Child, adolescent, and parent mental health in general population during a year of COVID-19 pandemic in belgium: a cross-sectional study

Background: This study aims to evaluate the mental health status of children, adolescents and their parents during the first year of COVID-19 pandemic in Belgium. Method(s): Analysis compared results before and during the second national lockdown, which started on November 2nd 2020. A cross-sectional online survey was conducted between May 2020 and April 2021. Result(s): Two hundred and eighteen adults and 273 children fully completed the survey. Almost one in five children (17.9%) presented moderate-to-severe scores of depression. Adolescents presented a higher level of depression than children (p = 0.007). The rate of moderate-to-severe depression scores (10.8% to 21%, p = 0.007) and internalized symptoms increased during the second lockdown (p < 0.001). Parents' depression (p < 0.001) and anxiety (p = 0.027) levels also increased during the second lockdown. Logistic regression showed that the use of psychotropic medication in parents and parents' depression scores were risk factors for children to have worse depression scores. Conclusion(s): The second lockdown appears to worsen the effects of the pandemic on children's and parents' mental health. There is a need to implement specific interventions targeting both children/adolescents and their parents to support them during lockdown periods and improve mental health outcomes.Copyright © 2022, The Author(s).

Longitudinal impact of psychosocial status on children's mental health in the context of COVID-19 pandemic restrictions.

Emerging research suggests that the prevalence of child and adolescent mental health problems has increased considerably during the COVID-19 crisis. However, there have been few longitudinal studies on children's mental health issues according to their social determinants in this context, especially in Europe. Our aim was to investigate the association between family socioeconomic status (SES) and children' mental health during the period of school closure due to COVID-19. Longitudinal data came from 4575 children aged 8-9 years old in 2020 and participating in the ELFE population-based birth cohort that focuses on children's health, development and socialization. Parents completed the Strengths and Difficulties Questionnaire (SDQ) when children were (a) 5 years of age and (b) 9 years of age, which corresponded to the period of school closure due to the COVID-19 pandemic in France. We retrieved data from the ELFE cohort collected on children from birth to age 5 years (birth, 1 year, 2 years, 3,5 years and 5 years). Socioeconomic status (SES) was measured based on information obtained when the child was 5 years old. Data were analyzed using multinomial logistic regression models. Children's elevated levels of symptoms of Attention-deficit/Hyperactivity disorder (ADHD) during the period of school closure were significantly associated with prior low family SES (aOR 1.26, 95% CI 1.08-1.48). Children's elevated symptoms of hyperactivity/inattention and of emotional symptoms were associated with decline in income during the COVID crisis (respectively, aOR 1.38, 95% CI 1.16-1.63 and aOR 1.23, 95% CI 1.01-1.51). Moreover, when testing interactions, a low prior SES was significantly associated with a higher risk of emotional symptoms aOR 1.54 (1.07-2.21), only for children whose families experienced a decline in income, while gender, parental separation and prior mental health difficulties were not associated. This study underlines the impact of the financial crisis related to the COVID-19 epidemic on children's mental health. Both pre-existing family SES before lockdown and more proximal financial difficulties during the COVID crisis were negatively associated with children's psychological difficulties during the period of school closure. The pandemic appears to exacerbate mental health problems in deprived children whose families suffer from financial difficulties.

The effects of covid-19 on child mental health: Biannual assessments up to april 2022 in a clinical and two general population samples

