Factors Associated with Anxiety-Related Disorders in Children and Adolescents during COVID-19 in Oman: A Cross-Sectional Study (preprint)

BACKGROUND Reports from different parts of the world suggest that the COVID-19 pandemic and the resultant lockdown and social distancing measures have heralded unprecedented mental health challenges among children and adolescents. To date, there is a dearth of studies emerging from the Arabian Gulf, where the majority of its population are children and adolescents. The study aims to examine the prevalence of anxiety-related disorders and their covariates among children and adolescents in an Arabian Gulf country, Oman. METHODS This is a cross-sectional analytic study carried out over two weeks (1st to 15th of August 2020) during the COVID-19 pandemic across Oman. Parents were asked to complete the online survey, which consisted of the parent version of the Screen for Child Anxiety Related Disorders (SCARED-41) scale and questions regarding basic socio-demographic information. Logistic regression was used to identify the contributing variables associated with anxiety-related disorders. RESULTS A total of 790 children, 33.3% (n=263) fulfilled the criteria for anxiety-related disorders. Logistic regression analysis suggested that anxiety-related disorders in children were significantly associated with three demographic variables. The model shows that children with divorced or separated parents were 1.9 times more likely to have anxiety-related disorders than children of married couples (OR=1.93, p=0.035). Children living in families with an income below USD 1,000/month, were 1.8 times more likely to have anxiety-related disorders than a family with an income of USD 4,000/month (OR=1.833, p=0.018). Children in grades 3-6 were 1.8 times more likely to have anxiety-related disorders than those in grades 1-2 (OR=1.79, p=0.024). CONCLUSIONS: Anxiety-related disorders are common among Arabic-speaking Omani children and adolescents. They are more likely to be reported in middle scholastic grade levels and children from families with marital discord and low socioeconomic status. It is not clear whether the presently observed rates of anxiety exceed the prevalence that would have been observed pre-COVID-19 era. More studies are therefore warranted using children and adolescents' self-reported scales.

Pandemic-Related Emergency Psychiatric Presentations for Self-Harm of Children and Adolescents in 10 Countries (PREP-Kids): A Retrospective International Cohort Study (preprint)

Background: Suicide is the second leading cause on death in young people and self-harm is one of the strongest predictors of death by suicide. Little is known about the impact of covid-19 lockdown on hospital presentations with self-harm.Method: We used electronic patient records from 23 hospital emergency departments in 10 countries to examine differences in hospital emergency psychiatric presentations for self-harm of youths through age 18 in March and April 2020 compared with the same period in 2019. To compare the number of hospital presentations a negative binomial model was used. For other variables, individual participant data (IPD) meta-analyses were carried out.Findings: The total number of emergency psychiatric hospital presentations decreased from 1,239 in 2019 to 834 in 2020, IRR 0·67, 95% CI 0·62-0·73. The proportion of youths presenting with self-harm increased from 50% in 2019 to 57% in 2020, OR 1·33, 95% CI 1·07-1·64, but there was no difference in the proportion presenting with severe self-harm. Within self-harm presentations, the proportion of youths with emotional disorders increased from 58% to 66%, OR 1·58, 95% CI 1·06-2·36. The proportion of youths admitted to an observation ward also decreased from 13% to 9% in 2020, OR 0·52, 95% CI 0·28 to 0·96. There were no differences in other outcomes and no evidence that youths from deprived areas or from ethnic minorities were disproportionally affected.Interpretation: During lockdowns, there are likely to be fewer hospital emergency psychiatric presentations. Many children and adolescents with psychiatric emergencies might not receive any service. Developing intensive community care services with outreach capabilities should be prioritised.Funding Statement: None.Declaration of Interests: In the last three years Dr. Carucci had collaborations within projects from the European Union (7th Framework Program) and as sub-investigator in sponsored clinical trials by Shire Pharmaceutical Company, Lundbeck, Otsuka, Janssen Cilag and Angelini. Travel support from Fidia Farmaceutici. PLP has received research funding from the German Federal Ministry of Education and Research (BMBF), the German Federal Institute for Drugs and Medical devices (BfARM), the Baden Wuerttemberg state foundation, eh Volkswagen foundation, Lundbeck and Servier. He received a speaker´s honorarium from Shire. All remaining authors have no competing interests to declare.Ethics Approval Statement: This study is based on the data from the NCDR obtained under licence from the UK Medicines and Healthcare products Regulatory Agency. The study was approved by the King’s College London/South London and Maudsley NHS Foundation Trust service evaluation and clinical audit committee Ref no: AP1312/05/2020.

The moral and political economy of the pandemic in Bangladesh: Weak states and strong societies during Covid-19.

As the Covid-19 pandemic spread in 2020, the government of Bangladesh ordered a lockdown and promised a program of relief. Citizens complied at first, but soon returned to economic and social life; relief proved slow and uncertain, and citizens could not rely on government assistance. The government tacitly and then officially permitted the lockdown to end, despite a rising Covid-19 caseload. This article draws on theories about state capacity to make and enforce policy to understand why Bangladesh proved unable to sustain a lockdown deemed necessary to contain the pandemic in this densely populated, low income country. Drawing on original qualitative mobile phone-based research in six selected communities, this article examines how the state exercised its capacities for coercion, control over lower factions within political society, and sought to preserve and enhance its legitimacy. It concludes that despite a) the growth in the capacity of the Bangladeshi state in the past decade and b) strong political incentives to manage the pandemic without harm to economic wellbeing, the pressures to sustain legitimacy with the masses forced the state and its frontline actors to tolerate lockdown rule-breaking, conceding that the immediate livelihood needs of the poor masses overrode national public health concerns. Chronically unable to enforce its authority over local political elites, the state failed to ensure a fair and timely distribution of relief. The weakness of the Bangladeshi state contrasts with the strength of widely shared 'moral economy' views within society, which provided powerful ethical and political justification for citizens' failures to comply with the lockdown, and for officials' forbearance in its enforcement. The Covid-19 pandemic highlights both the importance of state capacity in managing novel shocks from within the global system, and the challenges in settings where weak states are embedded in strong societies.