Abstract
PurposeDuring the COVID-19 pandemic in the Netherlands, governmental regulations resulted in a lockdown for adults as well as children/adolescents. Schools were closed and contact with other people was limited. In this cross-sectional, population-based study, we aimed to investigate the mental/social health of children/adolescents during COVID-19 lockdown.MethodsTwo representative samples of Dutch children/adolescents (8–18 years) before COVID-19 (2018, N = 2401) and during lockdown (April 2020, N = 844) were compared on the Patient-Reported Outcomes Measurement Information System (PROMIS) domains: global health, peer relationships, anxiety, depressive symptoms, anger, sleep-related impairment by linear mixed models and calculating relative risks (RR (95% CI)) for the proportion of severe scores. Variables associated with worse mental/social health during COVID-19 were explored through multivariable regression models. The impact of COVID-19 regulations on the daily life of children was qualitatively analyzed.ResultsParticipants reported worse PROMIS T-scores on all domains during COVID-19 lockdown compared to before (absolute mean difference range 2.1–7.1 (95% CI 1.3–7.9). During lockdown, more children reported severe Anxiety (RR = 1.95 (1.55–2.46) and Sleep-Related Impairment (RR = 1.89 (1.29–2.78) and fewer children reported poor Global Health (RR = 0.36 (0.20–0.65)). Associated factors with worse mental/social health were single-parent family, ≥ three children in the family, negative change in work situation of parents due to COVID-19 regulations, and a relative/friend infected with COVID-19. A large majority (> 90%) reported a negative impact of the COVID-19 regulations on daily life.ConclusionThis study showed that governmental regulations regarding lockdown pose a serious mental/social health threat on children/adolescents that should be brought to the forefront of political decision-making and mental healthcare policy, intervention, and prevention.
Highlights
The COVID-19 pandemic has an enormous impact on society as a whole, and on children and adolescents in particular
Significant differences were found on four variables (Table 1); age (during M = 13.4 (SD = 2.80) versus before M = 13.1 (SD = 3.14), mean difference = 0.3; 95% confidence intervals (95% CI) - 0.54 to - 0.06, d = 0.10), at least one parent born in a foreign country (during 11.8% versus before 20.2%, χ2(1) = 29.884, P < 0.001, relative risk (RR) = 0.58), parents with a low educational level (during 9.0% versus before 12.8%, χ2(2) = 7.470, P = 0.024, Cramer’s V = 0.06), and families with one child (during 25.5% versus before 15.5%, χ2(2) = 44.728, P < 0.001, Cramer’s V = 0.12)
Largest differences were found for Anxiety and Depressive Symptoms
Summary
The COVID-19 pandemic has an enormous impact on society as a whole, and on children and adolescents in particular. Children and adolescents are less affected by morbidity and mortality [1], the restrictions imposed by governments worldwide profoundly impact their daily life, including their mental and social health [2]. In the Netherlands, the first COVID-19 patient was identified on February 27th 2020 and restrictions were imposed by the government starting on March 12th 2020. People were asked to stay inside and work from home as much as possible, to comply with social distancing (1.5 m), and all large events were canceled. On March 15th, a ‘partial’ lockdown was implemented (www.government.nl/topics/coronavirus-covid-19). Children were still allowed to play outside, and visitors up to three persons were permitted at home. On May 11th primary schools were partially reopened and on June 2nd secondary schools followed
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