Mental health changes during and after the COVID-19 pandemic in children and adolescents with mental disorders

doi:10.21203/rs.3.rs-4599778/v1

Download PDF

Research Article

Mental health changes during and after the COVID-19 pandemic in children and adolescents with mental disorders

https://doi.org/10.21203/rs.3.rs-4599778/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Background

The COVID-19 pandemic negatively affected child and adolescent mental health, but it is unclear which subgroups were affected most. We investigated to what extent psychiatric diagnosis was related to the severity of mental health problems during and after the pandemic in children in psychiatric outpatient care.

Methods

We collected data at seven time points (from April 2020 to April 2023) in a total sample of 2,545 children (8-18 years old) in psychiatric outpatient care. We grouped diagnostic classifications in four categories: Autism, ADHD, Anxious/Depressive disorders, or ‘Other’. Mental health was assessed with parent‐reported data on internalizing and externalizing problems with the Brief Problem Monitor, and with self‐reported data on Anxiety, Depressive symptoms, Sleep‐related impairments, Anger, Global health, and Peer relations with the Patient‐Reported Outcomes Measurement Information System (PROMIS®). We tested for overall main effects in mental health outcomes between diagnostic categories, and for different trajectories over time.

Results

We found that mental health outcomes varied substantially between diagnostic categories as expected, with internalizing problems being largest in children with Anxious/Depressive disorders, and externalizing problems being largest in children with Autism and ADHD. However, we found no evidence for differences between diagnostic categories in trajectories in mental health outcomes during and after the COVID-19 pandemic.

Discussion

Differences between diagnostic categories were as expected, however trajectories over time during and after the pandemic were not different for diagnostic categories in our sample. This suggests that the pandemic had an overall negative effect on mental health outcomes in children and adolescents in psychiatric outpatient care, rather than different effects for children with specific mental disorders. Regular high-quality monitoring is vital to recognize changing trajectories of youth mental health and to adapt to crisis situations.

The COVID-19 pandemic has had a major impact on people’s lives, and concerns about its burden on mental health are substantial. In adults, evidence is converging that its effects on mental health problems have been limited (Sun et al., 2023), but in children and adolescents (hereafter referred to as children) this is not the case. Meta-analyses in general population samples showed a surge of mental health problems during the pandemic (in comparison to pre-pandemic data), with a particular increase in anxious and depressive symptoms (Deng et al., 2022; Kauhanen et al., 2023). Although few studies have been performed in clinical child populations, surveys in children with various diagnoses (e.g., autism, attention deficit hyperactivity disorder [ADHD], eating disorders) suggest that mental health problems increased during the pandemic in these populations as well (Bentenuto et al., 2021; Bobo et al., 2020; Colizzi et al., 2020; Lopez-Serrano et al., 2021; Schlegl et al., 2020; van Oers et al., 2023).

Thus far, the pursuit for factors that might predict which children were affected most by the pandemic has not been fruitful. Age and sex seem unrelated to mental health changes due to the pandemic in children (Kiviruusu et al., 2023; Zijlmans et al., 2023), although some studies found a slightly larger impact on adolescents compared to younger children (Ludwig-Walz et al., 2022, 2023). It has been suggested that some children with mental health problems may be especially susceptible to mental health effects due to the pandemic, whereas others may show surprising resilience or benefits. For example, relief of social and sensory pressure may have greater upsides for children with particular psychiatric morbidity (Bruining et al., 2020). To the best of our knowledge, no study to date has yet compared the pandemic impact on outcomes between children with different diagnoses directly.

In previous work, we examined changes in child mental health in a large clinical child psychiatric sample from the start of the COVID-pandemic until approximately one year after the pandemic (lockdown) measures ended (April 2023) (van Oers et al., 2023). Our results showed that internalizing mental health problems reported by both children and parents increased throughout the pandemic and were still elevated one year after the end of the pandemic. Here we investigated in a large cohort of Dutch children and adolescents receiving outpatient care by Child and Adolescent Mental Health Services if main effects on mental health problems, and trajectories over time differed across diagnostic categories during and after the COVID pandemic.

