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1.
EuropePMC; 2022.
Preprint in English | EuropePMC | ID: ppcovidwho-335214

ABSTRACT

Importance Heterogeneous mental health outcomes during the COVID-19 pandemic are recognized in the general population, but it has not been systematically assessed in youth with neurodevelopmental disorders (NDD), including autism spectrum (ASD). Objective Identify subgroups of youth with ASD/NDD based on the pandemic impact on symptoms and service changes, as well as predictors of outcomes. Design, Setting, and Participants This is a naturalistic observational study conducted across 14 North American and European clinical and/or research sites. Parent responses on the Coronavirus Health and Impact Survey Initiative (CRISIS) adapted for Autism and Related Neurodevelopmental Conditions (AFAR) were cross-sectionally collected from April to October 2020. The sample included 1275, 5-21 year-old youth with ASD and/or NDD who were clinically well-characterized prior to the pandemic. Main Outcomes and Measures To identify impact subgroups, hierarchical clustering analyzed eleven AFAR factors measuring pre- to pandemic changes in clinically relevant symptoms and service access. Random forest classification assessed the relative contribution in predicting subgroup membership of 20 features including socio-demographics, pre-pandemic service, and clinical severity along with indices of COVID-19 related experiences and environments empirically-derived from AFAR parent responses and global open sources. Results Clustering analyses revealed four ASD/NDD impact subgroups. One subgroup - broad symptom worsening only (20% of the aggregate sample) - included youth with worsening symptoms that were above and beyond that of their ASD/NDD peers and with similar service disruptions as those in the aggregate average. The three other subgroups showed symptom changes similar to the aggregate average but differed in service access: primarily modified services (23%), primarily lost services (6%), and average services/symptom changes (53%). Pre-pandemic factors (e.g., number of services), pandemic environments and experiences (e.g., COVID-19 cases, related restrictions, COVID-19 Worries), and age emerged in unique combinations as distinct protective or risk factors for each subgroup. Together they highlighted the role of universal risk factors, such as risk perception, and the protective role of services before and during the pandemic, in middle childhood. Conclusions and Relevance Concomitant assessment of changes in both symptoms and services access is critical to understand heterogeneous impact of the pandemic on ASD/NDD youth. It enabled the delineation of pathways to risk and resilience that include universal and ASD/NDD specific contributors.

2.
Curr Psychol ; : 1-11, 2021 Nov 19.
Article in English | MEDLINE | ID: covidwho-1827088

ABSTRACT

We examined pathways from pre-existing psychosocial and economic vulnerability to mental health difficulties and stress in families during the COVID-19 pandemic. Data from two time points from a multi-cohort study initiated during the COVID-19 pandemic were used. Parents of children 6-18 years completed questionnaires on pre-COVID-19 socioeconomic and demographic factors in addition to material deprivation and stress due to COVID-19 restrictions, mental health, and family functioning. Youth 10 years and older also completed their own measures of mental health and stress. Using structural equation modelling, pathways from pre-existing vulnerability to material deprivation and stress due to COVID-19 restrictions, mental health, and family functioning, including reciprocal pathways, were estimated. Pre-existing psychosocial and economic vulnerability predicted higher material deprivation due to COVID-19 restrictions which in turn was associated with parent and child stress due to restrictions and mental health difficulties. The reciprocal effects between increased child and parent stress and greater mental health difficulties at Time 1 and 2 were significant. Reciprocal effects between parent and child mental health were also significant. Finally, family functioning at Time 2 was negatively impacted by child and parent mental health and stress due to COVID-19 restrictions at Time 1. Psychosocial and economic vulnerability is a risk factor for material deprivation during COVID-19, increasing the risk of mental health difficulties and stress, and their reciprocal effects over time within families. Implications for prevention policy and parent and child mental health services are discussed. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12144-021-02459-z.

