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Mental health and its correlates among children and adolescents during COVID-19 school closure: The importance of parent-child discussion
Open accessAbstract
Background School closures due to the COVID-19 outbreak have affected 87% of the world's students physically, socially, and psychologically, yet rigorous investigation into their mental health during this period is still lacking. Methods A cross-sectional online survey of 4-342 primary and secondary school students from Shanghai, China was conducted during March 13-23, 2020. Besides demographic information, psychological distress (including depression, anxiety, and stress), life satisfaction, perceived impact of home quarantine, and parent-child discussions on COVID-19 were assessed. Results The three most prevalent symptoms were: anxiety (24.9%), depression (19.7%), and stress (15.2%). Participants were generally satisfied with life and 21.4% became more satisfied with life during school closures. Senior grades were positively correlated with psychopathological symptoms and negatively associated with life satisfaction, whereas the perceived benefit from home quarantine and parent-child discussions on COVID-19 were negatively correlated with psychopathological symptoms and positively correlated with life satisfaction. Among participants who perceived no benefit from home quarantine, those who had discussions with their parents about COVID-19 experienced less depression, anxiety, and stress. Limitations Limitations included the inability to infer the casual relationship, no parental report for mental health of children aged 6 to 9, and the inadequate measurement of parent-child discussion. Conclusions Mental health problems and resilience co-existed in children and adolescents during the COVID-19 outbreak. Given the important role of parent-child discussions, open communication between parents and children about the pandemic should be encouraged to help children and adolescents cope with mental health problems in public health crisis.
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“In an unfamiliar situation of home-quarantine, children do not always know how to communicate their fears and anxieties [31].”
From COVID-19-Related Anxiety Symptoms among Quarantined Adolescents and Its Impact on Sleep Pattern Changes and Somatic Symptoms (2022) · cites this paper as [31]
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“our findings of five studies on children and 16 studies on college students”
From Mental Health Impact of COVID-19 among Children and College Students: A Systematic Review (2023) · cites this paper as [17]
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“Five studies remained, which were all cross-sectional studies, conducted in China, and the variables most commonly measured were depression and anxiety [14–18].”
From Mental Health Impact of COVID-19 among Children and College Students: A Systematic Review (2023) · cites this paper as [17]
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“the variables most commonly measured were depression and anxiety [14–18]”
From Mental Health Impact of COVID-19 among Children and College Students: A Systematic Review (2023) · cites this paper as [17]
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BackgroundParental Perceptions of Child and Adolescent Mental Health During the COVID-19 Pandemic in Argentina
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“With regard to protective factors against depression, some authors suggest that frequent physical exercise [38,40] and frequent communication with parents [41] were among the key factors.”
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“The pandemic created a huge crisis for individuals, triggering stress responses both physically and psychologically (Tang et al., 2021).”
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“For example, the higher the frequency of parent-child communication, the less negative effects children face (Tang et al., 2021).”
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“Furthermore, if parents discuss the pandemic situation with their children, there is less risk that the child will experience depression, anxiety and stress [27].”
BackgroundThe Resilience of Caregivers and Children in the Context of COVID-19: A Systematic Review
Yates, J., & Mantler, T. (2023) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-022-00514-w · Cited by 18
“…the mental wellbeing of school-aged children, preliminary results from cross-sectional studies have varied (Duan et al., 2020; Liang et al., 2020; Ma et al., 2021; Marques de Miranda et al., 2020; Orgilés et al., 2021; Tang et al., 2021; Xie et al., 2020; Yeasmin et al., 2020; Zhou et al., 2020).”
Result[Epistaxis caused by leeches].
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Tinsae, T., Shumet, S., Takelle, G. M., Rtbey, G., Melkam, M., Andualem, F., Nakie, G., Segon, T., Koye, S., Fentahun, S., et al. (2024) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-024-00782-4 · Cited by 20
“These results are in line with other studies showing that older adolescents experienced significant emotional and behavioral problems [56–59] than younger adolescents.”
ResultEhrler, M., Hagmann, C. F., Stöckli, A., Kretschmar, O., Landolt, M. A., Latal, B., & Wehrle, F. M. (2022) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-022-02014-6 · Cited by 15
Renzi, A., Conte, G., & Tambelli, R. (2022) · Healthcare · doi:10.3390/healthcare10112171 · Cited by 17
“Third, recent research has emphasized the role of parent–child discussion on the pandemic as an important protective factor against psychopathological outcomes, showing that children and adolescents who discussed the pandemic with their parents were less likely to report symptoms of depression, anxiety and stress [95].”
BackgroundShmatova, Y., & Разварина, И. Н. (2022) · SOCIETY AND SECURITY INSIGHTS · doi:10.14258/ssi(2022)3-09 · Cited by 14
Panchal, U. R., Vaquerizo‐Serrano, J., Conde-Ghigliazza, I., Genç, H. A., Marchini, S., Pociūtė, K., Ocakoğlu, B. K., Sanchez-Roman, S., Őri, D., Catalán, A., et al. (2023) · The European Journal of Psychiatry · doi:10.1016/j.ejpsy.2023.06.003 · Cited by 17
Gül, M. K., & Demirci, E. (2021) · Eurasian Journal of Medicine and Oncology · doi:10.14744/ejmo.2021.14105 · Cited by 15
The ecology of youth psychological wellbeing in the COVID-19 pandemic.
