Examining Children and adolescent mental health trajectories during the COVID‐19 pandemic: Findings from a year of the Co‐SPACE study

Abstract

Background: A major concern throughout the COVID-19 pandemic has been on young people's experiences with mental health. In this study we mapped children and adolescents' mental health trajectories over 13 months of the pandemic and examine whether family, peer, and individual-level factors were associated with trajectory membership. Methods: This study focuses on a sub-sample from the Co-SPACE study of 3322 children and adolescents (aged 4-16 years) for whom parents completed a survey at Time 0 and at least one follow-up survey between March 2020 and May 2021. We used growth mixture models to examine trajectories in emotional, conduct, and hyperactivity/inattention difficulties using the Strengths and Difficulties Questionnaire and multinomial logistic regression models to estimate factors associated with individual trajectory membership. Results:The average trend in young people's mental health appeared to follow changes in national guidelines regarding the pandemic. Distinct trends in GMM models highlighting individual differences showed that a 5-trajectory model best explained the changes in emotional problems whilst 4-trajectory models best explained variation in hyperactivity/inattention and conduct problems. While most young people followed low stable (62%-85%) or moderate stable (28%) symptom trajectories, 14%-31% experienced very high, high stable or increasing mental health difficulties. Young people following high stable trajectories were more likely to have special educational needs and/or neurodevelopmental disorders, parents reporting higher levels of distress and parent-child conflict, and were less likely to have at least one close friend. Conclusions:Most young people adapted well and experienced low stable symptoms, but nearly one third experienced high stable or increasing mental health difficulties. Young people with complex needs and parents with higher psychological distress were particularly vulnerable to high stable problems while those with positive peer relationships were less vulnerable. This study offers insight into potential factors that can be addressed using targeted interventions to improve the This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

The Effectiveness and Cost-Effectiveness of a Universal Digital Parenting Intervention Designed and Implemented During the COVID-19 Pandemic: Evidence From a Rapid-Implementation Randomized Controlled Trial Within a Cohort

“…The RCT was conducted during spring 2021 and summer 2021, when pandemic-related restrictions were beginning to ease (ie, children were not homeschooled en masse, and restrictions on social contacts had relaxed). In this sense, we are unable to generalize our findings to more restrictive lockdown periods or to nonrestricted contexts, and parents of children in Co-SPACE reported a drop in conduct problems when restrictions eased [5]. However, during the RCT, there was continued concern and uncertainty about the course of the pandemic and its continued impact.…”

“…Children's behavioral and emotional problems increased during the pandemic [2], with individuals with preexisting vulnerabilities at particular risk [3]. COVID-19: Supporting Parents, Adolescents and Children during Epidemics (Co-SPACE), a UK-wide general population study, confirmed this pattern during both the first and second UK lockdowns [4,5]. Findings from Co-SPACE and other studies show that increases in parental stress and child-related help seeking were also reported [6,7].…”

“…On the basis of the very high and rapid rate of recruitment into the trial (646 participants in just over 2 months), high levels of retention, and relatively high numbers accessing the app compared with those in trials of similar mental health apps [36], there seemed to be a strong demand for the intervention. This was especially striking when one considers that this was a general population sample unselected on levels of conduct and emotional problems-although the wider Co-SPACE cohort reported fewer conduct problems than those who took part in SPARKLE [5]. Intervention-related AEs were very rare in the study, and the high number of AEs reported in both arms was likely to be due to how these were ascertained in SPARKLE as all parent-reported familial medical and nonmedical AEs were recorded.…”

“…Although not statistically significant, the difference in conduct problems between the 2 arms in favor of Parent Positive increased substantially by T3. This was in the context of restrictions easing, schools being open again, and reductions in conduct problems at the general population level being reported [5]. It would be interesting in future trials to extend the intervention period to ≥3 months on the grounds that it may take time for skills to embed and begin to show benefits [37].…”

Perfect storm: emotionally based school avoidance in the post-COVID-19 pandemic context

“…These conditions contributed to worsening mental health for children and their parents, which in some cases will have persisted once schools reopened 15. Adverse mental health impacts have been most sustained for children with special educational needs and disabilities, neurodevelopmental disorders, fewer close friendships and those living in families with lower incomes and higher parental stress 16. On the other hand, school closures provided a welcome relief from the stresses of school for some children, including those with pre-existing EBSA.…”