Mental Health of School Aged Children Before and During the COVID-19 Pandemic: A Longitudinal Study

Abstract

Background: Mental health of children has been a major concern during the COVID-19 pandemic. This study aimed to investigate suicide, self-harm and general mental health of children before and during the COVID-19 pandemic. Methods: In this longitudinal study, we used data from the Sichuan Positive Youth Development Cohort (SPYD) in Chengdu China. Children aged 6-15 years from 5 schools in urban and suburb Chengdu completed questionnaires at January 2019 before the COVID-19 outbreak, and were followed at June 2020 when schools’ resumption, after months of school closure and social distancing measures during the COVID-19 pandemic. Questionnaires were used to collect data on suicide, self-harm, anxiety, depression, internet addiction and family function from children and demographics, socio-economic status and mental health status from parents. Mental health outcomes of children were compared before and after the pandemic. Stratified analyses were conducted by demographics and socio-family contextual factors including children’s grade, parent’s mental health and family function status. Findings: Overall 8,124 children (mean age 11·0±2·2, female 48·3%) completed questionnaires both at the wave 1 and wave 2 survey were included in this study. Suicidal thoughts, plans and attempts (Odds ratio 1·65, 95%CI1·38-1·98) and internet addiction (1·13, 1·01-1·26) of children increased significantly during the pandemic period, while self-harm (0·90, 0·83-0·99) and anxiety (0·69, 0·63-0·76) decreased, with no significant change of depression (0·98, 0·89-1·07). However, children of higher grades, with parents of worsened depression or anxiety symptoms were more likely to have worse mental health outcomes mentioned above (pInterpretation: There are notable impacts of the COVID-19 pandemic on children’s mental health, and children beyond 9 years old with parents of mental health problems are especially vulnerable. Measures to screen and identify these children, support their parents and improve family function are important to protect children’s mental health during the pandemic. Further investigations on risk and protective factors, mediators of mental health of children during the pandemic are warranted to identify vulnerable individuals and inform targeted interventions.Funding Statement: This study was supported by the Hong Kong Polytechnic University (Longitudinal study of positive youth development 19H0642), the Sichuan University (Research on supportive strategies to promote positive development of primary school students in the anti-epidemic period,YQZX903). And KZ was supported by the China Medical Board Fund (CMB 16-252)Declaration of Interests: Authors declared no conflicts of interest.Ethics Approval Statement: The study protocol was approved by the Ethics Committee of Sichuan University (K2020025).