Child Mental Health Research Articles

“The new normal isn’t normal”: to what extent has the Covid-19 pandemic affected secondary school children’s mental health and wellbeing in the North of England?

ABSTRACT This paper reports on a study exploring the impact of the Covid-19 pandemic on secondary school children's mental health and well-being in the North of England. It explores three research questions: to what extent has the Covid-19 pandemic affected secondary school children’s mental health and wellbeing in England? What did students value most for their mental health and wellbeing in a secondary school context during the Covid-19 pandemic? What are the implications for the post-pandemic future? A qualitative multi-method research design was used consisting of an online questionnaire survey (n = 605) and follow-up focus group interviews (n = 16). The findings of the study show that the pandemic and associated restrictions had a detrimental effect on the lives of a very large proportion of the young people in our study, with greater impact on girls than boys. From the analysis the resilience and ability of the participants to “bounce back” from the upheavals caused by the restrictions was apparent. However, for a significant minority the adverse impacts on their mental health and wellbeing continue to affect their lives. The idea of returning to “normal” following a period of crisis and turmoil such as the Covid-19 pandemic, emerges as an unhelpful concept because of the implied associated expectation of a smooth return to the routines prior to the pandemic crisis. This assumption is problematic as this study’s findings demonstrate. The “new” normal is experienced differently by students, especially girls, to what was “normal” experience before the pandemic and this has significant implications for schools.

Can physical activity counteract the negative effects of sedentary behavior on the physical and mental health of children and adolescents? A narrative review.

The increase in sedentary behavior (SB) in children and adolescents is one of the major threats to global public health, and the relationship between physical activity (PA) and SB has always been a key topic. The literature search was conducted through PubMed, Web of Science, CNKI, Wanfang, and Scopus, and 121 pieces of literature were included in this study after screening and evaluation. (1) SB caused by screen time such as mobile phones and TVs has varying degrees of negative impact on obesity, cardiovascular metabolism, skeletal muscle development, and cognitive, and psychological disorders in children and adolescents. (2) Regular physical activity could effectively prevent, offset, or improve the harm of SB to the physical and mental health of children and adolescents, mainly by reducing the incidence of obesity, and cardiovascular and metabolic risks, promoting skeletal muscle development, and improving cognitive function and mental health. (3) The mechanism of physical activity to prevent or ameliorate the harm of SB was relatively complex, mainly involving the inhibition or activation of neurobiomolecules, the improvement of blood and cell metabolic factors, and the enhancement of brain functional connectivity. Children and adolescents should avoid excessive SB, and through a variety of moderate to vigorous physical activity (MVPA) to replace or intermittent SB, which could effectively prevent or improve the harm of SB to physical and mental health.

The Coronavirus Pandemic and Mental Health Presentations of Young Children.

Children under the age of four are emotionally vulnerable to global disasters, such as the COVID-19 pandemic given the lack of socialization opportunities and coping mechanisms, and susceptibility to heightened caregiver stress. Currently, the extent to which the pandemic impacted the mental health of clinically referred young children is unknown. To evaluate how children's mental health outcomes were impacted during the pandemic, interRAI Early Years assessments (N = 1343) were obtained from 11 agencies across the Province of Ontario, during pre-pandemic and pandemic timepoints. Findings demonstrated that the number of completed assessments declined during the pandemic. Further, children's emotional concerns differed before and during the pandemic, whereby children exhibited greater emotional dysregulation during the pandemic. However, there were no significant differences when examining caregiver distress, parenting strengths, child distractibility/inattention or behavioural issues. Implications for young children and their families, clinicians, and policy makers are discussed.

Disorders in Disguise: Proposed Clinical Competencies in Eating Disorders for All Child and Adolescent Mental Health Providers

Early detection and treatment of child and adolescent eating disorders is strongly linked to positive outcomes and can be achieved by recognizing the diverse and often concealed ways in which these conditions commonly present within mental health care settings. In particular, eating disorders are frequently disguised by the appearance of more familiar presenting problems, such as symptoms of anxiety, depression, and emotion or behavioral dysregulation. As a primer for child and adolescent mental health therapists seeking to provide efficient and effective treatment to young patients who may be presenting for mental health care with an undetected eating disorder, we present six cases of patients from differing child and adolescent mental health settings who presented for the treatment of psychiatric symptoms that ultimately were related to an eating disorder. In each case, the detection and treatment of an underlying eating disorder was paramount to improving the presenting problems. Within this context, we discuss key concepts and basic clinical competencies in child and adolescent eating disorders that are essential for all mental health providers, including those who do not consider eating disorder treatment as within their scope of practice.