Background The COVID-19 pandemic has had an acute impact on child mental and social health, but long-term effects are still unclear. We examined how child mental health has developed since the start of the COVID-19 pandemic up to 2 years into the pandemic (April 2022). Methods We included children (age 8-18) from two general population samples (N = 222-1333 per measurement and N = 2401-13,362 for pre-covid data) and one clinical sample receiving psychiatric care (N = 334-748). Behavioral questionnaire data were assessed five times from April 2020 till April 2022 and pre-pandemic data were available for both general population samples. We collected parent-reported data on internalizing and externalizing problems with the Brief Problem Monitor and self-reported data on Anxiety, Depressive symptoms, Sleep-related impairments, Anger, Global health, and Peer relations with the Patient-Reported Outcomes Measurement Information System (PROMIS). Results In all samples, parents reported overall increased internalizing problems, but no increases in externalizing problems, in their children. Children from the general population self-reported increased mental health problems from before to during the pandemic on all six PROMIS domains, with generally worst scores in April 2021, and scores improving toward April 2022 but not to pre-pandemic norms. Children from the clinical sample reported increased mental health problems throughout the pandemic, with generally worst scores in April 2021 or April 2022 and no improvement. We found evidence of minor age effects and no sex effects. Conclusions Child mental health in the general population has deteriorated during the first phase of the COVID-19 pandemic, has improved since April 2021, but has not yet returned to pre-pandemic levels. Children in psychiatric care show worsening of mental health problems during the pandemic, which has not improved since. Changes in child mental health should be monitored comprehensively to inform health care and policy. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Family Bonds with Pets and Mental Health during COVID-19 in Australia: A Complex Picture.

The COVID-19 pandemic has drawn attention to the health-promoting features of human-animal relationships, particularly for families with children. Despite this, the World Health Organization's (1986) Ottawa Charter remains human-centric. Given the reciprocal health impacts of human-animal relationships, this paper aims to (i) describe perceived pet-related benefits, worries, and family activities; and to (ii) examine differences in perceived benefits, worries, and activities for parents and children with and without clinical mental health symptoms. We recruited 1034 Australian parents with a child < 18 years and a cat or dog via a national online survey between July and October 2020. Most parents reported their pet was helpful for their own (78%) and their child's mental health (80%). Adjusted logistic regression revealed parents with clinical psychological distress were 2.5 times more likely to be worried about their pet's care, well-being, and behaviour (OR = 2.56, p < 0.001). Clinically anxious children were almost twice as likely to live in a family who engages frequently in pet-related activities (e.g., cooked treats, taught tricks, OR = 1.82, p < 0.01). Mental health and perceived benefits of having a pet were not strongly associated. Data support re-framing the Ottawa Charter to encompass human-animal relationships, which is an often-neglected aspect of a socioecological approach to health.

Parenting and child mental health during the COVID-19 pandemic: An online study with Portuguese and British Families

COVID-19 and the subsequent public health response created many additional stresses for families. We examined parental behaviour during the COVID-19 pandemic in two European Countries and explored the association between parents' behaviour and children's anxiety and quality of life. Caregivers of children and adolescents (N = 442;86.7% mothers) between 6 and 16 years old (M = 10, SD = 2.85) participated in an online cross-sectional survey in Portugal and the United Kingdom. Results show that higher children's anxiety and lower quality of life were associated with higher levels of unrealistic parental demands, lower parental self-care, and higher parental emotional dysregulation. Encouragement of children's emotion expression and management of exposure to COVID-19 information was negatively associated with children's anxiety. Promotion of routines, support of children's emotion modulation and promotion of children's healthy lifestyles were positively associated with children's quality of life. The predictors differed according to country and age group. These results highlight the importance of specific parenting behaviours on children's mental health during COVID-19. The need to moderate unrealistic demands and attend to parental self-care to reduce parental emotional dysregulation is important. (PsycInfo Database Record (c) 2022 APA, all rights reserved) Abstract (Spanish) COVID-19 y la subsiguiente respuesta de salud publica crearon muchas tensiones adicionales para las familias. Examinamos el comportamiento de los padres durante la pandemia de COVID-19 en dos paises europeos y exploramos la asociacion entre el comportamiento de los padres y la ansiedad y la calidad de vida del nino. Cuidadores de ninos y adolescentes (N = 442;86.7% madres) entre 6 y 16 anos (M = 10, DT = 2,85) participaran en una online encuesta en Portugal y en el Reino Unido. En los resultados se observa que la mayor ansiedad y una menor calidad de vida de los ninos se asociaron con niveles mas altos de demandas parentales poco realistas, menor autocuidado y mayor desregulacion emocional de los padres. El estimulo a la expresion de las emociones de los ninos y el manejo de la exposicion a la informacion de COVID-19 se asocio negativamente con la ansiedad de los ninos. La promocion de rutinas, el apoyo a la modulacion de las emociones de los ninos y la promocion de estilos de vida saludables de los ninos se asociaron positivamente con la calidad de vida de los ninos. Los predictores difirieron segun el pais y el grupo de edad. Estos resultados resaltan la importancia de comportamientos parentales especificos en la salud mental de los ninos durante el COVID-19. La necesidad de moderar las demandas poco realistas y prestar atencion al autocuidado de los padres para reducir la desregulacion emocional de los padres es importante. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

