In the present study, we conducted an internet-based cross-sectional study to assess the impact of the COVID-19 epidemic on behavioral problems of pediatric patients two months after discharge in Wuhan city, Hubei province, China. The prevalence of behavioral problems in pediatric patients was increased slightly, the highest of which was prosocial problems (15%), followed by total difficulties (13%), emotional symptoms (11%), hyperactivity (10%), and conduct problems (9%). With regarding to their parents' emotional problems, 26% of parents reported positive anxiety symptoms and 23% had positive depression symptoms. The behavioral problems of children with positive parents' anxiety and depression symptoms was more than that of children without emotional symptoms in their parents.
In this study, we investigated the prevalence of behavioral problems in pediatric patients, and observed obvious behavioral problems in children two months after discharge. In recent months, Coronavirus disease 2019 (COVID-19) has spread rapidly across the globe, becoming a major public health challenge for countries around the world. Behavioral problems in children are quite common worldwide, and persist until adulthood, imposing substantial burdens on children and parents [24–27]. In the United States, there are approximately 2.26 million children aged 6–11 who have behavioral problems [28]. Also, a number of previous studies have explored the prevalence of children's behavioral problems in different countries using SDQ questionnaire [29–31]. In 2008, Du et al. conducted a cross-sectional study in Shanghai (China) involving 1217 children (aged 3 to 10) to explore the validity, reliability and normative scores of the SDQ (parent-reported versions) and reported that the mean score of emotional symptoms was 2.09, conduct problems was 1.59, hyperactivity was 4.49, peer problems was 2.71, prosocial behavior 7.16, and total difficulties was 10.89 [16], which was slightly lower than that in the present study on subscales of emotional symptoms (2.21), conduct problems (1.87), and total difficulties (11.02). Pediatric patients are younger than adults, and once infected, they need to be hospitalized and isolated for treatment until they are asymptomatic and negative for nucleic acid testing. During hospitalization, about a fifth of pediatric patients rarely communicate with their parents. Many of the anticipated consequences of quarantine are themselves key risk factors for psychological and behavioral health issues. There is an urgent need for research to pay attention to the long-term psychological and behavioral consequences for vulnerable groups, which can provide swift, critical guidance regarding the pandemic.
For the parents of COVID-19 infected children, we observed that 26% of them reported having anxiety symptoms and 23% having depression symptoms. The hospitalization time of the included children is from January 23, 2020 to March 24, 2020, coving the beginning and the most serious period of the COVID-19 epidemic. On January 23, 2020, Wuhan was placed under lockdown. The World Health Organization declared the COVID-19 outbreak as a pandemic on 11 March 2020 [32]. Furthermore, the survey was conducted in Wuhan. As the worst hit area in China, Wuhan is the city with relatively poor medical resources, but has the largest number of confirmed cases and deaths. What's worse, it is widely reported that pediatric cases are generally infected by one sick parent or family member [9, 10]. Based on above-mentioned reasons, the prevalence of emotional problems among parents is still high, even when their infected children are discharged for about two months. It is suggested that in the further study, long-term psychological follow-up should be carried out for the high-risk population with positive screening, so as to be alert for the occurrence of more serious psychological disorders.
The more anxious and depressed parents were, the more behavioral problems children had. The link between parents’ and children’s post-disaster distress has been well established [33]. Previous studies have used parent distress to predict child’s symptoms, such as posttraumatic stress disorder (PTSD) after a disaster [34, 35]. Childhood is the time when children are most dependent on their parents and families. Parents play an important role in affecting young children to understand and to cope with a disaster [36, 37]. To further identify the potential risk factors for behavioral problems among pediatric patients, we have investigated the related information on basic and clinical characteristics, communication with parents during hospitalization, physical activity during discharge. We found a downward trend in SDQ scores in the related factors, but no statistical significance, which may be due to a small sample size of the study.
Although the present study emphasized the behavior issues of the young patients of COVID-19, it has some limitations. First, a cross-sectional design was applied in the study. Some information (e.g. communication with parents during hospitalization) obtained from the questionnaire might introduce recall bias. Furthermore, potential influencing factors (e.g. socio-economic characteristics) may not be identified in the analysis, although we collected basic features and related information during hospitalization and discharge in the study.