Participants

Participants were 2,545 children aged 8 to 18 years old (mean age 13.3, SD 2.93) who received outpatient care in one of the four child psychiatric institutes that offer specialized care and collaborate in DREAMS (www.dreams-study.nl). See Table 1 for an overview of participant characteristics.

Table 1

Characteristics of the Sample
Group		Early pandemic	Late pandemic	Post pandemic
Autism	N	628	294	200
	Male	62.3%	56.8%	56.5%
	M age in years (SD)	13.09 (2.85)	13.19 (2.83)	13.25 (2.77)
	Country of birth parents (both Dutch)	91.0%	85.7%	89.5%
	Educational level parents low	3.7%	4.2%	5.0%
	Educational level parents intermediate	42.6%	41.8%	37.0%
	Educational level parents high	53.8%	54.0%	58.0%
ADHD	N	354	137	96
	Male	72.6%	69.3%	63.5%
	M age in years (SD)	12.3 (2.81)	11.60 (2.53)	12.08 (2.79)
	Country of birth parents (both Dutch)	87.7%	83.9%	90.6%
	Educational level parents low	6.3%	7.4%	6.3%
	Educational level parents intermediate	46.0%	51.5%	42.1%
	Educational level parents high	47.7%	41.2%	51.6%
Anxiety/Mood	N	251	111	88
	Male	33.1%	34.2%	37.5%
	M age in years (SD)	14.70 (2.79)	14.41 (2.74)	14.35 (2.50)
	Country of birth parents (both Dutch)	82.6%	79.2%	79.6%
	Educational level parents low	6.9%	8.9%	5.7%
	Educational level parents intermediate	41.5%	38.6%	37.5%
	Educational level parents high	51.6%	52.5%	56.8%
Other	N	220	94	72
	Male	37.7%	31.9%	37.5%
	M age in years (SD)	14.19 (2.92)	14.10 (2.78)	14.94 (2.56)
	Country of birth parents (both Dutch)	79.3%	78.2%	85.9%
	Educational level parents low	5.1%	3.4%	5.6%
	Educational level parents intermediate	38.9%	40.2%	22.5%
	Educational level parents high	56.1%	56.3%	71.8%
Note. N = number of participants, M = mean, SD = standard deviation. Early pandemic = waves 1–3; April 2020-April 2021, Late pandemic = waves 4–5; November 2021-April 2022, Post pandemic = waves 6–7; November 2022-April 2023.

Procedure

We collected data at seven time points, approximately once every six months between April 2020 and April 2023. Parents of children receiving outpatient care in one of the DREAMS centers were invited via email to participate in the study together with their child. All data were gathered via online questionnaires and response rates varied between 9% and 11%. During COVID-19, in the Netherlands several restrictions were in place. Figure 1 provides an overview of the seven data waves in relation to Dutch COVID-19 restrictions at the time.

Measures

Diagnostic information

We collected primary DSM-5 diagnoses (American Psychiatric Association, 2013) as assessed in regular clinical care from the medical records of the participants. See Van der Mheen et al., 2024 for details on diagnostic procedures. We grouped the diagnoses into four categories: ADHD, Autism, Anxious/Depressive disorders, and Other (e.g., eating disorders, disruptive behavior disorders). For 16.2% of children no diagnosis was registered. We excluded these participants from the analyses.

Socio-demographic information

We collected socio-demographic information, including age and sex of the child, and the parents’ country of birth and educational level. We defined parents’ country of birth as both parents being born in the Netherlands (yes/no). We categorized parental educational level based on the highest education level among both parents and coded this as low (primary education, lower vocational education, or lower and middle general secondary education), intermediate (middle vocational education, higher secondary education, or pre-university education), and high (higher vocational education or university).