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.

Parental perceptions of child mental health stigma: Mixed-method study

This study considered three main aims of (1) developing and validating a tool to measure parental perceived child mental health (MH) stigma, (2) determining whether perceived stigma levels corresponded in any way to parental identities, and (3) producing a decision-making process flow identifying where barriers such as perceived child MH stigma may affect families dealing with child MH issues. Recruitment of parents/guardians (18 years or older) with children (under the age of 18 years) was done through convenience and respondent-driven sampling in Phoenix, Arizona. A 44-prompt MH stigma tool was developed and validated (N = 65, Cronbach's alpha 0.89) prior to utilizing (N = 623) it to measure levels of perceived child MH stigma in the community. Analysis of variance showed potential significant (p < .005) interactions among education, income, and race/ethnicity (white, non-Hispanic/Latinx and Hispanic/Latinx) and levels of stigma. Specifically, higher education and lower income among the Hispanic/Latinx population in Phoenix showed a greater likelihood for higher levels of perceived child MH stigma. Factor analysis yielded three underlying factors of this stigma: interaction with MH, discrimination, and positive aspects. Content and thematic analysis of free response questions in the survey conveyed parents talk about MH diagnoses differently between general MH and child MH (e.g., child MH included ADD/ADHD while general MH included anxiety and schizophrenia). Fifteen, one hour-long, semi-structured interviews were completed, transcribed, and analyzed using narrative analysis to develop a parental decision-making process flow. The resulting flow showed parents went through informal methods of accessing MH care (e.g., research, awareness of MH issue) prior to formal methods such as seeking medical experts or school support. While the study was able to address these three aims, a significant shift in the landscape of MH occurred with the COVID-19 pandemic, increasing child MH risk and decreasing care access. This study developed a tool and set of methods that may be applied to identify changes in perceived child MH stigma and in how parents make decisions to access child MH care. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Work-family interface and children's mental health: a systematic review.

The COVID-19 pandemic and the public health measures adopted to contain it have highlighted the centrality of the work-family interface in the etiology of mental health among the employed population. However, while the impact on the mental health of workers has been well documented, the relationship with the mental health of children of those workers remains to be clarified.A systematic review was conducted through the identification of peer-reviewed studies on the association between parental work-family interface (e.g. work-family conflict and/or work-family enrichment) and children's mental health. This method is based on the consultation of 7 databases (MEDLINE, PubMed, Web of Science, PsycINFO, SocIndex, Embase, and Scopus), considering all studies published through June 2022 (PROSPERO: CRD42022336058). Methodology and findings are reported according to the PRISMA guidelines. 25 of the 4146 identified studies met our inclusion criteria. Quality appraisal was performed using a modified Newcastle-Ottawa scale. Most studies investigated only work-family conflict, ignoring work-family enrichment. Child mental health outcomes evaluated included internalizing behaviours (n = 11), externalizing behaviours (n = 10), overall mental health (n = 13), and problematic Internet usage (n = 1). Results of the review are summarized qualitatively. Our analysis shows equivocal evidence for the direct relationships between the work-family interface and children's mental health, as a large proportion of associations did not reach statistical significance. We can, however, posit that work-family conflict seems to be more associated with children's mental health problems while work-family enrichment was more related to children's positive mental health. A greater proportion of significant associations are observed for internalizing behaviors compared to externalizing behaviors. Almost all the studies that test for a mediating effect found that parental characteristics and parental mental health are significant mediators.Our research provides insight into the complex association between work-family interface and child mental health, showing both beneficial and detrimental consequences that may even occur simultaneously. This highlights the far-reaching effects of contexts affecting the work-family interface, including the COVID-19 pandemic. We conclude with the need for research adopting more standardized and nuanced measures of the work-family interface to further validate these conclusions.

