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| How lockdown affects the mental health of children and young people | | | Er. Loveneesh Talwar
One of the most significant public health measures implemented during the COVID-19 pandemic has been extended periods of ‘lockdown’ where whole populations have been advised to remain in their households other than to collect necessary supplies, to care for others, or to exercise. There are increasing calls to understand the impacts of this lockdown, and of subsequent school closures, on the mental health and wellbeing of children and young people during the COVID-19 pandemic. As lockdown measures begin to ease, we require an understanding of what children and young people have been experiencing during the lockdown period1 as well as how children and young people can be best supported to resume to normal life, or the ‘new normal’, over the coming months and years. This understanding can inform responses to recovery implemented at the policy level and by those working directly with children and young people. Such responses are beginning to be formalised in other countries. In this evidence overview, we consider empirical studies of the impacts of lockdown of both COVID-19, and of similar previous health-related disasters, to identify important considerations about the mental health and wellbeing impacts of lockdown, both positive and negative, on children and young people. By similar health-related disasters in the past, we refer to previous pandemics, epidemics, and other health disasters. Given that much of the literature in this space is not focused specifically on the mental health and wellbeing of children and young people. We consider the empirical evidence of impacts across three areas:
1. The individual: Direct impacts on children and young people’s mental health and wellbeing.
2. The interpersonal/family: Impacts within the family context.
3. The school: Impacts within the context of education.
Based on our findings, we consider policy and practice recommendations that can help to inform solutions and responses to the challenges facing children and young people, their families, and those who work with these groups. As a result, this overview is focussed predominantly on the problem. This is an emerging situation evidence of effective interventions are limited. As such, we hope that by broadly contextualising some of the mental health impacts and challenges for children and young people, that decision-makers have more informed scope to develop effective programmes and interventions to support children and young people going forward.
To begin with we focussed on a wide set of events which could be considered similar to COVID-19. Initially, this included pandemics, epidemics, health disasters, natural disasters, and conflict zones. The hits on this wide search were large, so we decided to focus on health-related disasters more narrowly. Indicative search terms relating to health-related disasters include: pandemic OR endemic OR covid OR coronavirus OR SARS OR MERS OR H1N1 OR ebola OR health NEAR/2 [N1] disaster OR outbreak OR isolate* OR quarantine OR social distanc OR home confin. Searches were then refined to focus on mental health and wellbeing impacts and children and young people. This overview includes only articles printed in English. Searches were undertaken in the Web of Science and Psych Info databases. Thereafter, the reference lists of relevant articles were reviewed to identify additional relevant articles. In the overview of evidence, we also consulted available findings from several large-scale surveys of the mental health impacts of COVID-19 that relate to the potential impacts of lockdown. The surveys include but are not limited to: Mental Health in the Pandemic, Lockdown Lowdown, Co-SPACE & Co-SPYCE studies, Office for National Statistics routine survey of 16+iv, and the Carers Trust Survey of Young carers. The direct impact of lockdown on the mental health and wellbeing of children and young people yields mixed findings. Findings center on the mental health and wellbeing impacts of lockdown and the factors affecting mental health and wellbeing. In some cases, where quarantine was not at the population level, e.g. only required for those with contact with infected persons, one study on the impacts in the context of the H1N1 influenza found no immediate negative psychological effect of quarantine for undergraduate students7 . However, in the case of the SARS epidemic, stress scores for Post-Traumatic Stress Disorder (PTSD) were reported by parents to be 4 times higher in children quarantined than those not quarantined, in this case, criteria for PTSD was met by 30% of quarantined children. A study from India, during the COVID-19 pandemic, yields similar results and further studies conducted in China find that young people report increased depressive symptoms and anxiety symptoms and can experience negative psychological consequences as a result of the COVID-19 pandemic. Qualitative evidence indicates a number of reasons for these findings including the perceived threat of the virus, confusion, disruption, and isolation imposed by this type of health-related crisis8. Other studies have found that levels of distress were higher in young adults as a potential consequence of increased consumption of social media for example Emerging evidence from the COVID-19 pandemic in the UK suggests similar trends that young people, in particular teenagers, in the UK are feeling more anxious than they did before the outbreak, a trend which is up to 10% higher for black and mixed race participants. Further evidence of the mental health and wellbeing impacts of this kind of quarantine related to both the fear of stigma and the stigma experienced by those young people who had been quarantined and returned to college which this study identifies as a risk factor for maintaining social support mechanisms with friends, classmates, or roommates post-quarantine. Young carers are one group whose mental health has been negatively impacted by the lockdown restrictions. A survey of nearly 1000 young carers in the UK found that over half of young carers have felt overwhelmed and stressed and have, as a result, suffered worsened mental health during the lockdown. The individual: direct impacts on children and young people’s mental health and wellbeing lockdown period Around a third of those surveyed said they struggled to get emotional support with some respondents saying they had increased their alcohol intake as a result of the stresses they were feeling, and were struggling to take care of themselves. The survey identified that young carers require more practical support in coping with day to day life, but also more access to peer support, either online or in-person.
