Mental Health Impact of COVID-19 among Children and College Students: A Systematic Review

In the paper

“This is not surprising as rural areas, as opposed to urban areas, often have limited mental health services, lacking access to adequate healthcare, being economically and educationally under-resourced, and usually consisting of elder populations with worse health outcomes—making those living in these communities even more vulnerable to COVID-19 [49–51].”

What the sources say

• Partly supported

  In “Rural areas at risk during COVID-19 pandemic” (page unavailable), Ranscombe discusses rural communities’ need for resources to meet basic needs and the economic hardship caused by lockdowns. This offers some support for economic vulnerability, but the paper does not establish that rural areas are generally economically under-resourced relative to urban areas. Its discussion of education concerns communicating public-health information, not a lack of educational resources. (LLM, conf=0.76)

  cites [49] Ranscombe P (2020) Rural areas at risk during COVID-19 pandemic. Lancet Infect Dis 20(5):545. https://doi.org/10.1016/s1473-3099(20)30301-7 sourceExperimental — accuracy not yet measured
• Not checked yetcites [50] Human J, Wasem C (1991) Rural mental health in America. Am Psychol 46(3):232–9. https://doi.org/10.1037//0003-066x.46.3.232 source
• Not checked yetcites [51] CDC. Rural Communities CDC2021 [cited 2021]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/other-at-risk-populations/rural-communities.html.

In the paper

“Similar psychological effects have been found from wars and previous disease outbreaks [10–13].”

What the sources say

• Supported

  The Discussion reports long-term psychiatric effects associated with war-related experiences, including PTSD, major depressive episodes, and prolonged grief disorder. This source supports the war portion of the sentence; the citation range does not require this individual paper to address disease outbreaks. (LLM, conf=0.90)

  cites [10] Morina N, von Lersner U, Prigerson HG (2011) War and bereavement: consequences for mental and physical distress. PLoS One 6(7):e22140. https://doi.org/10.1371/journal.pone.0022140 source
• Supported

  The Introduction reports that war and military violence are associated with PTSD and depressive symptoms, supporting the war-related part of the sentence for which this source is relevant. The sentence cites several sources; this verdict does not assess its separate reference to disease outbreaks. (LLM, conf=0.90)

  cites [11] Thabet A, Tawahina AA, Sarraj E, Vostanis P (2013) Death anxiety, PTSD, trauma, grief, and mental health of Palestinians victims of War on Gaza. Health Care: Curr Rev. https://doi.org/10.4172/hccr.1000112 source
• Partly supported

  The International level section says the psychosocial effects of Ebola reflect those of other emergencies, particularly epidemics. That supports the comparison with previous disease outbreaks, but the paper does not specifically discuss similar effects from wars. Page numbers are not available in our copy. (LLM, conf=0.86)

  cites [12] Van Bortel T, Basnayake A, Wurie F, Jambai M, Koroma AS, Muana AT et al (2016) Psychosocial effects of an Ebola outbreak at individual, community and international levels. Bull World Health Organ 94(3):210–4. https://doi.org/10.2471/blt.15.158543 sourceExperimental — accuracy not yet measured
• Partly supported

  The ‘Ebola Virus Disease and Mental Health’ section reports fear, anxiety and distress during earlier Ebola and H1N1 outbreaks. Our copy does not address psychological effects of wars, so it supports only the disease-outbreak part of the sentence. (LLM, conf=0.86)

  cites [13] Tucci V, Moukaddam N, Meadows J, Shah S, Galwankar SC, Kapur GB (2017) The forgotten plague: psychiatric manifestations of Ebola, Zika, and emerging infectious diseases. J Glob Infect Dis 9(4):151–6. https://doi.org/10.4103/jgid.jgid_66_17 sourceExperimental — accuracy not yet measured

In the paper

“similar mental health effects were seen in past containment efforts during infectious disease outbreaks, such as the severe acute respiratory syndrome (SARS) in 2003 [2, 3], the 2009 swine flu pandemic [4, 5], and the 2014–2016 Ebola epidemic [6].”