Changes in Child Discipline Strategies in Iran During the Outbreak of COVID-19.

During the prolonged COVID-19 pandemic, anxiety and depression were common among caregivers and parents more prone to adopt harsh disciplinary techniques when angry or stressed. The purpose of this study was to investigate if there are any differences in parents' disciplinary strategies following social distancing efforts during the COVID-19 pandemic. An online questionnaire was completed by a convenience sample of parents (N = 605) and mothers (n = 533; 88.1%) aged 37.80 years old (SD = 5.66; range = 20-59) who lived with children aged 6-12 years in Iran during the COVID-19 pandemic. Iran's Multiple Indicator Demographic and Health Survey questionnaire was used to gauge child discipline. There was an increase in shaking (1.8%), shouting and yelling (15.5%). The findings of this study serve as a reminder to researchers and government officials that child abuse and violence are more likely to occur during stressful times and provide the scientific foundation for the development of tailored psychological treatment.

I Felt Like I was Going Crazy: Understanding Mother's and Young Children's Educational Experiences at Home During COVID-19.

The COVID-19 disruptions to children's education have been a major issue for families. This study examined how demographic, family, and mental health characteristics of 375 low-income children and their mothers from the City of Toronto were associated with children's educational experiences at home during COVID-19. Many mothers (82.3%) reported that they and their children (80.0%) experienced challenges related to children's education at home during the pandemic. However, a small percentage of mothers (1.1%) reported that this mode of learning was better for them and their children (4.3%). The most frequently reported challenges faced by mothers was taking on the role of a teacher (43.7%) and balancing their children's remote learning with other responsibilities (19.4%). The most frequently mentioned challenges faced by children was that children lacked both motivation (21.1%) and socialization (21.1%) and had difficulty focusing (26.9%). White mothers from households with higher income and with a higher number of adults in the home reported that their children experienced higher levels of challenges related to their education at home. Maternal and child challenges with children's education at home were also related to higher levels of maternal and child mental health challenges. Our findings suggest that the online educational experiences set up following the onset of the pandemic were difficult for many children and mothers to implement in the home. Given the significant associations of these challenges with child and maternal mental health, we encourage educators to provide flexibility, empathy, and support with learning from home to both children and mothers.

Caregiver Worry of Infection and Family Co-existence Difficulty and Association With Change in Children's Internalizing and Externalizing Symptoms During the Initial COVID-19 Lockdown in the UK and Turkey.

The study examined whether caregiver worry of COVID-19 infection and co-existence difficulty differentially predicted child mental health and wellbeing during the lockdown in two culturally different countries that were severely affected by the pandemic: the UK and Turkey. Co-existence difficulty is the hardship experienced by family members living all together in the same house at the same time during the lockdown period. Participants were 1849 caregivers of children between 5- and 12-years old living in the UK (n = 995) and Turkey (n = 854), who completed an electronic survey distributed via social networks during the initial phase of the COVID-19 lockdown (July and August 2020). Caregivers completed a set of questionnaires on child and family wellbeing and on whether the child's internalizing and externalizing symptoms changed during the lockdown as compared to before. Worry of COVID-19 infection was higher amongst caregivers in the Turkish sample and was associated with higher levels of child internalizing symptoms during the lockdown in the Turkish sample, however there were no statistically significant differences in the size of the impact of worry of infection on the children's internalizing symptoms between the two countries. Co-existence difficulty independently predicted increase in children's internalizing and externalizing symptoms during the lockdown in both samples. Families in the UK experienced a higher level of difficulty with co-existence compared to the families living in Turkey but the magnitude of the impact of co-existence difficulty on children's outcomes between the two samples was not significantly different.The findings suggest that public health strategies should aim to reduce social anxiety and invest in the development of programs aimed at supporting families to overcome the challenges of co-existence during times of public health crisis.