Assessing Brain Iron and Its Relationship to Cognition and Comorbidity in Children With Attention-Deficit/Hyperactivity Disorder With Quantitative Susceptibility Mapping

BackgroundQuantitative susceptibility mapping is a neuroimaging technique that detects local changes in magnetic susceptibility induced by brain iron. Brain iron and the dopaminergic system are linked because iron is an important cofactor for dopamine synthesis. Attention-deficit/hyperactivity disorder (ADHD) is associated with dysregulation of dopaminergic transmission. Therefore, we applied quantitative susceptibility mapping on subcortical structures to study potential alterations in brain iron and its impact on cognition and mental health in children with ADHD. MethodsQuantitative susceptibility mapping data (3T) of 111 participants (nADHD = 58, mean [SD] age = 13.2 [0.63] years; nControl = 53, mean [SD] age = 13.2 [0.51] years) were analyzed. Subcortical regional brain iron values were extracted. Analysis of variance was used to examine group differences for each region of interest. For dimensional approaches, Pearson correlation analysis was performed across the cohort to examine the association of brain iron with symptoms, mental health, and cognition. ResultsNo significant differences were found in iron susceptibility between participants with ADHD and control participants, between participants with persistent ADHD and those with remitted ADHD, or between participants treated with medication and medication-naïve participants. An unexpected finding was that children with an internalizing disorder had significantly higher iron susceptibility, but the result did not survive multiple comparison correction. Higher brain iron was associated with sustained attention, but not inhibition, IQ, or working memory. ConclusionsThis is the first study to address brain iron susceptibility and its association with comorbidities and cognition in ADHD. Alterations in brain iron may not fully account for a diagnosis of ADHD but may be an indicator of internalizing problems in children. Alterations in brain iron content in children were linked to detrimental sustained attention and may represent developmental variation in cognition.

Progress in Research into the Effectiveness of Pulmonary Rehabilitation in Children with Asthma - A Narrative Review.

Asthma is the most common chronic respiratory disease in children. It has a serious impact on children's physical and mental health. Pulmonary rehabilitation is a multidisciplinary and comprehensive intervention for patients with chronic respiratory disease, whose major components include breathing training, inspiratory muscle training and exercise training. Pulmonary rehabilitation is a multidisciplinary and comprehensive intervention for patients with chronic respiratory diseases, the main components of which are breathing training, inspiratory muscle training and exercise training. Pulmonary rehabilitation can improve the physical and mental condition of patients with chronic respiratory diseases and promote healthy behaviors. However, there is little research on pulmonary rehabilitation in children with asthma. This review comprehensively evaluated the effect of pulmonary rehabilitation in children with asthma at home and abroad, aiming to provide reference for clinical research on pulmonary rehabilitation in children with asthma.

Perceived Parental Distraction by Technology and Mental Health Among Emerging Adolescents

