A study today in JAMA Network Open reveals that 10.5% of children and teens in a Chinese province during distance learning early in the COVID-19 pandemic reported psychological distress—particularly among those who never wore a face covering or were physically active for less than a half hour a day.
A team led by researchers from Southern Medical University in Guangdong province analyzed data from an online survey of about 1.2 million randomly sampled school-aged children and adolescents from 21 cities receiving home-based instruction from Mar 8 to 30, 2020.
Of the 1,199,320 students, 126,355 (10.5%) said they had psychological distress, 51.5% of them girls. High school students, especially seniors, were at about 20% higher risk for poor well-being than those in elementary school (odds ratio [OR], 1.19).
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Wearing face coverings, exercise protective
Students who reported exercising for less than a half hour per day had higher odds of psychological distress than those who reported being active for at least 1 hour a day (OR, 1.64).
Likewise, students who said they never wore a face covering in public were at higher risk for despair than those who said they wore one often (OR, 2.59). “Students who wear face masks frequently might feel less likely to contract COVID-19, which could further reduce worry and anxiety levels and promote mental well-being,” the authors said.
After weighted analysis, the sociodemographic variables of age, economic status, school class, and residence location were also significantly linked to psychological distress. Compared with students with high socioeconomic status, those with median or low socioeconomic status were more likely to report poor psychological well-being (OR, 1.04 and 1.71, respectively).
Similarly, compared with students from areas at low risk for COVID-19, those living in areas at high risk for infection were slightly more likely to report distress (OR, 1.02). And compared with children and teens who had more than five sources of information on SARS-CoV-2 (the virus that causes COVID-19), those with only one, two or three, or four or five sources had higher odds of angst (OR, 1.59, 1.23, and 1.10, respectively).
“Often it is the unknown that is frightening, so students who have multiple sources for COVID-19–related information (eg, how to prevent COVID-19, transmission mechanisms of SARS-CoV-2) that they can understand may reduce psychological distress,” the researchers wrote.
Recognition, rapid intervention needed
The study comes on the heels of previous studies showing high levels of depression and anxiety among both adults and children during the coronavirus-related public health crisis and social isolation.
The authors noted that many other pandemic-related issues can also lead to psychological distress, including home confinement, lack of personal space at home, fear of infection, lack of information, uncertainty about college entrance exams and entering college, lack of access to online learning platforms, fear of falling behind, and family income loss.
The researchers said that public health mitigation policies, lack of contact with friends and nature, exposure to family members who continually discuss numbers of COVID-19 infections and deaths, increased social media use, negative parental emotional displays due to lost income, and increased threat of family violence due to the closure of key community resources and restricted travel may have all had a role in increased mental health issues early in the pandemic.
Prompt intervention beyond that provided before the pandemic, the researchers said, is needed to address psychological distress in children and teens to avoid adverse outcomes such as posttraumatic stress disorder over the long term.
“It is necessary for governments, schools, and families to pay attention to the mental health of school-aged children and adolescents during the COVID-19 pandemic and take appropriate countermeasures to reduce the impact of the COVID-19 pandemic on mental health for children and adolescents,” they concluded.