3.
BMJ Open ; 12(3): e057248, 2022 03 02.
Article in English | MEDLINE | ID: covidwho-1723819

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has impacted the mental health (MH) of children, adolescents and parents. Whereas youth with MH disorders and neurodevelopmental disorders (NDD) may be at higher risk for exacerbations in emotional and behavioural distress, children and adolescents without pre-existing MH disorders or NDD may also experience MH deterioration due to increases in stress, changes in health behaviours, loss of activities/school closures or loss of resources. Little is known about the impact of the COVID-19 emergency measures (EMs) on children's MH over the course of the pandemic. METHODS AND ANALYSIS: Longitudinal study of four well-established, pre-existing cohorts in Ontario (two recruited in clinical settings, two recruited in community settings). Primary outcomes include the impact of EMs on six MH domains: depression, anxiety, irritability, inattention, hyperactivity and obsessive-compulsive behaviours. Risk and protective factors related to youth MH profiles and trajectories will be identified. In addition, the effects of school mitigation strategies, changes in MH services and family factors (ie, parental MH, economic deprivation and family functioning) on children's MH will be examined. Data will be collected via repeated online survey measures selected to ensure reliability and validity for the proposed populations and distributed through the pandemic periods. ETHICS AND DISSEMINATION: The study was approved by institutional research ethics boards at participating research sites. Results will be disseminated through a robust knowledge translation partnership with key knowledge users. Materials to inform public awareness will be co-developed with educators, public health, and MH and health service providers. Connections with professional associations and MH advocacy groups will be leveraged to support youth MH policy in relation to EMs. Findings will further be shared through conference presentations, peer-reviewed journals and open-access publications.


Subject(s)
COVID-19 , Pandemics , Adolescent , COVID-19/epidemiology , Child , Humans , Longitudinal Studies , Mental Health , Ontario/epidemiology , Reproducibility of Results , SARS-CoV-2
4.
JAMA Netw Open ; 4(12): e2140875, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1595340

ABSTRACT

Importance: Longitudinal research on specific forms of electronic screen use and mental health symptoms in children and youth during COVID-19 is minimal. Understanding the association may help develop policies and interventions targeting specific screen activities to promote healthful screen use and mental health in children and youth. Objective: To determine whether specific forms of screen use (television [TV] or digital media, video games, electronic learning, and video-chatting time) were associated with symptoms of depression, anxiety, conduct problems, irritability, hyperactivity, and inattention in children and youth during COVID-19. Design, Setting, and Participants: A longitudinal cohort study with repeated measures of exposures and outcomes was conducted in children and youth aged 2 to 18 years in Ontario, Canada, between May 2020 and April 2021 across 4 cohorts of children or youth: 2 community cohorts and 2 clinically referred cohorts. Parents were asked to complete repeated questionnaires about their children's health behaviors and mental health symptoms during COVID-19. Main Outcomes and Measures: The exposure variables were children's daily TV or digital media time, video game time, electronic-learning time, and video-chatting time. The mental health outcomes were parent-reported symptoms of child depression, anxiety, conduct problems and irritability, and hyperactivity/inattention using validated standardized tools. Results: This study included 2026 children with 6648 observations. In younger children (mean [SD] age, 5.9 [2.5] years; 275 male participants [51.7%]), higher TV or digital media time was associated with higher levels of conduct problems (age 2-4 years: ß, 0.22 [95% CI, 0.10-0.35]; P < .001; age ≥4 years: ß, 0.07 [95% CI, 0.02-0.11]; P = .007) and hyperactivity/inattention (ß, 0.07 [95% CI, 0.006-0.14]; P = .04). In older children and youth (mean [SD] age, 11.3 [3.3] years; 844 male participants [56.5%]), higher levels of TV or digital media time were associated with higher levels of depression, anxiety, and inattention; higher levels of video game time were associated with higher levels of depression, irritability, inattention, and hyperactivity. Higher levels of electronic learning time were associated with higher levels of depression and anxiety. Conclusions and Relevance: In this cohort study, higher levels of screen use were associated poor mental health of children and youth during the COVID-19 pandemic. These findings suggest that policy intervention as well as evidence-informed social supports are needed to promote healthful screen use and mental health in children and youth during the pandemic and beyond.


Subject(s)
COVID-19/epidemiology , COVID-19/psychology , Neurodevelopmental Disorders/diagnosis , Pandemics , Screen Time , Adolescent , Anxiety/diagnosis , Attention Deficit Disorder with Hyperactivity/diagnosis , Child , Conduct Disorder/diagnosis , Depression/diagnosis , Female , Humans , Longitudinal Studies , Male , Ontario/epidemiology , SARS-CoV-2
5.
Curr Psychol ; : 1-11, 2021 Nov 19.
Article in English | MEDLINE | ID: covidwho-1530416