The digital phenomenon termed technoference refers to interruptions in routine social interactions due to technology use. Technoference may negatively affect parents' attention to cues necessary for supporting children's mental health. To explore whether there are directional prospective associations between perceived parental technoference and emerging adolescents' mental health symptoms (anxiety, depression, inattention, and hyperactivity). This cohort study assessed a general population of mothers and emerging adolescents in Calgary, Alberta, Canada. Women were recruited during pregnancy between May 3, 2008, and December 13, 2010, with convenience sampling and repeated follow-up; eligible women were 18 years or older, spoke English, had a gestational age of at least 24 weeks, and received local prenatal care. Data collection for the present study took place when emerging adolescents were aged 9 (May 20 to July 15, 2020), 10 (March 4 to April 30, 2021), and 11 (November 22, 2021, to January 17, 2022) years. Mothers provided consent for their child to participate, and emerging adolescents provided assent. Data were analyzed from December 1 to 31, 2023, using random-intercept cross-lagged panel models. Perceived parental technoference. Emerging adolescents completed questionnaires about their perception of parental technoference and their mental health symptoms (depression, anxiety, hyperactivity, and inattention) at the 3 study times. This study did not rely on statistical significance, but instead on the magnitude of effect sizes to determine meaningful effects. Participants included 1303 emerging adolescents (mean [SD] age, 9.7 [0.8] years at time 1; of the 1028 reporting information, 529 [51.5%] were girls). Cross-sectional associations indicated correlations between perceptions of parental technoference and emerging adolescents' mental health (r range, 0.17-0.19). Higher levels of anxiety at 9 and 10 years of age were prospectively associated with higher parental technoference scores at 10 (β = 0.11 [95% CI, -0.05 to 0.26]) and 11 (β = 0.12 [95% CI, 0.001-0.24]) years of age, with small magnitudes of effect size. Higher parental technoference scores at 9 and 10 years of age were prospectively associated with higher hyperactivity at 10 (β = 0.07 [95% CI, -0.07 to 0.22]) and 11 (β = 0.11 [95% CI, -0.02 to 0.24]) years of age and inattention at 11 years of age (β = 0.12 [95% CI, 0.001-0.24]), with small magnitudes of effect size. No gender differences were identified. In this 3-wave longitudinal birth cohort study, perceived parental technoference was associated with emerging adolescents' mental health. The findings speak to the need to discuss digital technology use and mental health with parents and emerging adolescents as a part of routine care.

Risk and protective factors of asthma and mental health condition multimorbidity in a national sample of Canadian children.

The coexistence of childhood asthma and mental health (MH) conditions can impact management and health outcomes but we need to better understand the etiology of multimorbidity. We investigated the association between childhood asthma and MH conditions as well as the determinants of their coexistence. We used data from the Canadian Health Survey of Children and Youth 2019 (3-17 years; n = 47,871), a cross-sectional, nationally representative Statistics Canada dataset. Our primary outcome was condition status (no asthma or MH condition; asthma only; MH condition only; both asthma, and a MH condition (AMHM)). Predictors of condition status were assessed using multiple multinomial logistic regression. Sensitivity analyses considered individual MH conditions. MH condition prevalence was almost two-fold higher among those with asthma than those without asthma (21.1% vs. 11.6%, respectively). There were increased risks of each condition category associated with having allergies, other chronic conditions, and family members smoking in the home while there were protective associations with each condition status category for being female and born outside of Canada. Four additional variables were associated with AMHM and MH condition presence with one additional variable associated with both AMHM and asthma. In sensitivity analyses, the associations tended to be similar for most characteristics, although there was some variability. There are common risk factors of asthma and MH conditions along with their multimorbidity with a tendency for MH risk factors to be associated with multimorbidity. MH condition presence is common and important to assess among children with asthma.

Antidepressant treatment initiation among children and adolescents with acute versus long COVID: a large retrospective cohort study

BackgroundChild and adolescent antidepressant use increased post-pandemic, but it is unknown if this disproportionally affected those who develop post-acute sequelae of coronavirus disease 2019 (COVID) or long COVID. This study compared the risk of antidepressant initiation among children and adolescents with long COVID with those who had COVID but did not have evidence of long COVID.MethodsOur retrospective cohort study of children and adolescents aged 3–17 years at the first evidence of COVID or long COVID from October 1, 2021 through April 4, 2022 was conducted within Komodo’s Healthcare Map™ database. The index date was the earliest date of a medical claim associated with a COVID (COVID comparators) or long COVID diagnosis (long COVID cases). The baseline period was six months before the index date. The outcome was antidepressant initiation within twelve months after the index date. Due to the large number of COVID relative to long COVID cases, COVID comparators were randomly selected with a ratio of 2 COVID to 1 long COVID. We used propensity score matching to control for confounding due to imbalances in the baseline covariates. Log-binomial models estimated the relative risk (RR) of antidepressant initiation in the propensity score matched sample. We conducted several sensitivity analyses to test the robustness of our findings to several assumptions.ResultsOur child and adolescent sample included 18 274 with COVID and 9137 with long COVID. Compared with those with COVID, a larger proportion of long COVID children and adolescents had psychiatric disorders, psychotropic use, medical comorbidities, were previously hospitalized, or visited the emergency department. In the propensity score-adjusted analysis, the long COVID group had a statistically significant higher risk of antidepressant initiation relative to the COVID comparator (adjusted-RR: 1.40, 95% CI = 1.20, 1.62). Our findings were robust across sensitivity analyses.ConclusionsThe increased risk of antidepressant initiation following long COVID warrants further study to better understand the underlying reasons for this higher risk. Emerging evidence of long COVID’s impact on child mental health has important implications for prevention and early interventions.