What the sources say

• Partly supported

  The Results report psychological distress after the 2003 SARS outbreak in Taiwan, supporting the SARS portion of the cited sentence. The study does not establish that containment efforts caused those effects; it examines distress after the epidemic. The swine flu and Ebola portions have separate citations and are not attributed to this source. (LLM, conf=0.82)

  cites [2] Peng EY, Lee MB, Tsai ST, Yang CC, Morisky DE, Tsai LT et al (2010) Population-based post-crisis psychological distress: an example from the SARS outbreak in Taiwan. J Formos Med Assoc 109(7):524–32. https://doi.org/10.1016/s0929-6646(10)60087-3 sourceExperimental — accuracy not yet measured
• Supported

  The citation is attached to the SARS example, not the later swine flu or Ebola examples. The Discussion reports PTSD and depressive symptoms among people quarantined during the SARS outbreak in Toronto, supporting the claim that containment efforts had mental health effects. (LLM, conf=0.93)

  cites [3] Hawryluck L, Gold WL, Robinson S, Pogorski S, Galea S, Styra R (2004) SARS control and psychological effects of quarantine, Toronto, Canada. Emerg Infect Dis 10(7):1206–12. https://doi.org/10.3201/eid1007.030703 source
• Partly supported

  For the 2009 swine flu portion of the sentence, The Study reports that Hong Kong participants felt worried, depressed, or emotionally disturbed about pH1N1, and the Conclusions discuss mental distress during that pandemic (pages not specified). The paper does not establish that containment efforts caused those effects; it measures psychological responses to the virus alongside preventive behaviors. (LLM, conf=0.86)

  cites [4] Yeung NCY, Lau JTF, Choi KC, Griffiths S (2017) Population responses during the pandemic phase of the influenza A(H1N1)pdm09 epidemic, Hong Kong, China. Emerg Infect Dis 23(5):813–5. https://doi.org/10.3201/eid2305.160768 sourceExperimental — accuracy not yet measured
• Not checked yetcites [5] Taha SA, Matheson K, Anisman H (2014) H1N1 was not all that scary: uncertainty and stressor appraisals predict anxiety related to a coming viral threat. Stress Health 30(2):149–57. https://doi.org/10.1002/smi.2505 source
• Supported

  Citation [6] is attached to the Ebola example, not the SARS or swine-flu examples. The Results (Multivariate analysis; page not provided) report that Sierra Leone respondents who knew someone quarantined because of Ebola exposure were more likely to report anxiety, depression, and PTSD symptoms. This supports the claim of mental health effects associated with Ebola-era containment efforts, although the study reports associations rather than establishing causation. (LLM, conf=0.90)

  cites [6] Jalloh MF, Li W, Bunnell RE, Ethier KA, O’Leary A, Hageman KM et al (2018) Impact of Ebola experiences and risk perceptions on mental health in Sierra Leone, July 2015. BMJ Glob Health 3(2):e000471. https://doi.org/10.1136/bmjgh-2017-000471 source

In the paper

“Studies show that food insecurity is associated with low educational performance, while school lunch is associated with high educational attainment [57, 58].”

What the sources say

• Partly supported

  The IV Results section (page unavailable) reports that greater school-lunch participation improved math and English test scores among New York City middle-school students. The Literature section also reports another study's finding of more years of completed education under more generous lunch-program reimbursement. This supports a link to educational outcomes, but the paper's own results measure test performance, not educational attainment. (LLM, conf=0.84)

  cites [57] Schwartz AE, Rothbart MW (2020) Let them eat lunch: The impact of universal free meals on student performance. J Policy Anal Manage 39(2):376–410 sourceExperimental — accuracy not yet measured
• Supported

  Section 4.5 (Evidence of the Long-Run Effects) reports that a study of expanded U.S. school lunch funding found increased educational attainment—about one year for men and a smaller increase for women. This supports the cited claim as a broad paraphrase, although the finding concerns a particular expansion of the school lunch program. (LLM, conf=0.91)

  cites [58] Bitler MP, Seifoddini A (2019) Health impacts of food assistance: evidence from the United States. Annu Rev Res Econ 11:261–287 source

In the paper

“Five studies remained, which were all cross-sectional studies, conducted in China, and the variables most commonly measured were depression and anxiety [14–18].”

