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A new study published in the Journal of Child Psychology and Psychiatry looked at the impact of COVID-19 on psychopathology in children and young people worldwide.

“Our study is about tracking what the changes were in children and adolescents’ mental health from before the pandemic to during the pandemic, by bringing together findings from lots of research published in the last two years,” study author Abigail Emma Russell told us. “Most studies that have been publicized just used information collected during the pandemic, where they asked families and children how they thought their mental health had been impacted.”

The research team was hoping to find out whether those findings were the same when they included research which asked young people (or parents) about young people’s mental health before the pandemic as well as during it, so they weren’t just relying on recall or perceptions of change after they knew the pandemic was already happening.

There were differing opinions on the research team about what the results would be. Some thought that they would find the pandemic had a negative impact on all young people, others thought that there would not have been a major impact.

“It’s a tricky one to decipher,” Russell told us, “because we know that from childhood to adolescence the frequency of different mental health problems changes with age- behaviour problems decrease as you age, but anxiety and depression (for example) increase.”

The research team was invited to write an annual research review for a top Psychology and Psychiatry journal about the impacts of the pandemic on mental health of young people, because they do research in child and adolescent mental health all day every day. They chose to be really strict about what kind of studies they would include in their review because they wanted to look at evidence that wasn’t only collected in retrospect after the pandemic had started.

“We did searches for all peer-reviewed published studies that used large samples of children and adolescents, that were ‘general population’ samples (i.e. represented children from a whole population, rather than subgroups who were already at risk of mental health problems, or convenience samples of people who respond to online surveys on social media for example),” Russell told us. “We checked all the studies we found against some strict criteria on what we would include, and for the 51 studies that met our criteria, we extracted all the relevant information about what they did, with who, where, what they measured and how, and what they found.”

Then the research team did a combination of statistical analysis (called meta-analysis) and narrative synthesis, where they described what studies found for each type of mental health problem, and the strengths and weaknesses of the studies that found different things.

“The results were pretty complicated,” Russell told us. “We found that there was evidence that there were small increases in mental health problems for lots of children and young people. But they were also very mixed, with a substantial number of studies showing no change in symptoms, and a few studies reporting improvements in mental health.”

There was a lot of variety in the countries studied, as well as when during the pandemic they collected their data, and every country and sometimes even regions within countries, had different restrictions on social contact and prevalence of covid-19, which made it really difficult to understand what was going on, explained Russell. Overall, the researchers found that on balance, there were some indications of small increases in symptoms of mental health problems for children on average.

“While this may not have a large impact on any one individual, and some individual children may have much better or much worse mental health, if thousands of children have slightly worse mental health as a result of the pandemic then this means that at a country-level there will be an increased need for specialist or other support for our young people,” Russell told us. “The differences between the findings of the studies we included were surprising.”

Even when studies used the same questionnaire to measure the same construct (e.g. depression) in the same country, some of them found different things.

“As researchers, they also judged the quality of the research that was done and how it was reported, and I was surprised that many studies were not high quality,” Russell told us. “We wondered if this was due to the rush to publish research during the pandemic, where it seems like getting findings out quickly took precedence over our normal standards of reporting.”
Normally, it can take up to nine months to get an article through the peer review process, whereas during the pandemic there was a lot of demand for quick turnarounds of reports.

According to Russell, the results mean that it is really difficult to predict whether the pandemic was highly detrimental for the mental health of any specific group of children or adolescents, and it is likely that the impacts were very different for young people living in different places or contexts.

“Headline findings that suggest everything is the same for everyone gloss over how complex the situation is,” Russell told us. “I do think that there is likely to be more need for child and adolescent mental health services as a result of the pandemic. When services are already at capacity with long waiting lists, we really need to do a better job of supporting our young people so they grow into healthy adults.”