A longitudinal meta-analysis today in JAMA Pediatrics surveyed studies published in 12 countries about the rates of anxiety and depression among adolescents and children before and after the pandemic and found that rates of depression increased, especially among female youth in high-income counties.
In total, the studies analyzed included 40,807 subjects pre-COVID and 33,682 subjects during the COVID-19 pandemic, from a total of 53 longitudinal studies. Longitudinal studies, as opposed to cross-sectional studies, allow for a more nuanced look as to how strong of an effect the pandemic had on youth mental health, the authors argue. But to date such studies have offered a muddled take on how and if youth mental health suffered during the pandemic.
"Longitudinal cohort studies examining changes from before to during the pandemic have revealed a range of different findings: some studies reported that depression and anxiety symptoms have decreased or remained stable, while others showed various levels of increase," the authors said.
Disruptions, restrictions, stress on children
All studies included were published from 2020 to 2022 and reported on depression or anxiety symptoms using validated measures, had data comparing prepandemic to pandemic estimates, and included pediatric samples, the author said.
Eighty-seven percent of studies included were self-reported, and 9% were parent-reported. Twenty-seven studies reported data from North America (51%), 13 (24%) from Europe, 10 (19%) from Asia, 2 (4%) from Australia, and 1 (2%) from Israel.
An increase in depression symptoms during the pandemic was backed by the strongest evidence (standardized mean change [SMC], 0.26; 95% confidence interval [CI,] 0.19 to 0.33; slight to small magnitude). Studies provided stronger estimates of depressive changes among girls (SMC, 0.32; 95% CI, 0.21 to 0.42), in kids and teens from families with medium to high incomes (SMC, 0.35; 95% CI, 0.07 to 0.63), and in children living in North America (SMC, 0.25; 95% CI, 0.15 to 0.36) or Europe (SMC, 0.35; 95% CI, 0.17 to 0.53).
The magnitude of this increase was more than what could be expected based on time trends and can therefore likely be attributed to the disruptions, restrictions, and stress imposed on children and adolescents and their families during the pandemic.
"The magnitude of this increase was more than what could be expected based on time trends and can therefore likely be attributed to the disruptions, restrictions, and stress imposed on children and adolescents and their families during the pandemic," the authors wrote.
Pandemic likely exacerbated, triggered symptoms
The pandemic likely worsened depression for those already experiencing depressive symptoms, while triggering new symptoms in those who had never yet experienced a depressive episode, the author wrote.
"Those who were experiencing depression before the pandemic may have had difficulty coping when faced with additional stressors; second, those with less experience with stress may have had difficulty coping with new unfamiliar and accumulating stressors," they said.
Similarly, children from higher-income countries may have seen more disruptions to their daily lives due to the pandemic, as with the shuttering of schools and extracurricular activities. Also, the increased reliance on technology and screens may have triggered depressive symptoms for some.
"The widespread uncertainty, at times severe restrictions, and repeated disruptions during the pandemic might have pushed some youth, especially female individuals and adolescents, beyond their typical stress threshold," the authors concluded.
Policy makers should consider the significant ramifications of depressive episodes in adolescents, the authors said, which might cause familial and financial disruptions well into adulthood.