What the sources say

• Not checked yetcites [14] Chen F, Zheng D, Liu J, Gong Y, Guan Z, Lou D (2020) Depression and anxiety among adolescents during COVID-19: A cross-sectional study. Brain Behav Immun 88:36–8. https://doi.org/10.1016/j.bbi.2020.05.061 source
• Not checked yetcites [15] Duan L, Shao X, Wang Y, Huang Y, Miao J, Yang X et al (2020) An investigation of mental health status of children and adolescents in china during the outbreak of COVID-19. J Affect Disord. 275:112–8. https://doi.org/10.1016/j.jad.2020.06.029 source
• Not checked yetcites [16] Liang L, Ren H, Cao R, Hu Y, Qin Z, Li C et al (2020) The effect of COVID-19 on youth mental health. Psychiatr Q 91(3):841–852 source
• Not checked yetcites [17] Tang S, Xiang M, Cheung T, Xiang Y-T (2021) Mental health and its correlates among children and adolescents during COVID-19 school closure: The importance of parent-child discussion. J Affect Disord 279:353–360 source
• Not checked yetcites [18] Xie X, Xue Q, Zhou Y, Zhu K, Liu Q, Zhang J et al (2020) Mental health status among children in home confinement during the coronavirus disease 2019 outbreak in Hubei Province, China. JAMA Pediatr 174(9):898–900. https://doi.org/10.1001/jamapediatrics.2020.1619 source

In the paper

“anxiety score for children was 23.87 ± 15.79, while the anxiety score for adolescents was 29.27 ± 19.70.”

In the paper

“our findings of five studies on children and 16 studies on college students found that both groups reported feeling more anxious, depressed, fatigued, and distressed than prior to the pandemic.”

• Also stated in: § Discussion · plain

  “Children and college students reported feeling more anxious, depressed, fatigued, and distressed than prior to the pandemic.”

In the paper

“over 75% of its sample felt fatigued and over 80% of individuals felt sad and empty due to the COVID-19 pandemic.”

In the paper

“low family income, having relatives or friends infected with COVID-19, and living in rural areas were risk factors for increased levels of anxiety among college students and overall worse mental well-being.”

In the paper

“Several risk factors such as living in rural areas, low family socioeconomic status, and being a family member or friend to a healthcare worker were strongly associated with worse mental health outcomes.”

• Also stated in: § Discussion · boosted

  “Additionally, several risk factors such as living in rural areas, low family socioeconomic status, being a family member or friend to a healthcare worker, and knowing someone who was infected with COVID-19 were strongly associated with worse mental health outcomes.”

In the paper

“The variables most commonly measured in these studies were depression and anxiety, and some studies included other variables such as stress and suicidal thoughts.”

In the paper

“Overall, 14% of the population, which included individuals from 14 to 35 years old, reported having PTSD symptoms.”

In the paper

“In summary, our systematic review of five studies on children and 16 studies on college students found that children and college students reported feeling more anxious, depressed, fatigued, and distressed than prior to the pandemic.”

In the paper

“138 countries had implemented national school closures due to COVID-19 by May 2020, which impacted more than one billion children and young adults—approximately 80% of the global student population [37].”

What the sources say

• Not checked yetcites [37] UNESCO. Education: From disruption to recovery: UNESCO; 2021 [cited 2021]. Available from: https://en.unesco.org/covid19/educationresponse.