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Considerations for the Safe Operation of Schools During the Coronavirus Pandemic
Lordan, R., Prior, S., Hennessy, E. J., Naik, A. S., Ghosh, S., Paschos, G. K., Skarke, C., Barekat, K., Hollingsworth, T., Juska, S. A., et al. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.751451 · Cited by 16
Self-citationWang, J., Chen, Y., Chen, H., Hua, L., Wang, J., Jin, Y., He, L., Chen, Y., & Yao, Y. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.991033 · Cited by 19
Shirotsuki, K., Sugaya, N., & Nakao, M. (2022) · BioPsychoSocial Medicine · doi:10.1186/s13030-021-00233-y · Cited by 14
“Furthermore, only about 24% were satisfied with their lives [6].”
BackgroundUysal, B., Morgül, E., Taştekne, F., Sönmez, D., Tepedelen, M. S., Gülay, S., Aydın, İ., Evecek, H., & Görmez, V. (2022) · School Psychology International · doi:10.1177/01430343221097613 · Cited by 14
“A study that was carried out in China showed that negative coping style is a predictor of depression, anxiety and stress in adolescents (Novak et al., 2021).”
BackgroundInfluentialLeón-Rojas, D., Castorena-Torres, F., Garza-Ornelas, B., Tarquino, A. M. C., Silva, C. A. S., Chanona, J. L. A., & Rodríguez-de-Ita, J. (2022) · BMJ Paediatrics Open · doi:10.1136/bmjpo-2022-001468 · Cited by 11
Dong, R., & Dou, K. (2023) · Brain and Behavior · doi:10.1002/brb3.3116 · Cited by 15
Unveiling Coronasomnia: Pandemic Stress and Sleep Problems During the COVID-19 Outbreak
Chen, S., & Cheng, C. (2024) · Nature and Science of Sleep · doi:10.2147/nss.s459945 · Cited by 13
Comelli, F. A. D. M., da Costa, M., & Tavares, E. D. S. (2021) · The International Review of Research in Open and Distributed Learning · doi:10.19173/irrodl.v23i1.5869 · Cited by 16
“Tang et al. (2021) describe a study with 4,391 students from Shanghai, China: a quarter of the students had anxiety symptoms, about 20% had depression, and more than 650 students had symptoms of stress.”
BackgroundWang, L., Yeerjiang, Y., Gao, H. F., Pei, J. F., Zhang, R. X., & Xu, W. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.01.056 · Cited by 17
“Finally, long-term social distancing and home confinement, the main measures taken to prevent spreading of COVID in China, could cause negative emotional responses like feelings of loneliness and helplessness, particularly for those lacking family support (Tang et al. 2021) and even undergoing increased domestic viole…”
BackgroundMatiz, A., Fabbro, F., Paschetto, A., Urgesi, C., Ciucci, E., Baroncelli, A., & Crescentini, C. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.803270 · Cited by 14
“, (92, 93)] and reviews (12, 16) reported greater severity of anxiety, depression and stress symptoms in adolescents than in primary school children during 2020.”
BackgroundPandemic Isolation and Mental Health Among Children
Brannen, D. E., Wynn, S., Shuster, J. L., & Howell, M. (2023) · Disaster Medicine and Public Health Preparedness · doi:10.1017/dmp.2023.7 · Cited by 13
Ito, Y., Kako, J., Kajiwara, K., Kimura, Y., Kakeda, T., Hamanishi, S., Sasaki, S., Yamanaka, M., Kiyohara, H., Wakiguchi, Y., et al. (2022) · Environmental Health and Preventive Medicine · doi:10.1265/ehpm.22-00128 · Cited by 16
“” Based on a study by Tang et al. [33], the following two parameters of life satisfaction were assessed: “ life satisfaction ” and “ change in life satisfaction since the start of the pandemic.”
Zeng, Z., Peng, L., Liu, S., He, Z., & Hu, Y. (2023) · Current Psychology · doi:10.1007/s12144-023-05217-5 · Cited by 15
“It is more important for children to experience a safe and warm environment (McQuaid et al., 2022; Tang et al., 2021).”
Preventive strategies for adolescent depression: What are we missing? A focus on biomarkers
Zonca, V. (2021) · Brain Behavior & Immunity - Health · doi:10.1016/j.bbih.2021.100385 · Cited by 13
Frye, W. S., Feldman, M. A., Katzenstein, J. M., & Gardner, L. M. (2022) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-021-09839-4 · Cited by 12
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Yi, L.-J., Liu, Y., Tang, L. Y., Cheng, L., Wang, G.-H., Hu, S.-W., Liu, X., Tian, X., & Herrera, M. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.890327 · Cited by 16
Li, P., Wang, Y., Kovess–Masféty, V., Su, X., Hou, X., Li, M., Li, P., Li, J., Pang, J., Ma, H., et al. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.05.006 · Cited by 12
COVID-19 and students' mental health: foreign studies
Ermolova, T. V., Litvinov, A. V., Savitskaya, N. V., & Krukovskaya, O. A. (2021) · Journal of Modern Foreign Psychology · doi:10.17759/jmfp.2021100108 · Cited by 12
Kim, S. Y., Lee, N.-E., Yoo, D. M., Kim, J. H., Kwon, M. J., Kim, J., Bang, W. J., & Choi, H. G. (2022) · Life · doi:10.3390/life12040600 · Cited by 12
“In a cross-sectional online survey, the three most common psychiatric symptoms in primary and secondary school students during school closures due to COVID-19 outbreaks were anxiety, depression, and stress [13].”
