The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was first reported in Wuhan, China, in December 2019, had an tremendous impact initially in China and subsequently throughout the world. While most patients infected with SARS-CoV-2 had mild illness, about 5% of patients experienced severe lung injury or multi-organ dysfunction, resulting in a 1-4% case fatality rate (1).
Restrictive measures in the general population were necessary to reduce the rate of virus transmission. Quarantines were imposed in many countries as a means of decreasing virus transmission. Quarantines and pandemic disasters have demonstrated negative psychological effects, including confusion, anger, and post-traumatic distress (2) (3).
During the first outbreak in Europe in March 2020, a strict lockdown took place in Spain with the population confined to their homes. Only essential work was permitted, and the population was allowed to leave their homes only for basic activities, such as going to the pharmacy, to buy food, or for emergencies.
In Spain, this strict lockdown was declared as of March 13, 2020. In addition to schools being closed, children were not allowed to leave their homes under any circumstances (except to go to the doctor or to accompany their parents for essential activities if they would have been left at home alone). As of April 26, children were allowed to leave their homes for a reduced period of time. Schools did not resume activities until September 2020.
Prior to COVID-19, a review in The Lancet on quarantines revealed their broad and potentially long-lasting negative psychological consequences (3). Another general population study compared mental health during the pandemic period and in the same time period 3 years prior. A clear psychological deterioration was found, with an increase in depression that was more pronounced in young adults (4).
Social distancing and school closures may increase mental health problems in children and adolescents, who are at greater risk of developing mental health problems compared to adults. Confinements have produced an emotional impact on the entire population (5) and children (6). The effects of the lockdown on emotional well-being have been perceived as negative (3)(7), with increased stress, anger, fear, and confusion (8). In children, it has also been shown that the COVID-19 pandemic has had a significant psychological impact (9). Children are frightened, nervous, sad, bored, and angry but also feel safe, calm, and happy to be with their families (10). Nonetheless, these negative feelings have been more prevalent and can affect the entire family (11). In adolescents, this has been associated with depression and anxiety (12).
During the confinement, daily routines have been altered, such as sleep habits, in both adults (13) and children (14). These changes may have long-term emotional effects (15). Other habits, such as eating patterns, have also undergone changes in this period (16). In addition, activities that help improve the emotional health of young people, such as exercise, physiotherapy, relaxation, and academic performance, were restricted (17).
Mental health in childhood is highly relevant and influenced by many factors. A recent large-scale review found that 2 out of 5 children in Great Britain had high scores in social problems, with gender, ethnicity, age, and socioeconomic status influencing the degree of affectation (18).
The emotional impact depends on many biological and sociodemographic factors that must be taken into account (18). The degree to which parents are affected also influences their children (19)(20). These effects on the family and children, as well as their needs during the first outbreak, were not taken into consideration (21)(22). It was therefore foreseeable that the lockdown in Spain would affect the emotional state of children.
Studies on emotional health in children during the COVID-19 pandemic have been conducted mainly in the Chinese population (23) . There are many methodological limitations in the studies carried out, such as small sample sizes or being performed after the period of confinement with the resulting recall bias, among other limitations (12).
The studies in children during this period of confinement are highly relevant because of the great emotional impact described and because they enable us to determine the sociodemographic characteristics of the children at greatest risk. In addition, there are variables that may involve a greater emotional impact on children, such as the direct or indirect consequences of COVID in the family (24), the presence of some type of disability (25) or having parents who are essential workers during the pandemic (26). On the other hand, variables such as having pets (27) or having outdoor access at home can be protective (17). This information is important in order to be able to implement measures to limit the effects of future confinement on the emotional health of children.
The aim of this study was to assess the degree of emotional impact on children as perceived by their parents during the strict lockdown and to identify the factors associated with emotional state.
We analyzed the most common sociodemographic variables, paying special attention to housing conditions (due to the situation of confinement) and examined several dimensions that may be associated with emotional state, such as communication with the children, parental perception of after effects, the effect on illnesses or the physical repercussions on the children.