Corona Virus

The financial crisis brought by the pandemic may have long-term serious impacts
such as excessive family conflict, violence, psychosis and drug abuse or alcohol abuse.
During the recent Coronavirus disease 2019 (COVID-19) outbreak in China, 54%
of the participants of a large online study rated the impact of the outbreak on their
mental health as moderate to severe, with depressive symptoms and anxiety being the
conditions most often stated. The current crises imposes multifaceted burdens on
children. They include the socio-ecological impact of the pandemic, which is understood
to be enormous. The environment of children is affected at different levels– including
community and family - as well as the individual child itself.
The coronavirus disease 2019 (COVID-19) is profoundly affecting life around the
globe. Isolation, contact restrictions and economic shutdown impose a complete change
to the psychosocial environment in affected countries. These measures have the
potential to threaten the mental health of children and adolescents significantly. Even
though the current crisis can bring with it opportunities for personal growth and family
cohesion, disadvantages may outweigh these benefits. Anxiety, lack of peer contact and
reduced opportunities for stress regulation are main concerns. Another main threat is
an increased risk for parental mental illness, domestic violence and child maltreatment.
Especially for children and adolescents with special needs or disadvantages, such as
disabilities, trauma experiences, already existing mental health problems, migrant
background and low socioeconomic status, this may be a particularly challenging time.
To maintain regular and emergency child and adolescent psychiatric treatment during
the pandemic is a major challenge but is necessary for limiting long-term consequences
for the mental health of children and adolescents. Urgent research questions comprise
understanding the mental health effects of social distancing and economic pressure,
identifying risk and resilience factors, and preventing long-term consequences, including
—but not restricted to—child maltreatment. The efficacy of telepsychiatry is another
highly relevant issue is to evaluate the efficacy of telehealth and perfect its applications
to child and adolescent psychiatry.
Since the pandemic was announced, at the community level, there has been
disruption of, or more limited access to basic services, such as kindergarten, schools,
and routine medical care. Several countries have seen a re-organization of hospital
services, with provisional care. There have been closures, partial closures or reduced
services of inpatient and day-care facilities, with outpatient contacts reduced in some
places to emergency cases only. Some hospitals have been unable to accept new
inpatients due to the risk of infection. Questions have arisen on how to deal with the
risk of infected patients in closed units infecting staff and other patients. There have
been concerns for the possible future lack of adequate resources for mental health
services as most resources are directed towards ICU and somatic care. Importantly,
even the activity of child protection services and currently existing programs of support
or supervision by youth welfare agencies have been disrupted or interrupted. The lack
of access to these basic services can be particularly harmful for vulnerable children
and/or families.
Moreover, leisure time activities have been limited. In most countries, children
have not been allowed to use regular playgrounds, social group activities are prohibited
and sports clubs are closed. Social relations have been strongly limited to closest family
members. In several countries, contact to peers has been prohibited or severely limited.
This can have a negative impact on children and adolescents given the importance of
peer contact for well-being. Many countries have experienced a lock-down of schools.
As pointed out by a recent review, school closures may not have a major impact on
reducing infections and preventing deaths. Hence, possible negative consequences such
as loss of education time, restricted access to peers and loss of daily structure need to
be taken into account when estimating the advantages and disadvantages of this
particular measure. Moreover, in some communities, stigmatization of infected children
and families may occur. At the family level, the pandemic has led to a re-organization of
everyday life. All family members have to cope with the stress of quarantine and social
distancing. School shutdowns have led to home-schooling and potential postponement
of exams. Parents have experienced increased pressure to work from home, to keep
jobs and businesses running as well as to take care of schooling children at home at the
same time, while caregiver resources including grandparents and the wider family have
been restricted. Family connections and support may be disrupted. Fear of losing family
members who belong to a risk group can increase. In case of death, the pandemic
disrupts the normal bereavement processes of families. Grief and mourning of lost
family members, especially in cases where contact with the infected member is
restricted or refused, could lead to adjustment problems, post-traumatic stress disorder,
depression and even suicide of both, adults and young people.
Research is needed to assess the implications of policies enacted to contain the
pandemic on mental health of children and adolescents, and to estimate the risk/benefit
ratio of measures such as home schooling, in order to be better prepared for future
developments.
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