In the paper

“ECMHC is a preventative intervention that places mental health consultants in early childcare settings and pairs these consultants with families to address a child’s individual needs and increase their social and emotional health [42, 45, 46].”

What the sources say

• Not checked yetcites [42] Cohen E, Kaufmann RK. Early childhood mental health consultation: National Technical Assistance Center for Children's Mental Health; 2000.
• Not checked yetcites [45] Zero to Three. Early Childhood Mental Health Consultation: Policies and Practices to Foster the Social-Emotional Development of Young Children Zero to Three2016 [cited 2021 October]. Available from: https://www.zerotothree.org/resources/1694-early-childhood-mental-health-consultation-policies-and-practices-to-foster-the-social-emotional-development-of-young-children.
• Not checked yetcites [46] Duran F, Hepburn K, Irvine M, Kaufmann R, Anthony B, Horenn N et al (2009) What works? A study of effective early childhood mental health consultation programs. Georgetown University. Center for Child and Human Development, Washington, DC

In the paper

“This is not surprising as rural areas, as opposed to urban areas, often have limited mental health services, lacking access to adequate healthcare, being economically and educationally under-resourced, and usually consisting of elder populations with worse health outcomes—making those living in these communities even more vulnerable to COVID-19 [49–51].”

What the sources say

• Not checked yetcites [49] Ranscombe P (2020) Rural areas at risk during COVID-19 pandemic. Lancet Infect Dis 20(5):545. https://doi.org/10.1016/s1473-3099(20)30301-7 source
• Not checked yetcites [50] Human J, Wasem C (1991) Rural mental health in America. Am Psychol 46(3):232–9. https://doi.org/10.1037//0003-066x.46.3.232 source
• Not checked yetcites [51] CDC. Rural Communities CDC2021 [cited 2021]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/other-at-risk-populations/rural-communities.html.

In the paper

“one-third of adolescents reported high levels of loneliness and almost half of young adults reported being lonely while quarantining [38–40].”

What the sources say

• Not checked yetcites [38] Lim M. Achieving resilience during COVID-19: psycho-social risk & protective factors amidst a pandemic in adolescents: Mental Health Research Matters; 2020 [cited 2021]. Available from: http://mentalhealthresearchmatters.org.uk/achieving-resilience-during-covid-19-psycho-social-risk-protective-factors-amidst-a-pandemic-in-adolescents/.
• Not checked yetcites [39] Young Minds. Coronavirus: Impact on young people with mental health needs 2020 [cited 2021]. Available from: https://youngminds.org.uk/media/3708/coronavirus-report_march2020.pdf.
• Not checked yetcites [40] Mental Health Foundation. Loneliness during coronavirus. MentalHealth. 2020.

In the paper

“Two authors of this review independently extracted data on basic demographic characteristics and mental health measurements”

In the paper

“Two authors of this review independently retrieved studies from the searches using terms relevant to the impact of COVID-19 on the mental health of children”

In the paper

“Studies have shown that ECMHC is effective and being used across child care centers, Head Start/Early Head Start centers, home visiting programs, primary care settings, elementary schools (kindergarten through third grade), and community outreach programs [41, 45, 46, 48].”

What the sources say

• Not checked yetcites [41] Gilliam WS, Maupin AN, Reyes CR (2016) Early Childhood Mental Health Consultation: Results of a Statewide Random-Controlled Evaluation. J Am Acad Child Adolesc Psychiatry. 55(9):754–61. https://doi.org/10.1016/j.jaac.2016.06.006 source
• Not checked yetcites [45] Zero to Three. Early Childhood Mental Health Consultation: Policies and Practices to Foster the Social-Emotional Development of Young Children Zero to Three2016 [cited 2021 October]. Available from: https://www.zerotothree.org/resources/1694-early-childhood-mental-health-consultation-policies-and-practices-to-foster-the-social-emotional-development-of-young-children.
• Not checked yetcites [46] Duran F, Hepburn K, Irvine M, Kaufmann R, Anthony B, Horenn N et al (2009) What works? A study of effective early childhood mental health consultation programs. Georgetown University. Center for Child and Human Development, Washington, DC
• Not checked yetcites [48] Hoffmann E, Ewen D. 2007 Supporting families, nurturing young children: Early Head Start programs in 2006. CLASP Policy Brief (Head Start Series). 9.

