Age-related effects of the COVID-19 pandemic on mental health of children and adolescents

<b>Background</b>: Children and adolescents are affected in various ways by the lockdown measures due to the COVID-19 pandemic. Therefore, it is crucial to better understand the effects of the COVID-19 pandemic on mental health in this age-group. <b>Objective</b>: The objective was to investigate and compare the effects of the COVID-19 pandemic on mental health in three age groups (1–6 years, 7–10 years, 11–19 years) and to examine the associations with psychological factors. <b>Methods</b>: An anonymous online survey was conducted from 9 April to 11 May 2020 during the acute phase of major lockdown measures. In this cross-sectional study, children and adolescents aged between 1 and 19 years were recruited as a population-based sample. They were eligible if they were residents in Austria, Germany, Liechtenstein or Switzerland, were parents/caregivers of a child aged between 1 and 10 years or adolescents ≥11 years, had sufficient German language skills and provided informed consent. <b>Results</b>: Among 5823 participants, between 2.2% and 9.9% reported emotional and behavioural problems above the clinical cut-off and between 15.3% and 43.0% reported an increase in these problems during the pandemic. Significant age-related effects were found regarding the type and frequency of problems (χ²₍₄₎≥50.2, <i>P</i> ≤ 0.001). While preschoolers (1–6 years) had the largest increase in oppositional-defiant behaviours, adolescents reported the largest increase in emotional problems. Adolescents experienced a significantly larger decrease in emotional and behavioural problems than both preschoolers and school-children. Sociodemographic variables, exposure to and appraisal of COVID-19, psychotherapy before COVID-19 and parental mental health significantly predicted change in problem-scores (F ≥ 3.69, <i>P</i> ≤ 0.001). <b>Conclusion</b>: A substantial proportion of children and adolescents experience age-related mental health problems during the COVID-19 pandemic. These problems should be monitored, and support should be offered to risk-groups to improve communication, emotion regulation and appraisal style. Between 15.3% and 43.0% of the 1 to 19 years old children and adolescents reported an increase of problems during COVID-19.Between 2.0% and 9.9% reported emotional and behavioural problems above the clinical cut-off.Effects were associated with age, gender, exposure to and appraisal of COVID-19, attending psychotherapy before COVID-19 and parental mental health. Between 15.3% and 43.0% of the 1 to 19 years old children and adolescents reported an increase of problems during COVID-19. Between 2.0% and 9.9% reported emotional and behavioural problems above the clinical cut-off. Effects were associated with age, gender, exposure to and appraisal of COVID-19, attending psychotherapy before COVID-19 and parental mental health.

<b>背景</b>：新冠疫情（COVID-19）期间的封控措施对儿童与青少年造成了多维度的影响。因此，深入理解新冠疫情对该年龄段人群心理健康的影响至关重要。
<b>目的</b>：本研究旨在探究并比较新冠疫情对三个年龄组（1~6岁、7~10岁、11~19岁）儿童及青少年心理健康的影响，并分析其与心理因素的关联。
<b>方法</b>：本研究于2020年4月9日至5月11日，即主要封控措施的急性实施阶段，开展了一项匿名在线调查。此项横断面研究（cross-sectional study）的招募对象为1~19岁的儿童及青少年，采用基于人群的抽样方法。纳入标准如下：居住在奥地利、德国、列支敦士登或瑞士；为1~10岁儿童或≥11岁青少年的父母/照料者；具备足够的德语语言能力；且已签署知情同意书。
<b>结果</b>：在5823名参与者中，2.2%~9.9%的人群报告存在超出临床截断值的情绪与行为问题，15.3%~43.0%的人群报告疫情期间此类问题有所加重。研究发现问题的类型与频率存在显著的年龄相关差异（χ²₍₄₎≥50.2，<i>P</i>≤0.001）。其中，学龄前儿童（1~6岁）的对立违抗行为增幅最大，而青少年的情绪问题增幅最为显著。青少年的情绪与行为问题降幅显著高于学龄前儿童与学龄儿童。社会人口学变量、新冠疫情暴露情况与认知评价、新冠疫情前的心理治疗史以及父母心理健康状况，均对问题评分的变化具有显著预测作用（<i>F</i>≥3.69，<i>P</i>≤0.001）。
<b>结论</b>：新冠疫情期间，有相当比例的儿童及青少年出现了与年龄相关的心理健康问题。应对此类问题进行监测，并为高风险群体提供支持，以改善其沟通能力、情绪调节能力与认知评价方式。在1~19岁的儿童及青少年中，15.3%~43.0%的人群报告疫情期间问题有所加重，2.0%~9.9%的人群存在超出临床截断值的情绪与行为问题。此类影响与年龄、性别、新冠疫情暴露情况与认知评价、新冠疫情前的心理治疗史以及父母心理健康状况显著相关。在1~19岁的儿童及青少年中，15.3%~43.0%的人群报告疫情期间问题有所加重，2.0%~9.9%的人群存在超出临床截断值的情绪与行为问题。此类影响与年龄、性别、新冠疫情暴露情况与认知评价、新冠疫情前的心理治疗史以及父母心理健康状况显著相关。