Ludwig-Walz Helena, Dannheim Indra, Pfadenhauer Lisa M, Fegert Jörg M, Bujard Martin
Federal Institute for Population Research (BiB), Wiesbaden, Germany.
Regional Innovative Centre of Health and Quality of Live Fulda (RIGL), Fulda University of Applied Sciences, Fulda, Germany.
Child Adolesc Psychiatry Ment Health. 2023 Jun 21;17(1):74. doi: 10.1186/s13034-023-00612-z.
Considering the heterogenous evidence, a systematic review of the change in anxiety in European children and adolescents associated with the COVID-19 pandemic is lacking. We therefore assessed the change compared with pre-pandemic baselines stratified by gender and age as well as evaluated the impact of country-specific restriction policies.
A registration on the 'International Prospective Register of Systematic Reviews' (PROSPERO) occurred and an a priori protocol was published. We searched six databases (PubMed, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, WHO COVID-19) using a peer-reviewed search string with citation tracking and grey literature screening. Primary outcomes were: (1) general anxiety symptoms; and (2) clinically relevant anxiety rates. We used the Oxford COVID-19 Stringency Index as an indicator of pandemic-related restrictions. Screening of title/abstract and full text as well as assessing risk of bias (using the 'Risk of Bias in Non-randomized Studies of Exposure' [ROBINS-E]) and certainty of evidence (using the 'Grading of Recommendations Assessment, Development and Evaluation' [GRADE]) was done in duplicate. We pooled data using a random effects model. Reporting is in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement.
Of 7,422 non-duplicate records, 18 studies with data from 752,532 pre-pandemic and 763,582 pandemic participants met full inclusion criteria. For general anxiety symptoms the total change effect estimate yielded a standardised mean difference (SMD) of 0.34 (95% confidence interval [CI], 0.17-0.51) and for clinically relevant anxiety rates we observed an odds ratio of 1.08 (95%-CI, 0.98-1.19). Increase in general anxiety symptoms was highest in the 11-15 years age group. Effect estimates were higher when pandemic-related restrictions were more stringent (Oxford Stringency Index > 60: SMD, 0.52 [95%-CI, 0.30-0.73]) and when school closures (School Closure Index ≥ 2: SMD, 0.44 [95%-CI, 0.23-0.65]) occurred.
General anxiety symptoms among children and adolescents in Europe increased in a pre/during comparison of the COVID-19 pandemic; particularly for males aged 11-15 years. In periods of stringent pandemic-related restrictions and/or school closures a considerable increase in general anxiety symptoms could be documented. PROSPERO registration: CRD42022303714.
鉴于现有证据存在异质性，目前缺乏对欧洲儿童和青少年因新冠疫情导致的焦虑变化的系统评价。因此，我们评估了与疫情前基线相比的变化情况，并按性别和年龄进行分层，同时评估了各国特定限制政策的影响。
在“国际系统评价前瞻性注册库”（PROSPERO）上进行了注册，并发表了一份预先制定的方案。我们使用经过同行评审的检索词，通过引文跟踪和灰色文献筛选，检索了六个数据库（PubMed、Embase、PsycINFO、Cochrane对照试验中心注册库、科学网、世卫组织新冠数据库）。主要结局为：（1）一般焦虑症状；（2）临床相关焦虑率。我们使用牛津新冠疫情防控严格指数作为与疫情相关限制的指标。对标题/摘要和全文进行筛选，并重复评估偏倚风险（使用“暴露非随机研究中的偏倚风险”[ROBINS-E]）和证据确定性（使用“推荐分级评估、制定与评价”[GRADE]）。我们使用随机效应模型汇总数据。报告遵循系统评价和Meta分析的首选报告项目（PRISMA）声明。
在7422条非重复记录中，18项研究的数据来自752532名疫情前参与者和763582名疫情期间参与者，符合完全纳入标准。对于一般焦虑症状，总体变化效应估计得出标准化均数差（SMD）为0.34（95%置信区间[CI]，0.17 - 0.51）；对于临床相关焦虑率，我们观察到比值比为1.08（95%CI，0.98 - 1.19）。一般焦虑症状增加在11 - 15岁年龄组中最为明显。当与疫情相关的限制更为严格时（牛津严格指数>60：SMD，0.52[95%CI，0.30 - 0.73]）以及学校关闭时（学校关闭指数≥2：SMD，0.44[95%CI，0.23 - 0.65]），效应估计值更高。
在新冠疫情的疫情前/疫情期间对比中，欧洲儿童和青少年的一般焦虑症状有所增加；特别是11 - 15岁的男性。在与疫情相关的严格限制期和/或学校关闭期间，可以记录到一般焦虑症状有相当大的增加。PROSPERO注册编号：CRD42022303714。
