What are the associations of COVID-19 policy related economic and schooling disruptions with mental health and sleep in US children?

By Pooja Toshniwal PahariaMar 17 2023Reviewed by Danielle Ellis, B.Sc.

In a recent study published in JAMA Network Open, researchers investigated whether economic and schooling disruptions associated with coronavirus disease 2019 (COVID-19) mitigation policies and unemployment rates were independently associated with perceived stress, sorrow, and positive stress effect, sleep, and COVID-19-associated worry.

Background

Policies to curtail severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission, such as the closure of schools and businesses, social distancing, and in-person activity limitations, were critical for controlling the pandemic prior to the availability of effective antiviral medications and vaccines. The restrictive and stringent COVID-19 policies lowered the SARS-CoV-2 spread but worsened the economic conditions of families and altered schooling patterns.

On the contrary, COVID-19 support policies provided financial aid, such as relief from debt, to reduce the financial burden of SARS-CoV-2 infections. Assessing the impact of COVID-19 on pediatric stress, sorrow, positive affect, sleep, and worry could better inform decision-making and policy-making to reduce the burden of SARS-CoV-2 infections.

Previous studies evaluating the impact of the SARS-CoV-2 pandemic on mental health were of the cross-sectional type, used convenience sampling, and analyzed mental health outcomes among adults.

About the study

In the present national cohort study, researchers assessed independent bias-corrected relationships between SARS-CoV-2-containment policies, associated perceived financial and school disruptions, sleep schedule, and mental well-being of children residing in the United States (US).

Data obtained from May to December 2020 from the adolescent brain cognitive development (ABCD) study participants and the coronavirus disease 2019 rapid response research (RRR) first and second data releases were analyzed.

State-wide COVID-19 mitigation policy and county-wide unemployment rate indexes were utilized for addressing confounding bias via 2.0-stage limited data maximum probability instrumental variables (IV) analyses. Geocoded data from 6,030 United States (US) children 10.0 to 13.0 years of age were analyzed between May 2021 and January 2023.

The study exposures were COVID-19 policy-caused economic disruptions (lost work or wages) and schooling disruptions (switch to web-based or hybrid offline-online schooling). The main measures and outcomes were perceived stress levels, measured using the four-item perceived stress scale (PSS-4); positive affect and sorrow, measured using the National Institutes of Health (NIH) toolbox emotion battery (NIH TB-EB); sleep duration, latency, and inertia, assessed using the Munich chronotype questionnaire (MCTQ); and COVID-19-associated worry.

The team included individuals who filled out surveys in 2020 and the sociodemographic data of whom were available. Missing data were imputed to obtain 25,555 mental health observations of 8,400 children and 25,948 sleep schedule observations of 8,472 children. ABCD study data were linked to three external datasets: (i) United States state-wide policy data from the Oxford COVID-19 government response tracker (OxCGRT); (ii) county-wide COVID-19 incidence data retrieved from John Hopkins University COVID-19 data; and (iii) county-level month-wise unemployment rates from the United States Bureau of Labor Statistics (BLS).

Results

The median age of the sample population was 13 years, 49% (n=2,947) of whom were female, and 273, 461, 1,167, 3,783, and 347 children were Asian, Black, Hispanic, White, and of other ethnicities, respectively. Economic disruptions were related to increases of 205%, 112%, and 74% elevation in stress levels, sorrow, and moderate-extreme SARS-CoV-2 infection-associated worry, respectively.

Economic disruption was associated with a 33% reduction in pediatric positive affectivity. However, school disruption was not associated with the mental well-being of children, and neither school nor economic disruptions affected sleep.

Higher psychological distress levels might have spillover effects on learning losses, peer and family relationship quality, and poor mental health. Addressing the economic difficulties could lessen the negative effects of the pandemic on pediatric development in the future.

The findings indicated that public health policies must evaluate the financial burden of SARS-CoV-2 containment policies and measures on families to protect the mental health status of children until antiviral drugs and vaccines are available for pediatric use. Optimized COVID-19 mitigation policies during the pandemic could prioritize pediatric mental health by providing financial relief to families.

Conclusions

Overall, the study findings provided bias-corrected predictions by linkage of SARS-CoV-2 containment policy-associated economic disruptions and pediatric mental health status. Schooling disruptions did not significantly impact mental health outcomes. Thus, clinicians must assess economic conditions when supporting the mental well-being of children.

Future studies must include assessments for objective measures, sleep quality, new-onset psychiatric disorders incidence and severity using specific mental well-being clinical evaluation scales such as the nine-item patient health questionnaire. In addition, more recent ABCD study release data must be analyzed and linked to social health determinants to evaluate the long-term effects of COVID-19 policies on children's mental health.