D., M.P.H
According to the World Health Organization (WHO), as of 2021, over 187 million cases of COVID-19 have been diagnosed globally and this number is increasing daily.1 The spread of COVID-19 is associated with an increase in symptoms of depression, anxiety, anger, insomnia, denial, and fear in the general population. Research studies from the United States, Poland, Spain, Germany, China, and Turkey have reported an increase in mental health symptoms among children and adolescents.2, 3 Risk factors for adverse psychological responses are complex and include individual, familial, and societal factors. The widespread uncertainty, economic disruption, morbidity, and mortality that has occurred during the past two years can be regarded as a “collective trauma.” 4
Based on mortality and fertility data from 21 countries from March 2020 to April 2021, an estimated 1 million children worldwide experienced the loss of a primary caregiver, yet few studies have examined grief responses or the prevalence of PTSD in children.4 A study by Liu et al., found that 18.4% of children who had been hospitalized for COVID-19 experienced clinically significant PTSD. A Saudi Arabian study based on a nationally representative sample found that 13% of the children had potential PTSD and a Chinese study based on parental report found that nearly 21% of the sample scored above the study’s cutoff for clinical PTSD.5
Most research to date has focused on general population or school-based samples, and do not disaggregate sub-groups of children such as those with pre-existing neurodevelopmental or mental health conditions, mentally ill, abusive, or substance abusing parents, or children of essential workers and healthcare professionals. These groups may be especially vulnerable. 
Containment measures such as quarantine and lockdowns have raised concerns about the negative impacts of increased exposure to digital devices by children and adolescents. Technology use has increased among both adults and children during the pandemic – some studies have estimated an increase of 15% among individuals who were “using it all the time”.6 While media (social and public) coverage of the pandemic contributes to anxiety levels in children and adolescents, the use of technology may also foster resilience when it is used to acquire new skills and to practice physical activity at home. Excessive “gaming” can become pathological, but video games also reduce anxiety, relieve loneliness, stimulate, or improve cognition.7 Most of the research to date has come from China, Europe and other countries at the forefront of the pandemic. Studies of U.S. populations are still emerging.
Articles of Interest
Limone Pierpaolo, Toto GA (2021).  Psychological and Emotional Effects of Digital Technology on Children in COVID-19 Pandemic.  Brain Science 2021 Aug.25: 11(9); pg. 1126.  Doi:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8465704/  Free PMC article
Marchi J, Johansson N, Sarkadi A, Werner G. (2021).  The Impact of the COVID-19 Pandemic and Societal Infection Control Measures on Children and Adolescents Mental Health:  A Scoping Review.  Front Psychiatry 2021 Sep 6, 12:711791.  PMID: 34552516PMCID: PMC8451953 DOI: 10.3389/fpsyt.2021.711791 Free PMC article
Pfefferbaum B (2021).  Children’s Psychological Reactions to the COVID-19 Pandemic.  Current Psychiatry Reports (2021), 23; pg.75. Int J Environ Res Public Health. 2021 Mar 26;18(7):3432. https://pubmed.ncbi.nlm.nih.gov/?term=pfefferbaum+2021&sort=date&filter=pubt.review&filter=pubt.systematicreview&filter=datesearch.y_1#:~:text=doi%3A%2010.1007/s11920,PMID%3A%2034613515 Free PMC article.
Ramdas, R et al. (2021) COVID-19 Related Mental Health Issues: A Narrative Review of Psychometric Properties of Scales and Methodological Concerns in Scale Development.  Australasian Psychiatry; 29(3); pg.326-332.  https://journals.sagepub.com/doi/10.1177/1039856221992645
1 Sniadach J, Szymkowiak S, Przemyslaw O, Waskiewicz N (2021). Increased Depression and Anxiety Disorders during the COVID-19 Pandemic in Children and Adolescents. A Literature Review. Life, 11: pg. 1188
2 Ma L, Mohsen M, Li K, Li Y, Chen S Kirwan R, Zhou H, Yan N, Rahman A, Wang W, Wang Y. (2021) Prevalence of Mental Health Problems Among Children and Adolescents during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. Journal of Affective Disorders. 2021
Oct. 1; 293: pg. 78-89. Doi: https:// doi.org.10.1016/j.jad.2021.06.021.
3 Sniadach J, et al.(2021). Increased Depression and Anxiety Disorders during the COVID-19 Pandemic in Children and Adolescents. A Literature Review. Life, 11: pg. 1188
4 Pfefferaum (2021). Children’s Psychological Reactions to the COVID=19 Pandemic. Current Psychiatry Reports, 23; pg. 75
6 Pierpaolo L and Tota GA (2021) Psychological and Emotional Effects of Digital Technology on Children in COVID-19 Pandemic. Brain Science 11 (9); pg. 1126.
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