Department of Psychology, University of Calgary, Calgary, Alberta, Canada.
Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.
JAMA Pediatr. 2021 Nov 1;175(11):1142-1150. doi: 10.1001/jamapediatrics.2021.2482.
Emerging research suggests that the global prevalence of child and adolescent mental illness has increased considerably during COVID-19. However, substantial variability in prevalence rates have been reported across the literature.
To ascertain more precise estimates of the global prevalence of child and adolescent clinically elevated depression and anxiety symptoms during COVID-19; to compare these rates with prepandemic estimates; and to examine whether demographic (eg, age, sex), geographical (ie, global region), or methodological (eg, pandemic data collection time point, informant of mental illness, study quality) factors explained variation in prevalence rates across studies.
Four databases were searched (PsycInfo, Embase, MEDLINE, and Cochrane Central Register of Controlled Trials) from January 1, 2020, to February 16, 2021, and unpublished studies were searched in PsycArXiv on March 8, 2021, for studies reporting on child/adolescent depression and anxiety symptoms. The search strategy combined search terms from 3 themes: (1) mental illness (including depression and anxiety), (2) COVID-19, and (3) children and adolescents (age ≤18 years). For PsycArXiv, the key terms COVID-19, mental health, and child/adolescent were used.
Studies were included if they were published in English, had quantitative data, and reported prevalence of clinically elevated depression or anxiety in youth (age ≤18 years).
A total of 3094 nonduplicate titles/abstracts were retrieved, and 136 full-text articles were reviewed. Data were analyzed from March 8 to 22, 2021.
Prevalence rates of clinically elevated depression and anxiety symptoms in youth.
Random-effect meta-analyses were conducted. Twenty-nine studies including 80 879 participants met full inclusion criteria. Pooled prevalence estimates of clinically elevated depression and anxiety symptoms were 25.2% (95% CI, 21.2%-29.7%) and 20.5% (95% CI, 17.2%-24.4%), respectively. Moderator analyses revealed that the prevalence of clinically elevated depression and anxiety symptoms were higher in studies collected later in the pandemic and in girls. Depression symptoms were higher in older children.
Pooled estimates obtained in the first year of the COVID-19 pandemic suggest that 1 in 4 youth globally are experiencing clinically elevated depression symptoms, while 1 in 5 youth are experiencing clinically elevated anxiety symptoms. These pooled estimates, which increased over time, are double of prepandemic estimates. An influx of mental health care utilization is expected, and allocation of resources to address child and adolescent mental health concerns are essential.
新出现的研究表明，在 COVID-19 期间，全球儿童和青少年精神疾病的患病率显著增加。然而，文献中报告的患病率存在很大差异。
确定 COVID-19 期间儿童和青少年临床明显抑郁和焦虑症状的全球患病率更准确的估计值；将这些比率与大流行前的估计值进行比较；并检查人口统计学因素（例如，年龄，性别）、地理位置（即全球区域）或方法学因素（例如，大流行数据收集时间点、精神疾病的报告者、研究质量）是否可以解释研究之间患病率的差异。
从 2020 年 1 月 1 日至 2021 年 2 月 16 日，在四个数据库（PsycInfo、Embase、MEDLINE 和 Cochrane 对照试验中心注册）中进行了搜索，并于 2021 年 3 月 8 日在 PsyArXiv 中搜索了未发表的研究，以报告儿童/青少年抑郁和焦虑症状的研究。搜索策略结合了来自 3 个主题的搜索词：（1）精神疾病（包括抑郁和焦虑），（2）COVID-19 和（3）儿童和青少年（≤18 岁）。对于 PsyArXiv，使用了关键术语 COVID-19、心理健康和儿童/青少年。
如果研究发表于英文，具有定量数据，并报告了年轻人（≤18 岁）临床明显的抑郁或焦虑症的患病率，则将其纳入研究。
共检索到 3094 篇非重复标题/摘要，并对 136 篇全文文章进行了审查。数据分析于 2021 年 3 月 8 日至 22 日进行。
青年中临床明显的抑郁和焦虑症状的患病率。
进行了随机效应荟萃分析。共有 29 项研究纳入了 80879 名参与者，符合全部纳入标准。临床明显抑郁和焦虑症状的汇总患病率分别为 25.2%（95%CI，21.2%-29.7%）和 20.5%（95%CI，17.2%-24.4%）。调节分析表明，在大流行后期收集的研究和女孩中，临床明显的抑郁和焦虑症状的患病率更高。较大的儿童中抑郁症状更高。
在 COVID-19 大流行的第一年中获得的汇总估计值表明，全球有 1/4 的青少年患有临床明显的抑郁症状，而 1/5 的青少年患有临床明显的焦虑症状。这些随时间增加的汇总估计值是大流行前估计值的两倍。预计会有大量的精神卫生保健需求，因此需要分配资源来解决儿童和青少年的精神健康问题。
