Study | Study designs included | HIC/LMIC | Countries | Number of studies | Age range | Mental health outcomes | Author’s conclusions | Impact on mental health |
Octavius et al18 | Prospective cohort; cross-sectional | Both | USA, Turkey and China | 4 | 12–18 years | Adolescent’s mental health, such as depression, fear and anger | COVID-19 has been found to be associated with mental health changes in adolescents which meant management of COVID-19 should also focus on mental health as well. | Negative |
Racine et al19 | Empirical studies (case studies and qualitative analyses excluded) | Both | Jordan, Ecuador, China, USA, Italy, Brazil, Greece, Canada, Spain, Portugal and Germany | 29 | Mean age: 13 years (range: 4.1–17.6 years) | Prevalence of clinically elevated depressive or anxiety symptoms in youth during COVID-19 | Pooled estimates obtained in the first year of the COVID-19 pandemic suggest that one in four youth globally are experiencing clinically elevated depression symptoms, while one in five youth are experiencing clinically elevated anxiety symptoms. These pooled estimates, which increased over time, are double of prepandemic estimates. An influx of mental healthcare utilisation is expected, and allocation of resources to address child and adolescent mental health concerns are essential. | Negative |
Sajid et al20 | Case-control, cross-sectional, cohort studies and case series (case reported >4), letters, perspectives and correspondences | Not reported | Not reported | 13 | 2–18 years | Mental health outcomes such as stress, anxiety, anger and depression | An analysis of available literature illustrates a clear correlation between increasing anxiety among children during the SARS-CoV-2 pandemic. Our systematic review encompasses school-going and early collegiate students who have shown to suffer from a deteriorating mental status due to the fear of being infected, a feeling of boredom and lack of productivity, which adds on to the stress level hindering their focused approach to learning. | Negative |
Ma et al21 | Cross-sectional and longitudinal studies | Upper-middle income | Turkey and China | 23 | 0–18 years | Prevalence of depression, anxiety, sleep disorders and post-traumatic stress symptoms | Early evidence highlights the high prevalence of mental health problems among children and adolescents during the COVID-19 pandemic, especially among female and adolescents. Studies investigating the mental health of children and adolescents from countries other than China are urgently needed. | Negative |
Chawla et al22 | Cross-sectional and cohort studies | Both | The Netherlands, Turkey, Italy, USA, China, Bangladesh, France, Germany, Brazil, Hong Kong, Canada, Iran, Spain, Portugal, India, Indonesia, Australia, Chile, Croatia, Singapore, Switzerland, Israel, UK, Uruguay, Uganda and Norway | 102 | 0–24 years (6–18 years in majority of studies) | Any psychological impact | Psychological impact on children and adolescents is significant, either due to the fear of the illness or social isolation related to COVID-19. One may focus on improving sleep habits and physical activity and regulating internet use for maintaining psychological well-being. | Negative |
Cachón-Zagalaz et al23 | Not reported | Both | USA, UK, Turkey, China, Italy, Spain | 9 | 0–12 years | Psychological and motor outcomes | There are very few studies on how confinement has affected children under 12 years psychologically and motorly. These articles agree on the consequences that confinement can have on minors and on the importance of psychological support from the family, and the establishment of routines can be effective. | Negative |
Chaabane et al24 | All types of studies included: modelling study; quasi-experimental time series analysis; report; prepublication release; expert viewpoint; snapshot of strategies/challenges analysis; cross-sectional; descriptive study (n=2) and survey | Both | USA, Japan, France, Italy, Thailand and Turkey | 10 | Not reported | Mental or physical health-related issues | The impact of school closures during the COVID-19 pandemic includes loss of access to school-based and critical services and resources particularly for children with disabilities and those living in poorer families. COVID-19 school closures were also associated with increased stress among children and emotional reactions (eg, sadness, frustration, indiscipline) in addition to the breakdown in daily routines. | Negative |
Sharma et al25 | Longitudinal and cross-sectional studies | Both | China, Italy, Israel, Canada, Spain, Brazil, Portugal and USA | 16 | 6 months to 18 years | Sleep disturbances: sleep quality, sleep duration and insomnia severity | The prevalence of sleep problems in children and adolescents during the COVID-19 pandemic is alarming. Preschool children had a trend towards relatively fewer sleep disturbances due to home confinement measures in comparison with prepandemic times. Sleep duration recommendations were not met in nearly half of healthy children. | Negative |
Stavridou et al26 | Cross-sectional studies, qualitative analyses, longitudinal cohort and case-report studies | Both | China, Italy, USA, Singapore, UK and Kosovo | 21 | 3–18 years | Any mental health condition | A deterioration in mental health is highlighted, encompassing anxiety and mood symptoms and developmental, stressor-related and eating disorders among children, adolescents and young adults during the COVID-19 pandemic. | Negative |
