Psychological and Behavioral Impact of Lockdown and Quarantine Measures for COVID-19 Pandemic on Children, Adolescents and Caregivers: A Systematic Review and Meta-Analysis

Abstract

Background During the current ongoing COVID-19 pandemic, psychological problems like anxiety, depression, irritability, mood swings, inattention and sleep disturbance are fairly common among quarantined children in several studies. A systematic review of these publications to provide an accurate burden of these psychiatric/behavioral problems is needed for planning mitigating measures by the health authorities. Methods Different electronic databases (MEDLINE, EMBASE, Web of Science, CENTRAL, medRxiv and bioRxiv) were searched for articles describing psychological/behavioral complications in children/adolescents with/without pre-existing behavioral abnormalities and their caregivers related to the COVID-19 pandemic. Only original articles with/without comparator arms and a minimum sample size of 50 were included in the analysis. The pooled estimate of various psychological/behavioral problems was calculated using a random-effect meta-analysis. Results Fifteen studies describing 22 996 children/adolescents fulfilled the eligibility criteria from a total of 219 records. Overall, 34.5%, 41.7%, 42.3% and 30.8% of children were found to be suffering from anxiety, depression, irritability and inattention. Although the behavior/psychological state of a total of 79.4% of children was affected negatively by the pandemic and quarantine, at least 22.5% of children had a significant fear of COVID-19, and 35.2% and 21.3% of children had boredom and sleep disturbance. Similarly, 52.3% and 27.4% of caregivers developed anxiety and depression, respectively, while being in isolation with children. Conclusion Anxiety, depression, irritability, boredom, inattention and fear of COVID-19 are predominant new-onset psychological problems in children during the COVID-19 pandemic. Children with pre-existing behavioral problems like autism and attention deficit hyperactivity disorder have a high probability of worsening of their behavioral symptoms.

Effects of COVID-19 Lockdown on the Emotional and Behavioral Profiles of Preschool Italian Children with and without Familial Risk for Neurodevelopmental Disorders

“…Starting from previous reports of negative effects of the COVID-19 lockdown on the general child and adolescent population and of the additional challenges for children with NDD, we expected worsening of emotional and behavioral profiles in all children and a more marked worsening in children at risk for NDD. Based on the previous literature, we expect worsening in specific CBCL scales, reflecting anxiety and depression [9][10][11][12]16,27], sleeping disorders [1,10], difficulty in concentrating [1,13,14,16], irritability and externalizing behaviors [1,13,14,16,33], and somatic complaints [27]. In addition, we hypothesized that some clinical, socio-demographic and environmental factors might act as protective or risk factors.…”

“…The first investigations conducted during the COVID-19 outbreak revealed a wide variety of mental health issues in children and adolescents, including anxiety and depression [9][10][11][12], sleeping disorders [1,10], irritability and difficulty in concentrating [1,13,14], clinginess and excessive dependence on parents [1,13] and worries and fear that family members could contract the infection [1,13,15]. A recent meta-analysis by Panda et al [16] revealed that 34.5%, 41.7%, 42.3% and 30.8% of the children were suffering, respectively, from anxiety, depression, irritability and inattention. One study specifically compared children from the general population-both younger and older than 6 years of age-and suggested that clinging, inattention and irritability were the most severe psychological conditions displayed by children in all age groups, whereas children in the younger age group (3-6 years) were more likely than older children to manifest symptoms such as clinginess and fear that family members may contract the infection [1].…”

The Impact of the COVID-19 Pandemic on Child Health and Well-Being: Are Children “Slipping through the Net”? A Qualitative Study of Frontline Emergency Care Staff

“…Widespread disruption to mental health services, including repurposing of staff and facilities, has been identi ed at a time when they may be needed more than ever (23). The conditions of imposed "lockdowns" may be having a negative effect on children's mental health (11), and as identi ed in this study and elsewhere (24), this is manifesting in rising psychosocial presentations at the ED, which may not be the most appropriate pathway to mental health care. As the pandemic continues to progress, policy makers and service providers must ensure the continued provision of essential health and social services, including targeted responses for those with existing conditions.…”

“…Another clinician relayed an interaction with a parent who misinterpreted the government message to stay home as including not being allowed to travel to the hospital: "she fully believed that if she was stopped by the guards [police] on the road that they would tell her to turn back" [11]. Furthermore, it was evident that parents believed hospitals were overwhelmed with COVID-19 patients.…”

“…"So, they [parents] would say like, 'You know, I really didn't want to come, I was trying to get a GP appointment but they're maybe just doing virtual clinics or whatever, so they told me to come along" [11] With regard to public health, di culties in maintaining infant's vaccination schedule was raised by one clinician who triaged patients, which parents explained as due to either an inability to secure an appointment with the GP or fear of attending the service. Those with new-born babies were also impacted by the suspension of public health nurse visits and some presented due to struggles with colic and feeding issues, compounded by not being able to rely on wider family or peer support networks: "These parents were rst time parents, you know, they didn't have the public health nurse they didn't have the support, that they often came in and they were very, you could see they were very vulnerable" [8] Restrictions on the delivery of primary and community health services left parents without what one clinician described as "normal systems and supports" [13], and the effect of this was manifesting in the ED.…”