The COVID-19 pandemic has caused unprecedented changes in the lives of 1.6 billion children and adolescents. First non-representative studies from China, India, Brazil, the US, Spain, Italy, and Germany pointed to a negative mental health impact. The current study is the first nationwide representative study to investigate the impact of the COVID-19 pandemic on health-related quality of life (HRQoL) and mental health of children and adolescents in Germany from the perspective of children themselves. A representative online survey was conducted among n = 1586 families with 7- to 17-year-old children and adolescents between May 26 and June 10. The survey included internationally established and validated instruments for measuring HRQoL (KIDSCREEN-10), mental health problems (SDQ), anxiety (SCARED), and depression (CES-DC). Results were compared with data from the nationwide, longitudinal, representative BELLA cohort study (n = 1556) conducted in Germany before the pandemic. Two-thirds of the children and adolescents reported being highly burdened by the COVID-19 pandemic. They experienced significantly lower HRQoL (40.2% vs. 15.3%), more mental health problems (17.8% vs. 9.9%) and higher anxiety levels (24.1% vs. 14.9%) than before the pandemic. Children with low socioeconomic status, migration background and limited living space were affected significantly more. Health promotion and prevention strategies need to be implemented to maintain children’s and adolescents’ mental health, improve their HRQoL, and mitigate the burden caused by COVID-19, particularly for children who are most at risk.

Background The COVID-19 pandemic has disrupted the lives of children and adolescents worldwide. The German COPSY study is among the first population-based longitudinal studies to examine the mental health impact of the pandemic. The objective of the study was to assess changes in health-related quality of life (HRQoL) and mental health in children and adolescents and to identify the associated risk and resource factors during the pandemic. Methods A nationwide longitudinal survey was conducted with two waves during the pandemic (May/June 2020 and December 2020/January 2021). In total, n = 1923 children and adolescents aged 7 to 17 years and their parents participated (retention rate from wave 1 to wave 2: 85%). The self-report and parent-proxy surveys assessed HRQoL (KIDSCREEN-10), mental health problems (SDQ with the subscales emotional problems, conduct problems, hyperactivity, and peer problems), anxiety (SCARED), depressive symptoms (CES-DC, PHQ-2) and psychosomatic complaints (HBSC-SCL). Mixed model panel regression analyses were conducted to examine longitudinal changes in mental health and to identify risk and resource factors. Results The HRQoL of children and adolescents decreased during the pandemic, and emotional problems, peer-related mental health problems, anxiety, depressive and psychosomatic symptoms increased over time, however the change in global mental health problems from wave 1 to wave 2 was not significant, and some changes were negligible. Socially disadvantaged children and children of mentally burdened parents were at particular risk of impaired mental health, while female gender and older age were associated with fewer mental health problems. A positive family climate and social support supported the mental health of children and adolescents during the pandemic. Discussion Health promotion, prevention and intervention strategies could support children and adolescents in coping with the pandemic and protect and maintain their mental health.

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Zusammenfassung Hintergrund Die mit der COVID-19-Pandemie einhergehenden Veränderungen und Kontaktbeschränkungen können das psychische Wohlbefinden von Kindern und Jugendlichen beeinflussen. Ziel der Arbeit COPSY ist die erste deutschlandweite repräsentative Studie, welche die psychische Gesundheit und Lebensqualität von Kindern und Jugendlichen während der Pandemie untersucht. Die Ergebnisse werden mit denen der repräsentativen longitudinalen BELLA-Studie aus der Zeit vor der Pandemie verglichen. Material und Methoden Vom 26.05. bis zum 10.06.2020 wurden n = 1586 Eltern mit 7‑ bis 17-jährigen Kindern und Jugendlichen, von denen n = 1040 11- bis 17-Jährige auch Selbstangaben machten, befragt. Dabei wurden international etablierte Instrumente zur Erfassung von gesundheitsbezogener Lebensqualität, psychischen Auffälligkeiten, Ängstlichkeit und depressiven Symptomen eingesetzt. Die Daten wurden mittels deskriptiver Statistiken und bivariater Tests ausgewertet. Ergebnisse 71 % der Kinder und Jugendlichen und 75 % der Eltern fühlten sich durch die erste Welle der Pandemie belastet. Im Vergleich zu der Zeit vor der Pandemie gaben die Kinder und Jugendlichen eine geminderte Lebensqualität an, der Anteil von Kindern und Jugendlichen mit psychischen Auffälligkeiten hat sich in etwa verdoppelt und ihr Gesundheitsverhalten hat sich verschlechtert. Sozial benachteiligte Kinder erlebten die Belastungen durch die Pandemie besonders stark. Zwei Drittel der Eltern wünschten sich Unterstützung im Umgang mit ihrem Kind. Diskussion Die COVID-19-Pandemie führt zu einer psychischen Gesundheitsgefährdung der Kinder und Jugendlichen, auf die präventiv mit niedrigschwelligen und zielgruppenspezifischen Angeboten in der Schule, in der ärztlichen Praxis und in der Gesellschaft im Sinne des Kinderschutzes reagiert werden sollte.

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Background: Methodological heterogeneity of studies and geographical variation limit conclusions about the impact of the COVID-19 pandemic on the mental health of youth. This study aimed to explore the health-related quality of life and mental health of children and adolescents in the second year of the pandemic in South Tyrol, Italy. Methods: An online survey representative for the age and gender of the children and adolescents in South Tyrol was conducted among 5159 families with children and adolescents aged 7–19 years, between 28 May and 16 June 2021. The survey collecting parental ratings and self-rated questionnaires from children and adolescents aged 11–19 years included instruments to measure health-related quality of life (KIDSCREEN-10), mental health problems (SDQ), anxiety (SCARED), and depression (CES-DC). The results were compared with data from corresponding studies conducted in Germany. Results: Decreased health-related quality of life and increased conduct problems, peer-related mental health problems, anxiety, and depressive and psychosomatic symptoms in children and adolescents observed in the second year of the pandemic in Germany were confirmed in the second year in South Tyrol. Children and adolescents with low socioeconomic status, a migration background, and limited living space were significantly affected. Female sex and older age were associated with increased psychosocial problems and a positive family climate supported the mental health of children and adolescents during the pandemic. Conclusions: Confirmation of findings of decreased health-related quality of life and increased emotional problems after the first year of the pandemic supports the ongoing call for low-threshold health promotion, prevention, and early intervention programs to support children and adolescents who have been severely affected by the pandemic.

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