Child mental health symptoms declined as COVID-19 restrictions eased in Ontario longitudinal study
Photo by Abraham Suna / Unsplash
Key Takeaway
Consider that child mental health symptoms may fluctuate with pandemic restrictions, but this is observational data from Ontario.
A population-based longitudinal study followed 1,261 children and youth aged 4-17 years in Ontario, Canada, across five waves of data collection from January 2021 to December 2022. The study examined how mental health symptoms changed across distinct phases of the COVID-19 pandemic with varying public health restrictions, without a formal comparator group.
The main finding was that mental health symptoms were elevated and stable during lockdown periods, followed by significant reductions as pandemic restrictions loosened. Specifically, oppositional defiant and inattention/hyperactivity symptoms showed significant reductions, particularly compared to internalizing symptoms. During lockdowns, relative increases in symptoms were observed for children without pre-existing clinician-diagnosed conditions and those not in lockdown at baseline. As restrictions loosened, girls demonstrated smaller reductions in internalizing symptoms compared to boys. Associations between concurrent and lagged parental distress and children's symptoms varied across the pandemic. No specific effect sizes, absolute numbers, or confidence intervals were reported for these outcomes.
Safety and tolerability data were not reported. The study was funded by the Ontario Ministry of Health. Key limitations include its observational design, which cannot establish causality, and its generalizability may be limited to Ontario, Canada, during the studied period. The absence of reported effect sizes, absolute numbers, and confidence intervals limits the precision of the findings. For practice, the study underscores the need for tailored, equity-informed pandemic planning. Policies designed to balance reducing viral transmission with limiting lockdowns may help mitigate adverse impacts on child and youth mental health, but these are associations, not proven interventions.
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View Original Abstract ↓
Background Although an expansive body of evidence exists on children's mental health during the COVID-19 pandemic, it is largely restricted to the early phases and lockdowns. This study examines longitudinal changes in child and youth mental health symptoms across two years of the COVID-19 pandemic, with data collection strategically timed to capture variability in pandemic restrictions. Methods A population-based longitudinal study of 1,261 children and youth aged 4-17 years followed prospectively from January 2021 to December 2022, with five waves of data collected in Ontario, Canada. Latent growth curve modelling was used to estimate trajectories of parent-reported mental health symptoms and identify baseline and time-varying covariates associated with variable trajectories. Findings Mental health symptoms were elevated and stable during lockdowns, followed by significant reductions as pandemic restrictions loosened, particularly for oppositional defiant and inattention/hyperactivity symptoms compared to internalizing symptoms. Children without pre-existing clinician diagnosed physical, mental or neurodevelopmental conditions and those not in lockdown at baseline demonstrated relative increases in mental health symptoms during lockdowns; and girls, compared to boys, demonstrated smaller reductions in internalizing symptoms as restrictions loosened. Concurrent and lagged associations between parental distress and children's mental health symptoms varied across the pandemic. Interpretation Variation in symptom trajectories by mental health domain, gender, pandemic restrictions and pre-existing diagnosed conditions underscores the need for tailored, equity-informed pandemic planning and response. Policies designed to optimize the balance between the need to reduce viral community transmission whilst limiting pandemic lockdowns may mitigate adverse impacts on child and youth mental health. Funding Ontario Ministry of Health
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