In the paper

“When COVID-19 social distancing measures were imposed, many businesses were forced to shut down—leaving many adults unemployed for several months [56].”

What the sources say

• Not checked yetcites [56] Parker K, Minkin R, Bennett J. 2020 Economic fallout from COVID-19 continues to hit lower-income Americans the hardest. Pew Research Center. 21.

In the paper

“The relationship between income status and mental health has been well-documented as there are higher rates of mental illness in groups with lower socioeconomic status [53–55].”

What the sources say

• Not checked yetcites [53] Warren JR (2009) Socioeconomic status and health across the life course: a test of the social causation and health selection hypotheses. Soc Forces. 87(4):2125–53. https://doi.org/10.1353/sof.0.0219 source
• Not checked yetcites [54] Perry MJ (1996) The relationship between social class and mental disorder. J Prim Prev 17(1):17–30. https://doi.org/10.1007/bf02262736 source
• Not checked yetcites [55] Wang H, Yang XY, Yang T, Cottrell RR, Yu L, Feng X et al (2015) Socioeconomic inequalities and mental stress in individual and regional level: a twenty one cities study in China. Int J Equity Health 14:25. https://doi.org/10.1186/s12939-015-0152-4 source

In the paper

“In the U.S., specifically, rural areas are becoming more racially and ethnically diverse, with more Black/African American, Latinx, and Native American populations—groups who are at increased risk of contracting COVID-19 and having severe illness due to inequities in social determinants of health—migrating to rural communities [51, 52].”

What the sources say

• Not checked yetcites [51] CDC. Rural Communities CDC2021 [cited 2021]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/other-at-risk-populations/rural-communities.html.
• Not checked yetcites [52] CDC. Health Equity Considerations and Racial and Ethnic Minority Groups CDC2020 [cited 2021]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fneed-extra-precautions%2Fracial-ethnic-minorities.html.

In the paper

“Some strengths of our review are it answers a more expansive question (as opposed to other similar reviews [62–65]), it is focused on COVID-19, and covers a large date range, which makes our review one of the first systematic reviews to have these qualities.”

In the paper

“Some strengths of our review are it answers a more expansive question (as opposed to other similar reviews [62–65]), it is focused on COVID-19, and covers a large date range, which makes our review one of the first systematic reviews to have these qualities.”

In the paper

“Studies show that food insecurity is associated with low educational performance, while school lunch is associated with high educational attainment [57, 58].”

What the sources say

• Not checked yetcites [57] Schwartz AE, Rothbart MW (2020) Let them eat lunch: The impact of universal free meals on student performance. J Policy Anal Manage 39(2):376–410 source
• Not checked yetcites [58] Bitler MP, Seifoddini A (2019) Health impacts of food assistance: evidence from the United States. Annu Rev Res Econ 11:261–287 source

In the paper

“Because urban areas are more densely populated, which raises concerns during an infectious disease outbreak, the public health community and policymakers may be investing more of its COVID-19 resources and informational messaging towards large cities.”

In the paper

“Additionally, although the COVID-19 pandemic has resulted in a widespread forced adoption of telehealth services to deliver psychiatric and mental health support [59–61], healthcare providers should identify ways to cater more healthcare workers, those infected by COVID-19, and the families of these groups through employer benefits and insurance companies.”

