[Strengths and Difficulties of 3- to 15-Year-Old Children and Adolescents in the Second andThird Year of the Corona Pandemic - Results of a Household-Representative Survey in Germany]. / Stärken und Probleme von 3- bis 15-jährigen Kindern und Jugendlichen im zweiten und dritten Jahr der Corona- Pandemie ­ eine haushaltsrepräsentative Befragung.

Behavioural strengths and psychosocial problems in children and adolescents between the ages of 3 and 15 are reported. The survey is based on a household-representative sample of 2,421 parents or guardians providing information on their everyday family-life in summer 2021 by online-questionnaire. 704 of the respondents participated again in the spring of 2022. In result, the behaviour of a quarter of the children and adolescents is described as psychosocially borderline/abnormal over the survey period (SDQ total). About a third of children and adolescents have emotional problems, behavioural problems or problems with their peers (respective SDQ-subscales). The proportion of primary-school children with emotional problems increases from summer 2021 to the following spring. Families in which children with disabilities live are disproportionally more affected. The results are discussed with regard to the SDQ standard values available for Germany, as well as the families' self-reported supportneeds and their planned use of professional support-services. Given the psychosocial burden of children, adolescents and their families presented here, which become apparent well after the closures of day-care centres and schools, or other contact-restricting measures to contain the pandemic, have ended, it remains of interest to observe how their well-being will further develop over time.

The Evaluation of Health Care Services for Children and Adolescents With Post-COVID-19 Condition: Protocol for a Prospective Longitudinal Study.

BACKGROUND: Some children and adolescents suffer from late effects of a SARS-CoV-2 infection despite a frequently mild course of the disease. Nevertheless, extensive care for post-COVID-19 condition, also known as post-COVID-19 syndrome, in children and young people is not yet available. A comprehensive care network, Post-COVID Kids Bavaria (PoCo), for children and adolescents with post-COVID-19 condition has been set up as a model project in Bavaria, Germany. OBJECTIVE: The aim of this study is to evaluate the health care services provided within this network structure of care for children and adolescents with post-COVID-19 condition in a pre-post study design. METHODS: We have already recruited 117 children and adolescents aged up to 17 years with post-COVID-19 condition who were diagnosed and treated in 16 participating outpatient clinics. Health care use, treatment satisfaction, patient-reported outcomes related to health-related quality of life (the primary endpoint), fatigue, postexertional malaise, and mental health are being assessed at different time points (at baseline and after 4 weeks, 3 months, and 6 months) using routine data, interviews, and self-report questionnaires. RESULTS: The study recruitment process ran from April 2022 until December 2022. Interim analyses will be carried out. A full analysis of the data will be conducted after follow-up assessment is completed, and the results will be published. CONCLUSIONS: The results will contribute to the evaluation of therapeutic services provided for post-COVID-19 condition in children and adolescents, and avenues for optimizing care may be identified. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/41010.

Trajectories of child mental health, physical activity and screen-time during the COVID-19 pandemic considering different family situations: results from a longitudinal birth cohort.

BACKGROUND: Many authors have described a significant mental health burden on children and adolescents during the COVID-19 pandemic, possibly moderated by social disparities. This analysis explores whether pre-pandemic family circumstances might be related to different aspects of child health during the pandemic. METHODS: We analyzed trajectories of health-related outcomes in children aged 5 to 9 years (T7 to T11) using the Ulm SPATZ Health study, a population based birth cohort study (baseline 04/2012-05/2013) conducted in the South of Germany. Outcomes were children's mental health, quality of life, and lifestyle, such as screen time and physical activity. We conducted descriptive statistics of maternal and child characteristics before and throughout the pandemic. We defined three different groups of pre-pandemic family situations and used adjusted mixed models to estimate differences in means associated with the time during the pandemic vs. before the pandemic in (a) all children and in (b) children belonging to specific pre-pandemic family situations. RESULTS: We analyzed data from n = 588 children from whom at least one questionnaire was completed between T7 and T11. When not considering the pre-pandemic family situation, adjusted mixed models showed statistically significant lower mean scores of health-related quality of life among girls during vs. before the COVID-19 pandemic (difference in means (b): - 3.9 (95% confidence interval (CI): - 6.4, - 1.4). There were no substantial differences in mental health, screen time, or physical activity in boys or girls. When considering pre-pandemic family situations, boys with mothers having symptoms of depression or anxiety showed a substantial loss of health-related quality of life on the subscale of friends (b: - 10.5 (95% CI: - 19.7, - 1.4)). Among girls in this group, 60% of the 15 assessed outcomes were negatively associated with a remarkable loss in health-related quality of life (e.g., KINDL-physical well-being difference in means: - 12.2 (95% CI: - 18.9, - 5.4)). Furthermore, a substantial increase in screen time was found (+ 2.9 h (95% CI: 0.3, 5.6)). CONCLUSION: Our results suggest that the health (and behavior) of primary school-aged children is possibly impacted by the COVID-19 pandemic, with adverse consequences differing by gender and very likely by the pre-pandemic family situation. Especially in girls having a mother with depression or anxiety symptoms, the adverse consequences of the pandemic on mental health seem to be aggregated. Boys showed fewer adverse trajectories, and it needs to be further assessed which factors exactly are behind the (socio-economic) factors, such as maternal working habits and limited living space, when analyzing the effect of the pandemic on children's health.

