On March 11, 2020, the World Health Organization (WHO) classified the outbreak of the coronavirus disease (Covid-19) as a pandemic (1). Since then the governments in Austria and Italy (where the present study took place) responded with specific containment measures to keep the virus propagation under control. In Austria, the first national lockdown including physical distancing, movement restriction as well as the closure of non-essential business and gastronomy was ordered on March 16, 2020 (2). Due to the severe outbreak in Northern Italy at that time, the Italian government reacted even before the WHO’s declaration that Covid-19 was a pandemic: on March 5, 2020, all schools as well as all childcare-related services and activities were suspended (3). Further lockdown measures were taken in the following days and on March 10, 2020, the first national lockdown was ordered in Italy (4). In the summer of 2020, the Austrian as well as the Italian government relaxed the corona measures, but at the end of summer in both countries stricter measures had to be implemented again (5, 6). This resulted in a second national lockdown in Austria on November 17, 2020 (7), and in Italy on November 3, 2020 (8). In Austria as well as in Italy, primary schools remained closed for about 60 instructional days in 2020: Austria ranked eighth, Italy sixth out of 30 countries in terms of school closure days (9). Beginning in spring 2021, the Austrian and Italian governments started to gradually relax the restrictions again (6, 10). Until June 2021, when the third measurement time point of the study took place, there had been 631 deaths related to Covid-19 in North Tyrol (Austria) (11) and 1,175 in South Tyrol (Italy) (12).
1.1 Effects of corona measures on children
Studies from all over the world report negative effects of the Covid-19 pandemic and its accompanying containment measures on children’s mental health. Systematic reviews and meta-analyses explicitly focusing on children report high levels of anxiety (e.g., 13-15) and trauma symptoms (e.g., 16, 17), in addition to other negative mental health outcomes such as depression and sleep problems. Also many European studies (which are of particular interest for the present study) from children’s and parent’s perspective outline anxiety as a widespread negative mental health outcome in kindergarten and school children during the corona crisis, e.g., Luijten et al. (18; The Netherlands), Pereira et al. (19; Portugal, United Kingdom, Romania, Spain, and The Netherlands), Pizarro-Ruiz and Ordóñez-Camblor (20; Spain) and Schmidt et al. (21; Austria, Germany, Liechtenstein, and Switzerland). In a German study Rothe et al. (22) found significant changes in emotions and worries from the time before Covid-19 to the time during the pandemic in four groups, namely adults with and without mental health conditions as well as children and adolescents with and without mental health conditions. Regarding Covid-19-virus related worries, Vogel et al. (23) found that German children worried most about their families and were least concerned about themselves. Concerning worries and anxiety, qualitative European studies found similar results: Spanish children reported negative emotional effects such as fear, nervousness, worry, sadness, anger, and boredom (24), Irish families described their children as anxious and high strung during the pandemic (25) and in an Italian sample most children reported mild to severe anxiety during quarantine and being concerned especially about their family members (26). With regard to traumatic effects of the Covid-19 pandemic, Terzioğlu and Büber (27) showed that 20.9% of 1,059 Turkish children aged 10 to 15 had high trauma scores and trauma scores were significantly higher in families with a low income level as well as in divorced families.
In the European context two studies in large samples which compared data before the pandemic in 2017 with data during the pandemic are available from the United Kingdom (UK; 28) and Germany (29, 30). Key findings of the study in the UK showed that the rates of probable mental disorders in 5 to 16 year old children increased from 10.8% in 2017 to 16.0% in July 2020. More than a quarter of the children reported disrupted sleep and one in ten often or always felt lonely (28). Similar results were reported from the COPSY-study (impact of Covid-19 on psychological health; 29, 30), which provides a pre-post comparison of mental health in a German population-based sample (before the pandemic: N = 1,556; wave 1: N = 1,586; wave 2: N = 1,288): in the first wave, two-thirds of the 7- to 17-year-old children and adolescents reported being highly burdened by the Covid-19 pandemic. Mental health problems increased from 9.9% before the pandemic to 17.8% during the pandemic and anxiety levels from 14.9–24.1% (29). In the second wave emotional problems, peer problems, anxiety, depressive symptoms as well as psychosomatic complaints increased significantly (30).
