Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19: A Meta-analysis

Nicole Racine, Brae Anne McArthur, Jessica E Cooke, Rachel Eirich, Jenney Zhu, Sheri Madigan, Nicole Racine, Brae Anne McArthur, Jessica E Cooke, Rachel Eirich, Jenney Zhu, Sheri Madigan

Abstract

Importance: Emerging research suggests that the global prevalence of child and adolescent mental illness has increased considerably during COVID-19. However, substantial variability in prevalence rates have been reported across the literature.

Objective: To ascertain more precise estimates of the global prevalence of child and adolescent clinically elevated depression and anxiety symptoms during COVID-19; to compare these rates with prepandemic estimates; and to examine whether demographic (eg, age, sex), geographical (ie, global region), or methodological (eg, pandemic data collection time point, informant of mental illness, study quality) factors explained variation in prevalence rates across studies.

Data sources: Four databases were searched (PsycInfo, Embase, MEDLINE, and Cochrane Central Register of Controlled Trials) from January 1, 2020, to February 16, 2021, and unpublished studies were searched in PsycArXiv on March 8, 2021, for studies reporting on child/adolescent depression and anxiety symptoms. The search strategy combined search terms from 3 themes: (1) mental illness (including depression and anxiety), (2) COVID-19, and (3) children and adolescents (age ≤18 years). For PsycArXiv, the key terms COVID-19, mental health, and child/adolescent were used.

Study selection: Studies were included if they were published in English, had quantitative data, and reported prevalence of clinically elevated depression or anxiety in youth (age ≤18 years).

Data extraction and synthesis: A total of 3094 nonduplicate titles/abstracts were retrieved, and 136 full-text articles were reviewed. Data were analyzed from March 8 to 22, 2021.

Main outcomes and measures: Prevalence rates of clinically elevated depression and anxiety symptoms in youth.

Results: Random-effect meta-analyses were conducted. Twenty-nine studies including 80 879 participants met full inclusion criteria. Pooled prevalence estimates of clinically elevated depression and anxiety symptoms were 25.2% (95% CI, 21.2%-29.7%) and 20.5% (95% CI, 17.2%-24.4%), respectively. Moderator analyses revealed that the prevalence of clinically elevated depression and anxiety symptoms were higher in studies collected later in the pandemic and in girls. Depression symptoms were higher in older children.

Conclusions and relevance: Pooled estimates obtained in the first year of the COVID-19 pandemic suggest that 1 in 4 youth globally are experiencing clinically elevated depression symptoms, while 1 in 5 youth are experiencing clinically elevated anxiety symptoms. These pooled estimates, which increased over time, are double of prepandemic estimates. An influx of mental health care utilization is expected, and allocation of resources to address child and adolescent mental health concerns are essential.

Conflict of interest statement

Conflict of Interest Disclosures: Dr Racine reported fellowship support from Alberta Innovates. Dr McArthur reported a postdoctoral fellowship award from the Alberta Children’s Hospital Research Institute. Ms Cooke reported graduate scholarship support from Vanier Canada and Alberta Innovates Health Solutions outside the submitted work. Ms Eirich reported graduate scholarship support from the Social Science and Humanities Research Council. No other disclosures were reported.

Figures

Figure 1.. Forest Plots of the Pooled…
Figure 1.. Forest Plots of the Pooled Prevalence of Clinically Significant Depressive Symptoms in Youth During the COVID-19 Pandemic
Contributing studies for clinically elevated depression symptoms are presented in order of largest to smallest prevalence rate. Square data markers represent prevalence rates, with lines around the marker indicating 95% CIs. The diamond data marker represents the overall effect size based on included studies.
Figure 2.. Forest Plots of the Pooled…
Figure 2.. Forest Plots of the Pooled Prevalence of Clinically Significant Anxiety Symptoms in Youth During the COVID-19 Pandemic
Contributing studies for clinically elevated anxiety symptoms are presented in order of largest to smallest prevalence rate. Square data markers represent prevalence rates, with lines around the marker indicating 95% CIs. The diamond data marker represents the overall effect size based on included studies.