Education as a protective factor for mental health risks among youth living in highly dangerous regions in Afghanistan.

BACKGROUND: Children in Afghanistan live in dangerous areas, and have been exposed to traumatic events and chaotic education. Progress has been made on access to education for girls who were the most affected by traditional attitudes against engagement in education. OBJECTIVES: The objectives were to evaluate the mental health of Afghan children living in regions of conflict and the association of mental health with school attendance for girls and boys. METHOD: The study included 2707 school aged children in eight regions of Afghanistan (16 provinces) residing in households recruited through a multi-stage stratified cluster sampling strategy in 2017. The level of terrorist threat was evaluated by the intensity of terrorist attacks recorded that year in each province. Child mental health was assessed with the parental report Strengths and Difficulties Questionnaire (SDQ) along with information on school attendance, sociodemographic characteristics and geographic location. RESULTS: A total of 52.75% of children had scores above threshold for the SDQ total difficulties score, 39.19% for emotional difficulties, 51.98% for conduct challenges, and 15.37% for hyperactivity/inattention. Peer relationship problems were high (82.86%) and 12.38% reported that these problems impacted daily life. The level of terrorist threat was associated with SDQ total difficulties (Adjusted Odds Ratio [AOR] = 4.08, P < 0.0001), with youth in regions with high levels of terrorist threat more likely to have problems than youth in regions with low or medium levels of danger, independent of region and ethnicity. School attendance was negatively associated with emotional symptoms (AOR = 0.65, P < 0.0001) and mental health difficulties with impairment (AOR = 0.67, P = 0.007), but positively associated with peer relationships difficulties (AOR = 1.96, P > 0.0001). Conduct (AOR = 1.66, P < .0001) and SDQ total difficulties (AOR = 1.22, P = 0.019) were higher among boys. Overall, gender did not modify the relationship between school attendance and child mental health. CONCLUSION: Attending school is essential for children's mental health, across gender, and should be supported as a priority in Afghanistan despite the return of the Taliban.

Socio-emotional adjustment throughout the COVID-19 pandemic: A longitudinal study of elementary school-aged children from low-income neighbourhoods.

Children's socio-emotional adjustment during the COVID-19 pandemic could depend on their pre-pandemic risk of heightened socio-emotional distress and available resources. In a sample of elementary school-aged children from low-income neighbourhoods in Germany, we examined children's socio-emotional adjustment throughout two pandemic-related school closing periods of 5 months each and explored possible determinants of their adjustment. On three occasions before and after school closing, home-room teachers reported on the distress of 365 children (Mage  = 8.45, 53% female) and provided information on their family backgrounds and internal resources. We studied child pre-pandemic risk of low socio-emotional adjustment based on low basic care by families and group membership (i.e., recently arrived refugee, deprived Roma family). We studied child resources regarding families' home learning support during school closings and selected internal resources of the children (German reading skills, academic ability). Results showed that children's distress did not increase throughout the school closings. Instead, their distress remained at constant levels or even decreased. On pre-pandemic risk, only low basic care was linked to higher levels of distress and worse trajectories. On child resources, home learning support, academic ability, and German reading skills were inconsistently linked to less distress and better trajectories depending on the school closing period. Our findings suggest better-than-expected socio-emotional adjustment of children from low-income neighbourhoods during the COVID-19 pandemic.

Prevalence and associated factors of psychosocial and behavioral problems in Indonesian adolescent students during the COVID-19 pandemic.