Parent-Reported Outcomes

Parents filled out the Brief Problem Monitor (BPM) from the Achenbach System of Empirical Based Assessment (ASEBA-BPM), which is a shortened version of the Child Behavior Checklist (CBCL/6–18 years) (Achenbach & Rescorla, 2001) that assesses behavioral and emotional problems in children as reported by their parents. Items were rated on a three-point Likert-scale, where parents rated if a statement applies to their child in the past seven days (0 = ‘not true’, 1 = ‘somewhat true’, 2 = ‘very true’). We used the internalizing and externalizing scales of the BPM. The externalizing score typically consists of seven items, but we excluded one item related to behavior at school due to data collection occurring during periods with COVID-19 restrictions when children did not attend school. The six remaining items were weighted to maintain the same range as the normal scoring system, allowing for comparison to other studies. The internalizing score was calculated using the regular six items. In line with the BPM manual, we coded missing items on the BPM as zero. If more than 20% of items were missing for a participant, they were excluded from the BPM analysis.

Child-Reported Outcomes

Children filled out six measures from the Patient-Reported Outcomes Measurement Information System (PROMIS®) to assess self-reported aspects of health over the past seven days: Anxiety v2.0 (Irwin et al. 2010), Depressive Symptoms v2.0 (Irwin et al., 2010), Anger v2.0 (Irwin et al. 2012), Sleep-related impairment v1.0 (Forrest et al. 2018), Global health v1.0 (Forrest et al. 2014), and Peer Relationships v2.0 (Dewalt et al. 2013). We administered the questionnaires (except Anger and Global Health) as Computerized Adaptive Tests (CAT), where items are selected based on responses to previously completed items, resulting in reliable scores with fewer items (Cella et al. 2007). Most items were scored on a five-point Likert scale ranging from ‘never’ to ‘(almost) always’. Total scores were calculated by transforming item scores into T-scores ranging from 0 to 100, with a mean of 50 and a standard deviation of 10 in the original calibration sample (Irwin et al. 2010). The U.S. item parameters were used in the CAT algorithm and T-score calculations, as by PROMIS convention. The PROMIS pediatric item banks and scales have previously been validated in the Dutch population (Klaufus et al. 2021; Luijten, van Litsenburg, et al. 2021; van Muilekom et al. 2021; Peersmann et al. 2022; Luijten et al. 2022).

Data analysis

We performed statistical analyses in IBM SPSS Statistics 28. For some participants we had data at multiple time points, but this was the case for too few participants to include these data into meaningful analyses. Therefore, we randomly selected one time point per participant to avoid dependencies in the data, and thus employed a repeated cross-sectional design. We grouped the data of seven measurements into three pandemic periods: early pandemic (wave 1–3; April 2020, November 2020, and April 2021), late pandemic (wave 4–5; November 2021 and April 2022), post pandemic (wave 6–7; November 2022 and April 2023) to increase power as subgroup sizes per diagnostic category were limited for the individual measurements. For each outcome variable, we performed an analysis of covariance (ANCOVA) to test for main effects of diagnosis and interaction effects between type of diagnosis and pandemic period. In all analyses, we included age and sex of the child, parental country of birth, and parental education as covariates. We report all outcomes as estimated marginal means (EMMs) of Z-scores standardized to pre-pandemic norms from the general population, assessed in independent studies (for details, see van Oers et al., 2023).

Parent-reported outcomes (BPM)

Internalizing problems differed between diagnostic categories (p < .001), with highest scores for Anxious/Depressive, followed by Autism and Other, and lowest for ADHD. Externalizing problems differed between diagnostic categories (p < .05), with highest scores for Autism and ADHD, followed by Anxious/Depressive and Other. Interaction effects between diagnosis and pandemic period were not significant for both outcomes.

Child-reported outcomes (PROMIS)

Anxiety (p < .001), Depression (p < .001), Sleep-related problems (p < .001), and Global Health (p < .001) differed between diagnostic categories with highest scores for Anxious/Depressive, followed by Autism, Other, and lowest scores for ADHD. Anger also differed between diagnostic categories (p < .05) with highest scores for Autism, followed by Anxious/Depressive, Other, and ADHD. Peer relations differed between diagnostic categories (p < .001), with lowest scores for Autism, followed by Other, Anxious/Depressive, and ADHD. For all outcomes, interaction effects between diagnosis and time were not significant.

