Annual Research Review: The impact of Covid-19 on psychopathology in children and young people worldwide: systematic review of studies with pre- and within-pandemic data.

BACKGROUND: The high volume and pace of research has posed challenges to researchers, policymakers and practitioners wanting to understand the overall impact of the pandemic on children and young people's mental health. We aimed to search for and review the evidence from epidemiological studies to answer the question: how has mental health changed in the general population of children and young people? METHODS: Four databases (Medline, CINAHL, EMBASE and PsychINFO) were searched in October 2021, with searches updated in February 2022. We aimed to identify studies of children or adolescents with a mean age of 18 years or younger at baseline, that reported change on a validated mental health measure from prepandemic to during the pandemic. Abstracts and full texts were double-screened against inclusion criteria and quality assessed using a risk of bias tool. Studies were narratively synthesised, and meta-analyses were performed where studies were sufficiently similar. RESULTS: 6917 records were identified, and 51 studies included in the review. Only four studies had a rating of high quality. Studies were highly diverse in terms of design, setting, timing in relation to the pandemic, population, length of follow-up and choice of measure. Methodological heterogeneity limited the potential to conduct meta-analyses across studies. Whilst the evidence suggested a slight deterioration on some measures, overall, the findings were mixed, with no clear pattern emerging. CONCLUSIONS: Our findings highlight the need for a more harmonised approach to research in this field. Despite the sometimes-inconsistent results of our included studies, the evidence supports existing concerns about the impact of Covid-19 on children's mental health and on services for this group, given that even small changes can have a significant impact on provision at population level. Children and young people must be prioritised in pandemic recovery, and explicitly considered in planning for any future pandemic response.

The COVID-19 pandemic and child and adolescent mental health—what has been learned and lessons for the future

Children and young people have arguably been the group most affected by the societal response to COVID-19. The quality of the evidence base globally on the impact of COVID-19 on child mental health is highly variable. However, it is clear that the pandemic has been associated with an overall deterioration in mental health in children and young people at a population level, but with evidence of unequal impacts on different groups. This chapter draws on the available evidence at the time of writing to provide an overview of a spectrum of topics, from the effects of acute COVID-19 illness on children and young people, to the impact on at-risk groups, and access to mental health services and education during the pandemic, as well as discussing the implications and recommendations for research, practice, and policy.

Are children who need help in contact with services?/what do we know about patterns of service contact?

BackgroundEven prior to the Covid-19 pandemic, referrals to child and adolescent mental health services have been rising, in conjunction with increased focus and demand on school based mental health support. This study investigates whether children with mental health problems are becoming more or less likely to be in contact with sources of help, examining secular trends using NHS Digital’s national child mental health surveys. These are the only repeated national epidemiological surveys to include standardised psychiatric diagnostic assessments in cross-sectional community samples of children and young people, using stratified probability sampling.Data Mental Health of Children and Young People (MHCYP) 2017 and British Child and Adolescent Mental Health Surveys 1999 and 2004 (BCAMHS), including ICD-10 psychiatric diagnoses from the validated Development and Wellbeing Assessment and parent and young person reported mental-health-related contact with a range of public sector services.MethodsDescriptive and trend analyses (using Stata v.17) of prevalence of service contact in relation to diagnosis amongst participants in 1999, 2004 and 2017, using survey weights to take account of selection probabilities and non response. Analysis is ongoing, early analyses of 2017 data are presented in this .ResultsIn MHCYP 2017 (n=7,654;5 to 19 years;mean age 11.2;49.7% female), of those with a diagnosis, a quarter (24.9%) reported contact with specialist mental health services, and 67.8% reported mental health-related contact with any education, health or social care service. In 5 to 16 year olds, males were more likely to have contact than females (75.1%, 95% CI 70.5–79.1% versus 64.3%, 95% CI 58.7–69.6%, p=0.0025). In 17 to 19 year olds, levels of service contact were higher amongst females (59.0%, 95% 48.8–68.4%) than males (47.8%, 95% CI 34.4–61.7%), although confidence intervals for estimates overlapped.ConclusionWhilst most participants with a diagnosis reported some type of service contact, only a quarter had contact with a specialist service (similar to the proportion reported in BCAMHS 2004). There were also gender and age differences in patterns of contact. Analyses in progress are examining trends in contact as well as trends in inequalities in contact to identify groups who may be under-served. Given that Covid-19 is likely to have amplified existing inequalities, and has impacted child mental health at a population level, our analyses will incorporate data from MHCYP 2020 & 2021 once these become available.