Abstract
In-person schooling has been disrupted for most school-aged youth during the COVID-19 pandemic, with low-income, Black, and Hispanic populations most likely to receive fully remote instruction. Disruptions to in-person schooling may have negatively and inequitably affected children's mental health. To estimate the association between school closures and child mental health outcomes and how it varies across sociodemographic factors. This cross-sectional population-based survey study included a nationally representative sample of US adults aged 18 to 64 years with at least 1 child in the household. The survey was administered between December 2 and December 21, 2020, via web and telephone in English and Spanish. Participants were recruited from the NORC AmeriSpeak panel, an address-based panel with known probability sampling and coverage of 97% of US households. Schooling modality (in person, fully remote, or hybrid), household income, age. Child mental health difficulties were measured with the parent-report version of the Strengths and Difficulties Questionnaire, with small, medium, and large effect sizes defined as 1.3-, 3.3-, and 5.2-point differences, respectively. A total of 2324 adults completed the survey. Overall, 1671 respondents (71.9%) were women, 244 (10.5%) were Black, 372 (16.0%) were Hispanic, and 421 (18.1%) had a high school education or less. Children attending school in-person had higher household incomes (mean difference, $9719; 95% CI, $4327 to $15 111; P < .001) and were more likely to be White compared with those attending remotely (366 of 556 [65.8%] vs 597 of 1340 [44.5%]; P < .001). Older children in remote schooling had more mental health difficulties than those attending in-person schooling (standardized effect size, 0.23 [95% CI, 0.07 to 0.39] per year older; P = .006), corresponding to small effect sizes in favor of in-person schooling for older children and very small effect sizes favoring remote schooling for younger children. Children from families with higher income benefitted more from attending schools in-person compared with their peers from families with lower income (B = -0.20 [95% CI, -0.10 to -0.30] per $10 000-increase in annual income; P < .001), although this advantage was not apparent for children attending hybrid school (B = -0.05 [95% CI, -0.16 to 0.06] per $10 000-increase in annual income; P = .34), and directionally lower but not significantly different for children attending remote school (B = -0.12 [95% CI, -0.04 to -0.20] per $10 000-increase in annual income; P < .001). Learning pods fully buffered the associations of hybrid schooling (d = -0.25; 95% CI, -0.47 to -0.04) but not remote schooling (d = 0.04; 95% CI, -0.10 to 0.18) with negative mental health outcomes. The findings of this study suggest that older and Black and Hispanic children as well as those from families with lower income who attend school remotely may experience greater impairment to mental health than their younger, White, and higher-income counterparts. Ensuring that all students have access to additional educational and mental health resources must be an important public health priority, met with appropriate funding and workforce augmentation, during and beyond the COVID-19 pandemic.
Highlights
Older children in remote schooling had more mental health difficulties than those attending in-person schooling, corresponding to small effect sizes in favor of in-person schooling for older children and very small effect sizes favoring remote schooling for younger children
Learning pods fully buffered the associations of hybrid schooling (d = −0.25; 95% CI, −0.47 to −0.04) but not remote schooling (d = 0.04; 95% CI, −0.10 to 0.18) with negative mental health outcomes
School closures have been widely used as a risk mitigation practice during the COVID-19 pandemic,[1] with in-person schooling disrupted for most school-aged youth
Summary
School closures have been widely used as a risk mitigation practice during the COVID-19 pandemic,[1] with in-person schooling disrupted for most school-aged youth. One-third of a convenience sample of US parents reported that their child was more sad, depressed, or lonely since the onset of the pandemic.[3] Longitudinal data from children in China aged 9 to 16 years showed an increase in depressive symptoms and suicidal thoughts and behaviors compared with before the implementation of COVID-19 home isolation restrictions.[4] Potential pathways through which remote schooling could be negatively affecting child mental health include loss of social connection; decreased access to mental health services[5,6]; lack of identification, reporting, and support for youth experiencing abuse or maltreatment at home[7,8]; heightened psychosocial consequences of missed free and reduced price meals[9]; disrupted routines and lack of structure[10]; and stress related to online learning. Older children, who are forming more complex social relationships and navigating more high stakes academic outcomes, may be at heightened risk
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