Article Text

Indirect effects of COVID-19 on child and adolescent mental health: an overview of systematic reviews
  1. Leila Harrison1,
  2. Bianca Carducci1,2,
  3. Jonathan D Klein3,
  4. Zulfiqar Ahmed Bhutta1,2,4
  1. 1Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
  2. 2Department of Nutritional Sciences, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
  3. 3Pediatrics, University of Illinois Chicago, Chicago, Illinois, USA
  4. 4Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
  1. Correspondence to Dr Zulfiqar Ahmed Bhutta; zulfiqar.bhutta{at}


Introduction To control the spread of COVID-19, mitigation strategies have been implemented globally, which may have unintended harmful effects on child and adolescent mental health. This study aims to synthesise the indirect mental health impacts on children and adolescents globally due to COVID-19 mitigation strategies.

Methods We included relevant reviews from MEDLINE, Embase, PsycINFO, LILACS, CINAHL, The Cochrane Library and Web of Science until January 2022 that examined the impact of COVID-19-related lockdown and stay-at-home measures on the mental health of children and adolescents. Data extraction and quality assessments were completed independently and in duplicate by BC and LH. A Measurement Tool to Assess Systematic Reviews-2 was used to assess the methodological quality.

Results Eighteen systematic reviews, comprising 366 primary studies, found a pooled prevalence of 32% for depression (95% CI: 27 to 38, n=161 673) and 32% for anxiety (95% CI: 27 to 37, n=143 928) in children and adolescents globally following COVID-19 mitigation measures. Subgroup analyses also uncovered important differences for both depression and anxiety by World Health Organization regions with few studies from Africa and relative high burden of anxiety and depression in the Eastern Mediterranean region.

Conclusions Our findings reveal a high prevalence of depression and anxiety in children and adolescents during the COVID-19 pandemic, globally, compared with prepandemic estimates. These findings highlight the urgency for governments and policymakers to strengthen mental health systems in the COVID-19 recovery, especially in low-and middle-income countries where compounding psychological stress, access and affordability of care and discrepant reporting of mental health in this population remains a challenge. We also provide insight into how to alter mitigation strategies to reduce the unintended negative consequences for the health and well-being of children and adolescents in future pandemics.

PROSPERO registration number CRD42022309348.

  • COVID-19
  • mental health & psychiatry
  • child health

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

View Full Text

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.


  • Handling editor Seye Abimbola

  • Contributors ZAB and JDK conceptualised and designed the study. BC screened the search results, screened the retrieved papers against the inclusion criteria, appraised the quality of the papers, extracted the data and drafted the initial manuscript. LH screened the search results, screened the retrieved papers against the inclusion criteria, appraised the quality of the papers, extracted the data, completed data tabulation, synthesis and analysed primary data in meta-analyses and drafted the initial manuscript. All authors reviewed, revised and approved the final manuscript as submitted. ZAB accepts full responsibility for the finished work, the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding Funding was provided by United Nations Children’s Fund through a Small-Scale Funding Agreement to the International Pediatric Association.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.