COVID-19 Policies, Pandemic Disruptions, and Changes in Child Mental Health and Sleep in the United States

Abstract

ImportanceThe adverse effects of COVID-19 containment policies disrupting child mental health and sleep have been debated. However, few current estimates correct biases of these potential effects.ObjectivesTo determine whether financial and school disruptions related to COVID-19 containment policies and unemployment rates were separately associated with perceived stress, sadness, positive affect, COVID-19–related worry, and sleep.Design, Setting, and ParticipantsThis cohort study was based on the Adolescent Brain Cognitive Development Study COVID-19 Rapid Response Release and used data collected 5 times between May and December 2020. Indexes of state-level COVID-19 policies (restrictive, supportive) and county-level unemployment rates were used to plausibly address confounding biases through 2-stage limited information maximum likelihood instrumental variables analyses. Data from 6030 US children aged 10 to 13 years were included. Data analysis was conducted from May 2021 to January 2023.ExposuresPolicy-induced financial disruptions (lost wages or work due to COVID-19 economic impact); policy-induced school disruptions (switches to online or partial in-person schooling).Main Outcomes and MeasuresPerceived stress scale, National Institutes of Health (NIH)–Toolbox sadness, NIH-Toolbox positive affect, COVID-19–related worry, and sleep (latency, inertia, duration).ResultsIn this study, 6030 children were included in the mental health sample (weighted median [IQR] age, 13 [12-13] years; 2947 [48.9%] females, 273 [4.5%] Asian children, 461 [7.6%] Black children, 1167 [19.4%] Hispanic children, 3783 [62.7%] White children, 347 [5.7%] children of other or multiracial ethnicity). After imputing missing data, experiencing financial disruption was associated with a 205.2% [95% CI, 52.9%-509.0%] increase in stress, a 112.1% [95% CI, 22.2%-268.1%] increase in sadness, 32.9% [95% CI, 3.5%-53.4%] decrease in positive affect, and a 73.9 [95% CI, 13.2-134.7] percentage-point increase in moderate-to-extreme COVID-19–related worry. There was no association between school disruption and mental health. Neither school disruption nor financial disruption were associated with sleep.Conclusions and RelevanceTo our knowledge, this study presents the first bias-corrected estimates linking COVID-19 policy-related financial disruptions with child mental health outcomes. School disruptions did not affect indices of children’s mental health. These findings suggest public policy should consider the economic impact on families due to pandemic containment measures, in part to protect child mental health until vaccines and antiviral drugs become available.

Annual Research Review: Sex, gender, and internalizing conditions among adolescents in the 21st century – trends, causes, consequences

“…Available data that have emerged since the onset of the COVID‐19 pandemic indicates that psychological distress may be accelerating at an even more rapid pace in recent years (Harrison, Carducci, Klein, & Bhutta, 2022; Racine et al., 2021), although in promising news, suicide among young people has stabilized or declined in most countries during the pandemic (Pirkis et al., 2022). Furthermore, there has been substantial variability in the impact of the pandemic on youth mental health across countries (Chavira, Ponting, & Ramos, 2022), and increases in psychological distress due to the pandemic among youth are concentrated youth in families financially and otherwise adversely impacted by the pandemic (Hossain et al., 2022; Xiao et al., 2023). Continued focus on understanding the potential short‐ and long‐term consequences of pandemic‐related illness and bereavement, disruptions in socialization and learning, and other effects of the pandemic will be a critical part of mental health surveillance for years to come.…”

Mental Well-Being Among Adversity-Exposed Adolescents During the COVID-19 Pandemic

“…We believe the clinical importance of these associations to be substantial for several reasons. First, prior literature 29 , 41 has used the PA and PS scales similarly to assess adolescent mental health correlates. Furthermore, given that stress and well-being are of critical importance in adolescent development and that adolescents experience ACEs at unacceptably high rates, we believe these associations will have major impacts on adolescent mental health at a population level.…”

An Observational Study Quantifying the Disproportionate Impact of COVID-19 Among Immigrant Adults, 2021 California Health Interview Survey

“…[19][20][21] The economic disruption of shelter-in-place policies may have had substantial negative consequences on the physical and mental health of some populations, particularly children, pregnant women, and those with precarious employment. [21][22][23] A nationwide cohort study of 6030 US children and adolescents aged 10-13 years found that experiencing financial disruptions, despite supportive policies, was associated with a 205.2% increase in perceived stress and a 112.1% increase in sadness. 23 Physical activity levels, especially among medically underserved populations, also declined after the onset of the pandemic.…”

“…[21][22][23] A nationwide cohort study of 6030 US children and adolescents aged 10-13 years found that experiencing financial disruptions, despite supportive policies, was associated with a 205.2% increase in perceived stress and a 112.1% increase in sadness. 23 Physical activity levels, especially among medically underserved populations, also declined after the onset of the pandemic. 24…”