Psychological Symptom Progression in School-Aged Children After COVID-19 Home Confinement: A Longitudinal Study

BackgroundThe long-term mental health effects of coronavirus disease 2019 (COVID-19) in children are rarely reported. We aimed to investigate the progression of depressive and anxiety symptoms among a cohort of children in the initial epicenter of COVID-19 in China. MethodsTwo waves of surveys were conducted in the same two primary schools in Wuhan and Huangshi, Hubei province: Wave 1 from 28 February to 5 March, 2020 (children had been confined to home for 30-40 days) and Wave 2 from 27 November to 9 December, 2020 (schools had reopened for nearly 3 months). Depressive and anxiety symptoms were estimated using the Children's Depression Inventory - Short Form (CDI-S) and the Screen for Child Anxiety Related Emotional Disorders (SCARED), respectively. Delta CDI-S and Delta SCARED scores between Wave 2 and Wave 1 were calculated and further categorized into tertiles. Multivariable linear regression and multinomial logistic regression models were then applied. ResultsA total of 1,224 children completed both surveys. The prevalence of mental health outcomes at Wave 2 increased significantly compared to Wave 1, specifically depressive symptoms (age-standardized prevalence rates: 37.5 vs. 21.8%) and anxiety symptoms (age-standardized prevalence rates: 24.0 vs. 19.6%). Higher Delta SCARED scores were observed in females and children in Wuhan, and children with experience of neglect had higher Delta CDI-S (beta = 1.12; 95% CI = 0.67-1.58) and Delta SCARED (beta = 6.46; 95% CI = 4.73-8.19) scores compared with those without experience of neglect. When the Delta scores were further categorized into tertiles, similar results were found. ConclusionsThe prevalence of depressive and anxiety symptoms after schools resumed was increased compared with that during the home quarantine period, even though the COVID-19 pandemic was under control. Females and children in Wuhan, and also children with experience of neglect were at increased risk of mental health disorders.

Automated summary

This study investigated the long-term mental health effects of COVID-19 in children in China and found that there was an increased prevalence of depressive and anxiety symptoms after schools resumed. Females, children in Wuhan, and children with experience of neglect were at higher risk of mental health disorders.