Parental perceptions of child mental health stigma: Mixed-method study

This study considered three main aims of (1) developing and validating a tool to measure parental perceived child mental health (MH) stigma, (2) determining whether perceived stigma levels corresponded in any way to parental identities, and (3) producing a decision-making process flow identifying where barriers such as perceived child MH stigma may affect families dealing with child MH issues. Recruitment of parents/guardians (18 years or older) with children (under the age of 18 years) was done through convenience and respondent-driven sampling in Phoenix, Arizona. A 44-prompt MH stigma tool was developed and validated (N = 65, Cronbach's alpha 0.89) prior to utilizing (N = 623) it to measure levels of perceived child MH stigma in the community. Analysis of variance showed potential significant (p < .005) interactions among education, income, and race/ethnicity (white, non-Hispanic/Latinx and Hispanic/Latinx) and levels of stigma. Specifically, higher education and lower income among the Hispanic/Latinx population in Phoenix showed a greater likelihood for higher levels of perceived child MH stigma. Factor analysis yielded three underlying factors of this stigma: interaction with MH, discrimination, and positive aspects. Content and thematic analysis of free response questions in the survey conveyed parents talk about MH diagnoses differently between general MH and child MH (e.g., child MH included ADD/ADHD while general MH included anxiety and schizophrenia). Fifteen, one hour-long, semi-structured interviews were completed, transcribed, and analyzed using narrative analysis to develop a parental decision-making process flow. The resulting flow showed parents went through informal methods of accessing MH care (e.g., research, awareness of MH issue) prior to formal methods such as seeking medical experts or school support. While the study was able to address these three aims, a significant shift in the landscape of MH occurred with the COVID-19 pandemic, increasing child MH risk and decreasing care access. This study developed a tool and set of methods that may be applied to identify changes in perceived child MH stigma and in how parents make decisions to access child MH care. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Parenting and child mental health during the COVID-19 pandemic: An online study with Portuguese and British Families

(Spanish) COVID-19 y la subsiguiente respuesta de salud publica crearon muchas tensiones adicionales para las familias. Examinamos el comportamiento de los padres durante la pandemia de COVID-19 en dos paises europeos y exploramos la asociacion entre el comportamiento de los padres y la ansiedad y la calidad de vida del nino. Cuidadores de ninos y adolescentes (N = 442;86.7% madres) entre 6 y 16 anos (M = 10, DT = 2,85) participaran en una online encuesta en Portugal y en el Reino Unido. En los resultados se observa que la mayor ansiedad y una menor calidad de vida de los ninos se asociaron con niveles mas altos de demandas parentales poco realistas, menor autocuidado y mayor desregulacion emocional de los padres. El estimulo a la expresion de las emociones de los ninos y el manejo de la exposicion a la informacion de COVID-19 se asocio negativamente con la ansiedad de los ninos. La promocion de rutinas, el apoyo a la modulacion de las emociones de los ninos y la promocion de estilos de vida saludables de los ninos se asociaron positivamente con la calidad de vida de los ninos. Los predictores difirieron segun el pais y el grupo de edad. Estos resultados resaltan la importancia de comportamientos parentales especificos en la salud mental de los ninos durante el COVID-19. La necesidad de moderar las demandas poco realistas y prestar atencion al autocuidado de los padres para reducir la desregulacion emocional de los padres es importante. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Negative effects of the SARS-CoV-2 pandemic: The interlinking of maternal attachment representation, coping strategies, parental behavior, and the child's mental health.