Figures 2 and 3 illustrate the EMMs of the different groups over time, represented as standard deviations from pre-pandemic general population norm scores. The exact statistics are reported in Table 2.

Table 2

BPM and PROMIS standardized estimated marginal means (EMM) and standard errors.
	Cohort		1 Early pandemic	2 Late pandemic	3 Post pandemic
Parent-reported outcomes	Autism	BPM Internalizing	3.27 (0.13)	3.56 (0.16)	3.35 (0.18)
		BPM Externalizing	1.63 (0.10)	1.63 (0.12)	1.45 (0.14)
	ADHD	BPM Internalizing	2.08 (0.15)	2.86 (0.21)	2.53 (0.25)
		BPM Externalizing	1.30 (0.11)	1.65 (0.16)	1.49 (0.19)
	Anxiety/Mood	BPM Internalizing	3.63 (0.17)	3.98 (0.25)	4.26 (0.26)
		BPM Externalizing	1.28 (0.13)	1.42 (0.18)	1.30 (0.19)
	Other	BPM Internalizing	3.07 (0.18)	2.86 (0.27)	3.62 (0.29)
		BPM Externalizing	1.33 (0.13)	1.24 (0.20)	1.25 (0.21)
Child-reported outcomes	Autism	Anxiety	1.07 (0.07)	1.31 (0.08)	1.22 (0.10)
		Depressive symptoms	1.01 (0.07)	1.13 (0.09)	1.09 (0.10)
		Sleep-related impairments	0.74 (0.07)	0.96 (0.09)	0.86 (0.10)
		Anger	0.87 (0.06)	0.97 (0.08)	0.94 (0.09)
		Global health	-0.82 (0.06)	-0.99 (0.07)	-1.02 (0.09)
		Peer relations	-0.64 (0.06)	-0.63 (0.08)	-0.72 (0.09)
	ADHD	Anxiety	0.76 (0.08)	1.02 (0.12)	0.68 (0.15)
		Depressive symptoms	0.61 (0.08)	1.04 (0.13)	0.67 (0.15)
		Sleep-related impairments	0.56 (0.08)	0.64 (0.13)	0.46 (0.15)
		Anger	0.63 (0.07)	0.94 (0.11)	0.61 (0.14)
		Global health	-0.62 (0.07)	-0.87 (0.11)	-0.62 (0.13)
		Peer relations	-0.22 (0.07)	-0.35 (0.12)	-0.36 (0.14)
	Anxiety/Mood	Anxiety	1.16 (0.09)	1.52 (0.14)	1.48 (0.15)
		Depressive symptoms	1.00 (0.09)	1.11 (0.14)	1.22 (0.15)
		Sleep-related impairments	0.89 (0.09)	0.95 (0.14)	1.01 (0.15)
		Anger	0.73 (0.09)	0.72 (0.13)	0.94 (0.14)
		Global health	-0.92 (0.08)	-0.88 (0.12)	-1.15 (0.13)
		Peer relations	-0.31 (0.09)	-0.30 (0.13)	-0.55 (0.14)
	Other	Anxiety	1.01 (0.10)	1.02 (0.15)	1.04 (0.15)
		Depressive symptoms	0.97 (0.10)	0.94 (0.16)	1.09 (0.16)
		Sleep-related impairments	0.73 (0.10)	0.44 (0.16)	0.79 (0.16)
		Anger	0.80 (0.09)	0.55 (0.14)	0.93 (0.14)
		Global health	-0.83 (0.09)	-0.92 (0.13)	-1.04 (0.13)
		Peer relations	-0.44 (0.10)	-0.42 (0.15)	-0.45 (0.14)
Note. Scores represent the constructs. As such, higher scores indicate more symptoms. For Global health and Peer relations, higher scores indicate better functioning.