A descriptive evaluation of children presenting with Technology Assisted-Harmful Sexual Behaviour (TA-HSB) within a regional Forensic Child and Adolescent Mental Health Service (FCAMHS)

ABSTRACT Unsupervised technology use by children is increasing rapidly and with it, a common area of crime is emerging: Technology Assisted-Harmful Sexual Behaviour (TA-HSB). Previous research has demonstrated that there are significant differences between adult offenders displaying TA-HSB, offline Harmful Sexual Behaviour (offline HSB) and those displaying both (dual HSB). This study aimed to investigate these differences further within a community adolescent forensic population over a period of four years (1 April 2018 to 31 March 2022). The demographic characteristics and TA-HSB typologies of an adolescent forensic population who were displaying TA-HSB (n = 43), offline HSB (n = 116) and dual HSB (n = 130) were examined. The implications for future research are discussed. PRACTICE IMPACT STATEMENT This evaluation promotes a greater sense of awareness and knowledge of the characteristics of young people engaging in TA-HSB in a community adolescent forensic service and the incidence and types of TA-HSB they engage in. Findings help develop an understanding of risk formulation, differential needs and support of young people presenting with TA-HSB.

Maternal Antenatal Depression Is Associated With Metabolic Alterations That Predict Birth Outcomes and Child Neurodevelopment and Mental Health

BackgroundEvidence regarding metabolic alterations associated with maternal antenatal depression (AD) is limited, and their role as potential biomarkers that improve the prediction of AD and adverse childbirth, neurodevelopmental, and mental health outcomes remains unexplored. MethodsIn a cohort of 331 mother-child dyads, we studied associations between AD (a history of medical register diagnoses and/or a Center for Epidemiological Studies Depression Scale score during pregnancy ≥ 20) and 95 metabolic measures analyzed 3 times during pregnancy. We tested whether the AD-related metabolic measures increased variance explained in AD over its risk factors and in childbirth, neurodevelopmental, and mental health outcomes over AD. We replicated the findings in a cohort of 416 mother-child dyads. ResultsElastic net regression identified 15 metabolic measures that collectively explained 25% (p < .0001) of the variance in AD, including amino and fatty acids, glucose, inflammation, and lipids. These metabolic measures increased the variance explained in AD over its risk factors (32.3%, p < .0001 vs. 12.6%, p = .004) and in child gestational age (9.0%, p < .0001 vs. 0.7%, p = .34), birth weight (9.0%, p = .03 vs. 0.7%, p = .33), developmental milestones at the age of 2.3 to 5.7 years (21.0%, p = .002 vs. 11.6%, p < .001), and any mental or behavioral disorder by the age of 13.1 to 16.8 years (25.2%, p = .03 vs. 5.0%, p = .11) over AD, child sex, and age. These findings were replicated in the independent cohort. ConclusionsAD was associated with alterations in 15 metabolic measures, which collectively improved the prediction of AD over its risk factors and birth, neurodevelopmental, and mental health outcomes in children over AD. These metabolic measures may become biomarkers that can be used to identify at-risk mothers and children for personalized interventions.

Leveraging community-based mental health services to reduce inequities for children and families living in United States who have experienced migration-related trauma.