For more than two years, young families have been confronted with a large number of restrictions and following burdens as a result of the SARS-CoV-2 pandemic. In fact, it became evident, that the current circumstances are particularly stressful for child's mental health. With regard to the child's mental health in times of a pandemic, additional factors within the family, such as maternal attachment representations as well as coping strategies and parental behavior, may play an important role. This study aims to investigate the interplay of maternal attachment representation, coping strategies, parental behavior and child's mental health during the SARS-CoV-2 pandemic. In this longitudinal study, previously collected data regarding maternal attachment representation and newly attained data from the SARS-CoV-2-pandemic-assesment (lack of coping strategies, children's mental health and parental behavior) were combined and analyzed. The data were collected in an online survey since beginning of the pandemic, including N = 73 mothers. A path model was calculated in form of multiple linear regression. A path model could be confirmed, which indicates that insecure maternal attachment representation predicts lack of coping strategies during the pandemic [b = 5.55, 95%-CI = (4.51; 6.55), p = 0.001]. Furthermore, lack of coping strategies predicts harmful parental behavior during the pandemic [b = -0.77, 95%-CI = (-1.27; -0.21), p = 0.007], which in turn predicts children's mental health problems, namely behavioral problems [b = -0.08, 95%-CI = (-0.14; -0.01), p = 0.027]. Presence of short-time work and decrease in income since beginning of the pandemic were used as control variables. This means that since the pandemic mothers with insecure attachment representation have an increased risk of having only a few coping mechanisms available, leading to harmful parental behaviors and ultimately affecting the mental health of their children. In conclusion, the pandemic could potentially have a particularly negative influence on mothers with an insecure attachment type and therefore on their children. Therefore, tailored interventions for families should be offered that both focus on the different types of mental health problems in children and support parents in their coping skills.

Use of Acute Mental Health Care in U.S. Children's Hospitals Before and After Statewide COVID-19 School Closure Orders.

Objective: This study aimed to examine changes in child emergency department (ED) discharges and hospitalizations for primary general medical (GM) and primary psychiatric disorders; prevalence of psychiatric disorders among acute care encounters; and change in acute mental health (MH) care encounters by disorder type and, within these categories, by child sociodemographic characteristics before and after statewide COVID-19­related school closure orders. Methods: This retrospective, cross-sectional cohort study used the Pediatric Health Information System database to assess percent changes in ED discharges and hospitalizations (N=2,658,474 total encounters) among children ages 3­17 years in 44 U.S. children's hospitals in 2020 compared with 2019, by using matched data for 36- and 12-calendar-week intervals. Results: Decline in MH ED discharges accounted for about half of the decline in ED discharges and hospitalizations for primary GM disorders (−24.8% vs. −49.1%), and MH hospitalizations declined 3.4 times less (−8.0% vs. −26.8%) in 2020. Suicide attempt or self-injury and depressive disorders accounted for >50% of acute MH care encounters before and after the statewide school closures. The increase in both ED discharges and hospitalizations for suicide attempt or self-injury was 5.1 percentage points (p<0.001). By fall 2020, MH hospitalizations for suicide attempt or self-injury rose by 41.7%, with a 43.8% and 49.2% rise among adolescents and girls, respectively. Conclusions: Suicide or self-injury and depressive disorders drove acute MH care encounters in 44 U.S. children's hospitals after COVID-19­related school closures. Research is needed to identify continuing risk indicators (e.g., sociodemographic characteristics, psychiatric disorder types, and social determinants of health) of acute child MH care.

Child's Play: Examining the Association Between Time Spent Playing and Child Mental Health.

It is theorised that adventurous play offers learning opportunities that help to prevent mental health problems in children. In this study, data from two samples is used to examine associations between the time that children aged 5-11 years spent playing adventurously and their mental health. For comparison, time spent playing unadventurously and time spent playing outdoors are also examined. Study 1 includes a sample of 417 parents, Study 2 includes data from a nationally representative sample of 1919 parents. Small, significant associations between adventurous play and internalising problems, as well as positive affect during the first UK-wide Covid-19 lockdown, were found; children who spend more time playing adventurously had fewer internalising problems and more positive affect during the Covid-19 lockdown. Study 2 showed that these associations were stronger for children from lower income families than for children from higher income families. The results align with theoretical hypotheses about adventurous play.