In previous work, we showed increases in mental health problems over the course of the COVID-19 pandemic (April 2020 – April 2023) in children in psychiatric care (van Oers et al., 2023). In the current study, we assessed within the same sample to what extent mental health differed between diagnostic categories, and whether these outcomes were differently affected by the COVID pandemic across these diagnostic categories. As expected, we found that overall problems varied substantially between diagnostic categories with internalizing problems most prevalent in Anxiety/Depressive disorders, and externalizing problems most prevalent in ADHD and Autism. Crucially, we found no evidence for different trajectories of diagnostic groups over time, suggesting that on average children with different psychiatric classifications were equally negatively impacted by the COVID-19 pandemic and related measures.

The lack of differences in trajectories for different diagnostic categories mirrors the lack of evidence for differences in trajectories for other moderators such as age, sex, or educational attainment (Kiviruusu et al., 2023; van Oers et al., 2023). These findings suggest the pandemic had an overall negative effect on the mental health of children and adolescents, rather than on specific subgroups. Of course, the pandemic has impacted people in different ways, and it may be the case that putative differences exist on a more individual level, or depend on broader factors such as family, neighborhood, or school. For example, early in the pandemic, economic concerns of the parents were found to be related to differences in pandemic impact on child mental health (Cost et al., 2022). Likewise, parental stress and mental health may mediate or moderate pandemic effects on child mental health (Babore et al., 2023). Alternatively, the impact of the pandemic may have been substantial in specific subgroups, but the coping response by caregivers, clinicians, and children themselves may have been effective in mitigating the negative impact.

Another important factor that influences the interpretation of our findings concerns the changes in mental health care itself due to the pandemic. A substantial portion of mental health care transitioned to telehealth during the pandemic, which impacted intakes, procedures, and treatments (Folk et al., 2022). In addition, the workload, stress, and mental health problems of mental health care workers increased (Van Doesum et al., 2023). Such factors may have affected the accessibility of care and possibly have influenced the patient population we studied. Although we controlled for background variables and the proportion of different diagnoses did not substantially change over time, we cannot rule out that this may have contributed to our results.

This study benefits from data from a large sample of children in psychiatric care in the Netherlands and relies on both child-reported and parent-reported data. The findings of parent ratings and self-reports are congruent, suggesting that different sources of information converge towards similar outcomes. Our findings are limited by the fact that not all diagnostic categories were represented in this study since sample sizes would become too low to perform meaningful analyses, hence, our findings cannot be generalized to other specific mental disorders. Likewise, our sample consists of children in specialized psychiatric care and findings may not generalize to broader child populations with mental health problems. In addition, for our analyses we used only three time points to retain sufficient power, but thereby also increased the time spans of measurements, and therefore we cannot rule out differences between and within smaller time scales. Finally, no pre-pandemic data was available and thus we cannot rule out that the acute impact of the pandemic may have been different for children with different diagnoses.

In sum, we found no differences between diagnostic categories in mental health changes over time from the start to a year after the COVID-19 pandemic. Our data suggest that having a specific psychiatric diagnosis did not pose a risk factor for worse outcomes during and after the pandemic compared to other diagnoses. We stress the need for regular, high-quality monitoring of child mental health to better understand changes that occur and to be able to better adapt to crisis situations.

Ethical approval

We received approval for data collection from the appropriate ethics committees (METc Amsterdam UMC) and all children and parents provided informed consent. The studies were conducted in accordance with the ethical standards outlined in the 1964 Declaration of Helsinki and its later amendments.

Funding

This research was funded by ZonMw project numbers 50-56300-98-973 and 05-16048-2130001.

Author Contribution

JZ, ML, JT, HvO, and TJCP designed the study; JZ, ML, JT, MvdM, HvA acquired, processed, or analyzed the data; JZ, JRZ, and TJCP drafted the manuscript; all authors have worked on the revision of the manuscript; all authors have approved the submitted version (and any substantially modified version that involves the author's contribution to the study); and all authors have agreed both to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature.

Acknowledgements

We thank all participating families and the 'COVID-19 Wellbeing and Mental Health Consortium’.

