Impact of the COVID-19 pandemic on pediatric anxiety and depression: Prevalence data, theoretical synthesis, and clinical implications

The COVID-19 pandemic, which began in late 2019, brought immense disruption to individuals and societies worldwide, including children and adolescents. Alongside its immediate physical health impacts, the pandemic had a profound effect on mental health. Children and youth were particularly vulnerable due to school closures, social isolation, and the uncertainty surrounding the pandemic's progression. This review provides an extensive analysis of pediatric mental health data from various countries, synthesizes theoretical frameworks, and discusses clinical implications for managing the psychological sequelae of the pandemic.

Prevalence of Pediatric Anxiety and Depression During the Pandemic

Studies have consistently shown a global rise in anxiety and depression among children and adolescents during the COVID-19 pandemic. Depression prevalence ranged from 2.2% to 11.8% globally, with one notable study suggesting that 25% of youth experienced depressive symptoms. In countries such as the United States, 44% of adolescents reported feelings of hopelessness, and similar increases were seen across countries including Canada and Australia. Anxiety symptoms were reported by 20% of youth worldwide, with higher rates documented in Denmark (44%) and Canada (45%).

Suicidal Behavior

Suicidality also increased during the pandemic, with a 50% rise in emergency room visits for suicidal ideation among U.S. girls between 2019 and 2021. In Catalonia, Spain, there was a 195% increase in suicidal behaviors among young females in the first year of the pandemic. Globally, studies documented significant rises in self-injurious behaviors, particularly in adolescents aged 12 to 24 years.

Obsessive-Compulsive Disorder (OCD)

The review highlighted the exacerbation of obsessive-compulsive symptoms among youth during the pandemic, driven by contamination fears and heightened worries about viral spread. Studies from Denmark and Canada reported that 38% to 73% of adolescents with OCD experienced worsening symptoms, with contamination-related obsessions being the most prominent.

Theoretical Synthesis: Intolerance of Uncertainty

A key theoretical framework in understanding the mental health effects of the pandemic is the concept of intolerance of uncertainty (IU). The pandemic's unpredictability, especially in the early months, created a state of prolonged uncertainty that intensified anxiety, depression, and OCD symptoms. IU, which refers to the inability to tolerate uncertain situations, emerged as a transdiagnostic factor contributing to the psychological distress seen in youth.

Clinical Implications

The review emphasizes the importance of routine mental health screenings in pediatric care, particularly in the post-pandemic era. Tools such as the Patient Health Questionnaire (PHQ-9) for depression and the Screen for Child Anxiety Related Disorders (SCARED) are recommended to assess symptoms and guide treatment planning. Cognitive-behavioral therapy (CBT), identified as the gold standard for treating pediatric mental health issues, was shown to be effective in mitigating pandemic-related distress through modules focused on psychoeducation, behavioral activation, and exposure to uncertainty.

Limitations and Future Research

The review acknowledges several limitations in the current literature, including the reliance on self-reported data, lack of longitudinal studies, and underrepresentation of marginalized populations. Future research should focus on expanding studies to include diverse and at-risk populations, such as undocumented or low-income youth, and further explore interventions targeting IU and other pandemic-related stressors.

Conclusions

The COVID-19 pandemic triggered a significant increase in pediatric mental health challenges, with rising rates of anxiety, depression, OCD, and suicidality. Theoretical models such as intolerance of uncertainty offer valuable insights into the mechanisms behind these increases, and CBT interventions provide promising strategies for addressing them. Moving forward, the focus should be on enhancing early detection and treatment to mitigate the long-term psychological effects on children and adolescents.

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https://www.xiahepublishing.com/2472-0712/ERHM-2024-00004

The study was recently published in the Exploratory Research and Hypothesis in Medicine.

Exploratory Research and Hypothesis in Medicine (ERHM) publishes original exploratory research articles and state-of-the-art reviews that focus on novel findings and the most recent scientific advances that support new hypotheses in medicine. The journal accepts a wide range of topics, including innovative diagnostic and therapeutic modalities as well as insightful theories related to the practice of medicine. The exploratory research published in ERHM does not necessarily need to be comprehensive and conclusive, but the study design must be solid, the methodologies must be reliable, the results must be true, and the hypothesis must be rational and justifiable with evidence.

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