New research reveals impact of COVID-19 pandemic on child and youth mental health

New research from The Hospital for Sick Children (SickKids) shows a large majority of children and youth experienced harm to their mental health during the first wave of the COVID-19 pandemic. Greater stress from social isolation, including both the cancellation of important events and the loss of in-person social interactions, was strongly associated with mental health deterioration. The study, published in European Child & Adolescent Psychiatry on February 26, 2021, offers a robust look at the impact of COVID-19 pandemic emergency measures on child and youth mental health in Ontario.

“Mostly worse, occasionally better”

The research team surveyed more than 1,000 parents of children and youth aged two to 18 years old, and nearly 350 youth between 10 and 18 years old, from April to June of 2020. Across six domains of mental health – depression, anxiety, irritability, attention span, hyperactivity, and obsessions/compulsions – 70.2 per cent of school-aged children (six to 18 years old) and 66.1 per cent of preschool-aged children (two to five years old) reported deterioration in at least one domain. A smaller proportion, 19.5 per cent of school-aged children and 31.5 per cent of preschool-aged children, reported improvement in at least one domain.

“We found that overall, children were faring mostly worse, and occasionally better, compared to their pre-pandemic selves,” says Dr. Daphne Korczak, Child and Adolescent Psychiatrist at SickKids and Principal Investigator of the study. “We also found that the mental health impacts of the pandemic were greater for school-aged children during the first lockdown, underscoring the importance of in-class learning and extracurricular activities for children.”

The study included four ongoing research and clinical cohorts: the SickKids Child and Youth Psychiatry Outpatient Program, the Province of Ontario Neurodevelopmental Network (POND), The Applied Research Group for Kids (TARGet Kids!), and Spit for Science. This unique study design enabled the researchers to survey a large sample of children and youth both with and without pre-existing mental health or neurodevelopmental disorders.

Variability among children with pre-existing mental health conditions

The study found children and youth experienced relatively similar overall mental health impacts no matter their clinical history. However, those with autism spectrum disorder (ASD) reported the greatest deterioration in depression, irritability, attention span and hyperactivity. The researchers say this could be due to several factors, including closure of school-based services combined with greater online learning challenges, reduction of home care services and disruptions to daily routines.

Having a pre-existing psychiatric or neurodevelopmental diagnosis was associated with both improvements and deterioration in mental health. The researchers note that for some children with pre-existing conditions, the stay-at-home directives may have provided relief from sources of stress, therefore improving symptoms of anxiety or irritability. However, they say that for children with diagnoses such as ASD or ADHD, the loss of structure, consistency and familiar social interactions may have significant negative impacts on their mental health and well-being.

“Furthering our understanding of how different children are impacted by the pandemic is crucial to developing targeted interventions,” says Dr. Katherine Cost, lead author of the study and Research Associate in the Department of Psychiatry. “Our study seeks to uncover these nuances by finding out which kids are being impacted, by which factors, and to what degree.”

The researchers stress that ensuring continuous access to mental health services will be an important mitigation strategy for all children and youth during the pandemic.

Balancing risk of COVID-19 infection with mental health deterioration

One concerning finding for the study team was the significant proportion of otherwise healthy school-aged children who experienced deterioration in a number of mental health domains, including depression (37.6 per cent), anxiety (38.7 per cent), irritability (40.5 per cent) and attention span (40.8 per cent).

The researchers argue that the strong association of stress from social isolation with mental health deterioration points to the importance of in-person school, recreation, social activities and milestone events.

“Keeping schools open safely and maintaining or adapting activities so they can continue to be offered will go a long way to protecting and addressing children’s mental health and well-being,” adds Korczak, who is also an Associate Scientist in the Neurosciences & Mental Health program at SickKids and an Associate Professor in the Department of Psychiatry at the University of Toronto.

“Encouraging group work at school, whether in-person or online; running extracurricular activities adhering to local public health guidelines; and ensuring ongoing communication between home and school are all tangible ways we can support children and youth during this incredibly challenging time.”

The researchers continue to issue their survey to study participants and will monitor the pandemic’s ongoing impacts to child and youth mental health.

This work was supported by the Canadian Institutes for Health Research (CIHR), the Ontario Ministry of Health, the SickKids Centre for Brain and Mental Health, the Edwin S.H. Leong Centre for Healthy Children, the Miner’s Lamp Innovation Fund in Prevention and Early Detection of Severe Mental Illness at the University of Toronto and SickKids Foundation.