Data Availability

Data are available upon reasonable request

Achenbach TM, Rescorla LA. Manual for the ASEBA School-Age Forms and Profiles. University of Vermont Research Center for Children, Youth, & Families; 2001.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Babore A, Trumello C, Lombardi L, Candelori C, Chirumbolo A, Cattelino E, Baiocco R, Bramanti SM, Viceconti ML, Pignataro S, Morelli M. Mothers’ and Children’s Mental Health During the COVID-19 Pandemic Lockdown: The Mediating Role of Parenting Stress. Child Psychiatry Hum Dev. 2023;54(1):134–46. https://doi.org/10.1007/s10578-021-01230-6.
Bentenuto A, Mazzoni N, Giannotti M, Venuti P, de Falco S. (2021). Psychological impact of Covid-19 pandemic in Italian families of children with neurodevelopmental disorders. Research in Developmental Disabilities, 109. https://doi.org/10.1016/j.ridd.2020.103840.
Bobo E, Lin L, Acquaviva E, Caci H, Franc N, Gamon L, Picot MC, Pupier F, Speranza M, Falissard B, Purper-Ouakil D. How do children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) experience lockdown during the COVID-19 outbreak? Encephale. 2020;46(3):S85–92. https://doi.org/10.1016/j.encep.2020.05.011.
Bruining H, Bartels M, Polderman TJC, Popma A. (2020). COVID-19 and child and adolescent psychiatry: an unexpected blessing for part of our population? European Child and Adolescent Psychiatry, 0123456789. https://doi.org/10.1007/s00787-020-01578-5.
Colizzi M, Sironi E, Antonini F, Ciceri ML, Bovo C, Zoccante L. Psychosocial and behavioral impact of COVID-19 in autism spectrum disorder: An online parent survey. Brain Sci. 2020;10(6). https://doi.org/10.3390/brainsci10060341.
Cost KT, Crosbie J, Anagnostou E, Birken CS, Charach A, Monga S, Kelley E, Nicolson R, Maguire JL, Burton CL, Schachar RJ, Arnold PD, Korczak DJ. Mostly worse, occasionally better: impact of COVID-19 pandemic on the mental health of Canadian children and adolescents. Eur Child Adolesc Psychiatry. 2022;31(4):671–84. https://doi.org/10.1007/s00787-021-01744-3.
Deng J, Zhou F, Hou W, Heybati K, Lohit S, Abbas U, Silver Z, Wong CY, Chang O, Huang E, Zuo QK, Moskalyk M, Ramaraju HB, Heybati S. Prevalence of mental health symptoms in children and adolescents during the COVID-19 pandemic: A meta‐analysis. Ann N Y Acad Sci. 2022. https://doi.org/10.1111/nyas.14947.
Folk JB, Schiel MA, Oblath R, Feuer V, Sharma A, Khan S, Doan B, Kulkarni C, Ramtekkar U, Hawks J, Fornari V, Fortuna LR, Myers K. The Transition of Academic Mental Health Clinics to Telehealth During the COVID-19 Pandemic. J Am Acad Child Adolesc Psychiatry. 2022;61(2):277–e2902. https://doi.org/10.1016/j.jaac.2021.06.003.
Irwin DE, Stucky B, Langer MM, Thissen D, DeWitt EM, Lai JS, Varni JW, Yeatts K, DeWalt DA. An item response analysis of the pediatric PROMIS anxiety and depressive symptoms scales. Qual Life Res. 2010;19(4):595–607. https://doi.org/10.1007/s11136-010-9619-3.
Kauhanen L, Yunus WM, Lempinen WMA, Peltonen L, Gyllenberg K, Mishina D, Gilbert K, Bastola S, Brown K, J. S. L., Sourander A. A systematic review of the mental health changes of children and young people before and during the COVID-19 pandemic. Eur Child Adolesc Psychiatry. 2023;32(6):995–1013. https://doi.org/10.1007/s00787-022-02060-0.
Kiviruusu O, Haravuori H, Lindgren M, Therman S, Marttunen M, Suvisaari J, Aalto-Setälä T. Generalized anxiety among Finnish youth from 2013 to 2021—Trend and the impact of COVID-19. J Affect Disord. 2023;330:267–74. https://doi.org/10.1016/j.jad.2023.03.010.
