10 October 2021 – Building on the first report in a series on child and adolescent mental health and timed with the launch of UNICEF’s State of the World’s Children 2021: On My Mind: Promoting, protecting, and caring for children’s mental health, a new report released for World Mental Health Day in 2021 looks at how the early stages of the global COVID-19 pandemic in 2020 affected the mental health of children and adolescents.
A rapid evidence review was conducted to understand two key research questions:
- What has been the immediate impact of COVID-19 and associated containment measures on the mental health and psychosocial well-being of children and adolescents?
- Which risk and protective factors have affected the mental health of children and adolescents during the COVID-19 pandemic, and how have these factors varied across subgroups of children and adolescents?
Building on a framework established for UNICEF Innocenti’s Worlds of Influence research report, the conceptual framework guiding the report explored the ramifications of COVID-19 on the child’s intimate world, the world around them and the outer worlds of influence while also assessing pre-existing and on-going risks. Uniquely the report also looked at positive mental health outcomes of the pandemic and found evidence on the impact of the pandemic on special populations and vulnerable groups including but not limited to migrant children, children in humanitarian settings, and children with disabilities.
"Life in Lockdown emphasizes the importance of focusing on child and adolescent mental health during the pandemic, a group that was considered to have been largely spared from the physical effects of the virus, " said Manasi Sharma, a research consultant with UNICEF Innocenti who worked on the report. "Government-imposed lockdowns, school closures, and disruption of services (including mental health care) have led to increased reports of fear and stress, anxiety, depression, anger, irritability, inattention, alcohol/substance, along with irregular physical activity and sleep patterns," she added.
The report demonstrates that "although there were negative impacts, especially due to social isolation and loss of learning and networks, there were many positive outcomes and perceived opportunities, especially related to quality time with family, online learning, and time for recreation," Sharma said. "The use of digital technology during the pandemic provided social connectedness, remote learning opportunities, and a way to cope with isolation and stress. Engaging in positive coping strategies, prosocial behaviours and online learning opportunities have been key factors in building children’s resilience during this time, and these need to be highlighted and harnessed through greater investment in mental health promotion and prevention interventions."
Life in Lockdown’s rapid research review included more than 130,000 children from 22 different countries. Most studies were from high- and upper-middle-income countries that were immediately affected by high infection and death rates in the early part of the pandemic, namely: China, the United States, and Italy.
Females reported greater depressive symptoms, anxiety and externalizing behaviout while males reported greater alcohol and substance abuse during COVID-19.
Older children and adolescents reported higher and more severe rates of depressive symptoms.
Children living in more affected areas, rural areas, or near the epi-centres of COVID-19 outbreaks were associated with higher stress and depressive symptoms including anxiety and substance abuse.
Children living in poverty or in lower socio-economic status were found to be at greater risk of stress and depressive symptoms, whereas higher socio-economic status was found to be a protective factor.
Children with pre-existing conditions were more significantly affected by pandemic-related changes.
Children in lower socio-economic settings or humanitarian settings experienced more depression and trouble adapting to online education.
Children who were exposed to pre-existing childhood abuse and neglect were at increased risk of stress.
Family conflict increased the risk of mental distress among children and adolescents.
Separation from families and parental depression were also risk factors for stress and adjustment during the Pandemic.
Stigma based on ethnicity and all forms of racial discrimination were associated with greater anxiety among adolescents.
Social isolation and loneliness during lockdowns contributed to a range of outcomes including depression, irritability, anxiety, stress, alcohol use and sedentary behaviours.
However, in some studies, children reported benefits of confinement including spending time with family, relief from academic stressors, which correlated with more life satisfaction.
Experience or fear of exposure to COVID-19 predicted stress and depressive symptoms but also positive outcomes of health promotion and infection prevention, great social distancing and news monitoring.
Children and adolescents who spent more time on physical activities and maintaining routines were better protected from depressive symptoms. Stress management, leisure activities and regular communication with loved ones proved to be protective coping strategies to deal with the lockdown stressors.
Engaging in recreational activities, using technology to communicate with loved ones, having more time for oneself and one’s family, protected against anxiety and contributed to overall wellbeing during the pandemic.
Recommendations from the research for policy and programming:
It’s never too early to start building a foundation for positive mental health in children.
Foster family-friendly policies to support parents and quality family time during pandemics.
Invest in age- and gender-sensitive child and adolescent mental health care interventions and services.
Promote physical activity and good nutrition for young people.
Make schools a safe space for positive mental health.
Focus on at-risk young populations.
Address stigma and discrimination in mental health.
Support digital technologies as a force for change.
Download the report to read about the recommendations to close the gaps in research on effects of COVID-19 on mental health.