What the sources say

• Not checked yetcites [59] Zhou X, Snoswell CL, Harding LE, Bambling M, Edirippulige S, Bai X et al (2020) The role of telehealth in reducing the mental health burden from COVID-19. Telemed e-Health 26(4):377–379 source
• Not checked yetcites [60] Ohannessian R, Duong TA, Odone A (2020) Global telemedicine implementation and integration within health systems to fight the COVID-19 pandemic: a call to action. JMIR Public Health Surveil 6(2):e18810 source
• Not checked yetcites [61] Smith AC, Thomas E, Snoswell CL, Haydon H, Mehrotra A, Clemensen J et al (2020) Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19). J Telemed Telecare 26(5):309–313 source

In the paper

“Because healthcare workers are on the frontlines in combatting COVID-19 as they treat patients on a frequent basis, children and young adults who are in close contact with these healthcare professionals may be even more worried about contracting the virus, given their level of direct contact.”

In the paper

“However, even if we did exclude these non-peer reviewed studies from our systematic review, our overall findings would remain the same.”

In the paper

“This is not surprising as rural areas, as opposed to urban areas, often have limited mental health services, lacking access to adequate healthcare, being economically and educationally under-resourced, and usually consisting of elder populations with worse health outcomes—making those living in these communities even more vulnerable to COVID-19 [49–51].”

What the sources say

• Not checked yetcites [49] Ranscombe P (2020) Rural areas at risk during COVID-19 pandemic. Lancet Infect Dis 20(5):545. https://doi.org/10.1016/s1473-3099(20)30301-7 source
• Not checked yetcites [50] Human J, Wasem C (1991) Rural mental health in America. Am Psychol 46(3):232–9. https://doi.org/10.1037//0003-066x.46.3.232 source
• Not checked yetcites [51] CDC. Rural Communities CDC2021 [cited 2021]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/other-at-risk-populations/rural-communities.html.

In the paper

“As a result, college students who worked several jobs to pay for tuition and/or housing were also laid off—adding economic pressure during an already overwhelming time.”

In the paper

“In the U.S., specifically, rural areas are becoming more racially and ethnically diverse, with more Black/African American, Latinx, and Native American populations—groups who are at increased risk of contracting COVID-19 and having severe illness due to inequities in social determinants of health—migrating to rural communities [51, 52].”

What the sources say

• Not checked yetcites [51] CDC. Rural Communities CDC2021 [cited 2021]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/other-at-risk-populations/rural-communities.html.
• Not checked yetcites [52] CDC. Health Equity Considerations and Racial and Ethnic Minority Groups CDC2020 [cited 2021]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fneed-extra-precautions%2Fracial-ethnic-minorities.html.

In the paper

“There were also more college student studies identified than children-related studies.”

In the paper

“Some strengths of our review are it answers a more expansive question (as opposed to other similar reviews [62–65]), it is focused on COVID-19, and covers a large date range, which makes our review one of the first systematic reviews to have these qualities.”

What the sources say

• Not checked yetcites [62] Loades ME, Chatburn E, Higson-Sweeney N, Reynolds S, Shafran R, Brigden A et al (2020) 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. https://doi.org/10.1016/j.jaac.2020.05.009 source
• Not checked yetcites [63] Racine N, Cooke JL, Eirich R, Korczak DJ, McArthur B, Madigan S (2020) Child and adolescent mental illness during COVID-19: A rapid review. Psychiatr Res. https://doi.org/10.1016/j.psychres.2020.113307 source
• Not checked yetcites [64] Guessoum SB, Lachal J, Radjack R, Carretier E, Minassian S, Benoit L et al (2020) Adolescent psychiatric disorders during the COVID-19 pandemic and lockdown. Psychiatr Res. https://doi.org/10.1016/j.psychres.2020.113264 source
• Not checked yetcites [65] da Silva Junior FJG, de Souza Monteiro CF, Costa APC, Campos LRB, Miranda PIG, de Souza Monteiro TA et al (2020) Impact of COVID-19 pandemic on mental health of young people and adults: a systematic review protocol of observational studies. BMJ Open 10(7):e039426 source

In the paper

“This highlights an important global health concern as children are not only experiencing worse mental health outcomes, but their physical health is also being negatively impacted.”