References

    1. Tiirikainen K, Haravuori H, Ranta K, Kaltiala-Heino R, Marttunen M. Psychometric properties of the 7-item Generalized Anxiety Disorder Scale (GAD-7) in a large representative sample of Finnish adolescents. Psychiatry Res. 2019;272:30-35. doi:10.1016/j.psychres.2018.12.004
    1. Lu W. Adolescent depression: National trends, risk factors, and healthcare disparities. Am J Health Behav. 2019;43(1):181-194. doi:10.5993/AJHB.43.1.15
    1. Lee J. Mental health effects of school closures during COVID-19. Lancet Child Adolesc Health. 2020;4(6):421. doi:10.1016/S2352-4642(20)30109-7
    1. Sprang G, Silman M. Posttraumatic stress disorder in parents and youth after health-related disasters. Disaster Med Public Health Prep. 2013;7(1):105-110. doi:10.1017/dmp.2013.22
    1. Brooks SK, Webster RK, Smith LE, et al. . The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020;395(10227):912-920. doi:10.1016/S0140-6736(20)30460-8
    1. Loades ME, Chatburn E, Higson-Sweeney N, et al. . Rapid systematic review: the impact of social isolation and loneliness on the mental health of children and adolescents in the context of COVID-19. J Am Acad Child Adolesc Psychiatry. 2020;59(11):1218-1239.e3. doi:10.1016/j.jaac.2020.05.009
    1. Golberstein E, Wen H, Miller BF. Coronavirus disease 2019 (COVID-19) and mental health for children and adolescents. JAMA Pediatr. 2020;174(9):819-820. doi:10.1001/jamapediatrics.2020.1456
    1. Racine N, Cooke JE, Eirich R, Korczak DJ, McArthur B, Madigan S. Child and adolescent mental illness during COVID-19: a rapid review. Psychiatry Res. 2020;292:113307. doi:10.1016/j.psychres.2020.113307
    1. Singh S, Roy D, Sinha K, Parveen S, Sharma G, Joshi G. Impact of COVID-19 and lockdown on mental health of children and adolescents: a narrative review with recommendations. Psychiatry Res. 2020;293:113429. doi:10.1016/j.psychres.2020.113429
    1. Zhang L, Zhang D, Fang J, Wan Y, Tao F, Sun Y. Assessment of mental health of Chinese primary school students before and after school closing and opening during the COVID-19 pandemic. JAMA Netw Open. 2020;3(9):e2021482. doi:10.1001/jamanetworkopen.2020.21482
    1. Hafstad GS, Sætren SS, Wentzel-Larsen T, Augusti E. Adolescents’ symptoms of anxiety and depression before and during the Covid-19 outbreak: a prospective population-based study of teenagers in Norway. Lancet Reg Health Eur. 2021;5:100093. doi:10.1016/j.lanepe.2021.100093
    1. Yue J, Zang X, Le Y, An Y. Anxiety, depression and PTSD among children and their parent during 2019 novel coronavirus disease (COVID-19) outbreak in China. Curr Psychol. 2020;1-8.
    1. Giannopoulou I, Efstathiou V, Triantafyllou G, Korkoliakou P, Douzenis A. Adding stress to the stressed: senior high school students’ mental health amidst the COVID-19 nationwide lockdown in Greece. Psychiatry Res. 2021;295:113560. doi:10.1016/j.psychres.2020.113560
    1. Merikangas KR, He JP, Burstein M, et al. . Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication—Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010;49(10):980-989. doi:10.1016/j.jaac.2010.05.017
    1. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2013.
    1. Courtney D, Watson P, Battaglia M, Mulsant BH, Szatmari P. COVID-19 impacts on child and youth anxiety and depression: challenges and opportunities. Can J Psychiatry. 2020;65(10):688-691. doi:10.1177/0706743720935646
