The Prevalence of Mental Problems for Chinese Children and Adolescents During COVID-19 in China: A Systematic Review and Meta-Analysis

Abstract

The outbreak of coronavirus disease 2019 (COVID-19) has caused mental problems among the public and medical staff in China, especially for children and adolescents, a vulnerable group that might present with more mental problems. It seems that there is a rapid growth in the mental problems (such as depression or anxiety) of Chinese children and adolescents during the outbreak of COVID-19. Although several studies reported the prevalence of depression or anxiety problems for children and adolescents, the results are different across different age groups and sex groups. Moreover, the sample size of these studies was small. In the present study, we aim to perform a meta-analysis to identify the confirmed prevalence of depression and anxiety problems for Chinese children and adolescents during home confinement. Five databases were searched including PubMed, Web of Science, PsycINFO, Google Scholar, and the China National Knowledge Infrastructure (CNKI), and both inclusion and exclusion criteria were developed. Finally, a total of 12 studies were included in this meta-analysis. The protocol of this systematic review was registered with INPLASY (protocol ID: INPLASY202150032). It found that the pooled prevalence of mental problems was 28% (95% confidence interval, CI: 0.22–0.34), and the depression and anxiety problem for children and adolescents in China was 22% (95% CI: 0.16–0.30) and 25% (95% CI: 0.20–0.32) based on a random effect model, separately. Subgroup analysis was used to identify that there are no differences between different age groups (primary and middle school vs. high school) (p = 0.26). Meta-regression analysis was performed and the results showed that the moderator of boy percentage was a significant factor (p = 0.04). It indicated that there was an increasing number of children and adolescents with mental problems during the home confinement. It suggested that we should pay more attention to this vulnerable population during a public health crisis in the future, especially for the girls groups, and more detailed implements for mental health management were needed and should be prepared.Systematic Review: The protocol of this systematic review was registered with INPLASY. The protocol ID was INPLASY202150032

Global burden of mental health problems among children and adolescents during COVID-19 pandemic: A systematic umbrella review

“…A total of 24 citations met our preliminary criteria and were retained for full-text review. After full-text evaluation, 17 systematic reviews [29,34,[48][49][50][51][52][53][54][40][41][42][43][44][45][46][47], including 6 meta-analytic reviews [34,42,43,46,49,51] met all criteria of this umbrella review and were selected for further analysis (see Table 2).…”

“…The methodological quality of the reviews was assessed using the JBI critical appraisal checklist (See Supplementary Material). Most of the reviews (n = 13) included in this umbrella review were of high quality [29,34,51,53,54,[40][41][42][43][44][48][49][50], whereas the remaining (n = 4) reviews had medium quality [45][46][47]52]. None of the reviews were identified to have low methodological quality as per the JBI checklist.…”

“…Thirteen reviews reported a varying burden of anxiety among children and adolescents during this pandemic [29,34,51,53,54,40,43,44,[46][47][48][49][50]. The prevalence of anxiety ranged from 1.85% to 74% across primary studies included in the reviews.…”

“…Gender was associated with mental health outcomes as reported in several reviews. Chai et al [43] reported the percentage of boys was a moderator of mental health outcomes across study samples. In contrast, several reviews reported girls had a higher burden of mental health problems during this pandemic.…”

“…Understanding those and addressing the same should be prioritized in future meta-research. [5, 34, 44-46, 48, 52, 53] • Using representative samples of children and adolescent populations rather than using small, non-representative samples, or sub-groups [40,52] • Examining the biopsychosocial determinants of CAMH during and after COVID-19 pandemic to explore specific risk and protective factors [40,50,52] • Applying appropriate psychometric tools for CAMH problems with standardized cutoff values [34,40,43,53] • Exploring the impacts of COVID-19 on education, work, and living conditions and their associations with CAMH [42] • Investigating the impacts of parents' psychosocial health and family relationships on CAMH during COVID-19 [42] • Studying the psychosocial correlates of pandemic-related events and their impacts on CAMH [44,45] • Investigating the persistence of psychosocial symptomology or development of mental disorders in the future [46,48,50] • Strengthening research capacities of the researchers and institutions on CAMH research in the context of COVID-19 [46] • Emphasizing younger children's mental health research-an area with little evidence but high significance for long-term impacts [34] • Examining psychiatric comorbidities alongside identified physical and mental health problems [34] • Examining the role of timing and context of studies (e.g., studied undertaken during lockdown vs. after returning to school) on CAMH [50] • Exploring pre-pandemic and existing mental health gaps to develop stronger mental health systems in the future [50,52] • Conducting implementation research on mental health services for children and adolescents emphasizing trends, barriers, and facilitators of mental health utilization in different contexts [5,52,64]…”