Factors affecting the mental health and wellbeing of children and young people
Loneliness
Loneliness is considered as a key risk factor of lockdown for the mental health and wellbeing of children and young people. A rapid review of the links between loneliness and mental health highlights the potential for increases in children and young people experiencing loneliness to link to mental health problems in children and young people18. However, it is important to note that experiences of loneliness involve some form of social comparison, and in the UK case, the shared experience of lockdown might mitigate the negative impacts of loneliness to some extent. Yet, emerging evidence of the impact of the COVID-19 pandemic suggests that, despite the shared experience of lockdown, children and young people are experiencing loneliness. Emerging evidence suggests that, amongst the general population in the UK, the proportion of adults experiencing loneliness is highest amongst young adults aged 18-24, with another survey identifying that 50% of 16-24 year-olds have experienced ‘lockdown loneliness. This could, as the literature suggests, be a consequence of the loss of peer group support during this important developmental stages where peer interaction is important for brain development, self-concept construction, and ultimately mental health and wellbeing.
Worries about school and the future
Emerging evidence from the COVID-19 pandemic also suggests several other factors influencing the mental health and wellbeing of children and young people including: worries and concerns around their education (all ages), missing school (all ages), transitions and being away from school (primary school age), academic pressures (secondary school age), their career (young adults), and uncertainties about the future more generally (young adults). Similarly, in the case of children and young people currently in contact with youth justice systems, it has similarly been reported that lack of contact with others, boredom, not being able to attend school, financial worries and general uncertainty about the future are key factors impacting mental health and wellbeing.
Mental health and wellbeing impacts of lockdown on parents/carers
For a variety of reasons, quarantine can be traumatising for some parents. In a study on post-traumatic stress disorder in health-related disasters, criteria for PTSD was met in 25% of isolated or quarantined parents. The same study found links between PTSD criteria in adults and their children having PTSD symptoms . Duration of quarantine and consequent lack of social and physical contact with friends/family and the outside world has been shown to be associated with increased PTSD symptoms. Similarly, it has been shown that social isolation and associated loneliness have a negative impact on mental health outcomes for adults. Other factors that have been shown to have an impact on stressors and wellbeing9 include the duration of quarantine, fear of infection, frustration and boredom, inadequate supplies and information (guidelines, rationale for actions, and level of risk), loss of work or working more than usual, or COVID-19 related stressful life events e.g. bereavement/having an acquaintance infected. The links between experience of COVID-19 related stressful life events and increased stress were shown to be the case in one study regardless of previous mental illness or childhood trauma. .
Worries about financial security, homelife, and the future
Emerging evidence from the COVID-19 pandemic suggests that in general, many adults are feeling anxious or worried about the future. In particular, adults who are unemployed have reported not coping as well with a quarter of this group feeling hopeless with primary concerns around financial security. Parents who are working have also reported difficulties in balancing the needs of their child with the demands of working. Moreover, parents with children with special educational needs/ neuro developmental disorders have reported that they were experiencing higher levels of stress and require more support to cope with changes in their children’s behaviour. One study has reported that difficulties in relationships and conflict within the family home are problematic for children and young people, particularly those with experience of the youth justice system.
The school: Impacts within the context of education
Lockdown related school closures has been one of the most significant public health measures across the world. For children and young people in the India, this has been the first extended closure of schools in recent history and as such, its impact on their mental health and wellbeing is important to consider, particularly given the already contentious nature of the effectiveness of school closures on disease containment and the fact that school is often the first place that children and young people can and do seek support for their mental health and wellbeing.
Factors affecting the delivery of education
In terms of the delivery of education during lockdown, there has been concern over the exclusion of children without digital access, physical space, and other resources to support their learning. Emerging evidence from England suggests that there has been a substantial deficit in curriculum coverage across schools, that just over half of parents are engaged with their children’s home learning, and that less than half of pupils had returned their last piece of work at the time the survey was undertaken. In this particular survey, teachers expressed concern over the engagement of the most disadvantaged pupils with the analysis finding that the level of disadvantage of the school being influential on pupil engagement. Variability in engagement with the curriculum will potentially have differing effects on both the development and mental health of pupils returning to school. Moreover, those receiving free school meals may have experienced increasing food insecurity, although recent policy changes reflect governments’ commitment to continuing such funding over the summer break this year.
School responses
In previous outbreaks, there has been variability in school responses to public health measures. In one study, despite highly consistent evidence of duty of care, schools varied in extent to which information was shared openly and transparently; in how responsive school decision-makers were to the changing situation. In this study, schools had reservations about the need for closures/quarantine, including a lack of understanding about the rationale for this action. The study concludes that there needs to be high levels of trust between schools, public officials, and governments. School closures worked where there were high levels of trust between key players. The findings here highlight the importance of schools as agents of public health and the significance of their role in response to such crises. This variability in response may have implications for parents and children. For example, there may be parental concerns about going back to school, particularly worries around the child being upset and not understanding social distancing measures and so increasing their chances of catching/transmitting COVID-19. |
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