The spread of the Coronavirus disease 2019 (COVID-19) has caused many changes in society and has led to isolation and distancing, economic crises and environmental changes at the family, academic and interpersonal level, in the affected countries. Globally, early childhood centers, primary and secondary schools have experienced closures for a long time as part of COVID-19. These measures bring a loss of education time, restricted access to peers and loss of daily structure. On a global scale, 463 million children have been unable to access remote learning in 2020 (1). When early childhood centers, primary and secondary schools returned to work, they worked inconsistently due to illness of staff or children and their group isolation. A sense of uncertainty, deaths due of Coronavirus, and fear of becoming infected by Coronavirus, all led to an exacerbation of anxiety, depression, and avoidant behavior, deepening the mental difficulties in minors and adults that had existed before. In studies addressing the psychological effects of COVID-19 in China, the authors were able to show that more than half of the adults who participated in the study, about 53.8%, developed stress, depression and anxiety responses in the first wave of the plague. 84.7% of them chose to stay at home most of the day (2). Fear and anxiety due to the spread of the coronavirus, as well as consequences of the economic crisis following the pandemic, led to an increase in conflicts and quarrels within the family and an increase in the incidence of abuse, drug use and suicide (3, 4). In the shadow of the economic and health crises there has been a significant decrease in emergency room visits due to physical and psychological complaints, in particular among children and adolescents during the pandemic period compared with the preceding year (5). This finding raises concerns that psychiatric problems among minors remain unmonitored and untreated (5–7). The reduction in referrals to mental health care could be explained in several ways, one of which is lack of educational staff’s attention to students' distress (7). However, a study from England that examined changes in emotional symptoms, behavioral problems and hyperactivity/inattention, using an online survey about the child's mental health at two points between March and May 2020, during early lockdown, has shown a deterioration in mental health symptoms among preadolescent children (8). Similar results were shown in a prospective cohort study done in Japan, which found an increase in the number of schoolchildren with severe emotional/behavioral problems during the COVID-19 pandemic (9), as well as a recent Israeli study which found an increase in depression, eating disorders, anxiety and stress-related diagnoses during the COVID-19 period (10). A family atmosphere that depends on the parents’ financial and health situation, the lack of support of an extended family and the quality of the familial relationship added to this complexity. There indirect effects of COVID‐19, including disruptions to daily life that impact on mental health and wellbeing, disrupted family income and increased household stress (11). There are several studies which try to describe the immediate predict and long-term consequences of the lockdowns and the economic and health crisis, and try to formulate recommendations for educational staff and parents regarding their conduct toward children, but there is still a long way to go in understanding the consequences of the pandemic (12).
In the present study we aim to examine the impact of COVID-19 and lockdown on the mental health of minors during the pandemic period and to characterize the type and number of referrals to a regional psychiatric outpatient clinic. We assumed that during LD fewer minors would be referred to psychiatric evaluation due to behavioral disorders and there would be a decrease in diagnosis of ADHD and stimulants use because of closure of the educational system, which carries a large weight in the detection of psychiatric disorders in children, especially those with manifestations of behavioral disorders. At the same time, we assumed there would be an increase in anxiety, depression, suicide, and eating and drug abuse disorders.