The objectives of the current study are:
- to monitor the mental health and quality of life of children and adolescents and collect data on their specific challenges and needs during the pandemic;
- to compare mental health, quality of life, and specific challenges and needs of children and adolescents across different countries (e.g. Hungary, Norway, The Netherlands);
- to support children and adolescents in coping with the current situation in a constructive way: to reduce the unpleasant psychological experiences and improve their mental health by providing a targeted online prevention program that reflects their actual needs on a weekly basis;
- to facilitate the sharing of good practices through the involvement of international experts, thus accelerating the development of prevention;
- to contribute to adequate preparation for any potentially occurring, similar situation in the future.
Centres and Ethics
The study entitled “Coronavirus pandemic - #stayhome: How are you holding up? Questions and tips for 11–18 year olds to make it better” is an international multicentre study. The coordinating centre of the study is the Research Group of Childhood Mental Disorders of the Institute of Psychology, Eotvos Lorand University (ELTE), Budapest, Hungary. Other, already participating sites are the Utrecht University, Utrecht, Netherlands and the Bjorknes University College, Oslo, Norway. Further centres are under involvement, i.e. from Austria and Indonesia. The study is still open for other participating countries.
The multicentre study, with all sub-centres included, has been approved by the ethical committee at the Institute of Psychology ELTE, Budapest (Ethical permission number: 2020/144, dated 31/03/2020). Furthermore, ethical approval is obtained from each site’s local ethics committee.
The study logo is designed for the project and translated to all participating languages. Currently it is available in English, Hungarian, Dutch and Norwegian (see Fig. 1, Fig. 2, Fig. 3, Fig. 4).
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Participant and Procedure
Children and adolescents aged 11–18 years and their parents/caregivers from different parts of Europe and non-European countries are recruited. After written informed consent of the parents/caregivers and the children and adolescents (under 16 or 18 years, respectively, according to national legislation) and the youngsters only (above 16 or 18–19 years, respectively), the questionnaire is distributed online.
The following text is used for online recruitment by posting it on the respective institution’s official web pages and Facebook pages: “#stayhome: How are you holding up? Questions and tips for 11-18-year olds to make it better. Do you have 10 minutes to help yourself and others? If you do, please fill out our questionnaire and we will share useful materials about how to improve your physical and mental health and other exciting topics.”
Further distribution happens through snowball sampling as it will be spread among the target groups through various public and social media channels. The target baseline sample is a minimum of 300 children and adolescents in each participating country. The baseline evaluation questionnaire is followed up weekly to study changes in mental health, quality of life and attitudes of children and adolescents during the coronavirus disease pandemic. Data are collected by means of structured questionnaires (see below).
The time frame of the study is set to one year from study start. Thus, the study will be running while the participants are experiencing restrictions due to the COVID-19 and likely also after the restrictions may have been reduced or removed depending on the development of the pandemic and on national policies.
Measures
Children and adolescents and their parents/caregivers administer a self-report questionnaire that includes well-established measures and items developed for the current study.
Mental health. The Strengths and Difficulties Questionnaires (SDQ) is used to evaluate the mental health of children and adolescents. It is a brief screening instrument, consisting of 25 items and 5 subscales: Emotional Symptoms, Conduct Problems, Hyperactivity, Peer Relationship Problems, Prosocial Behaviour (Goodman, 1997). All the scales together, except the prosocial scale, form the SDQ Difficulties scale. The total difficulties score is generated by summing scores of the four difficulty scales. Participants are asked to indicate how true different statements are describing behaviour and feelings (1 = not true, 2 = somewhat true, and 3 = certainly true). Higher scores indicate higher level of mental health impairment. The extended version of the SDQ is used in the current study, which includes an impact supplement, a measure of functional impairment (Goodman, Meltzer, & Bailey, 1998). Both the self-report and the parent-report versions of the SDQ are used.
Quality of life. Quality of life of children and adolescents was measured by the Inventar zur Erfassung der Lebensqualität von Kindern und Jugendlichen (ILK) scale (Mattejat and Remschmidt, 1998; Kiss et al., 2007). The ILK scale evaluated six domains of quality of life: school, family, peer relations, time spent alone, somatic and mental health, and general QoL using seven items. ILK use a 5-point Likert scale (from 1 = less impairment to 5 = the most serious impairment) for the evaluation of the items. High scores indicate low levels of QoL. Both the self-report and the parent-report versions of ILK are used.
Additional questions. Questions designed for the study: demographic data and guided questions on the participants’ fields of interests and the effects the pandemic has on their psychosocial needs and everyday life.
The questionnaire follows a branching structure, so it does not burden the respondents unnecessarily; completing it takes approximately 15 minutes the first time and 10 minutes at all follow-up occasions. We use the same above described questionnaires during baseline and follow up evaluations, except a few basic not-changeable demographic data are asked only at the baseline.
Prevention Program
As highlighted by Brooks et al. (2020) in their recent systematic literature review on the psychological impact of restrictions during previous epidemics, lack and/or inadequate information, boredom and reduced motivation are related to mental distress. Based on this, to support children and adolescents to cope in a constructive way with their current situation during COVID19 pandemic, weekly prevention programs are sent to each participant. As data are analyzed parallel with data collection, the prevention program can continuously reflect on the current needs of the participants. The program consists of the followings:
• general information on how to improve mental health,
• informational about crises hotlines and online platforms,
• specific information focusing on a weekly mental health topic, based on the results of the current week - delivered to participants through a letter with a personal tone, an illustration designed for the weekly topic, and a video message by a popular person (e.g. singer, actor),
• a personalized and culturally adapted selection of links related to activities that the participant has responded that she/he would like to receive materials about,
• social media platforms where the key messages of the prevention program are delivered, to reach and support adolescents beyond those involved directly in the study.
Data Handling And Security
Data is collected anonymously and in line with the General Data Protection Regulation (GDPR). The participants are guided on how to create a personal id-code that is used throughout the study to identify each participant to ensure anonymity. E-mail-addresses are also requested for follow-up. Email addresses are stored separately from the participants answers and only the dedicated researchers of each study centre have access to it.
Data collection is handled through the Qualtrics XM online platform technology, which is fully GDPR compliant and ISO certified, implying strong encryption under transfer, storage and accessing of data. The server is physically located within the EU (in Brussels). Only the Qualtrics licence holder can access the data on the server. Each study sites hold separate Qualtrics licences, and data from the various sites are thus stored separately from another. Only data in anonymised form (i.e. with id-code only and with no e-mail addresses attached) will be transferred to the coordinating centre of the multicenter study to allow for analyses on the pooled data set.
Financing
The multisite study is an ad-hoc project tailored to the unexpected situation of the Covid-19 pandemic. There is no public financing of the study now apart from covering of running expenses by the hosting institutions and the regular payroll of researchers. Applications for study financing will be sent to appropriate funding agencies.