Page:Child-adolescent-mh-covid.pdf/1

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ASPE
ASSISTANT SECRETARY FOR PLANNING AND EVALUATION

ISSUE BRIEF
September 22, 2021

Child and Adolescent Mental Health During COVID-19: Considerations for Schools and Early Childhood Providers

KEY POINTS

  • Children and adolescents had high likelihood of having a mental health condition after a COVID-19 diagnosis, negative COVID-19 test or COVID-19 like symptoms only.
  • Likelihood of mental health diagnosis after a COVID-19 related event increased with age.
  • Type of mental health condition among diagnosed children who also experienced a COVID-19 related event varied by age, with different patterns of diagnosis for children age 0-5, age 6-11, and adolescents age 12-17.
  • The odds of developing a mental health condition following COVID-19 related event were higher among children with adverse childhood experiences.
  • Children with an Intellectual Disability/Developmental Disability had high odds of having new or recurring mental health condition after a COVID-19 related event.
  • Early childhood education providers and schools are essential resources to meet the post-COVID mental health needs of students returning to educational settings.


POLICY ISSUE

After a prolonged period of social isolation and school closures during the COVID-19 pandemic, the re-opening and continuing operation of schools and early childhood education (ECE) providers for in-person learning is a public health priority. The President’s Executive Order on school and ECE re-opening[1] identified the need for “trauma-informed care, and behavioral and mental health support” for younger children, and the “promotion of mental health and social-emotional well-being” as schools and other educational institutions re-open. Studies on child and adolescent mental health and well-being indicate that the COVID-19 pandemic’s social restrictions prompted a surge in the mental health needs of children[2][3][4][5][6][7][8][9][10][11] with worse mental health outcomes among children and adolescents exposed to adverse childhood experiences (ACEs).[3][4][12] At the same time, research on adults found potential heightened risk for mental health conditions after COVID-19 diagnosis[13][14][15] but no such analysis has been done on children or adolescents. Nationwide 4.3 million children/adolescents have been diagnosed with COVID-19 as of August 2021,[16] and many of them will be returning to early childhood and school settings. Schools and ECE programs have long been essential settings[17] for delivery of mental health services where children, students, and especially low-income and non-Hispanic Black students,[18] face fewer structural barriers to accessing services.

This brief is using descriptive analysis to expand on prior research and provide more detailed information on the mental health needs, co-occurring conditions, and ACEs experienced by a cohort of young children age 0-5, children age 6-11, and adolescents age 12-17 during the time of the COVID-19 pandemic. The large sample of children and adolescents (N=4,168,031) allows us to examine patterns across all COVID-19 related events (COVID-19 diagnosis, negative COVID-19 test, or COVID-19 symptoms only). The data for the study were extracted from December 2018-April 2021 from the IQVIA multi-payer health insurance claims database, covering all 50 states and Washington, D.C. Children and adolescents age 0-5 (early childhood/ preschool), age

September 2021
ISSUE BRIEF     1
  1. ↑ The White House, Executive Order on Supporting the Reopening and Continuing Operation of Schools and Early Childhood Education Providers. Accessed July 13, 2021, at https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/21/executive-ordersupporting-the-reopening-and-continuing-operation-of-schools-and-early-childhood-educationproviders/.
  2. ↑ Singh S, Roy D, Sinha K, Parveen S, Sharma G, Joshi G. Impact of COVID-1919 and lockdown on mental health of children and adolescents: A narrative review with recommendations. Psychiatry Res, 2020 Nov; 293: 113429.
  3. ↑ 3.0 3.1 Patrick SW, Henkhaus LE, Zickafoose JS, Lovell K, Halvorson A, Loch S, Letterie M, Davis MM. Well-being of parents and children during the COVID-19 pandemic: A national survey. Pediatrics, 2020 Oct; 146(4)
  4. ↑ 4.0 4.1 Gassman-Pines A, Ananat EO, Fitz-Henley J. COVID-19 and parent-child psychological well-being. Pediatrics, 2020 Oct; 146(4).
  5. ↑ Loades ME, Chatburn E, Higson-Sweeney N, Reynolds S, Shafran R, Brigden A, Linney C, McManus MH, Borwick C, Crawley E. 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 Nov; 59(11): 1218-1239.e3.
  6. ↑ 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 Jan; 279: 353-360.
  7. ↑ 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 Jan; 50(1): 44-57.
  8. ↑ Raviv T, Warren CM, Washburn JJ, Kanaley MK, Eihentale L, Goldenthal HJ, Russo J, Martin CP, Lombard LS, Tully J, Fox K, Gupta R. Caregiver perceptions of children's psychological well-being during the COVID-19 pandemic. JAMA Network Open, 2021 Apr 1; 4(4).
  9. ↑ Jones EAK, Mitra AK, Bhuiyan AR. Impact of COVID-19 on mental health in adolescents: A systematic review. Int J Environ Res Public Health, 2021 Mar; 18(5): 2470.
  10. ↑ 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 May; 14, 100291.
  11. ↑ Tulsa SEED Study Team. Parents, teachers, and distance learning during the COVID-19 pandemic: A snapshot from Tulsa, OK. 2020. Accessed on July 13, 2021, at https://static1.squarespace.com/static/5ec6d9f9144482661ecd735a/t/5f3e7f8d5bbd1934e03165f8/1597931409407/Tulsa+SEED+Study_COVID-19+Survey+Findings_FINAL1.pdf.
  12. ↑ Shah K, Mann S, Singh R, Bangar R, Kulkarni R. Impact of COVID-19 on the mental health of children and adolescents. Cureus, 2020 Aug; 12(8): e10051.
  13. ↑ Taquet M, Luciano S, Geddes JR, Harrison PJ. Bidirectional associations between COVID-19 and psychiatric disorder: Retrospective cohort studies of 62 354 COVID-19 cases in the USA. Lancet Psychiatry, 2021 Feb; 8(2): 130-140.
  14. ↑ Zhang J, Lu H, Zeng H, et al. The differential psychological distress of populations affected by the COVID-19 pandemic. Brain Behav Immun, 2020 Jul; 87: 49-50.
  15. ↑ Ali, M. Mental health consequences of COVID-19: The role of social determinants of health research brief. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. Accessed on June 28, 2021, at https://aspe.hhs.gov/mh-consequences-covid.
  16. ↑ American Academy of Pediatrics. Children and COVID-19: State-level data report. Accessed on July 24, 2021, at https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-andcovid-19-state-level-data-report/.
  17. ↑ Kase C, Hoover S, Boyd G, West KD, Dubenitz J, Trivedi PA, Peterson H, Stein BD. Educational outcomes associated with school behavioral health interventions: A review of the literature. J Sch H, 2017 Jul; 87(7): 554-562
  18. ↑ Ali MM, West K, Teich J, Lynch S, Mutter R, Dubenitz J. Utilization of mental health services in educational setting by adolescents in the United States. J Sch H, 2019 May; 89(5): 393-401.
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