Children and adolescents represent a vulnerable population group and their mental health can be particularly affected by pandemics and confinement measures (Chung, Baum, & . Nyquist, 2020; Stevenson et al., 2009). Children and adolescents who already had mental health problems before the pandemic may experience these side effects. However, the extent to which the current COVID-19 pandemic is affecting the mental health of children and adolescents needs to be further examined.
Failure to address these immediate mental health needs during a pandemic could contribute to greater deterioration in children and. By ethical challenges we mean: (a) issues that families might face that cause conflicting values or morally difficult decisions; and (b) challenges specifically related to interventions to support child and adolescent mental health during a pandemic (such as those related to telehealth). We work with key users of knowledge to assess the utility of interventions specifically for child and adolescent mental health.
Inclusion criteria: Papers were included in this review based on 5 criteria: (1) addressing mental health or mental well-being; (2) in connection with SARS-CoV-2, SARS-CoV-1 or influenza disease outbreaks, pandemics, epidemics or confinement/isolation/quarantine/physical distancing; (3) applies to the mental health of children and adolescents; (4) published between and (5) in English or French. Certain groups of children and young people with pre-existing mental health problems may be particularly vulnerable during pandemics and related lockdown measures.
Long-term General Psychological Distress Across Age Groups
Furthermore, young people at clinically high risk for psychosis are also particularly vulnerable during the COVID-19 pandemic, as observations made by mental health professionals reveal that patients have "experienced a worsening of some. Moreover, a thematic analysis of medical records of patients receiving mental health services that "children and those with neurotic/somatoform disorders [are] most concerned about swine flu" (Page et al., 2011, p. 67). Additionally, children and youth with a history of obsessive-compulsive disorder (OCD) may be particularly vulnerable during the COVID-19 pandemic, as interviews with youth ages 12 to 18 who have been diagnosed with OCD indicate that 80% of them characterized their OCD behaviors and thoughts as constant during the COVID-19 pandemic (Huscsava et al., 2020).
This worsening of OCD symptoms is reflected in findings in a literature review (Imran, Aamer et al., 2020). Another review of the literature reveals findings that highlight other vulnerable groups during the COVID-19 pandemic, such as adolescents who have suicidal thoughts or self-mutilate, young patients with schizophrenia or even those with serious eating disorders (Chevance et al., 2020). .
Specific Detrimental Effects on Children and Adolescents’ Mental Health
- Fear, Anxiety, and Stress
- Depressive Symptoms
- Externalizing Behaviours
- Posttraumatic Symptoms and Disorders
- Somatic Symptoms
- Inattention and Distractibility
- Alterations in Sleep Habits
Likewise, the assessment of children and adolescents' anxiety between the ages of 9 and 18 years on the State and Trait Inventory (STAI) via teleconference indicates that they show increased anxiety scores during the COVID-19 pandemic (Senkalfa et al., 2020). Similarly, Indian mothers of 9- to 11-year-old children indicate that their children's most important distress symptoms during the COVID-19 pandemic include anxiety and fear of the disease (Tiwari et al., 2020). Yet a literature review also finds that adolescents are at risk of having anxiety symptoms during the COVID-19 pandemic (Guessoum et al., 2020).
In children more specifically, telephone interviews with mothers of Indian children between the ages of 9 and 11 show that they report their children experiencing depressive symptoms during the COVID-19 pandemic (Tiwari et al., 2020). A European parent report study indicates that, due to COVID-19, 39% of children and adolescents aged 3 to 18 show increased irritability and restlessness (Orgilés et al., 2020). Similarly, in a summary of a study under review, parents report that their children show greater irritability and agitation during the COVID-19 pandemic (Jiao et al., 2020).
Parent reports indicate that 76.6% of children and adolescents aged 3 to 18 years exhibit greater concentration difficulties during the COVID-19 pandemic, according to a study currently under review (Orgilés et al., 2020). Finally, sleep habits in children and adolescents with ADHD also appear to be disrupted during the COVID-19 confinement measures in France, according to parental reports (Bobo et al., 2020).
Factors that Increase Vulnerability to Detrimental Mental Health Effects
Parent Distress
Changes in sleep habits appear to be a widespread consequence of pandemics and confinement for children and adolescents. More specifically in terms of symptoms, 20% of parents report in an online survey that their children between the ages of 4 and 10 “have sleep problems, including difficulty falling asleep, agitation and frequent waking.” Pisano et al., 2020, p.9) during the COVID-19 pandemic, parents of children and adolescents aged 5 to 17 years report that their children “sleep more during the first outbreak of the COVID-19 virus than the limitations for that” (Moore et al., 2020, p.6).