Trauma systems therapy for refugees (TST-R) is a trauma-focused, culturally responsive mental health prevention and intervention model designed to meet the needs of children and families who are fleeing their home countries and seeking humanitarian refuge. TST-R provides trauma-focused mental health treatment and addresses problems in part exacerbated by harsh U.S. immigration policies (e.g., poor mental health, stigma, fear) that have implications for the psychosocial well-being of immigrant children and families, especially those who have experienced migration-related trauma. Informed by a community-based participatory research approach, TST-R was developed as an adaptation of trauma systems therapy to address common barriers to care experienced by those of refugee and immigrant backgrounds, including mental health stigma, distrust of service systems, and cultural and linguistic barriers. TST-R is a multitiered and phase-based intervention that strategically addresses stressors and needs across levels of the social ecology. Most TST-R services are delivered in easily accessible, nonstigmatizing settings (e.g., school) by a cultural broker and a clinician who work in partnership. TST-R has been disseminated and implemented with multiple cultural groups (e.g., Somali, Bhutanese) across the United States and Canada. Given the unique stressors, strengths, and needs of immigrant children and their families, mental health services must be equitable, community based, and sustainable. TST-R demonstrates promise as a prevention and intervention model especially for those experiencing immigration policy-related stressors and may serve as a guide for developing child mental health policies and immigration policies that promote mental well-being for immigrant families. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A non-randomized feasibility study of a voice assistant for parents to support their children's mental health.

Mental disorders affect one in seven Australian children and although effective, evidenced based treatments exist, there is a critical shortage of mental health clinicians which has created a "treatment gap." Artificial intelligence has the potential to address the high prevalence rates of mental disorders within overburdened mental health systems. This was a non-randomized feasibility study to evaluate the novel application of voice technology to an evidence-based parenting intervention designed to support children's mental health. We deployed an Amazon Alexa app to parents recruited from the community (N = 55) and to parents with children receiving psychological treatment (N = 4). Parents from the community used the app independently whereas parents from the clinical group used the app in conjunction with attending a six-week parenting program. The primary outcome measure, feasibility was assessed in terms of acceptability, via recruitment and retention rates, quantitative surveys and qualitative interviews. In the community group, the recruitment rate was 23.8% and the retention rate 49.1%. In the clinical group, all 6 families approached for recruitment agreed to participate and 4 out of 6 completed the trial. Parents attending the parenting program spent on average, three times longer using the app than parents from the community. Overall, parents reported that the app contained easy-to-understand information on parenting, and that they could see the potential of voice technology to learn and practice parenting skills. Parents also faced several challenges, including difficulties with installation and interactions with the app and expressed privacy concerns related to voice technology. Further, parents reported that the voices used within the app sounded monotone and robotic. We offer specific recommendations that could foster a better voice assistant user experience for parents to support their children's mental health. The app is highly scalable and has the potential to addresses many of the barriers faced by parents who attempt to access traditional parenting interventions.

The Effect of Parent-child Relationships on the Social and Emotional Competence of Elementary School Students in the Lower School Grades

Over the years, social and emotional competence has received much attention as a key competence for the social development of individuals. The level of social and emotional competence has gradually become an important indicator for assessing students' personal social adaptability and well-being in life. Based on the global report of Social and Emotional Competence Measurement released by OECD in 2021, understanding parents and a good parent-child relationship will promote the development of social and emotional competence of primary and secondary school students to a certain extent. Under the educational background of home-school-society co-education, family education has become an important part of education. Research shows that a harmonious family atmosphere is more conducive to the healthy development of children's physical and mental health. Moreover, lower elementary school students are in the transition period and have the psychological characteristics of preschool children, such as insecurity, judgment, emotional instability, etc., which require more attention and guidance from parents, teachers, and society. This study analyzes relevant literature to investigate the influence of the parent-child relationship on the social and emotional competence of lower elementary school students and develops parent-child activities for the five major competencies of social and emotional competence.

