Impact of the COVID-19 pandemic on children with special healthcare needs

ABSTRACT

Background: Though not primarily affected by severe disease due to Sars-CoV-2-infection, emerging evidence suggests that children and adolescents are particularly impacted by the indirect effects of the COVID-19 pandemic, such as school closures and reduced or delayed access to healthcare services. Surveys conducted in several countries at different times during the pandemic point towards a rising mental health burden in children and adolescents. Children with special health care needs are a particularly vulnerable group in this context. They rely on a wide range of services, which were mostly suspended during the first and subsequent waves of the pandemic. We aim (1) to describe the perceived pandemic burden and psychosocial outcomes in families with children with and without special health care needs;(2) to assess the impact of socioeconomic status (SES), disease complexity and psychosocial burden on parent-reported child mental health problems. Methods: We conducted a sequential cross-sectional online survey among caregivers of children aged 1 - 18 years, the first round from August 11th - October 5th 2020 (n = 1619) and the second round from April 2nd - July 31st 2021 (n = 521). Participants were recruited through the Kindernetzwerk e. V., a patient organization for families of children with chronic diseases and disabilities;through promoting the link on free access websites;and via social und public media. Both families with and without children with special healthcare needs were encouraged to participate. We performed descriptive statistics, simple and hierarchical logistic regression to explore the association between SES and psychological outcome measures, disease complexity and general burden related to COVID-19. Results: A majority of parents felt burdened by the pandemic. Almost half reported an increase in family conflict or insufficient social support. There was a high prevalence of parent-reported mental health problems in children (1st survey 57.4%;2nd survey 66.7%) and of a positive screening score for depression in parents (1st survey 30.9%;2nd survey 72.5%). Parent-reported mental health problems were more likely to affect children from a low SES, children with complex chronic disease and those whose parents screened positive for depression. Conclusion: The study highlights inequalities in parent-reported child mental health outcomes by SES and disease complexity at two time points in a large sample of German families with and without children with special health care needs. It shows a high burden of both child and parental mental health problems in the study population and identifies children from low SES with complex chronic disease as a particularly vulnerable group concerning the impact of the pandemic on their mental health outcomes. Long-term policies, which put children at the center, aim at reducing health inequalities, and mitigate the unequal impact of the pandemic, should be an integral part of the COVID- 19-response.