Less school assignment completion, increased screen time, and caregiver depression were linked with worse mental health in children during the middle of the COVID-19 pandemic, according to new research from Child and Adolescent Psychiatry and Mental Health.

This is the first study utilizing pre- and mid-pandemic data to assess the psychosocial impact the COVID-19 pandemic has had on a cohort of children primarily of racial and ethnic minority groups, the researchers said.

The researchers recruited school-age children (n=168 aged 8.5±1.8 years 57% boys 54% non-Hispanic Black, 29% Hispanic) who had been screened for

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emotional and behavioral symptoms and social risks via the Pediatric Symptom Checklist (PSC-17) in routine care at an urban, safety-net hospital-based pediatric primary care clinic between September 2019 and February 2020. Assisted by their caregivers, the children again completed the PSC-17, the THRIVE screening tool, the Patient Health Questionnaire-2, the Generalized Anxiety Disorder-2, along with a questionnaire of COVID-specific variables between August 2020 and January 2021.

The researchers found that mean PSC-17 total scores were higher midpandemic (8.04±6.41) compared with before the pandemic (5.59±5.80 P <.001). The portion of children who had PSC-17 scores indicating overall risk for mental health problems rose from 8% prior to the pandemic to 18% in the midpandemic period (z = 2.64 P <.01). More children scored at risk on the internalizing subscale at midpandemic compared with before the pandemic (18% vs 5% z = 3.72 P <.001). The children (n=139) who had negative PSC-17 total scores before the pandemic had higher midpandemic scores (mean difference 2.70 P <.001).

THRIVE scores were elevated midpandemic (2.12±2.12) compared with before the pandemic (0.97±1.60), apart from the social risks of transportation difficulties and affording medication. Food insecurity impact 50% of families midpandemic, up from 16% before the pandemic began (P <.001).

Midpandemic PSC-17 scores were not associated with THRIVE scores before or in the middle of the pandemic.

More completion of school assignments was associated with lower midpandemic PSC-17 total scores (β = − 0.14, P <.05). Screen time increases during the pandemic were associated with higher midpandemic PSC-17 total scores (β = 0.15, P <.01). Caregivers with higher depression symptoms, based on PHQ-2 scores, tended to have children with increased mental health symptoms, based on PSC-17 total scores, midpandemic.

The most commonly reported negative impacts of COVID-19 on children’s health or wellbeing were lack of activities outside the house (n=11) and social isolation (n=11). In response to the researchers’ question asking participants if they needed assistance, the services participants most frequently requested assistance with were utility bills (29%), food (27%), and financial difficulties (20%).

Limitations of the study include generalization to other locations and populations, lack of pre-pandemic measure of caregiver mental health, and need for more longitudinal data.

“Pre-pandemic, access to child mental health care was already a problem, and this increased volume will be difficult to accommodate within the current mental health system,” the researchers said. “Rather, public funding sources could support new or expanded community-based, school-based, family-based, and trauma-informed treatment and prevention programs to reach the most affected families. Employing evidence-informed, community health worker approaches may hold particular promise to meet the increased need.”


Spencer AE, Oblath R, Dayal R, et al. Changes in psychosocial functioning among urban, school‑age children during the COVID‑19 pandemic. Child and Adolescent Psychiatry and Mental Health. Published online December 2, 2021. doi:10.1186/s13034-021-00419-w

This article originally appeared on Psychiatry Advisor