Life in Lockdown: Child and adolescent mental health and well-being in the time of COVID-19

UNICEF Innocenti has released a report aimed at exploring the immediate effects of Covid-19 on the mental health of children and adolescents. The studies cover more than 130,000 children and adolescents across 22 countries, mostly of high- and upper-middle-income and severely affected in the early stage of the pandemic.

By using the social-ecological systems model; the life-course perspective; and the social determinants of health approach, the studies have shown the following:

1. The key findings on mental health:

• The levels of depression, fear, anxiety, anger, irritability, negativity, conduct disorder, alcohol and substance use, and sedentary behaviours have increased compared with pre-pandemic.
• Positive mental health changes: increase of quality time with family and school closure benefited children and adolescents’ well-being.

2. The key findings on risk and protective factors:

• Sex: Females reported more depressive symptoms, anxiety than males, who reported greater alcohol and substance use.
• Age: older children and adolescents had higher rates of depressive symptoms and anxiety than younger children.
• Location: stress symptoms, depressive symptoms, anxiety, alcohol and substance usage, and sleep disturbance were linked to living in more affected and rural areas, or near the epicenter of COVID-19 outbreaks.
• Socio-economic status: children living in poverty and lower socioeconomic positions were at increased risk of stress and depressive symptoms.
• Pre-existing conditions: children with neurodevelopmental and health conditions were more concerned about the danger of COVID-19.
• Adverse childhood experiences: children and adolescents who had previously experienced negative childhood experiences and maltreatment, such as abuse, neglect, and family dysfunction, have been at an elevated risk of stress and anxiety symptoms.
• Parenting: family conflict, separation from families, and parental depression increased the risk of mental distress, depression, and anxiety, while positive parenting and communication about the pandemic resulted in improvement of coping and well-being of children.
• Stigma and discrimination: ethnicity-based stigma and racial discrimination were linked to greater anxiety.
• Lockdown and isolation: social isolation and loneliness increased stress, anxiety, and depressive symptoms, alcohol use, and sedentary behaviors, but some studies show a rise in life satisfaction as a result of home confinement and school closure.
• Coping strategies: physical activity, maintenance of daily living routines, stress management and leisure time activities, communication with loved ones showed to be proactive coping strategies when dealing with pandemic stress.

3. Recommendations for policy and programming:

1. Begin early to build mental health assets of children and adolescents with nurture and support.
2. Foster family-friendly policies. Encouraging positive action through play, support to family, and quality family time help to reduce stress and pandemic-induced stress.
3. Invest in age- and gender-sensitive child and adolescent mental health care interventions and services. In light of the global mental health crisis, it is crucial to treat mental health care as an increasing priority when working with primary health care centers.
4. Promote physical activity and good nutrition for young people due to their impact on positive mental health
5. Make schools a safe space for positive mental health. Addressing mental distress from both the absence of school and schooling itself is vital.
6. Focus on at-risk young populations. It is essential to put greater emphasis on working with children and adolescents suffering from pre-existing child and adolescent mental health conditions.
7. Support digital technologies as a force for change. With the recognition of the essentiality of digital technologies in the COVID era, it is highly recommended to develop innovative mental health psychological support services.

The report provides the necessary evidence data necessary not only for the better understanding of the pandemic effect on the mental health of children and adolescents but also practical recommendations for their support.