1.2 Gender differences in mental health during the corona crisis
Meta-analyses on posttraumatic stress in children and adolescents (e.g., 31, 32) identified female gender as a risk factor, i.e. girls tend to show more trauma symptoms than boys. Research on previous epidemics (e.g., Severe Acute Respiratory Syndrome (SARS), Influenza A virus subtype H1N1) showed that gender is a factor influencing perceptions, responses and psychological distress in adults. For example, women were more likely to be emotionally disturbed (33) and reported more posttraumatic stress symptoms than men (33–35). With regard to children, Sprang & Silman (34) found no gender differences in their posttraumatic stress symptoms (reported by their parents) due to a pandemic disaster with accompanying disease-containment measures. However, concerning the current Covid-19 pandemic meta-analyses on children’s mental health consistently found that girls were more likely to experience negative mental health outcomes than boys´ (e.g., 13-17). A systematic review by Ma et al. (17) including 23 studies with 57,927 Chinese and Turkish child/adolescent participants showed that female participants and adolescents exhibited a higher prevalence of anxiety and depression compared to male participants and children, respectively (17). Another meta-analysis (15) of 115 articles presenting data on a total of 127,923 children and adolescents notes that in most studies girls reported higher levels of worry, concern and fear regarding Covid-19 as well as more notable declines in general mental health during the pandemic based on retrospective self-report compared with boys (e.g., 36, 37). In the German COPSY-study, girls reported more symptoms than boys with regard to having headaches, stomach aches and feeling low while female gender was also associated with fewer parent-reported mental health problems (emotional symptoms, conduct problems, hyperactivity) except for peer problems (29).
In research on mental health on children it is a commonly accepted practice to obtain information from multiple informants, e.g. children and parents (e.g., 38). Findings on child-parent agreement on symptom estimation show that correlations between children and parents are low to moderate (39). Child characteristics, such as age and gender, have been suggested as potential factors having an impact on child-parent agreement (e.g., 40), but findings regarding gender have been mixed. Some studies found higher agreement between boys and parents than between girls and parents (41), other studies reported that gender has no predictive value (e.g., 42).
1.3 Gender framework
The above mentioned meta-analyses (e.g., 15) show that the majority of studies confirm the existence of gender-specific challenges associated with the Covid-19 pandemic. In other words, the pandemic might impact mental health differently by gender. Looking at gender beyond sex (the biological determinant) gender is viewed as an achieved status, i.e. it is constantly created and re-created out of human interaction, and out of social life. West and Zimmerman (43) coined this process with the term “doing gender”. Gender is individually and socially experienced, and these social roles might partially explain gender differences (ibid.). According to Ellemers (44) parents might raise and educate children in a way that implicitly teaches them what behaviour is (in)appropriate for girls and boys. Brody and Hall (45) assume that girls and boys acquire gender-related rules for emotion expression as a result of a combination of biologically predispositions and socialisation. In many Western cultures girls and women are believed to be more emotionally intense, i.e. they exhibit greater levels of emotions such as happiness and internalising emotions (e.g., sadness, fear and anxiety) (ibid.). In this study, we refer to gender as we consider any differences and similarities in a socio-constructivist and socio-developmental light compared to a biological perspective. However, we are aware of the mostly used integral perception of emotional development, which combines biological, socio-constructivist and social development theories (46).
The present study aims to discover the negative effects of the Covid-19 pandemic measures on girls and boys from North Tyrol (Austria) and South Tyrol (Italy). North and South Tyrol – although belonging to two different countries nowadays – are geographically and historically tightly related territories. Until 1919, South Tyrol had been part of the Austrian Crown (47). With the Treaty of Saint-Germain at the end of World War I the Habsburgian province Tyrol was divided into two halves, the southern part (South Tyrol) being awarded to Italy and the northern part (North Tyrol) remaining with Austria (48). Due to this historical background North and South Tyrol not only share the German language (49; South Tyrol: 69.4% German, 26.1% Italian, 4.5% Ladin (50)) but many other commonalities: a similar racial background, many cultural similarities, similar lifestyles and many customs (48). Today, along with the Autonomous Province of Trento, North and South Tyrol constitute the transboundary European Region Tyrol – South Tyrol – Trentino (47).
The main purpose of this investigation was to explore the impact of corona containment measurements on girls and boys with regard to their self-rated experience of threat, trauma, and anxiety at three measurement times (June 2020, December 2020, June 2021). In addition to the children's self-assessments, adults, who have children between 7 and 13 years (henceforward: parents), also assessed from their perspective the children's experience of threat, trauma and anxiety (at the same time points). Across the three measurement time points differences between self and proxy ratings were also a focus. Specifically, we analysed differences in perceived threat, trauma, and anxiety between (1) girls’ and boys’ self-ratings, assuming that girls score higher than boys, (2) parents’ ratings of girls, and parents’ ratings of boys, assuming that parents report a similar amount of symptoms for girls and for boys, (3) girls’ and parents’ ratings of girls, assuming that parents report less symptoms than girls themselves, and (4) boys’ and parents’ ratings of boys, assuming that parents report less symptoms than boys themselves.