    1. Zhou SJ, Zhang LG, Wang LL, et al. . Prevalence and socio-demographic correlates of psychological health problems in Chinese adolescents during the outbreak of COVID-19. Eur Child Adolesc Psychiatry. 2020;29(6):749-758. doi:10.1007/s00787-020-01541-4
    1. Magson NR, Freeman JYA, Rapee RM, Richardson CE, Oar EL, Fardouly J. Risk and protective factors for prospective changes in adolescent mental health during the COVID-19 pandemic. J Youth Adolesc. 2021;50(1):44-57. doi:10.1007/s10964-020-01332-9
    1. Xie X, Xue Q, Zhou Y, et al. . Mental health status among children in home confinement during the coronavirus disease 2019 outbreak in Hubei Province, China. JAMA Pediatr. 2020;174(9):898-900. doi:10.1001/jamapediatrics.2020.1619
    1. Duan L, Shao X, Wang Y, et al. . An investigation of mental health status of children and adolescents in China during the outbreak of COVID-19. J Affect Disord. 2020;275:112-118. doi:10.1016/j.jad.2020.06.029
    1. Pierce M, McManus S, Jessop C, et al. . Says who? the significance of sampling in mental health surveys during COVID-19. Lancet Psychiatry. 2020;7(7):567-568. doi:10.1016/S2215-0366(20)30237-6
    1. Klein R. Parent-child agreement in clinical assessment of anxiety and other psychopathology: a review. J Anxiety Disord. 1991;5(2):187-198. doi:10.1016/0887-6185(91)90028-R
    1. Edelbrock C, Costello AJ, Dulcan MK, Conover NC, Kala R. Parent-child agreement on child psychiatric symptoms assessed via structured interview. J Child Psychol Psychiatry. 1986;27(2):181-190. doi:10.1111/j.1469-7610.1986.tb02282.x
    1. Hawes MT, Szenczy AK, Olino TM, Nelson BD, Klein DN. Trajectories of depression, anxiety and pandemic experiences: a longitudinal study of youth in New York during the spring-summer of 2020. Psychiatry Res. 2021;298:113778. doi:10.1016/j.psychres.2021.113778
    1. Cost KT, Crosbie J, Anagnostou E, et al. . Mostly worse, occasionally better: impact of COVID-19 pandemic on the mental health of Canadian children and adolescents. Eur Child Adolesc Psychiatry. 2021. doi:10.1007/s00787-021-01744-3
    1. MacTavish A, Mastronardi C, Menna R, et al. . The acute impact of the COVID-19 pandemic on children’s mental health in southwestern Ontario. PsyArXiv. Preprint posted online September 19, 2020. doi:10.31234/
    1. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. doi:10.1371/journal.pmed.1000097
    1. Ebesutani C, Bernstein A, Martinez JI, Chorpita BF, Weisz JR. The youth self report: applicability and validity across younger and older youths. J Clin Child Adolesc Psychol. 2011;40(2):338-346. doi:10.1080/15374416.2011.546041
    1. National Heart, Lung, and Blood Institute. Study quality assessment tools: quality assessment tool for observational cohort and cross-sectional studies. Accessed July 6, 2021.
    1. Borenstein M, Hesdges L, Higgins J, Rothstein H.. Introduction to Meta-Analysis. Wiley; 2009.
    1. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629-634. doi:10.1136/bmj.315.7109.629
    1. AlAzzam M, Abuhammad S, Abdalrahim A, Hamdan-Mansour AM. Predictors of depression and anxiety among senior high school students during COVID-19 pandemic: the context of home quarantine and online education. J Sch Nurs. 2021;1059840520988548.
    1. Asanov I, Flores F, McKenzie D, Mensmann M, Schulte M. Remote-learning, time-use, and mental health of Ecuadorian high-school students during the COVID-19 quarantine. World Dev. 2021;138:105225. doi:10.1016/j.worlddev.2020.105225
    1. Cao Y, Huang L, Si T, Wang NQ, Qu M, Zhang XY. The role of only-child status in the psychological impact of COVID-19 on mental health of Chinese adolescents. J Affect Disord. 2021;282:316-321. doi:10.1016/j.jad.2020.12.113
