The COVID-19 pandemic introduced disruptions that uniquely hindered opportunities for children and young people to achieve critical milestones for healthy development. This included navigating school transitions, forming personal identities and relationships, and taking exams. These unprecedented disruptions may have introduced risks for mental health outcomes.
Children and young people who prior to the pandemic already had difficulties with depression, anxiety, autism, and attention deficit hyperactivity disorder, may be at risk for worse mental health outcomes because of the pandemic. Indeed, some existing systematic reviews suggest this may be the case.
Why would children and young people with pre-existing conditions have been more vulnerable?
This group of children and young people may be more vulnerable than healthy counterparts to the negative effects of pandemic restrictions. For example, they may find it more difficult to engage in remote schooling without additional educational support or being stuck indoors with limited access to outside space.
Additionally, the pandemic restrictions may have overwhelmed children and young people with pre-existing conditions limiting their ability to make functional adaptations to meet their pre-existing needs, worsening their mental health.
Despite these predictions, no study has comprehensively investigated the longitudinal impact of the pandemic on this clinical group.
Aims of this study
Our recent systematic review and meta-analysis aimed to investigate the longitudinal impact of the pandemic on the mental health of children and young people with pre-existing mental health and neurodevelopmental conditions.
It also aimed to identify potential explanatory factors for mental health changes during the pandemic in this group.
We conducted a literature search of peer-reviewed papers published between January 2020 and August 2023 across four databases. We included 21 studies (N=2,617) that longitudinally compared mental health outcomes between pre-pandemic and during pandemic timepoints in children and young people with pre-existing conditions.
Mental health outcomes were grouped by symptom categories. These were internalising (includes depression and anxiety), externalising (includes conduct problems, inattention, and hyperactivity), and other symptoms.
What did we find?
The meta-analysis unexpectedly found overall no significant change in internalising or externalising symptoms during the pandemic. At first glance, this might suggest that the pandemic had no impact on the mental health of children and young people with pre-existing conditions.
Further exploration showed a more complex and less clear picture in which many individual studies reported significant effects of the pandemic, but some showed mental health improvements and others deterioration. The narrative synthesis found variation within studies, such that even when the overall results found overall no change or improved mental health outcomes during the pandemic, there may be a proportion of children and young people within those samples who saw worse mental health.
In addition to the high heterogeneity between studies, we also saw variations within studies. Some studies found differences in mental health outcomes based on symptoms assessed or parent/child reported data.
Within many studies, findings of improvement or deterioration were not consistent across different symptoms (e.g., depressive vs anxiety symptoms), informants (e.g. parent vs young people), or timepoint (e.g., March-June 2020 vs July-December 2020).
This variation in findings highlights that the impact of the pandemic was heterogenous and complex. It also highlighted that examining mental health changes through overall means and pooled effects may not capture divergent effects within samples. The methods and measures used varied widely across studies, which may also have added to the inconsistency in published findings.
Lastly, we did not find any explanatory factors that were consistently reported by studies to play a role in the variation of mental health changes during the pandemic.
Why does this research matter?
Since the pandemic, there is increasing evidence of poorer mental health in children and young people. To explore this, we used robust methods to understand how the pandemic impacted this clinically vulnerable group of children and young people. Our study identified that there may be subgroups whose mental health fared worse during the pandemic, but who they may be is still unclear. This research is the first step in facilitating the identification and targeted support of these vulnerable children and young people.
The next steps are to improve our understanding of what the pandemic-related ‘active ingredients’ are and how they impact children and young people’s mental health. We also need to improve the longitudinal data we have so far so we can continue examining the long-term impact of the pandemic on mental health outcomes as children and young people transition through major milestones.
Having a better understanding of how the pandemic impacted children and young people with pre-existing mental health conditions in the short and longer-term will allow clinical services and policy makers to make more informed decisions and provide more effective care in the event of future epidemics/pandemics.
You can read more in the paper, Research Review: The impact of the COVID-19 pandemic on the mental health of children and young people with pre-existing mental health and neurodevelopmental conditions – a systematic review and meta-analysis of longitudinal studies, published in The Journal of Child Psychology and Psychiatry https://doi.org/10.1111/jcpp.14117