Lopez-Serrano J, Díaz-Bóveda R, González-Vallespí L, Santamarina-Pérez P, Bretones-Rodríguez A, Calvo R, Lera-Miguel S. Psychological impact during COVID-19 lockdown in children and adolescents with previous mental health disorders. Revista de Psiquiatria y Salud Mental. 2021. https://doi.org/10.1016/j.rpsm.2021.04.002.
Ludwig-Walz H, Dannheim I, Pfadenhauer LM, Fegert JM, Bujard M. (2022). Increase of depression among children and adolescents after the onset of the COVID-19 pandemic in Europe: a systematic review and meta-analysis. In Child and Adolescent Psychiatry and Mental Health (Vol. 16, Issue 1). BioMed Central Ltd. https://doi.org/10.1186/s13034-022-00546-y.
Ludwig-Walz H, Dannheim I, Pfadenhauer LM, Fegert JM, Bujard M. Anxiety increased among children and adolescents during pandemic-related school closures in Europe: a systematic review and meta-analysis. Child Adolesc Psychiatry Mental Health. 2023;17(1):74. https://doi.org/10.1186/s13034-023-00612-z.
Schlegl S, Maier J, Meule A, Voderholzer U. Eating disorders in times of the COVID-19 pandemic—Results from an online survey of patients with anorexia nervosa. Int J Eat Disord. 2020;53(11):1791–800. https://doi.org/10.1002/eat.23374.
Sun Y, Wu Y, Fan S, Dal Santo T, Li L, Jiang X, Li K, Wang Y, Tasleem A, Krishnan A, He C, Bonardi O, Boruff JT, Rice DB, Markham S, Levis B, Azar M, Thombs-Vite I, Neupane D, Thombs BD. Comparison of mental health symptoms before and during the covid-19 pandemic: evidence from a systematic review and meta-analysis of 134 cohorts. BMJ. 2023. https://doi.org/10.1136/bmj-2022-074224.
Van Doesum TJ, Shields-Zeeman LS, Leone SS, Van Meijel B, Jabbarian LJ, Van Bon-Martens M. Impact of the COVID-19 pandemic on working conditions and mental well-being of mental health professionals in the Netherlands: A cross-sectional study. BMJ Open. 2023;13(4). https://doi.org/10.1136/bmjopen-2022-062242.
van Oers HA, Alrouh H, Tieskens JM, Luijten MAJ, de Groot R, Broek E, van der Doelen D, Klip H, De Meyer R, van der Mheen M, Ruisch IH, van den Berg G, Bruining H, Buitelaar J, van der Rijken R, Hoekstra PJ, Kleinjan M, Lindauer R, Oostrom KJ, Zijlmans J. Changes in child and adolescent mental health across the COVID-19 pandemic (2018–2023): Insights from general population and clinical samples in the Netherlands. JCPP Adv. 2023. https://doi.org/10.1002/jcv2.12213.
Zijlmans J, Tieskens JM, van Oers HA, Alrouh H, Luijten MAJ, de Groot R, van der Doelen D, Klip H, van der Lans RM, de Meyer R, van der Mheen M, Ruisch IH, van den Berg G, Bruining H, Buitelaar J, van der Rijken R, Hoekstra PJ, Kleinjan M, Lindauer RJL, Polderman TJC. The effects of COVID-19 on child mental health: Biannual assessments up to April 2022 in a clinical and two general population samples. JCPP Adv. 2023;3(2). https://doi.org/10.1002/jcv2.12150.

No competing interests reported.

Download PDF

Version 1

posted

You are reading this latest preprint version

Mental health changes during and after the COVID-19 pandemic in children and adolescents with mental disorders

Status:

Version 1

Abstract

Figures

Introduction

Methods

Participants

Procedure

Measures

Diagnostic information

Socio-demographic information

Parent-Reported Outcomes

Child-Reported Outcomes

Data analysis

Results

Parent-reported outcomes (BPM)

Child-reported outcomes (PROMIS)

Discussion

Declarations

Funding

Author Contribution

Acknowledgements

Data Availability

References

Additional Declarations

Status:

Version 1