    1. Cheah CSL, Wang C, Ren H, Zong X, Cho HS, Xue X. COVID-19 racism and mental health in Chinese American families. Pediatrics. 2020;146(5):e2020021816. doi:10.1542/peds.2020-021816
    1. Chen F, Zheng D, Liu J, Gong Y, Guan Z, Lou D. Depression and anxiety among adolescents during COVID-19: a cross-sectional study. Brain Behav Immun. 2020;88:36-38. doi:10.1016/j.bbi.2020.05.061
    1. Chen S, Cheng Z, Wu J. Risk factors for adolescents’ mental health during the COVID-19 pandemic: a comparison between Wuhan and other urban areas in China. Global Health. 2020;16(1):96. doi:10.1186/s12992-020-00627-7
    1. Chi X, Liang K, Chen ST, et al. . Mental health problems among Chinese adolescents during the COVID-19: the importance of nutrition and physical activity. Int J Clin Health Psychol. 2021;21(3):100218. doi:10.1016/j.ijchp.2020.100218
    1. Crescentini C, Feruglio S, Matiz A, et al. . Stuck outside and inside: an exploratory study on the effects of the COVID-19 outbreak on Italian parents and children’s internalizing symptoms. Front Psychol. 2020;11:586074. doi:10.3389/fpsyg.2020.586074
    1. Dong H, Yang F, Lu X, Hao W. Internet addiction and related psychological factors among children and adolescents in China during the coronavirus disease 2019 (COVID-19) epidemic. Front Psychiatry. 2020;11:00751. doi:10.3389/fpsyt.2020.00751
    1. Garcia de Avila MA, Hamamoto Filho PT, Jacob FLDS, et al. . Children’s anxiety and factors related to the COVID-19 pandemic: an exploratory study using the Children’s Anxiety Questionnaire and the Numerical Rating Scale. Int J Environ Res Public Health. 2020;17(16):E5757. doi:10.3390/ijerph17165757
    1. Glynn LM, Davis EP, Luby JL, Baram TZ, Sandman CA. A predictable home environment may protect child mental health during the COVID-19 pandemic. Neurobiol Stress. 2021;14:100291. doi:10.1016/j.ynstr.2020.100291
    1. Hou TY, Mao XF, Dong W, Cai WP, Deng GH. Prevalence of and factors associated with mental health problems and suicidality among senior high school students in rural China during the COVID-19 outbreak. Asian J Psychiatr. 2020;54:102305. doi:10.1016/j.ajp.2020.102305
    1. Li W, Zhang Y, Wang J, et al. . Association of home quarantine and mental health among teenagers in Wuhan, China, during the COVID-19 pandemic. JAMA Pediatr. 2021;175(3):313-316. doi:10.1001/jamapediatrics.2020.5499
    1. Luthar SS, Ebbert AM, Kumar NL. Risk and resilience during COVID-19: a new study in the Zigler paradigm of developmental science. Dev Psychopathol. 2021;33(2):565-580.
    1. McGuine TA, Biese KM, Petrovska L, et al. . Mental health, physical activity, and quality of life of us adolescent athletes during COVID-19-related school closures and sport cancellations: a study of 13 000 athletes. J Athl Train. 2020. doi:10.4085/478-20
    1. Murata S, Rezeppa T, Thoma B, et al. . The psychiatric sequelae of the COVID-19 pandemic in adolescents, adults, and health care workers. Depress Anxiety. 2021;38(2):233-246. doi:10.1002/da.23120
    1. Orgilés M, Espada JP, Delvecchio E, et al. . Anxiety and depressive symptoms in children and adolescents during COVID-19 pandemic: a transcultural approach. Psicothema. 2021;33(1):125-130.
    1. Ravens-Sieberer U, Kaman A, Erhart M, Devine J, Schlack R, Otto C. Impact of the COVID-19 pandemic on quality of life and mental health in children and adolescents in Germany. Eur Child Adolesc Psychiatry. 2021. doi:10.1007/s00787-021-01726-5