BackgroundSocial isolation among adolescents and its association with depression symptoms
Alsadoun, D. A., Alotaibi, H. S., Alanazi, A. I., Almohsen, L. A., Almarhoum, N. N., & Mahboub, S. M. (2023) · Middle East Current Psychiatry · doi:10.1186/s43045-023-00314-4 · Cited by 11
Psychological Resilience Interventions for Adolescents during the COVID-19 Pandemic
Xing, J., Xu, X., Li, X., & Luo, Q. (2023) · Behavioral Sciences · doi:10.3390/bs13070543 · Cited by 16
“Similar studies have shown gradual and substantial increases in depression, anxiety, and stress in adolescents [14].”
ResultRimpelä, A., Kesanto‐Jokipolvi, H., Myöhänen, A., Heikonen, L., Oinas, S., & Ahtiainen, R. (2023) · BMC Public Health · doi:10.1186/s12889-023-17342-8 · Cited by 17
“This was also true in most above-mentioned studies dealing with gender, but some studies showed no gender difference [13].”
Advances in the prevalence and treatment of depression for adolescents: a review
Yin, C., Xu, M., & Zong, Z. (2025) · Frontiers in Pharmacology · doi:10.3389/fphar.2025.1574574 · Cited by 13
Kako, J., Ito, Y., Kajiwara, K., Kimura, Y., Kakeda, T., Hamanishi, S., Sasaki, S., Yamanaka, M., Kiyohara, H., Wakiguchi, Y., et al. (2021) · BMJ Open · doi:10.1136/bmjopen-2021-055916 · Cited by 11
“39 Current life satisfaction will be assessed using an 11-point Likert scale, ranging from ‘0: extremely dissatisfied’ to ‘10: extremely satisfied’.”
MethodTian, Y., Chen, L., & Shi, Y. (2022) · Vaccines · doi:10.3390/vaccines11010087 · Cited by 11
Heaton, K. G., Camacho, N. L., & Gaffrey, M. S. (2023) · Scientific Reports · doi:10.1038/s41598-023-42268-x · Cited by 12
“Situational parenting practices, like emotion-coaching and parent–child discussions, have previously been associated with decreases in children’s anxiety symptoms during COVID-19 34–37 .”
BackgroundResultAlizadeh, S., Shahrousvand, S., Sepandi, M., & Alimohamadi, Y. (2023) · Journal of Public Health · doi:10.1007/s10389-023-02168-w · Cited by 12
Ma, J., Ding, J., Hu, J., Wang, K., Xiao, S., Luo, T., Yu, S., Liu, C.-T., Xu, Y.-X., Liu, Y., et al. (2021) · Journal of Psychiatry and Brain Science · doi:10.20900/jpbs.20210020 · Cited by 12
“Previous studies have found that age [10,11], distance learning [10], screen usage [9,12], parents’ occupation as doctors [13], and parents’ mental health during the epidemic [12], the children’s mental health before the outbreak [13,14], high school students [15,16], sleep time [12,16,17], exercise time [12,17,18] af…”
Metadata
- Authors
- Tang, S., Xiang, M., Cheung, T., & Xiang, Y.-T.
- Affiliations
- Shenzhen University (CN)
- Shanghai Jiao Tong University (CN)
- Hong Kong Polytechnic University (HK)
- University of Macau (MO)
- Corresponding author
- Tang, Suqin
- Xiang, Mi
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2021-01
- Volume
- 279
- Pages
- 353-360
- ISSN
- 0165-0327 (ISSN-L)
- PMC
- PMC7550131
- OpenAlex
- W3092386566
- Cited by
- 628
- References
- 29
- Citations by year
- 2026: 17 · 2025: 56 · 2024: 84 · 2023: 144 · 2022: 208 · 2021: 115
- FWCI
- 46.94
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Shenzhen University
- National Natural Science Foundation of China
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Developmental and Educational Psychology › Student Stress and Coping
- Keywords
- COVID-19 pandemic, school closures, child and adolescent mental health, psychological distress, depression, anxiety, stress, life satisfaction, parent-child communication, home quarantine, resilience, pandemic coping
- MeSH terms
- COVID-19, SARS-CoV-2, Adolescent, Anxiety, Child, China, Cross-Sectional Studies, Depression, Female, Humans, Male, Mental Health, Parent-Child Relations, Parents, Quarantine, Surveys and Questionnaires, Schools, Students, Pandemics
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