April 24, 2020

expert reaction to paper looking at mental health in children under lockdown in Hubei in China

Research, published in JAMA Pediatrics, reports on the mental health in children under lockdown in Hubei in China.

Prof David Porteous, Centre for Genomic and Experimental Medicine, University of Edinburgh, said:

“The battle to control COVID-19 infection continues.  Meanwhile, there is a growing realisation that next up on the agenda are the wider effects of the ‘lockdown’.  The closure of businesses, loss of employment, restriction of movement and social distancing are highly stressful ‘life events’.  School closures isolate children, fellow pupils and their teachers from each other.  They place an unexpected and unplanned burden of responsibility on parents.   The study from Zie at al (2020) of the mental health of primary school children in Hubei province, China is therefore of great interest.

“In summary, 1784 children, aged 6-12, took a well-used test of depression, with 22.6% reporting symptoms.  That is 30% higher than historical norms (17.2%).  Anxiety levels were also higher.  These findings are a warning of what to expect elsewhere, but also raise questions.  How were the parents of the children affected?  Enrolment in the study was by parental consent, but 24% of parents declined.  Were they parents of more ‘fragile’ or ‘resilient’ children?  The average time under ‘lockdown’ was 34 days.  What will the impact be on children and parents in the longer term?  The effects of early ‘life events’ often don’t fully emerge until later.  We know that adolescence is an important developmental change, which can often trigger mental health problems.  Right now, we are conducting CovidLife, a survey of mental health and wellbeing in UK adults, set in the wider context of the social and economic impacts of COVID-19.  A survey of 12-17’s will follow shortly, which attempts to answer some of the question posed by the Hubei province study.”

Prof Dame Til Wykes, Vice Dean Psychology and Systems Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, said:

“The study is a cross-sectional survey of primary school children (grade 2-6) from two Chinese cities who were confined to their homes.  The study used short assessments of well-known measures to assess mental health symptoms and their questionnaire had a high completion rate (76.6%).  The results are therefore likely to be a reasonable estimate of the problems.  They found that just over a fifth of children had anxiety and depressions symptoms which is higher than might be expected from usual levels (22.6% vs 17.2%).  Anxiety and depression symptoms were higher in children who were less optimistic about the outcome of the pandemic and were more worried about catching Covid-19.  Children from Wuhan, the epicentre of the pandemic, seemed to have more symptoms than those in the nearby city.

“The study shows that everyone is affected by the pandemic.  These results suggest that the response is affected by the child’s view of potential outcomes like catching the virus and their optimism.  Both these issues are affected by their experience and the experience of their families.  Good information and good advice is vital for everyone’s mental health – clear, concise and accurate and tailored to their developmental level.  We do not know if the effects will continue as the lockdown in China eases and this is important for us to work out what services and supports we need to offer.

“But it is not all gloomy.  A recent UK survey by the charity Young Minds reported that 7% of young people with existing mental health problems actually noticed their mental health had improved since schools had closed.”

Prof Andrea Danese, Professor of Child and Adolescent Psychiatry at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London, and Consultant Child & Adolescent Psychiatrist at the National & Specialist CAMHS Trauma, Anxiety, and Depression Clinic at the South London & Maudsley NHS Foundation Trust, said:

“Many of the factors associated with home confinement amidst the COVID-19 pandemic – from fear of infection to social isolation and risk of child maltreatment – are known risk factors for poor mental health in children.  This research letter is among the first pieces of evidence to help us quantify the toll of home confinement on child mental health.

“1784 primary school children (3 in 4 of the 2330 surveyed) from Wuhan and Huangshi in the in Hubei province, China, completed an assessment of the children’s attitudes on the pandemic as well as their mental health.  The assessment was carried out, on average, after 30 days of home confinement.

“The research found that 22.6% children reported high depressive symptoms while 18.9% reported high anxiety symptoms.  Both rates were higher compared previous surveys of primary school students in China – 30% higher in the case of depressive symptoms.  Depressive symptoms (but not of anxiety symptoms) were higher in children who were more worried about being infected with COVID-19 and who were more pessimistic about the pandemic.

“The research suggests that home confinement may be linked to increase in anxiety and depressive symptoms among primary school children.  Because of the design of the study, it is unclear if these emotional symptoms should be interpreted as short-term, normal psychological responses to the restrictions imposed by home confinement or early signs of longer-term psychiatric problems in children.  To adequately respond to the mental health needs of children during and after home confinement, it is important that governments allocate adequate resources to the often stretched child & adolescent mental health services (CAMHS).”

Dr Wendy Sims-Schouten, Associate Professor Childhood Studies, University of Portsmouth, said:

“The study on the mental health status of children in home confinement during the COVID-19 outbreak in Hubei Province, China is the first of its kind.  The study investigates depressive and anxiety symptoms among students in Hubei province, China, with the aim of optimizing interventions on the mental health of children for stakeholders in countries across the world affected by COVID-19.

“The authors highlight the association between a reduction of outdoor activities and social interaction and an increase in children’s depressive symptoms.  One of the key findings from the study, with relevance for children from all over the world, is that the pandemic and the threat of serious infectious diseases is traumatic for children, impacting greatly upon their mental health and wellbeing.

“There are important lessons to be learnt here when it comes to trauma-support for children and how well services around the child, including schools and social services, as well as parents, are prepared for this.  Evidence suggests that two sets of factors are of key importance in understanding the risk and protective factors shaping the mental health of children following trauma exposure, as well as being potential portals for interventions: exposure to past and ongoing traumatic events and the complexities of navigating support systems/environments, including dealing with school and reconfigured family life.”

‘Mental Health Status Among Children in Home Confinement During the Coronavirus Disease 2019 Outbreak in Hubei Province, China’ by Xinyan Xie et al. was published in JAMA Pediatrics at 16:00 UK time on Friday 24 April 2020.

DOI: 10.1001/jamapediatrics.2020.1619

Declared interests

None received.