ABSTRACT

We examined pathways from pre-existing psychosocial and economic vulnerability to mental health difficulties and stress in families during the COVID-19 pandemic. Data from two time points from a multi-cohort study initiated during the COVID-19 pandemic were used. Parents of children 6-18 years completed questionnaires on pre-COVID-19 socioeconomic and demographic factors in addition to material deprivation and stress due to COVID-19 restrictions, mental health, and family functioning. Youth 10 years and older also completed their own measures of mental health and stress. Using structural equation modelling, pathways from pre-existing vulnerability to material deprivation and stress due to COVID-19 restrictions, mental health, and family functioning, including reciprocal pathways, were estimated. Pre-existing psychosocial and economic vulnerability predicted higher material deprivation due to COVID-19 restrictions which in turn was associated with parent and child stress due to restrictions and mental health difficulties. The reciprocal effects between increased child and parent stress and greater mental health difficulties at Time 1 and 2 were significant. Reciprocal effects between parent and child mental health were also significant. Finally, family functioning at Time 2 was negatively impacted by child and parent mental health and stress due to COVID-19 restrictions at Time 1. Psychosocial and economic vulnerability is a risk factor for material deprivation during COVID-19, increasing the risk of mental health difficulties and stress, and their reciprocal effects over time within families. Implications for prevention policy and parent and child mental health services are discussed. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12144-021-02459-z.

6.
Can J Public Health ; 112(5): 831-842, 2021 10.
Article in English | MEDLINE | ID: covidwho-1524702

ABSTRACT

OBJECTIVE: The primary objective was to determine the association between public health preventive measures and children's outdoor time, sleep duration, and screen time during COVID-19. METHODS: A cohort study using repeated measures of exposures and outcomes was conducted in healthy children (0 to 10 years) through The Applied Research Group for Kids (TARGet Kids!) COVID-19 Study of Children and Families in Toronto, Canada, between April 14 and July 15, 2020. Parents were asked to complete questionnaires about adherence to public health measures and children's health behaviours. The primary exposure was the average number of days that children practiced public health preventive measures per week. The three outcomes were children's outdoor time, total screen time, and sleep duration during COVID-19. Linear mixed-effects models were fitted using repeated measures of primary exposure and outcomes. RESULTS: This study included 554 observations from 265 children. The mean age of participants was 5.5 years, 47.5% were female and 71.6% had mothers of European ethnicity. Public health preventive measures were associated with shorter outdoor time (-17.2; 95% CI -22.07, -12.40; p < 0.001) and longer total screen time (11.3; 95% CI 3.88, 18.79; p = 0.003) during COVID-19. The association with outdoor time was stronger in younger children (<5 years), and the associations with total screen time were stronger in females and in older children (≥5 years). CONCLUSION: Public health preventive measures during COVID-19 were associated with a negative impact on the health behaviours of Canadian children living in a large metropolitan area.


RéSUMé: OBJECTIF: L'objectif principal était de déterminer la relation entre les mesures préventives de la santé publique et le temps passé en plein air, la durée du sommeil ainsi que le temps passé devant l'écran par les enfants pendant COVID-19. MéTHODES: Une étude de cohorte utilisant des mesures répétées des expositions et des effets a été menée chez des enfants en bonne santé (0 à 10 ans) par l'entremise de l'Étude COVID-19 sur les Enfants et Familles du Groupe de Recherche Appliquée pour les Enfants (TARGet Kids!) à Toronto, au Canada, entre le 14 avril et le 15 juillet 2020. Les parents ont été invités à remplir des questionnaires sur adhésion aux mesures préventives de la santé publique et les comportements de santé des enfants. La principale exposition était le nombre moyen de jours par semaine durant lesquels les enfants pratiquaient des mesures préventives de la santé publique. Les trois effets étaient le temps passé en plein air par les enfants, le temps total passé devant l'écran et la durée du sommeil pendant le COVID-19. Des modèles linéaires à effets mixtes ont été ajustés en utilisant des mesures répétées d'exposition primaire et des effets. RéSULTATS: Cette étude comprend 554 observations sur 265 enfants. L'âge moyen des participants était de 5,5 ans, 47,5 % étaient des femmes et 71,6 % avaient des mères d'origine européenne. Les mesures préventives de la santé publique ont été associées à un temps passé en plein air plus court (-17,2 ; IC 95% -22,07, -12,40; p < 0,001) et à un temps total devant l'écran plus long (11,3 ; IC 95% 3,88, 18,79; p = 0,003) pendant la COVID-19. La relation avec le temps passé en plein air était plus importante chez les jeunes enfants (<5 ans), et les relations avec le temps total passé devant l'écran étaient plus importantes chez les enfants de sexe féminin et les enfants plus âgés (≥5 ans). CONCLUSION: Les mesures préventives de la santé publique prises lors de COVID-19 ont été associées à un impact négatif sur les comportements de santé des enfants canadiens vivant dans une grande région métropolitaine.


