Table 1

Characteristics of included studies and author’s conclusions

StudyStudy designs includedHIC/LMICCountriesNumber of studiesAge rangeMental health outcomesAuthor’s conclusionsImpact on mental health
Octavius et al18Prospective cohort; cross-sectionalBothUSA, Turkey and China412–18 yearsAdolescent’s mental health, such as depression, fear and angerCOVID-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.
Racine et al19Empirical studies (case studies and qualitative analyses excluded)BothJordan, Ecuador, China, USA, Italy, Brazil, Greece, Canada, Spain, Portugal and Germany29Mean age: 13 years (range: 4.1–17.6 years)Prevalence of clinically elevated depressive or anxiety symptoms in youth during COVID-19Pooled 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 al20Case-control, cross-sectional, cohort studies and case series (case reported >4), letters, perspectives and correspondencesNot reportedNot reported132–18 yearsMental health outcomes such as stress, anxiety, anger and depressionAn 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 al21Cross-sectional and longitudinal studiesUpper-middle incomeTurkey and China230–18 yearsPrevalence of depression, anxiety, sleep disorders and post-traumatic stress symptomsEarly 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.
Chawla et al22Cross-sectional and cohort studiesBothThe 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 Norway1020–24 years (6–18 years in majority of studies)Any psychological impactPsychological 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 al23Not reportedBothUSA, UK, Turkey, China, Italy, Spain90–12 yearsPsychological and motor outcomesThere 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 al24All 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 surveyBothUSA, Japan, France, Italy, Thailand and Turkey10Not reportedMental or physical health-related issuesThe 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 al25Longitudinal and cross-sectional studiesBothChina, Italy, Israel, Canada, Spain, Brazil, Portugal and USA166 months to 18 yearsSleep disturbances: sleep quality, sleep duration and insomnia severityThe 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 al26Cross-sectional studies, qualitative analyses, longitudinal cohort and case-report studiesBothChina, Italy, USA, Singapore, UK and Kosovo213–18 yearsAny mental health conditionA 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 al27Cross-sectional studiesBothChina, Italy, Poland, Turkey and USA123–18 yearsAny mental health disorder or outcomeThe findings show
that COVID-19 has an impact on youth mental health and is particularly associated with depression and anxiety in adolescent cohorts
Panda et al28Prospective cohort and cross-sectional studiesBothFrance, Italy, China, Spain, India, Hong Kong, Brazil, Turkey, Bangladesh and Korea1518 years or youngerVarious psychological and behavioural symptoms/disordersAnxiety, 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 al29Quantitative studiesBothUSA, China, UK, Japan, Germany, Canada, Philippines and Denmark1613–17 yearsAny mental health issueGlobally, 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.
Samji et al30Prospective/Retrospective cohort, case-control, chart review, cross-sectional and qualitative studiesBothEurope
(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
1160–18 years (24 studies also included populations ≥18 years)COVID-19-related mental health changesMental 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.
Panchal et al31Cross-sectional and longitudinal cohort studiesBothEurope, Western Pacific, South-East Asia and the Americas610–19 yearsAny mental health outcomeThe 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.
Marques de Miranda et al32Original data from surveys, cross-sectional and longitudinal studies, editorials, research letters and original papersBothMost articles were from China (n=11). Also, USA (n=2), Europe (n=1) and South America (n=1)516–21 yearsAny mental health outcomeChildren 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 al33Longitudinal, retrospective and cross-sectional studiesBothItaly, UK, The Netherlands, Spain, Germany, Switzerland, China, Japan, South Korea, Singapore, Israel, Turkey, Canada, USA and Argentina715–13 yearsInternalising problems, externalising problems and sleep disturbancesStudies 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.34Not reportedLMICChina1218 years or youngerMental health-related problems including depression, anxiety, stress or other associated problemsMeta-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 al35Cohort, uncontrolled prepost, cross-sectional and modelling studiesBothUSA, Turkey, UK, China, Italy, Canada, Brazil, Japan, Spain, Ireland, India and Bangladesh360–19 yearsMental 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.