    1. Tang S, Xiang M, Cheung T, Xiang YT. Mental health and its correlates among children and adolescents during COVID-19 school closure: the importance of parent-child discussion. J Affect Disord. 2021;279:353-360. doi:10.1016/j.jad.2020.10.016
    1. Zhou J, Yuan X, Qi H, et al. . Prevalence of depression and its correlative factors among female adolescents in China during the coronavirus disease 2019 outbreak. Global Health. 2020;16(1):69. doi:10.1186/s12992-020-00601-3
    1. Zhang Z, Zhai A, Yang M, et al. . Prevalence of depression and anxiety symptoms of high school students in Shandong province during the COVID-19 epidemic. Front Psychiatry. 2020;11:570096. doi:10.3389/fpsyt.2020.570096
    1. Zhang C, Ye M, Fu Y, et al. . The psychological impact of the COVID-19 pandemic on teenagers in China. J Adolesc Health. 2020;67(6):747-755. doi:10.1016/j.jadohealth.2020.08.026
    1. Masonbrink AR, Hurley E. Advocating for children during the COVID-19 school closures. Pediatrics. 2020;146(3):e20201440. doi:10.1542/peds.2020-1440
    1. Schaller J, Zerpa M. Short-run effects of parental job loss on child health. Am J Health Econ. 2019;5(1):8-41. doi:10.1162/ajhe_a_00106
    1. Marques L, Robinaugh DJ, LeBlanc NJ, Hinton D. Cross-cultural variations in the prevalence and presentation of anxiety disorders. Expert Rev Neurother. 2011;11(2):313-322. doi:10.1586/ern.10.122
    1. Rzymski P, Nowicki M, Mullin GE, et al. . Quantity does not equal quality: scientific principles cannot be sacrificed. Int Immunopharmacol. 2020;86:106711. doi:10.1016/j.intimp.2020.106711
    1. Essau CA, Lewinsohn PM, Seeley JR, Sasagawa S. Gender differences in the developmental course of depression. J Affect Disord. 2010;127(1-3):185-190. doi:10.1016/j.jad.2010.05.016
    1. Riecher-Rössler A. Sex and gender differences in mental disorders. Lancet Psychiatry. 2017;4(1):8-9. doi:10.1016/S2215-0366(16)30348-0
    1. Oldehinkel AJ, Verhulst FC, Ormel J. Mental health problems during puberty: Tanner stage-related differences in specific symptoms: the TRAILS study. J Adolesc. 2011;34(1):73-85. doi:10.1016/j.adolescence.2010.01.010
    1. Hall-Lande JA, Eisenberg ME, Christenson SL, Neumark-Sztainer D. Social isolation, psychological health, and protective factors in adolescence. Adolescence. 2007;42(166):265-286.
    1. Christakis DA, Van Cleve W, Zimmerman FJ. Estimation of US children’s educational attainment and years of life lost associated with primary school closures during the coronavirus disease 2019 pandemic. JAMA Netw Open. 2020;3(11):e2028786. doi:10.1001/jamanetworkopen.2020.28786
    1. Madigan S, Racine N, Cooke JE, Korczak DJ. COVID-19 and telemental health: benefits, challenges, and future directions. Can Psychol. 2021;62(1):5-11. doi:10.1037/cap0000259
    1. Webb Hooper M, Nápoles AM, Pérez-Stable EJ. COVID-19 and racial/ethnic disparities. JAMA. 2020;323(24):2466-2467. doi:10.1001/jama.2020.8598
    1. Hawke LD, Hayes E, Darnay K, Henderson J. Mental health among transgender and gender diverse youth: an exploration of effects during the COVID-19 pandemic. Psychol Sex Orientat Gend Divers. Published online February 4, 2021. doi:10.1037/sgd0000467
    1. Craig S, Ames ME, Bondi BC, Pepler DJ. Canadian Adolescents’ mental health and substance use during the covid-19 pandemic: associations with COVID-19 stressors. PsyArXiv. Preprint posted online September 9, 2020. doi:10.31234/

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