Subject(s)
COVID-19 , Health Behavior , Public Health , COVID-19/epidemiology , COVID-19/prevention & control , Canada/epidemiology , Child , Child, Preschool , Cohort Studies , Female , Humans , Male
7.
Can J Public Health ; 112(5): 831-842, 2021 10.
Article in English | MEDLINE | ID: covidwho-1299747

ABSTRACT

OBJECTIVE: The primary objective was to determine the association between public health preventive measures and children's outdoor time, sleep duration, and screen time during COVID-19. METHODS: A cohort study using repeated measures of exposures and outcomes was conducted in healthy children (0 to 10 years) through The Applied Research Group for Kids (TARGet Kids!) COVID-19 Study of Children and Families in Toronto, Canada, between April 14 and July 15, 2020. Parents were asked to complete questionnaires about adherence to public health measures and children's health behaviours. The primary exposure was the average number of days that children practiced public health preventive measures per week. The three outcomes were children's outdoor time, total screen time, and sleep duration during COVID-19. Linear mixed-effects models were fitted using repeated measures of primary exposure and outcomes. RESULTS: This study included 554 observations from 265 children. The mean age of participants was 5.5 years, 47.5% were female and 71.6% had mothers of European ethnicity. Public health preventive measures were associated with shorter outdoor time (-17.2; 95% CI -22.07, -12.40; p < 0.001) and longer total screen time (11.3; 95% CI 3.88, 18.79; p = 0.003) during COVID-19. The association with outdoor time was stronger in younger children (<5 years), and the associations with total screen time were stronger in females and in older children (≥5 years). CONCLUSION: Public health preventive measures during COVID-19 were associated with a negative impact on the health behaviours of Canadian children living in a large metropolitan area.


RéSUMé: OBJECTIF: L'objectif principal était de déterminer la relation entre les mesures préventives de la santé publique et le temps passé en plein air, la durée du sommeil ainsi que le temps passé devant l'écran par les enfants pendant COVID-19. MéTHODES: Une étude de cohorte utilisant des mesures répétées des expositions et des effets a été menée chez des enfants en bonne santé (0 à 10 ans) par l'entremise de l'Étude COVID-19 sur les Enfants et Familles du Groupe de Recherche Appliquée pour les Enfants (TARGet Kids!) à Toronto, au Canada, entre le 14 avril et le 15 juillet 2020. Les parents ont été invités à remplir des questionnaires sur adhésion aux mesures préventives de la santé publique et les comportements de santé des enfants. La principale exposition était le nombre moyen de jours par semaine durant lesquels les enfants pratiquaient des mesures préventives de la santé publique. Les trois effets étaient le temps passé en plein air par les enfants, le temps total passé devant l'écran et la durée du sommeil pendant le COVID-19. Des modèles linéaires à effets mixtes ont été ajustés en utilisant des mesures répétées d'exposition primaire et des effets. RéSULTATS: Cette étude comprend 554 observations sur 265 enfants. L'âge moyen des participants était de 5,5 ans, 47,5 % étaient des femmes et 71,6 % avaient des mères d'origine européenne. Les mesures préventives de la santé publique ont été associées à un temps passé en plein air plus court (-17,2 ; IC 95% -22,07, -12,40; p < 0,001) et à un temps total devant l'écran plus long (11,3 ; IC 95% 3,88, 18,79; p = 0,003) pendant la COVID-19. La relation avec le temps passé en plein air était plus importante chez les jeunes enfants (<5 ans), et les relations avec le temps total passé devant l'écran étaient plus importantes chez les enfants de sexe féminin et les enfants plus âgés (≥5 ans). CONCLUSION: Les mesures préventives de la santé publique prises lors de COVID-19 ont été associées à un impact négatif sur les comportements de santé des enfants canadiens vivant dans une grande région métropolitaine.


