Risk factors for prospective increase in psychological stress during COVID-19 lockdown in a representative sample of adolescents and their parents

Abstract

Background COVID-19 lockdown measures imposed extensive restrictions to public life. Previous studies suggest significant negative psychological consequences, but lack longitudinal data on population-based samples. Aims We aimed to prospectively identify increased psychological stress and associated risk factors in parent–child dyads. Method We conducted a prospective, observational online study on a representative German sample of 1221 adolescents aged 10–17 years and their parents. Psychological stress and psychosocial variables were assessed before the pandemic (baseline) and 1 month after the start of lockdown (follow-up), using standardised measures. We used multilevel modelling to estimate changes in psychological stress, and logistic regression to determine demographic and psychosocial risk factors for increased psychological stress. Results The time of measurement explained 43% of the psychological stress variance. Of 731 dyads with complete data, 252 adolescents (34.5%, 95% CI 31.0–37.9) and 217 parents (29.7%, 95% CI 26.4–33.0) reported a significant increase in psychological stress. Baseline levels were lower than in dyads without increased psychological stress. Risk factors for increased psychological stress included sociodemographic (e.g. female parents, severe financial worries) and emotion regulation aspects (e.g. non-acceptance of emotional responses in parents, limited access to emotion regulation strategies in adolescents), explaining 31% of the adolescent (Nagelkerke R2 = 0.31) and 29% of the parental (Nagelkerke R2 = 0.29) model variance. Conclusions This study is the first to prospectively show an increase in psychological stress during COVID-19 lockdown in a representative family sample. Identified demographic and psychosocial risk factors lead to relevant implications for prevention measures regarding this important public health issue.

The Impact of the COVID-19 Pandemic and Societal Infection Control Measures on Children and Adolescents' Mental Health: A Scoping Review

“…The presence of COVID-19 cases in adolescents' communities contributed to poorer mental health, which was more pronounced for older adolescents (13). Several studies indicated that parental mental health problems were related to poorer child and adolescent outcomes (7,16,25,37,48,53,56), which strengthens the evidence that social environment is an important factor. Internet, social media and video game use was another common research topic, evidence from which suggests negative association with child and adolescent mental health (9,18,24,26,31,51,67).…”

“…Five longitudinal studies involved children ( 51 , 55 , 56 , 58 , 59 ), nine involved adolescents ( 53 , 54 , 57 , 60 – 65 ) and one involved children and adolescents ( 52 ). Most of the studies indicated negative impact of the pandemic on mental health, including increased symptoms of depression ( 60 , 63 , 64 , 66 ), anxiety ( 60 , 63 , 64 , 67 ), loneliness ( 63 ), psychological distress ( 51 , 53 , 65 ), hyperactivity and impulsivity ( 55 ), and emotional and behavioural problems ( 59 ), as well as reductions in emotional regulation ( 55 ), happiness and positive emotions ( 54 , 65 ), and life satisfaction ( 64 ). However, a study from Spain reported no significant change among preschool-aged children and, despite some statistically significant differences in a primary school-aged group, no change was identified for depression or challenging behaviour ( 55 ).…”

“…When specifically considering the impact of societal control measures, which have varied internationally, many studies suggested negative impact yet the evidence was mixed. The closure of schools and home quarantine, sometimes referred to as “lockdown,” was reportedly negatively associated with children's mental health outcomes across various international settings ( 28 , 33 , 39 , 53 , 54 , 56 , 66 ), as were physical distancing measures ( 65 ). Boredom and difficulty concentrating emerged as specific concerns ( 35 , 38 ), which is understandable given the loss of routine that comes with such control measures.…”

“…Further research from Europe was conducted in Belgium ( n = 1), Spain ( n = 4), Germany ( n = 1), the Netherlands ( n = 2), and the United Kingdom ( n = 1). Increased depressive symptoms were reported in the UK ( 66 ), there was some evidence of increased psychological stress in Germany ( 53 ), the evidence from Spain was mixed ( 38 – 40 , 55 ), and only slight impact was interpreted in the Netherlands ( 56 , 57 ). The Belgian study explored the relationship between anxiety and social media ( 31 ).…”

“…The scoping review discovered 15 longitudinal studies (Table 3), which involved repeated measures over time and provide stronger evidence to address the question of impact on mental health. Five longitudinal studies involved children (51,55,56,58,59), nine involved adolescents (53,54,57,(60)(61)(62)(63)(64)(65) and one involved children and adolescents (52). Most of the studies indicated negative impact of the pandemic on mental health, including increased symptoms of depression (60,63,64,66), anxiety (60,63,64,67), loneliness (63), psychological distress (51,53,65), hyperactivity and impulsivity (55), and emotional and behavioural problems (59), as well as reductions in emotional regulation (55), happiness and positive emotions China, Asia "To assess the prevalence of two specific mental symptoms, anxiety, and depression, and their socio-demographic correlates among adolescents in the Chinese population during the COVID-19 outbreak.…”