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Impacts of the COVID-19 pandemic on the mental health of children and their families. 06.14.2021

The intention of this article is to systematically summarize the consequences of the limitations on the functioning of basic components of social life in the context of the COVID-19 pandemic. In particular, economic, health and social impacts have been discussed in the media. Mental health impacts - such as an increase in depressive symptoms, anxiety, self-harm, eating disorders, addictions or suicidal behaviour - have only been discussed sporadically. Stress or mental illness is not immediately visible and measurable, but it can be very serious and can significantly affect not only the quality but also the length of an individual's life.

The Czech Republic is one of the countries that had the longest school closures in Europe as a result of the COVID 19 pandemic (UNESCO).

Leisure activities were also gradually restricted or completely banned. Restrictions on movement and meeting of people made social contacts of children and adults impossible.

The impact of isolation on individual and personality development and its fundamentally negative consequences have been documented in many studies. As an extreme example, abused or neglected children will experience arrested psychomotor development if they are not stimulated. In a milder form, as many children and families experienced during the pandemic, various symptoms of mental discomfort, stress or even mental illness appeared. The development of symptoms of mental illness in children may have been further caused by the effects of parental mental discomfort due to isolation, threats to basic subsistence and social security, as well as fear of COVID-19 illness. As a consequence of the prolonged measures, there was no place and no way to vent emotions, so everything took place in nuclear families - mother, father, children - and it had a negative impact on all members of the household.

 

 

The Lancet magazine recently published a study showing that increasing mental health problems among adults in England during the Covid-19 pandemic have had the effect of increasing the incidence of mental illness in children aged 5-16 years from 10.8% in 2017 to 16% in July 2020. These data clearly show that children whose parents experience psychological distress are more prone to mental illness. Researchers stress that the welfare system should reflect the socio-economic impact on families with children. 

If a child or adult develops a serious mental illness, which includes depressive disorder, it can shorten that individual's life by up to 10 years, according to some studies.

According to the U.S. National Alliance on Mental Illness, 50% of all lifelong mental illnesses develop within the first 14 years of life and 75% by age 24. Suicide is the second most frequent cause of death between the ages of 10 and 34. During a pandemic, suicidal ideation among young people is on the rise, according to available studies. It is this group of children, adolescents and young adults who are now most affected by the pandemic in terms of mental health, and the consequences will be long-term, negative both for society and the economy, including the potential shortening of their lives.

In our experience as psychologists and physicians involved in the long-term mental health of children and adults, we can give several specific examples that show the deterioration of the mental health of the younger generation and those who care for them in the context of the statistics documenting the issue.

The influence of social media on young people is evolving exponentially. Even children who attend middle schools are completely dependent on electronic media (CTK, 2019). The only way to entertain yourself is to passively engage and connect to a virtual game. They don't know boredom, they are constantly stimulated, filled and drawn into a world of virtual "fast" emotions by a parent or a phone. The result is distractedness, an inability to focus and a constant need to multitask and enjoy multi-content. This fragmentation manifests itself in various neurotic manifestations or increased irritability and nervousness. Children or adolescents are eventually diagnosed with ADHD because their behavioural manifestations are consistent with this, but the main cause is often the above menktioned multitasking. Online learning has, of course, exacerbated this addiction. Children and teenagers were connected to the lessons but in parallel they were chatting with friends, playing games or watching videos on YouTube. A study on adolescents at Ohio University (2019) proved that when multitasking, students first experience positive emotions (from doing the task while doing their favourite parallel activities) and negative emotions (stress about whether they will actually do the task well). Over time, however, the predominant emotion is a feeling of exhaustion and emotional flatness - apathy. It is this apathy that parents complain about most with their children and tend to keep the child under control all the time - which in most cases is not possible, or creates domestic conflicts and a tense atmosphere.

 

 

 

 

More often, since the pandemic began in March 2020, parents have sought psychological or psychiatric services because they perceive in their children a progressive loss of motivation, increasing apathy, fatigue, sleep and eating disorders, and existential doubts about their own future and the future of the world. In worse cases, incipient or severe symptoms of depression, such as continuous sadness, loss of meaning and associated thoughts of suicide. Also, a large number of children who already had pre-existing conditions such as ADHD, OCD or eating disorders before the pandemic experienced a major deterioration during isolation, as these children lost the discipline that was often provided by school or leisure activities which kept them in a fragile but functional state. We also observe increased manifestations of self-harm in the form of scratching, pinching or, in the worst case, cutting with various objects. The incidence of self-harm has tripled in the last twenty years (BBC, 2019). Current statistics show 14-39% in the normal adolescent population and 40-61% in the clinical adolescent population.

