The impact of lockdown during the COVID-19 pandemic on mental and social health of children and adolescents
Authors: Luijten Michiel A. J. , van Muilekom Maud M. , Teela Lorynn , van Oers Hedy A. , Terwee Caroline B. , Zijlmans Josjan , Klaufus Leonie , Popma Arne , Oostrom Kim J. , Polderman Tinca J. C. , Haverman Lotte 
Published: November 2020

Importance

It is unknown how a lockdown during the COVID-19 pandemic impacts children’s and adolescents’ mental and social health.

Objective

To compare mental and social health of children and adolescents during the COVID-19 lockdown versus before, identify associated factors, describe the change in atmosphere at home and qualitatively assess the impact of COVID-19 regulations on daily life.

Design

Cross-sectional study comparing two Dutch representative samples of children and adolescents (8-18 years); before COVID-19 (Dec2017-July2018) and during the COVID-19 lockdown (April/May 2020).

Setting

Population-based

Participants

Children and adolescents aged 8-18 years (M=13.4, 47.4% male), representative of the Dutch population on key demographics.

Exposure(s)

COVID-19 pandemic lockdown

Main Outcome(s) and Measure(s)

Patient-Reported Outcomes Measurement Information System (PROMIS®) domains: Global Health, Peer Relationships, Anxiety, Depressive Symptoms, Anger and Sleep-Related Impairment. Single item on atmosphere at home and open question regarding the impact of the regulations on the child/adolescent’s daily life

Results

Children and adolescents reported significantly worse PROMIS T-scores on all domains (absolute mean difference range, 2.1-7.1; absolute 95% CI range, 1.3-7.9) during the COVID-19 lockdown as compared to before COVID-19. More children reported severe Anxiety (during 16.7% vs. before 8.6%; relative risk 1.95; 95% CI 1.55-2.46) and Sleep-Related Impairment (during 11.5% vs. before 6.1%; relative risk 1.89; 95% CI 1.29-2.78). Fewer children reported poor Global Health (during 1.7 vs. before 4.6%; relative risk 0.36; 95% CI 0.20-0.65). More mental and social health complaints during the COVID-19 lockdown were found in children and adolescents growing up in a single-parent family, having ≥three children in the family, a negative change in work situation of parents due to COVID-19 regulations, and having a relative/friend infected with COVID-19. A small effect was found on atmosphere at home during the lockdown compared to before (mean difference, −3.1; 95% CI, −4.1 −−2.1). A large majority (>90%) reported a negative impact of the COVID-19 regulations on their daily life.

Conclusions and Relevance

This study showed that governmental regulations regarding lockdown pose a serious mental and social health threat on children and adolescents that should be brought to the forefront of political decision making and mental health care policy, intervention and prevention.

Key points

Question

What is the impact of lockdown during the COVID-19 pandemic on mental and social health in children and adolescents compared to before COVID-19?

Findings

This population-based study shows that during the COVID-19 lockdown children and adolescents report lower mental and social health, especially on anxiety and depressive symptoms.

Meaning

In proposing new COVID regulations (e.g., closing schools) governments should be mindful of the negative impact of a lockdown on mental and social health of children and adolescents.