Child, parent, and family mental health and functioning in Australia during COVID-19: comparison to pre-pandemic data.

The COVID-19 pandemic presents significant risks to population mental health. Despite evidence of detrimental effects for adults, there has been limited examination of the impact of COVID-19 on parents and children specifically. We aim to examine patterns of parent and child (0-18 years) mental health, parent substance use, couple conflict, parenting practices, and family functioning during COVID-19, compared to pre-pandemic data, and to identify families most at risk of poor outcomes according to pre-existing demographic and individual factors, and COVID-19 stressors. Participants were Australian mothers (81%) and fathers aged 18 years and over who were parents of a child 0-18 years (N = 2365). Parents completed an online self-report survey during 'stage three' COVID-19 restrictions in April 2020. Data were compared to pre-pandemic data from four Australian population-based cohorts. Compared to pre-pandemic estimates, during the pandemic period parents reported higher rates of parent depression, anxiety, and stress (Cohen's d = 0.26-0.81, all p < 0.001), higher parenting irritability (d = 0.17-0.46, all p < 0.001), lower family positive expressiveness (d = - 0.18, p < 0.001), and higher alcohol consumption (22% vs 12% drinking four or more days per week, p < 0.001). In multivariable analyses, we consistently found that younger parent age, increased financial deprivation, pre-existing parent and child physical and mental health conditions, COVID-19 psychological and environmental stressors, and housing dissatisfaction were associated with worse parent and child functioning and more strained family relationships. Our data suggest wide-ranging, detrimental family impacts associated with the COVID-19 pandemic; and support policy actions to assist families with financial supports, leave entitlements, and social housing.

PARENT AND CHILD MENTAL HEALTH TRAJECTORIES APRIL- OCTOBER 2020: STRICT LOCKDOWN VS NO LOCKDOWN IN AUSTRALIA

Background: To control a second wave of COVID-19 outbreak, the state of Victoria in Australia experienced one of the world's first long and strict lockdowns over July-October 2020, while the rest of Australia experienced 'COVID-normal' with minimal restrictions. Objectives: To (1) investigate trajectories of parent/child MH outcomes in Victoria vs non-Victoria and (2) identify baseline demographic, individual and factors related to COVID-19 associated with MH trajectories. Methods: An online community sample of 2004 Australian parents of a child aged 0-18 years with rapid repeated assessment over 14 time points from April 2020 to May 2021. Measures assessed parent MH (Depression, Anxiety and Stress Scales-21), child depression symptoms (13-item Short Mood and Feelings Questionnaire) and child anxiety symptoms (4 items from the Brief Spence Children's Anxiety Scale). Findings: MH trajectories shadowed COVID-19 infection rates. Victorians reported a peak in MH symptoms at the time of the second-wave lockdown compared to other states. Key baseline predictors, including parent and child loneliness (standardised regression coefficient (β) = 0.09- 0.46), parent/child diagnoses (β = 0.07-0.21), couple conflict (β = 0.07-0.18), and COVID-19 stressors, such as worry/concern about COVID-19, illness and loss of job (β = 0.12-0.15)), predicted elevated trajectories. Conclusion: Our findings provide evidence of worse trajectories of parent and child MH symptoms associated with a second COVID-19 outbreak involving strict lockdown in Victoria, compared to non-locked states in Australia. We identified several baseline factors that may be useful in detecting high-risk families who are likely to require additional support early in future lockdowns.

RISK AND PROTECTIVE FACTORS ASSOCIATED WITH MENTAL HEALTH DIFFICULTIES FOR CHILDREN WITH ADHD OVER THE COVID-19 PANDEMIC: A LONGITUDINAL STUDY

Background: A growing number of studies have reported both positive and negative outcomes associated with COVID-19 in children with attention-deficit/hyperactivity disorder (ADHD) and their families. However, very few longitudinal studies have examined outcomes over multiple time points over the pandemic. Objectives: To examine COVID-19-related mental health (MH) impacts for children with ADHD and their families over a 12-month period over the pandemic. Methods: The parents of 213 Australian children (5-17 years) with ADHD were recruited in May 2020 when COVID-19 restrictions were in place. Parents completed surveys at repeated time points assessing MH (CoRonavIruS Health Impact Survey [CRISIS] - mood states subscale) and predictors. Latent profile analyses were used to examine the patterns of MH difficulties over the pandemic using the first four waves of data collected from May to August 2020, and the fifth wave of data collected in May-July 2021. Numerous baseline predictors of MH patterns were examined. Findings: Using the first four waves of data, three groups were identified comprising: (1) children with unchanging (36%), (2) increasing resolved (30%) and (3) increasing persistent (34%) MH difficulties. The most robust predictor of increasing persistent MH difficulties was stress related to COVID-19 (e.g. stress associated with restrictions related to COVID-19). Analyses are being updated to include our fifth wave of data collection (May-July 2021) (70% retention rate). Conclusion: A subgroup of children with ADHD appears to be struggling with MH, which is related to the stress associated with COVID-19 restrictions.

THE IMPACT OF THE COVID-19 PANDEMIC ON CHILDREN AND THEIR PARENTS ACROSS COMMUNITY SAMPLES AND IN SPECIFIC MENTAL HEALTH POPULATIONS

Background: There is increasing recognition of the mental health (MH) impacts associated with COVID-19 for children and their families. Objectives: This symposium will examine the long-term MH impacts associated with COVID-19 across communitybased samples, children attending child and youth mental health services (CYMS) and children with attention-deficit/ hyperactivity disorder (ADHD). Methods: The first presentation will feature the COVID-19 unmasked study, a cohort study assessing MH in young children and their parents at four time points during the pandemic. The second presentation will focus on the COVID-19 Pandemic Adjustment Survey, which has tracked the MH of children and parents over 14 time points from April 2020 to May 2021. The final two presentations will focus on specific populations including the impact of COVID-19 on community CYMHS services (e.g. impacts on symptoms for children already in treatment and the demand for MH care both in CYMHS and emergency settings: presentation 3). The final presentation will report on the COVID-19 ADHD survey, which has surveyed families at five time points over the pandemic. Findings: Across all studies, there was evidence of MH impacts associated with COVID-19 restrictions for children aged from 0 to 18 years, and their caregivers, across both community samples and specific MH subgroups. The study in the CYMHS setting found a 50% increase in referrals and acute presentations when comparing January to December 2019 to January to December 2020. Conclusion: Increased resources and supports are needed to address the MH needs of children and their caregivers during the ongoing COVID-19 pandemic.