Cost Katherine Tombeau, Crosbie Jennifer, Anagnostou Evdokia, Birken Catherine S, Charach Alice, Monga Suneeta, Kelley Elizabeth, Nicolson Rob, Maguire Jonathon L, Burton Christie L, Schachar Russell J, Arnold Paul D, Korczak Daphne J
Department of Psychiatry, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, 6th Floor, Toronto, On, M5G 0A4, Canada.
Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada.
Eur Child Adolesc Psychiatry. 2022 Apr;31(4):671-684. doi: 10.1007/s00787-021-01744-3. Epub 2021 Feb 26.
This large cross-sectional study examined the impact of COVID-19 emergency measures on child/adolescent mental health for children/adolescents with and without pre-existing psychiatric diagnoses. Using adapted measures from the CRISIS questionnaire, parents of children aged 6-18 (N = 1013; 56% male; 62% pre-existing psychiatric diagnosis) and self-reporting children/adolescents aged 10-18 (N = 385) indicated changes in mental health across six domains: depression, anxiety, irritability, attention, hyperactivity, and obsessions/compulsions. Changes in anxiety, irritability, and hyperactivity were calculated for children aged 2-5 years using the Strengths and Difficulties Questionnaire. COVID-19 exposure, compliance with emergency measures, COVID-19 economic concerns, and stress from social isolation were measured with the CRISIS questionnaire. Prevalence of change in mental health status was estimated for each domain; multinomial logistic regression was used to determine variables associated with mental health status change in each domain. Depending on the age group, 67-70% of children/adolescents experienced deterioration in at least one mental health domain; however, 19-31% of children/adolescents experienced improvement in at least one domain. Children/adolescents without and with psychiatric diagnoses tended to experience deterioration during the first wave of COVID-19. Rates of deterioration were higher in those with a pre-exiting diagnosis. The rate of deterioration was variable across different age groups and pre-existing psychiatric diagnostic groups: depression 37-56%, anxiety 31-50%, irritability 40-66%, attention 40-56%, hyperactivity 23-56%, obsessions/compulsions 13-30%. Greater stress from social isolation was associated with deterioration in all mental health domains (all ORs 11.12-55.24). The impact of pre-existing psychiatric diagnosis was heterogenous, associated with deterioration in depression, irritability, hyperactivity, obsession/compulsions for some children (ORs 1.96-2.23) but also with improvement in depression, anxiety, and irritability for other children (ORs 2.13-3.12). Economic concerns were associated with improvement in anxiety, attention, and obsessions/compulsions (ORs 3.97-5.57). Children/adolescents with and without pre-existing psychiatric diagnoses reported deterioration. Deterioration was associated with increased stress from social isolation. Enhancing social interactions for children/adolescents will be an important mitigation strategy for current and future COVID-19 waves.
这项大型横断面研究调查了新冠疫情防控措施对患有和未患有精神疾病诊断的儿童及青少年心理健康的影响。研究采用了经改编的CRISIS问卷，6至18岁儿童的家长（N = 1013；56%为男性；62%患有精神疾病诊断）以及10至18岁的儿童/青少年（N = 385）进行自我报告，表明六个领域的心理健康发生了变化：抑郁、焦虑、易怒、注意力、多动以及强迫观念/强迫行为。对于2至5岁的儿童，使用长处与困难问卷计算焦虑、易怒和多动方面的变化。通过CRISIS问卷测量新冠病毒暴露情况、对防控措施的遵守情况、对新冠疫情的经济担忧以及社交隔离带来的压力。估计每个领域心理健康状况变化的患病率；使用多项逻辑回归来确定与每个领域心理健康状况变化相关的变量。根据年龄组的不同，67%至70%的儿童/青少年至少在一个心理健康领域出现恶化；然而，19%至31%的儿童/青少年至少在一个领域有所改善。在新冠疫情的第一波期间，未患有和患有精神疾病诊断的儿童/青少年都倾向于出现恶化情况。已有诊断的儿童恶化率更高。恶化率在不同年龄组和已有精神疾病诊断组中有所不同：抑郁为37%至56%，焦虑为31%至50%，易怒为40%至66%，注意力为40%至56%，多动为23%至56%，强迫观念/强迫行为为13%至30%。更大的社交隔离压力与所有心理健康领域的恶化相关（所有比值比为11.12至55.24）。已有精神疾病诊断的影响是异质性的，对一些儿童来说，与抑郁、易怒、多动、强迫观念/强迫行为的恶化相关（比值比为1.96至2.23），但对其他儿童来说，也与抑郁、焦虑和易怒的改善相关（比值比为2.13至3.12）。经济担忧与焦虑、注意力和强迫观念/强迫行为的改善相关（比值比为3.97至5.57）。患有和未患有精神疾病诊断的儿童/青少年均报告了心理健康恶化情况。恶化与社交隔离带来的压力增加有关。加强儿童/青少年的社交互动将是应对当前及未来新冠疫情的一项重要缓解策略。