Constant access to the internet and information that a child is unable to understand contextually often causes children or adolescents to "Google" their own diagnosis and become convinced of its truth. They are looking for self-described manifestations and symptoms in the form of a "self-fulfilling prophecy". This is how a 10-year-old child, for example, comes up with his/her own self-diagnosis of bipolar depression without really understanding what it is.

Online learning has distanced children from real life. On the one hand, it protected them from the real burden or threat that the school collective posed to certain children, but it also prevented them from acquiring the skills to overcome everyday obstacles. In this way, the teenagers moved in a "safe" online environment, which, however, made demands on them equal to those of a university student, such as the organisation of lessons and assignments, independence and self-study. They have come to expect from themselves the constant perfectionism that social networks are full of, such as maximum efficiency, which they have alternated with laziness with multi-screens.  In their household they often lacked regular chores and real attention from overburdened parents or sharing with them.

Parents were expected to be continuously flexible and adapt to new and emerging regulations. The repeated opening and closing of schools required them to constantly change their priorities: should I work or teach my child? Should I stay home and baby-sit or go to work? The one is often incompatible with the other, so parents have functioned in several roles, feeling that each role is poorly and inadequately filled. In adult individuals, burnout syndrome, breakdowns, psychosomatic difficulties, anxiety, existential worries, panic attacks and sleep disorders accumulate in outpatient practice. According to a survey by the American Society (KFF, 2021), 11% of adults reported symptoms of anxiety and depression between January and June in 2019, rising to 41.1% during January 2021 (see tables in Appendix). Similar studies in the Czech Republic (V. Bartoš et al., 2020) showed that 20% of respondents suffered from worsened mental health (symptoms of at least moderate depression or anxiety) in the first phase of the pandemic. This represented a more than threefold increase from the pre-pandemic level (6%).

 

 

Last but not least, it is necessary to mention the effects of isolation and lack of social contact. Contact with another person is not an unimportant detail of our lives that we can do without indefinitely. Sharing and meeting other people is a basic human need. Social skills cannot be learned in an online environment! It is necessary to actually meet another person, to perceive that person, to learn to make eye contact, to react and observe their non-verbal speech, to learn to create your own comfort zone, to strike up a conversation with a stranger - all practices that are increasingly difficult for today's adolescents and children. More introverted individuals develop social phobias. Such children are increasingly afraid of returning to the collective, preferring to avoid it and escape to the safety of their room. I have also encountered expressions of panic at the idea of returning to school. Children who are more extroverted actually suffered from the lack of social contact and fell into depressive states because they had no prospect of improvement.

Access to quality assistance is limited. In 2018, an alarming article was published highlighting a significant increase in the consumption of antidepressants (a six-fold increase in the last 25 years). Needless to say, this trend continues to grow. Psychological counselling centres are overloaded and waiting times are long. Antidepressants therefore seem to be the only solution, although their prescription, especially in children, should not be automatic.

The effects of the pandemic are severe and, as a result of measures aimed at reducing social contact through widespread isolation, have affected our lives in a psychologically unhealthy way. 

It is of course encouraging that schools have been reopened and that the gradual relaxation of restrictive government measures is bringing us closer to normal life. However, it would be naive to think that the negative psychological consequences that children suffer as a result of long-term isolation will disappear with the return to school. We therefore want to appeal for conditions to be created that would enable not only the health system but also school institutions to catch in time and to work effectively with mental health problems of children and adolescents.

Even though the pandemic seems to be on the wane at the moment, we are facing a wave of children in our surgeries who cannot cope with the onset of the collective after long-term isolation. There is a significant increase in anxiety disorders or social phobias, self-harm, suicide attempts by children and a persistently high number of children with eating disorders.

It is therefore necessary to highlight the long-term effects of isolation measures on mental health and it is crucial to have a suitable scenario for the future to ensure that proper schooling can function effectively should a pandemic strike again.

The article was prepared by our specialists

Annex