Nearchou et al27 | Cross-sectional studies | Both | China, Italy, Poland, Turkey and USA | 12 | 3–18 years | Any mental health disorder or outcome | The findings show that COVID-19 has an impact on youth mental health and is particularly associated with depression and anxiety in adolescent cohorts | Negative |
Panda et al28 | Prospective cohort and cross-sectional studies | Both | France, Italy, China, Spain, India, Hong Kong, Brazil, Turkey, Bangladesh and Korea | 15 | 18 years or younger | Various psychological and behavioural symptoms/disorders | Anxiety, depression, irritability, boredom, inattention and fear of COVID-19 are predominant new-onset psychological problems in children during the COVID-19 pandemic. | Negative |
Jones et al29 | Quantitative studies | Both | USA, China, UK, Japan, Germany, Canada, Philippines and Denmark | 16 | 13–17 years | Any mental health issue | Globally, adolescents of varying backgrounds experience higher rates of anxiety, depression and stress due to the pandemic. Second, adolescents also have a higher frequency of using alcohol and cannabis during the COVID-19 pandemic. However, social support, positive coping skills, home quarantining and parent–child discussions seem to positively impact adolescent mental health during this period of crisis. | Negative |
Samji et al30 | Prospective/Retrospective cohort, case-control, chart review, cross-sectional and qualitative studies | Both | Europe (39/116), followed in diminishing order by East Asia (28/116), North America (21/116), South Asia (7/116), Australia (7/116), West Asia (6/116), South America (2/116), South-East Asia (2/116), sub-Saharan Africa (1/116) and North Africa (1/116). Two studies involved multiple countries or were international in focus | 116 | 0–18 years (24 studies also included populations ≥18 years) | COVID-19-related mental health changes | Mental health impacts of the COVID-19 pandemic on children and adolescents are significant and should be of tremendous concern to policymakers and practitioners globally. As the pandemic continues, innovative approaches that increase access to mental health services, as well as promote resilience and mental well-being such as maintaining social connection despite isolation and renewing social ties during the recovery phase may be explored. | Negative |
Panchal et al31 | Cross-sectional and longitudinal cohort studies | Both | Europe, Western Pacific, South-East Asia and the Americas | 61 | 0–19 years | Any mental health outcome | The COVID-19 lockdown has resulted in psychological distress and highlighted vulnerable groups such as those with mental health difficulties, and risk factors such as lack of routine and excessive COVID-19 media exposure. However, for some families being able to spend more quality time together has been positive. Supporting the mental health needs of children and adolescents at risk is key. Clinical guidelines to alleviate the negative effects of COVID-19 lockdown and public health strategies to support this population need to be developed. | Negative |
Marques de Miranda et al32 | Original data from surveys, cross-sectional and longitudinal studies, editorials, research letters and original papers | Both | Most articles were from China (n=11). Also, USA (n=2), Europe (n=1) and South America (n=1) | 51 | 6–21 years | Any mental health outcome | Children from all development phases had high rates of depression, anxiety and post-traumatic symptoms as expected in the aftermath of any disaster. | Negative |
Bussières et al33 | Longitudinal, retrospective and cross-sectional studies | Both | Italy, UK, The Netherlands, Spain, Germany, Switzerland, China, Japan, South Korea, Singapore, Israel, Turkey, Canada, USA and Argentina | 71 | 5–13 years | Internalising problems, externalising problems and sleep disturbances | Studies included in this review suggest that children’s mental health was generally negatively impacted during the COVID-19 pandemic. More research is needed to understand the long-term effects of the COVID-19 pandemic on children’s mental health and the influence of specific risks factors as they evolve over time. | Negative |
Chai et al.34 | Not reported | LMIC | China | 12 | 18 years or younger | Mental health-related problems including depression, anxiety, stress or other associated problems | Meta-regression analysis indicated that there was an increasing number of children and adolescents with mental problems during the home confinement. It suggested that we should pay more attention to this vulnerable population during a public health crisis in the future, especially for the girl groups, and more detailed implements for mental health management were needed and should be prepared. | Negative |
Viner et al35 | Cohort, uncontrolled prepost, cross-sectional and modelling studies | Both | USA, Turkey, UK, China, Italy, Canada, Brazil, Japan, Spain, Ireland, India and Bangladesh | 36 | 0–19 years | Mental health outcomes (eg, anxiety, depression, psychological distress, sense of loneliness/isolation, suicide, psychiatric admission) | In this narrative synthesis of reports from the first wave of the COVID-19 pandemic, studies of short-term school closures as part of social lockdown measures reported adverse mental health symptoms and health behaviours among children and adolescents. | Negative |
HIC, high-income country; LMIC, low- and middle-income country.