How not to talk about it: Using digital storytelling with children with anxiety

This paper explores the benefits and challenges of using digital storytelling (DST) in mental health research with children. By using DST to centre children's experiences, the study empathetically deepens our understanding of children's complex mental health issues. DST involves a gradual process that fosters safe self-expression and imaginative storytelling. The DST process can help convey difficult or stressful stories coherently and creatively to support both researchers and participants in understanding mental health issues. However, a narrow focus on neat endings and resolutions may limit authentic expression, indicating a need for more open-ended narrative structures to capture the complexities of children's mental health experiences.This is a story about three stories. This is also a story about the discoveries and challenges of working alongside children (ages 10–13) as they used digital storytelling to share their anxiety experiences through short self-made videos. Our journey began with two questions: How would children portray their anxiety through digital storytelling? What aspects of the digital storytelling process would be the most fruitful for both participants and researchers, and why? In this paper, we weave three of the children's stories within our own narrative of using digital storytelling as a research tool to better understand children's experiences of anxiety. Rather than present the children's stories as the results of our research, we use their stories as springboards for articulating and interrogating digital storytelling as a tool for understanding anxiety. We intertwine the first-person accounts of each child with our academic prose, deliberately highlighting the different ways of knowing that our approach enables.

Is the availability and quality of local early childhood education and care services associated with young children's mental health at school entry?

PurposeThis study investigated the relationship between geographic availability (and quality) of local early childhood education and care services and children's early mental health outcomes for all children entering their first year of full-time school in Melbourne, Australia. MethodsWe capitalise on a unique population linked dataset, the Australian Early Development Census – Built Environment, which combines geospatial measures of children's neighbourhoods with demographic information and child mental health outcomes for all school entrants in Australia's 21 most populous cities and towns. Objective early childhood education and care service location and quality exposures were developed for each study child based on home addresses. Four geographic availability exposures (counts within 3 km) were examined for cross-sectional associations with child mental health outcomes (externalising and internalising difficulties, competence). We estimated associations using multilevel logistic regression (Markov Chain Monte Carlo estimation) adjusting for child demographics and stratifying by urbanicity. ResultsChildren with higher counts of high-quality preschool services within 3 km of home had lower odds of difficulties and higher odds of competence. Overall, exposures were most consistently associated with children's competence. Across all outcomes, the most consistent patterning was observed for children living in the inner city and middle ring. Results varied depending on whether service quality was accounted for in measures of availability. Geographic availability of early childhood services showed patterning by neighbourhood disadvantage and by maternal education. ConclusionWe found some evidence that geographic availability of high-quality preschools was associated with better child mental health outcomes, but results varied by urbanicity. While future research is required to unpack these differences, these findings indicate the importance of accounting for both geographic availability and service quality simultaneously in future research, policy and practice.

Pilot of a text messaging system to monitor caregivers' and children's mental health recovery after pediatric traumatic injury.

Pediatric traumatic injury (PTI) is associated with a high risk for psychiatric sequelae. Most trauma centers do not adequately address the emotional needs of children and their caregivers. Technology-based programs offer a low-cost and low-burden opportunity to track and potentially enhance families' emotional recovery following PTI. This feasibility pilot project was designed to examine caregivers' usage of and feedback on a text message-based symptom monitoring service. Participants included 25 caregivers of PTI patients under age 12. Caregivers received up to four texts daily for 30 days postdischarge from the automated system: one symptom-based question to capture the current mental health status of the caregiver and child, respectively, and a corresponding educational tip each time a symptom was endorsed. Data analyses describe the number of questions to which caregivers responded on behalf of themselves and their children. A semistructured qualitative interview was used to assess caregivers' reactions and suggested improvements for the service. Almost all caregivers (91.1%) responded to at least one text message, and two thirds (66.6%) responded to over half of the messages. Themes from the qualitative interviews indicated that caregivers perceived the timing and content of the text messaging service facilitated their own and their child's emotional recovery following PTI. Caregivers suggested that the service could be improved by providing an option to interact directly with mental health care providers. Text message-based symptom monitoring services offer an opportunity to bridge the gap in mental health services during the acute recovery phase for families of traumatically injured children. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Oscillating autonomy: a grounded theory study of women’s experiences of COVID-19 infection during pregnancy, labour and birth, and the early postnatal period

