Anxiety increased among children and adolescents during pandemic-related school closures in Europe: a systematic review and meta-analysis

Child and Adolescent Psychiatry and Mental Health

Review

Lisa M. Pfadenhauer¹  Jörg M. Fegert²  Helena Ludwig-Walz³  Martin Bujard⁴  Indra Dannheim⁵ 

[1] Chair of Public Health and Health Services Research, IBE, Faculty of Medicine, LMU Munich, Munich, Germany;Pettenkofer School of Public Health, Munich, Germany;Department for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center, Competence Domain Mental Health Prevention, Ulm, Germany;Federal Institute for Population Research (BiB), Wiesbaden, Germany;Federal Institute for Population Research (BiB), Wiesbaden, Germany;Institute of Medical Psychology, Medical Faculty, University Heidelberg, Heidelberg, Germany;Regional Innovative Centre of Health and Quality of Live Fulda (RIGL), Fulda University of Applied Sciences, Fulda, Germany;Department of Nutritional, Food and Consumer Sciences, Fulda University of Applied Sciences, Fulda, Germany;

关键词: Anxiety;    COVID-19;    Child;    Adolescent;    Europe;    Meta-analysis;    Communicable disease control;    Lockdown;    Evidence-informed decision-making;    Pandemic preparedness;    Health policy;   

DOI  :  10.1186/s13034-023-00612-z

 received in 2023-04-05, accepted in 2023-05-10,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundConsidering the heterogenous evidence, a systematic review of the change in anxiety in European children and adolescents associated with the COVID-19 pandemic is lacking. We therefore assessed the change compared with pre-pandemic baselines stratified by gender and age as well as evaluated the impact of country-specific restriction policies.MethodsA registration on the ‘International Prospective Register of Systematic Reviews’ (PROSPERO) occurred and an a priori protocol was published. We searched six databases (PubMed, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, WHO COVID-19) using a peer-reviewed search string with citation tracking and grey literature screening. Primary outcomes were: (1) general anxiety symptoms; and (2) clinically relevant anxiety rates. We used the Oxford COVID-19 Stringency Index as an indicator of pandemic-related restrictions. Screening of title/abstract and full text as well as assessing risk of bias (using the ‘Risk of Bias in Non-randomized Studies of Exposure’ [ROBINS-E]) and certainty of evidence (using the ‘Grading of Recommendations Assessment, Development and Evaluation’ [GRADE]) was done in duplicate. We pooled data using a random effects model. Reporting is in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement.ResultsOf 7,422 non-duplicate records, 18 studies with data from 752,532 pre-pandemic and 763,582 pandemic participants met full inclusion criteria. For general anxiety symptoms the total change effect estimate yielded a standardised mean difference (SMD) of 0.34 (95% confidence interval [CI], 0.17–0.51) and for clinically relevant anxiety rates we observed an odds ratio of 1.08 (95%-CI, 0.98–1.19). Increase in general anxiety symptoms was highest in the 11–15 years age group. Effect estimates were higher when pandemic-related restrictions were more stringent (Oxford Stringency Index > 60: SMD, 0.52 [95%-CI, 0.30–0.73]) and when school closures (School Closure Index ≥ 2: SMD, 0.44 [95%-CI, 0.23–0.65]) occurred.ConclusionGeneral anxiety symptoms among children and adolescents in Europe increased in a pre/during comparison of the COVID-19 pandemic; particularly for males aged 11–15 years. In periods of stringent pandemic-related restrictions and/or school closures a considerable increase in general anxiety symptoms could be documented.PROSPERO registration: CRD42022303714.

【 授权许可】

CC BY   
© The Author(s) 2023

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Fig. 1