Background: The COVID-19 pandemic and the subsequent measures to control it, such as social distancing, school closure, and online learning, put adolescent students at higher risk of psychosocial and behavioral problems (PSBP). The adverse potential is more concerning as the outbreak continues, especially in limited-resource countries, and requires further mitigation. Objective: To assess the prevalence and factors associated with PSBP in Indonesian adolescent students in the COVID-19 pandemic. Subject/methods: We conducted a cross-sectional study in Yogyakarta Province, Indonesia, involving junior high school students. An anonymous online questionnaire in google form format was used to collect demographic data and the potential variables and screen the PSBP with the Strengths and Difficulties Questionnaire (SDQ). Logistic regression was applied to determine the independent variables. Results: Six hundred seventy-six subjects participated, including 237 males (35.1%) and 439 females (64.9%). There were 34.6% subjects with PSBP, with a peer-relation problem as the most common one. The multivariable logistic regression showed that subjects with longer screen time duration and more family conflicts were more likely to have PSBP, with an adjusted odds ratio (OR) of 1.5 (95% CI: 1.1-2.1, p = 0.025) and 2.4 (95% CI: 1.5-3.8, p < 0.001), respectively, whereas whom with better family cohesion are less likely to have the problem with an adjusted OR of 0.4 (95% CI: 0.3-0.6, p < 0.001). Conclusions: There is a high prevalence of PSBP among Indonesian adolescent students during the COVID-19 pandemic. Longer screen time duration and more family conflict are associated with higher prevalence, whereas better family cohesion with lower prevalence of PSBP.

Lifestyle changes, mental health, and health-related quality of life in children aged 6-7 years before and during the COVID-19 pandemic in South Germany.

BACKGROUND: The measures against the COVID-19 pandemic are challenging for children and parents, and detrimental effects on child health are suggested especially from lock-down measures and school closings. METHODS: We conducted a cross-sectional analysis using a population based longitudinal (birth-) cohort study (SPATZ study) conducted in the South of Germany. Data included all 6 or 7 year old children for whom a questionnaire was completed during first grade of school. Consequently, we were able to analyze children being in first grade before the first lockdown in Germany (≤ 15th March 2020), as well as children being in first grade during the pandemic (> 15th March 2020). We conducted descriptive statistics and estimated the associations between the two time periods, before and during the pandemic, and various outcomes of child health using multivariable adjusted linear or logistic regression modeling. The analysis was stratified by gender. RESULTS: Results among n = 362 children aged six or seven years showed substantially lower mean scores of health-related quality of life (difference in means: - 5.5, 95% confidence interval (CI) - 9.0, - 2.0), and higher mean scores in total emotional and behavioral difficulties (difference in means: 2.0, 95% CI 0.2, 3.8) in girls during vs. before the COVID-19 pandemic using multivariable linear regression modeling. In addition, weekly screen-time was increased in boys by 3.5 h (95% CI 0.6, 6.4). We did not find substantial differences in sleep quality, physical activity, and time spent with books, neither in boys nor in girls, however, the limited sample size has to be considered. CONCLUSION: Child health (and behavior) of first grade school children is possibly impacted by the COVID-19 pandemic with adverse consequences possibly differing by gender.

Emotional Situation of Children and Adolescents during the COVID-19 Pandemic in Germany: Results from the COVID-19 Snapshot Monitoring Study (COSMO).

The COVID-19 pandemic led to numerous restrictions in daily life that had a significant impact on the well-being and mental health of the population. Among others, children and adolescents were particularly affected, being a vulnerable group at risk. The aim of this study was to assess the emotional situation of children and adolescents during different phases of the pandemic and to identify modifying factors. Data from the serial cross-sectional COVID-19 Snapshot Monitoring (COSMO) survey in Germany were used for this study. The survey waves 12 (19th/20th May 2020) and 21 (15th/16th September 2020) were investigated as examples of two different pandemic phases. The psychosocial and emotional situation and well-being of children were measured with the emotional subscale of the Strengths and Difficulties Questionnaire (SDQ) assessed by parents. Descriptive analyses and logistic regressions were calculated. In total, a third of the participating parents in wave 12 and in wave 21 reported having children and adolescents with emotional symptoms. Especially children with younger parents seemed to be more affected by emotional symptoms. Sociodemographic aspects, such as household language, showed a significant association with reported emotional symptoms in children (Wave 12: OR = 2.22; 95% CI: 1.20-4.09). Reported prevalences of emotional symptoms in children did not differ between the pandemic phases. In conclusion, the pandemic had negative influences on the emotional symptoms of children and adolescents in COVID-19 pandemic waves in 2020, indicating a forecasted reoccurrence and need for preventive measures for upcoming waves and other pandemics in the future.