Subject(s)
COVID-19 , Health Behavior , Public Health , COVID-19/epidemiology , COVID-19/prevention & control , Canada/epidemiology , Child , Child, Preschool , Cohort Studies , Female , Humans , Male
8.
J Am Acad Child Adolesc Psychiatry ; 60(5): 544-554.e8, 2021 05.
Article in English | MEDLINE | ID: covidwho-1135380

ABSTRACT

Over the last year, the coronavirus disease 2019 (COVID-19) pandemic has resulted in profound disruptions across the globe, with school closures, social isolation, job loss, illness, and death affecting the lives of children and families in myriad ways. In an Editors' Note in our June 2020 issue,1 our senior editorial team described this Journal's role in advancing knowledge in child and adolescent mental health during the pandemic and outlined areas we identified as important for science and practice in our field. Since then, the Journal has published articles on the impacts of the pandemic on child and adolescent mental health and service systems,2-5 which are available in a special collection accessible through the Journal's website.6 Alongside many opinion papers, the pace of publication of empirical research in this area is rapidly expanding, covering important issues such as increased frequency of mental health symptoms among children and adolescents3,5,7-10 and changes in patterns of clinical service use such as emergency department visits.11-14 As the Senior Editors prepared that Editors' Note, they were acutely aware that the priorities that they identified were broad and generated by only a small group of scientists and clinicians. Although this had the advantage of enabling us to get this information out to readers quickly, we decided that a more systematic approach to developing recommendations for research priorities would be of greater long-term value. We were particularly influenced by the efforts of the partnership between the UK Academy of Medical Scientists and a UK mental health research charity (MQ: Transforming Mental Health) to detail COVID-19-related research priorities for "Mental Health Science" that was published online by Holmes et al. in The Lancet Psychiatry in April 2020.15 Consistent with its focus on mental health research across the lifespan, several recommendations highlighted child development and children's mental health. However, a more detailed assessment of research priorities related to child and adolescent mental health was beyond the scope of that paper. Furthermore, the publication of that position paper preceded the death of George Floyd at the hands of Minneapolis police on May 25, 2020, which re-energized efforts to acknowledge and to address racism and healthcare disparities in the United States and many other countries. To build upon the JAACAP Editors' Note1 and the work of Holmes et al.,15 we conducted an international survey of professionals-practitioners and researchers-working on child and adolescent development and pediatric mental health to identify concerns about the impact of the pandemic on children, adolescents, and their families, as well as what is helping families navigate these impacts, and the specific research topics that are of greatest importance.


Subject(s)
COVID-19 , Pandemics , Adolescent , Child , Communication , Humans , Interdisciplinary Research , Mental Health , Research , SARS-CoV-2
9.
Eur Child Adolesc Psychiatry ; 31(4): 671-684, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1103467

ABSTRACT

This large cross-sectional study examined the impact of COVID-19 emergency measures on child/adolescent mental health for children/adolescents with and without pre-existing psychiatric diagnoses. Using adapted measures from the CRISIS questionnaire, parents of children aged 6-18 (N = 1013; 56% male; 62% pre-existing psychiatric diagnosis) and self-reporting children/adolescents aged 10-18 (N = 385) indicated changes in mental health across six domains: depression, anxiety, irritability, attention, hyperactivity, and obsessions/compulsions. Changes in anxiety, irritability, and hyperactivity were calculated for children aged 2-5 years using the Strengths and Difficulties Questionnaire. COVID-19 exposure, compliance with emergency measures, COVID-19 economic concerns, and stress from social isolation were measured with the CRISIS questionnaire. Prevalence of change in mental health status was estimated for each domain; multinomial logistic regression was used to determine variables associated with mental health status change in each domain. Depending on the age group, 67-70% of children/adolescents experienced deterioration in at least one mental health domain; however, 19-31% of children/adolescents experienced improvement in at least one domain. Children/adolescents without and with psychiatric diagnoses tended to experience deterioration during the first wave of COVID-19. Rates of deterioration were higher in those with a pre-exiting diagnosis. The rate of deterioration was variable across different age groups and pre-existing psychiatric diagnostic groups: depression 37-56%, anxiety 31-50%, irritability 40-66%, attention 40-56%, hyperactivity 23-56%, obsessions/compulsions 13-30%. Greater stress from social isolation was associated with deterioration in all mental health domains (all ORs 11.12-55.24). The impact of pre-existing psychiatric diagnosis was heterogenous, associated with deterioration in depression, irritability, hyperactivity, obsession/compulsions for some children (ORs 1.96-2.23) but also with improvement in depression, anxiety, and irritability for other children (ORs 2.13-3.12). Economic concerns were associated with improvement in anxiety, attention, and obsessions/compulsions (ORs 3.97-5.57). Children/adolescents with and without pre-existing psychiatric diagnoses reported deterioration. Deterioration was associated with increased stress from social isolation. Enhancing social interactions for children/adolescents will be an important mitigation strategy for current and future COVID-19 waves.


Subject(s)
COVID-19 , Adolescent , COVID-19/epidemiology , Canada/epidemiology , Child , Cross-Sectional Studies , Female , Humans , Male , Mental Health , Pandemics
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