Behavioral, Affective, and Cognitive Parenting Mechanisms of Child Internalizing and Externalizing Problems during the COVID-19 Pandemic.

The COVID-19 pandemic has led to increased mental health concerns, including depression and anxiety among parents and internalizing and externalizing problems among youth. To better understand the mechanisms and moderators of child mental health during the pandemic, the current study tested two moderated mediation models in which parent depression and anxiety indirectly impacted child internalizing and externalizing problems through negative effects on multiple parenting variables, with these associations moderated by families' exposure to COVID-19-stressors. A national sample representative of U.S. parents (N = 796, 48.2% female, Mage = 38.87 years, 60.3% Non-Hispanic white, 18.1% Hispanic/Latinx, 13.2% Non-Hispanic Black/African-American, 5.7% Asian, 2.8% Other Race) completed a cross-sectional online survey in February-April 2021. Children ranged from 5-16 years old (Mage = 10.35 years, 59.8% Non-Hispanic white, 17.2% Hispanic/Latinx, 13.7% Non-Hispanic Black/African-American, 4.5% Asian, 4.8% Other Race). Parent depression/anxiety was directly and indirectly associated with child internalizing and externalizing problems. For both internalizing and externalizing problems, indirect associations occurred by means of increased parent hostility and inconsistent discipline and decreased routines and parent supportiveness. There were also specific indirect effects through decreased monitoring (internalizing problems) and parenting self-efficacy (externalizing problems). Multiple indirect effects were moderated by number of COVID-19-stressors experienced. Notably, COVID-19-stressors did not have direct effects on child mental health when other variables were considered. Findings highlight the buffering effects of parents for child mental health, the need to address parent depression/anxiety in child interventions, the utility of existing evidence-based parent interventions during the pandemic, and the need to assess families' level of exposure to COVID-19-stressors.

How did the COVID-19 pandemic affect child and adolescent psychiatry outpatient clinic admissions? A single-center, retrospective study.

BACKGROUND: The COVID-19 pandemic and the measures for controlling the pandemic adversely affected child and adolescent mental health; however, studies that examined the effects of the pandemic on child and adolescent mental health services are limited. This study aimed to determine the changes in admission to a child and adolescent psychiatry outpatient clinic (CAPOC) in the first year of the COVID-19 pandemic compared with the previous year. METHODS: In this study, the information regarding admissions to Baskent University Faculty of Medicine's CAPOC between March 2019 and March 2021 was examined. Information including age, sex, admission date, the form of admission (first admission/follow-up), and the diagnosis was obtained from the electronic medical record system and the differences between the pre-pandemic period and the pandemic period were assessed. RESULTS: It was found that during the pandemic, there was a decrease in CAPOC admissions; however, both female admissions and median age increased compared with the previous year. Also, admissions due to obsessive-compulsive disorder and somatic symptom-related disorders increased. CONCLUSIONS: Although there were fewer CAPOC admissions during the pandemic period compared with the pre-pandemic period, there were differences between the age, sex, and diagnosis distributions of the patients between the pandemic and the pre-pandemic period. Understanding the impact of the COVID-19 pandemic on CAPOC admissions will help plan child and adolescent mental health protective measures.

Effectiveness of an Internet-Based and Telephone-Assisted Training for Parents of 4-Year-Old Children With Disruptive Behavior: Implementation Research.