BackgroundTesting positive for COVID-19 was associated with higher rates of detrimental psycho-social and physical health outcomes. The COVID-19 pandemic caused unprecedented disruption to everyday life. This included major reconfiguration of maternal, child, and perinatal mental health and care services and provision. This study aimed to investigate the experiences of those who tested positive for COVID-19 during pregnancy, labour and birth, or the early postnatal period.MethodsNational on-line recruitment from across the United Kingdom resulted in sixteen mothers being invited to qualitative semi-structured interviews to understand the experiences of mothers who had been infected by COVID-19 during pregnancy, labour and birth, or the early postnatal period. Interviews were conducted, recorded, and transcribed using video-conferencing software. A Grounded Theory approach was used to analyse the data gathered pertaining to women’s experiences of their positive COVID-19 diagnosis during pregnancy, labour and birth, or the early postnatal period.ResultsThe theory of ‘Oscillating Autonomy – Losing and Seeking to Regain Control by Striving for Agency’ was developed, comprising three main themes: ‘Anxious Anticipation: The fear of infection was worse than COVID-19 itself’; ‘Fluctuating Agency: What changed when COVID-19 took control’; and ‘Reclaiming Control: Seeking reassurance during COVID-19 positivity’. Testing positive for COVID-19 whilst pregnant, during labour or birth, or in the early postnatal period was associated with a perceived loss of control. Those who were able to regain that control felt more secure in their situation.ConclusionsSupport was paramount to manage increased vulnerability, as was reassurance achieved by information seeking and positive action including increased health monitoring and COVID-19 vaccination.

Children's Addictive Behavior in Watching Animation on Youtube, What is the Solution?

In this modern era, many entertainment media are easily accessible to children via Youtube. Along with the progress and evolution of educational knowledge and technology, the role of parents in early childhood education is very important. Parents need to understand and learn about every latest knowledge and technology in this era full of various challenges. Many parents do not realize that gadget addiction can be dangerous because it can damage children's mental and physical health. Some parents don't even realize when their children spend 3 hours or even the whole day watching YouTube without a break. Situations like this can indicate when the child has experienced addiction. Based on the results, researchers want to provide an understanding of parents related to children who are addicted to animated YouTube content using an interpersonal communication approach. With parental guidance, the selection of animated content on the elements of learning methods and watching together actively can reduce the potential for excessive addiction and the weakness of watching negative animated content. The selection of animations such as Nussa and Rara as children's shows is an educational selection. This animation includes good character education, so it is suitable for shaping children's character if introduced early.

Life changes and symptoms of depression and anxiety among Chinese children and adolescents before, during, and after the COVID-19 pandemic lockdown: a combination of cross-sectional, longitudinal, and clustering studies.

The measures to prevent COVID-19 pandemic had caused significant life changes, which may have caused stress on the mental health of children and adolescents. We aimed to evaluate the short- and long-term effects of life changes on children's mental health in a large Chinese cohort. Survey-based life changes during COVID-19 lockdown were measured among 7,829 Chinese students at Grade 1-9, including social contacts, lifestyles and family financial status. Clustering analysis was applied to identify potential patterns of these changes. Depressive and anxiety symptoms were measured using the Center for Epidemiologic Studies Depression Scale and Screen for Child Anxiety Related Emotional Disorders. Logistic regression models were used to investigate the associations between these changes, their patterns and the presence of depression/anxiety symptoms using both cross-sectional and longitudinal designs. We found that the prevalence of depression and anxiety symptoms decreased during pandemic (34.6-32.6%). However, during and shortly after lockdown, students who reported negative impacts on their study, social and outside activities, and diet had increased risks of depressive/anxiety symptoms. Decreased electronic time and sugar-sweetened consumption, as well as family income decline and unemployment, were also associated with higher risks of these symptoms. Additionally, students with changed sleep time had increased depressive symptoms. These associations attenuated or disappeared one year later. Similar patterns were observed in clustering analysis, while only the group with severe impact on family financial status showed a sustained increase in depression symptoms. In summary, restrictive measures that changed children and adolescents' daily life during COVID-19 lockdown showed negative effects on their mental health, with some commonalities and distinctions patterns in the manifestation of depression and anxiety symptoms.