Mostly worse, occasionally better: impact of COVID-19 pandemic on the mental health of Canadian children and adolescents

Abstract

This large cross-sectional study examined the impact of COVID-19 emergency measures on child/adolescent mental health for children/adolescents with and without pre-existing psychiatric diagnoses. Using adapted measures from the CRISIS questionnaire, parents of children aged 6–18 ( N = 1013; 56% male; 62% pre-existing psychiatric diagnosis) and self-reporting children/adolescents aged 10–18 ( N = 385) indicated changes in mental health across six domains: depression, anxiety, irritability, attention, hyperactivity, and obsessions/compulsions. Changes in anxiety, irritability, and hyperactivity were calculated for children aged 2–5 years using the Strengths and Difficulties Questionnaire. COVID-19 exposure, compliance with emergency measures, COVID-19 economic concerns, and stress from social isolation were measured with the CRISIS questionnaire. Prevalence of change in mental health status was estimated for each domain; multinomial logistic regression was used to determine variables associated with mental health status change in each domain. Depending on the age group, 67–70% of children/adolescents experienced deterioration in at least one mental health domain; however, 19–31% of children/adolescents experienced improvement in at least one domain. Children/adolescents without and with psychiatric diagnoses tended to experience deterioration during the first wave of COVID-19. Rates of deterioration were higher in those with a pre-exiting diagnosis. The rate of deterioration was variable across different age groups and pre-existing psychiatric diagnostic groups: depression 37–56%, anxiety 31–50%, irritability 40–66%, attention 40–56%, hyperactivity 23–56%, obsessions/compulsions 13–30%. Greater stress from social isolation was associated with deterioration in all mental health domains (all ORs 11.12–55.24). The impact of pre-existing psychiatric diagnosis was heterogenous, associated with deterioration in depression, irritability, hyperactivity, obsession/compulsions for some children (ORs 1.96–2.23) but also with improvement in depression, anxiety, and irritability for other children (ORs 2.13–3.12). Economic concerns were associated with improvement in anxiety, attention, and obsessions/compulsions (ORs 3.97–5.57). Children/adolescents with and without pre-existing psychiatric diagnoses reported deterioration. Deterioration was associated with increased stress from social isolation. Enhancing social interactions for children/adolescents will be an important mitigation strategy for current and future COVID-19 waves. Supplementary Information The online version contains supplementary material available at 10.1007/s00787-021-01744-3.

The impact of COVID-19 on the lives and mental health of Australian adolescents

“…This is the first finding to indicate that Australian adolescents with a history of depression or anxiety experience greater levels of psychopathology and disruption to daily life in response to a crisis; in this case, the COVID-19 pandemic. Moreover, these results are consistent with findings examining adolescents in Canada [18] and adults in Australia and the US [5,6], which collectively suggest that a history of mental illness is a vulnerability factor for deterioration in mental health during the pandemic.…”

“…To our knowledge, existing adolescent studies focus on the mental health impact of the pandemic on young people (e.g. [12,18,19]) or lifestyle factors (e.g. [40]) or worry, concern and behaviour change related to COVID-19 (e.g.…”

“…Despite the significant potential impact of pandemicrelated restrictions on adolescents, little empirical work has addressed this possibility [13]. Six published studies have assessed adolescent mental health (< 18 years) in response to the pandemic, three conducted in China, one each in Canada, Germany and the US [14][15][16][17][18][19], which collectively show that the prevalence of mental illness (most commonly depression and anxiety) is elevated relative to pre-pandemic prevalence estimates. Evidence of a similar pattern of worsening youth mental health in Australia is emerging.…”

COVID-19 and Education Disruption in Ontario: Emerging Evidence on Impacts

“…29 Similarly, heightened mental health challenges have been identified among children during the COVID-19 pandemic. 30 Youth, aged 15-24 years, saw the greatest declines in self-reported mental health of any age group. 31 The percentage of young people who reported their mental health was excellent or very good dropped from 60% to 40% between March 2019 and July 2020.…”

A longitudinal study of mental health in adolescents before and during the COVID-19 pandemic

“…In contrast, other cohort studies found that the increase in psychiatric symptoms was limited to adults without pre-pandemic symptoms, while adults with preexisting symptoms did not report an increase in their symptoms during the pandemic 14 . In addition, among children and adolescents a psychiatric diagnosis prior to the pandemic was predictive of both improvement and a reduction in depressive, anxiety, and irritability symptoms experienced during the pandemic 15 .…”