Changes in Emotional-Behavioral Functioning Among Pre-school Children Following the Initial Stage Danish COVID-19 Lockdown and Home Confinement.

Unintended negative outcomes on child behavior due to lockdown and home confinement following the corona virus disease (COVID-19) pandemic needs highlighting to effectively address these issues in the current and future health crises. In this sub-study of the ODIN-study, the objectives were to determine whether the Danish lockdown and home confinement following the COVID-19 pandemic affected changes in emotional-behavioral functioning of pre-school-aged children using the validated Strength and Difficulties Questionnaire (SDQ) answered by parents shortly before lockdown and 3 weeks into lockdown, and moreover, to examine whether baseline family and social characteristics could predict change in child emotional-behavioral functioning during lockdown. Parents of 40 (82%) children with a mean(SD) age of 5.0(0.7) completed the baseline questionnaire and the lockdown follow-up questionnaire. The SDQ-Total difficulties score (SDQ-TD) and Prosocial Behavioral score (PSB) changed significantly from pre- to lockdown [SDQ-TD mean(SD): 6.0(3.8) and 7.9(5.2); P = 0.02, respectively and PSB mean(SD): 8.5(1.4) and 7.9(1.5); P = 0.03, respectively]. Attending leisure time activities before lockdown was a predicting factor of changes to the worse in the children's SDQ-TD scores, with a mean difference in SDQ-TD between those with and without activities of 3.16 (95%CI 0.27-6.12); P = 0.03. In conclusion, the study showed a modest decrease in child-emotional behavioral functioning during the COVID-19 lockdown, potentially due to parental stress. Although these results might not be generalizable due to small sample size and selected population, the results point to a need of a greater awareness of child mental wellbeing during a lockdown situation.

The COVID-19 lockdown and psychological distress among Italian parents: Influence of parental role, parent personality, and child difficulties.

The Italian lockdown following the spread of COVID-19 exposed residents to a long and unexpected period of managing offspring at home. Throughout this time, most parents continued to work remotely. The present research aimed at assessing multiple sociodemographic and psychological variables for parental well-being during the lockdown. An online survey was administered from 6 to 11 April 2020. Respondents were 917 parents aged 23-67 years with up to six children, aged 3-13 years. The measures employed were: 14 demographic questions, the Big Five Inventory (BFI-10), the Emotional Symptoms and Hyperactivity-Inattention subscales of the Strength and Difficulties Questionnaire (SDQ-P), and the General Health Questionnaire (GHQ-12). Multiple moderated linear regression analyses were performed. Motherhood, higher levels of education, higher neuroticism, lower extroversion, and more child emotional and hyperactivity-inattention symptoms were found to be significant predictors of parent distress. Furthermore, a significant two-way interaction between child emotional problems and parent extroversion was found. Overall, parents showed high rates of psychological distress, signalling severe difficulties during the lockdown. Families with a child suffering from emotional and behavioural difficulties should immediately be detected by social services to activate support interventions to prevent chronic and amplified manifestations of these problems.

How Personality Relates to Distress in Parents during the Covid-19 Lockdown: The Mediating Role of Child's Emotional and Behavioral Difficulties and the Moderating Effect of Living with Other People.

Since the initiation of the COVID-19 lockdown, Italian parents have been forced to manage their children at home. The present study aimed at investigating the psychological distress of parents during the lockdown, identifying contributing factors. An online survey was administered to 833 participants from 3 to 15 April 2020. Mediation and moderated mediation models were run to explore the association between parent neuroticism and parent distress, mediated by child hyperactivity-inattention and child emotional symptoms, and the moderating effect of living only with child(ren) on the direct and indirect effects of parent neuroticism on parent distress. For parents living only with child(ren), high levels of psychological distress depended exclusively on their levels of neuroticism. For parents living with at least one other person in addition to child(ren), distress levels were also mediated by child behavioral and emotional difficulties. Motherhood emerged as a significant factor contributing to greater distress. Furthermore, parent psychological distress decreased in line with increased child age. The results confirm that neuroticism is an important risk factor for mental health. Preventive measures should be primarily target multicomponent families with younger children and directed towards parents who are already known to present emotional instability and to parents of children who have received local mental health assistance for behavioral and/or emotional difficulties.