BACKGROUND: There is a lack of effectiveness studies when digital parent training programs are implemented in real-world practice. The efficacy of the internet-based and telephone-assisted Finnish Strongest Families Smart Website (SFSW) parent training intervention on the disruptive behavior of 4-year-old children was studied in a randomized controlled trial setting in Southwest Finland between 2011 and 2013. After that, the intervention was implemented nationwide in child health clinics from 2015 onwards. OBJECTIVE: The main aim of this study was to compare the treatment characteristics and effectiveness of the SFSW parent training intervention between the families who received the intervention when it was implemented as a normal practice in child health clinics and the families who received the same intervention during the randomized controlled trial. METHODS: The implementation group comprised 600 families who were recruited in the SFSW intervention between January 2015 and May 2017 in real-world implementation. The RCT intervention group comprised 232 families who were recruited between October 2011 and November 2013. The same demographic and child and parent measures were collected from both study groups and were compared using linear mixed-effect models for repeated measurements. The child psychopathology and functioning level were measured using the Child Behavior Checklist (CBCL) version 1.5-5 for preschool children, the Inventory of Callous-Unemotional Traits (ICU), and a modified version of the Barkley Home Situations Questionnaire. Parenting skills were measured using the 31-item Parenting Scale and the shorter 21-item Depression, Anxiety and Stress Scale (DASS-21). The estimated child and parent outcomes were adjusted for CBCL externalizing scores at baseline, maternal education, duration of the behavior problems, and paternal age. The baseline measurements of each outcome were used as covariates. RESULTS: The implementation group was more likely to complete the intervention than the RCT intervention group (514/600, 85.7% vs 176/232, 75.9%, respectively; P<.001). There were no significant differences between the implementation and RCT intervention groups with regard to child measures, including CBCL externalizing score (-0.2, 95% CI -1.3 to 1.6; P=.83), total score (-0.7, 95% CI -3.0 to 4.5; P=.70), internalizing score (-0.3, 95% CI -1.0 to 1.6; P=.64), and ICU total score (-0.4, 95% Cl -1.9 to 1.2; P=.64). No significant difference was detected in the Parenting Scale total score (0.0, 95% Cl -0.1 to 0.1; P=.50), while DASS-21 total score differed nearly significantly (2.5, 95% Cl 0.0-5.1; P=.05), indicating better improvement in the implementation group. CONCLUSIONS: The internet-based and telephone-assisted SFSW parent training intervention was effectively implemented in real-world settings. These findings have implications for addressing the unmet needs of children with disruptive behavior problems. Our initiative could also provide a quick socially distanced solution for the considerable mental health impact of the COVID-19 pandemic. TRIAL REGISTRATION: ClinicalTrials.gov NCT01750996; https://clinicaltrials.gov/ct2/show/NCT01750996. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/1471-2458-13-985.

Caregiver-Reported Changes in the Socioemotional Wellbeing and Daily Habits of Children With Special Educational Needs During the First COVID-19 National Lockdown in the United Kingdom

The implementation of social distancing measures (e.g., school closures) by governments worldwide to prevent the spread of COVID-19 has affected millions of children and their families. However, the consequences of such measures on the wellbeing of children with special educational needs (SEN) and their caregivers are not fully understood. The present study examined the socioemotional wellbeing and daily habits of children between 5 and 12 years old with SEN during the first national COVID-19 lockdown in the United Kingdom. Participants were 995 caregivers between 18 and 61 years old living in the United Kingdom who completed a 20 -min electronic survey on child and family wellbeing distributed via social networks between July and August 2020. The findings showed that children with SEN were more likely to experience more emotional and behavioral difficulties during the lockdown than children without SEN. Children with SEN but without mental health difficulties did not have more behavior difficulties during the lockdown than children without SEN. There was a significant increase in screen time and decrease in sleep time for children with and without SEN during the lockdown, but children with SEN were using screens more often than children without SEN both before and during the lockdown. Finally, caregivers with children with SEN reported more difficulty with the confinement than caregivers with children without SEN, but caregiver and child poor mental health were likely to explain the difference. The findings show that the wellbeing of children with SEN was more likely to be negatively affected by the lockdown than the wellbeing of children without SEN. Caregiver and child mental health were likely to explain the differences.