In addition, Indian children and adolescents interviewed reported insomnia, especially those who were quarantined (Saurabh & Ranjan, 2020), while preliminary results indicate that parents of children and adolescents aged 3 to 18 years, report that their children have more nightmares, fatigue, and sleep disturbances (Jiao et al., 2020). Findings from the literature reviews underscore similar findings from original studies concluding that influenza pandemics and the COVID-19 pandemic can cause nightmares and other sleep problems in children and adolescents (Buheji et al., 2020; Douglas et al., 2009; Guessoum et al., 2020; INESSS, 2020c; Murray, 2010; Sajid et al., 2020). These findings are also mentioned in the literature review by Imran et al. (2020), such as sleep problems such as
- Family’s Economic Hardships
- Rises in Cases of Child Maltreatment and Intrafamilial Violence An increase in the likelihood that child maltreatment and intrafamilial violence is
- Social Isolation
- Overexposure to Media Content About Pandemics
- Other Notable Factors Increasing Vulnerability to the Detrimental Mental Health Effects of Pandemics and Confinement
- Positive Mental Health Effects
- Interventions and recommendations to support children and adolescents’ mental health during and after the pandemic (Question 2)
- Interventions
- Tele-practice Guides
- Preparation
- Therapeutic relationship
- Engagement
- Ethical challenges
- Tools
- Recommendations
- Ethical challenges related to children and adolescents’ mental health in the context of a pandemic (Question 3)
These original findings are mirrored by those from literature reviews (Bahn, 2020; Imran, Zeshan, et al., 2020). Imran, Zeshan, et al., 2020, p. S68) as a result of confinement measures may worsen the psychological problems of children and adolescents during the COVID-19 pandemic. To optimize treatment, Huscsava et al. 2020) suggested that screening patients before offering teletherapy could be useful.
Veterans in this study reported significant improvements in their children's behavior following the intervention (Riegler et al., 2020). As for teachers, these interventions could help children focus better at school and reduce the effects of the pandemic on their mental health (Zhao et al., 2020). Therefore, it is important to address mental health problems in children early to avoid negative health and social consequences (Buheji et al., 2020, p. 4).
Another reason why these interventions are implemented is to “reduce immediate effects and prevent long-term consequences” (Hawke et al., 2020, p. 7) on mental health. 34; Telepsychotherapeutic interventions such as OPPT [online parenting tips] can increase access to much-needed services during and outside of confinement shelter.” (Riegler et al., 2020, p. 300).
Children's mental health services in China during the COVID-19 pandemic: results of an expert-based national survey among child and adolescent psychiatric hospitals. A survey of mental health status of children and adolescents in China during the outbreak of COVID-19. Investigating perceptions of stress, well-being and fear among Hungarian adolescents and their parents under lockdown during the COVID-19 pandemic.
Consequences of COVID-19 for mental health and physical distancing: The need for prevention and early intervention. Impacts of COVID-19 on youth mental health, substance use and well-being: A rapid survey of clinical and community samples. Prevalence and factors associated with mental health problems and suicidality among senior high school students in rural China during the COVID-19 outbreak.
Rapid systematic review: The impact of social isolation and loneliness on child and adolescent mental health in the context of COVID-19. A qualitative report on exploratory data on the possible emotional/behavioural correlates of Covid-19 containment in 4-10 year old children in Italy. Social isolation, mental health and use of digital interventions in youth during the COVID-19 pandemic: a nationally representative survey.
A pilot trial of a telepsychotherapy parenting skills intervention for veteran families: Implications for managing parenting stress during COVID-19. Investigating the impact of COVID-19 on adolescent OCD in the context of emotional reactivity, experiential avoidance, depression and anxiety. The impact of the COVID-19 pandemic on the anxiety of children with cystic fibrosis and their mothers.
Prevalence and correlates of PTSD and depressive symptoms one month after the outbreak of the COVID-19. The effects of online homeschooling on children, parents, and teachers of grades 1–9 during the COVID-19 pandemic. Prevalence and sociodemographic correlates of psychological health problems in Chinese adolescents during the outbreak of COVID-19.
Annexe
RAPPORT PRÉLIMINAIRE