Increase of depression among children and adolescents after the onset of the COVID-19 pandemic in Europe: a systematic review and meta-analysis

Abstract

Background Research points to a high depression burden among youth during the COVID-19 pandemic; however, a lack of systematic evidence exists. We determine the change in depression symptoms among children and adolescents during COVID-19 compared to pre-pandemic baselines. By using country differences in pandemic-related restrictions and school closures in Europe as quasi-experimental design, we evaluate policy impacts on depression. Methods In this systematic review and meta-analysis, following the PRISMA statement, we searched six databases (MEDLINE, EMBASE, PsycINFO, Cochrane Central, Web of Science, WHO COVID-19) using a peer-reviewed search string up until March 18, 2022 with citation tracking and grey literature searches. No limitations regarding language and effect measures existed. We included studies that compared (1) general depression symptoms or (2) clinically relevant depression rates in children and adolescents (≤ 19 years) before and during the COVID-19 pandemic in Europe. The validated Oxford Stringency Index was used as indicator for pandemic-related restrictions. Screening for eligibility, extracting data from published reports and from unpublished data requested directly from study authors, assessing the study risk of bias and grading certainty of evidence using the GRADE approach, were all done in duplicate. Data were pooled in a random-effects model. PROSPERO: CRD42022303714. Results Of 7,422 nonduplicate records, 22 studies with data from 868,634 participants pre-pandemic and 807,480 during pandemic, met full inclusion criteria. For the comparison of depression symptoms before and during the COVID-19 pandemic, moderate certainty of evidence was observed for general depression symptoms (standardized mean difference, 0.21 [95%CI, 0.12–0.30]; I2 = 94%) and low certainty of evidence for clinically relevant depression rates (odds ratio, 1.36 [95%CI, 1.05–1.76]; I2 = 95%) for total population. Increase in general depression symptoms was higher for male adolescents, whereas increase in clinically relevant depression rates was higher for females. Effect estimates were significantly higher when pandemic-related restrictions were more stringent or school closure occurred. Conclusion An increase in depression symptoms occurred in a pre-pandemic vs. during-pandemic comparison within the COVID-19 pandemic, whereby pandemic-related restrictions (such as school closures) resulted in a considerable effect increase. Ensuring adequate supply of mental health recovery services and long-term monitoring is of high public health relevance.

A large sample cross-sectional study on mental health challenges among adolescents and young adults during the COVID-19 pandemic at-risk group for loneliness and hopelessness during the COVID-19 pandemic

“…Adolescents or their parents have reported symptoms of internalizing disorders such as depression and anxiety, with increased levels in female adolescents compared to male peers ( Duan and Zhu, 2020 ). Based on previous studies, perceived difficulties such as social isolation, confinement, and school closures resulted in mental health problems, particularly higher depressive symptoms and more loneliness compared to pre-pandemic baselines ( Loades et al, 2020 ; Rogers et al, 2021 ; Ludwig-Walz et al, 2022 ). Furthermore, during the COVID-19 pandemic, a higher dose-response relationship was found when school closures occurred ( Ludwig-Walz et al, 2022 ).…”

“…The pandemic causes significant changes in friendship and family dynamics among adolescents and young adults. They perceived social and emotional changes such as less support from friends and negative affect, which were associated with mental health problems and loneliness ( Rogers et al, 2021 ; Cooper et al, 2021 ; Ludwig-Walz et al, 2022 ). For adolescents and young adults, the peer group is one of the most significant groups for supporting and developing identity ( Meeus and Dekoviíc, 1995 ).…”

“…However, emerging data have indicated that the younger population is the most vulnerable group to the development of mental health problems during this pandemic ( McQuaid et al, 2021 ), especially with pre−/ existing psychopathological symptoms ( Essau and de la Torre-Luque, 2021 ). Most of the studies demonstrated longitudinal deterioration in the mental health of the young population with increased depression and anxiety symptoms, psychological distress, negative affect, decreased mental well-being and increased loneliness ( Loades et al, 2020 ; Rogers et al, 2021 ; Cooper et al, 2021 ; Ludwig-Walz et al, 2022 ; Cénat et al, 2022 ), especially for early and late adolescence ( Kauhanen et al, 2022 ; Ludwig-Walz et al, 2022 ). Home isolation and social distancing ( Loades et al, 2020 ), lack of prosocial/physical activity ( Mittal et al, 2020 ), family stress and heightened concerns ( Meade, 2021 ), increased screen time ( Duan et al, 2020 ), etc.…”

Anxiety among children and adolescents during the COVID-19 pandemic in Europe: a systematic review protocol

“…The range of the School Closure Index comprises 0 to 3: 0 for no measures, 1 for recommended closings or changes in school operations, 2 for partially school closures and 3 for closing of all school levels [ 6 , 40 ]. Therefore, we will define the following cut-offs points: no or few alterations compared to a pre-COVID-19 situation (index < 2) and partial or full school closure (index ≥ 2) [ 24 ].…”

“…Since the COVID-19 pandemic confronted populations in Europe with several waves and national state governments reacted with heterogenous contact restrictions like lockdowns, school/kindergarten closures, quarantine orders, decreased peer interactions etc., a summary within a European context could allow a differential view on a potential increase of anxiety symptoms during the course of the pandemic. A recent published meta-analysis of our research group regarding the changes of depression symptoms in CA in Europe during the COVID-19 pandemic highlights an overall increase as well as a dose–response relationship of restriction measures and general depression symptoms [ 24 ]. At present, no systematic review specifically addresses the changes during COVID-19 pandemic for anxiety among CA on the European continent.…”