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Cited by 3COVID-19 and Mental HealthChild and Adolescent Psychosocial and Emotional DevelopmentMaternal Mental Health During Pregnancy and Postpartum

COVID-19-Related Anxiety Symptoms among Quarantined Adolescents and Its Impact on Sleep Pattern Changes and Somatic Symptoms

Open access
Gendler, Yulia, Blau, Ayala·2022·Children
DOI 10.3390/children9050735PMC PMC9139826
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Abstract

Background: Home-quarantine due to COVID-19 may have negative psychological effects on vulnerable sub-groups such as children and adolescents. We aimed to explore the prevalence of anxiety among adolescents who were in home-quarantine and its impact on onset of sleep disturbance and somatic symptoms, and on the level of agreement between adolescent and parent perceptions. Methods: Five hundred adolescents (ages 10–17) and 500 parents participated in the study. Adolescents filled out PROMIS Anxiety, PROMIS Sleep Disturbance, and PHQ-15 Physical-Symptom forms, while their parents completed proxy questionnaires containing the same domains. Results: 38% of the adolescents reported experiencing anxiety during home-quarantine period, 29% suffered from sleep disturbance, and 48% reported somatic symptoms. Addition of one day in home-quarantine was significantly associated with sleep disturbance (OR = 3.78, 95%CI: 1.09–8.45) and somatic symptoms (OR = 1.80, 95%CI: 1.01–3.08); female gender was associated with increased risk for somatic symptoms (OR = 2.15, 95%CI: 1.07–4.55); poor agreement in levels of anxiety, sleep disturbance and somatic symptoms was found between adolescent and parent reports (ICCs of 0.197–0.262). Discussion: Total isolation from household members during home-quarantine may cause anxiety, sleep disturbance, and somatization among adolescents. Achieving the appropriate balance between infection control and mitigation of the potential adverse psychological effect of home-quarantine among children and adolescents should be immediate priorities for policymakers.

AI snapshot

Written from the paper’s full text.

TL;DR

In a cross-sectional web-based study of 500 quarantined Israeli adolescents and 500 parents, 38% of adolescents reported anxiety, 29% sleep disturbance, and 48% somatic symptoms during home quarantine. Anxiety was strongly associated with sleep disturbance and somatic symptoms, while adolescent and parent reports showed poor agreement across all three domains.

Key findings

  • Among adolescents, 38% scored above the PROMIS anxiety threshold, 29% had mild/moderate/severe sleep disturbance, and 48% reported somatic symptoms; the most common somatic symptoms were sleep disturbance (42%), feeling tired or having no energy (38%), and headaches (29%).
  • Anxiety correlated positively with sleep disturbance (r = 0.726, p < 0.001) and somatic symptoms (r = 0.614, p < 0.001).
  • In logistic regression, each additional quarantine day was associated with sleep disturbance (OR = 3.78, 95% CI: 1.09–8.45) and somatic symptoms (OR = 1.80, 95% CI: 1.01–3.08); female gender increased somatic symptom risk (OR = 2.15, 95% CI: 1.07–4.55); older age decreased somatic symptom risk (OR = 0.73, 95% CI: 0.55–0.94); anxiety was the strongest predictor of sleep disturbance (OR = 31.66, 95% CI: 7.46–66.34) and somatic symptoms (OR = 8.44, 95% CI: 2.77–25.72).
  • Adolescent and parent reports showed poor agreement, with ICCs of 0.262, 0.254, and 0.197 for anxiety, sleep disturbance, and somatic symptoms; adolescents’ mean T-scores were significantly higher than parents’ proxy reports in all three domains.

Methods

  • Cross-sectional, web-based study conducted during Israel’s third COVID-19 wave from 20 January to 20 March 2021; participants were 500 adolescents aged 10–17 quarantined due to exposure to COVID-19-positive individuals and 500 parents, one per adolescent.
  • Adolescents completed PROMIS Anxiety Short Form, PROMIS Sleep Disturbance Short Form, and PHQ-15 Physical-Symptom forms; parents completed proxy questionnaires with the same domains.
  • Analyses included descriptive statistics, chi-square tests, Pearson correlations, binary logistic regression, and intraclass correlations (ICCs) to assess adolescent–parent agreement.

Limitations

  • Stated by the paper: the online design meant response rate could not be calculated, potentially causing selection bias; the cross-sectional design prevented establishing temporal ordering or causation; and medical background/pre-COVID-19 anxiety or mood disorder history was not collected.
  • Evident from the text: recruitment through a Facebook-distributed URL may further limit generalizability and introduce selection bias beyond the stated online-response limitation.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3390/children9050735

Cites

31 of 31 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

17 of 22 cited sources checked · 7 supported · 0 flagged · accuracy not yet measured

  • Interpretationcitation

    Sleep disturbance during home-quarantine may be caused by changes in routine, decreased physical activity, absence of social contact with peers, and increased technology consumption.

    “Sleep disturbance during home-quarantine may be caused by changes in routine, decreased physical activity, absence of social contact with peers, and increase in technology consumption such as mobile phones and computers [8,9].”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [8] Bates, L.C., Zieff, G., Stanford, K., Moore, J.B., Kerr, Z.Y., Hanson, E.D., Barone Gibbs, B., Kline, C.E., and Stoner, L. (2020). COVID-19 Impact on Behaviors across the 24-Hour Day in Children and Adolescents: Physical Activity, Sedentary Behavior, and Sleep. Children, 7. source

      Section 4 (COVID-19 and Sleep; page unavailable) links disrupted routines, reduced outdoor activity, and increased screen time to changes in sleep or circadian timing during COVID-19 restrictions. Section 5.3 recommends promoting connectedness before sleep, but does not identify absence of contact with peers as a cause of sleep disturbance. The paper’s discussion also concerns children and adolescents, rather than people in home quarantine generally. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [9] 2021, Consequences of COVID-19 Confinement on Anxiety, Sleep and Executive Functions of Children and Adolescents in Spain, Front. Psychol. source
  • Interpretationcitation

    In an unfamiliar situation of home-quarantine, children do not always know how to communicate their fears and anxieties.

    “In an unfamiliar situation of home-quarantine, children do not always know how to communicate their fears and anxieties [31].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [31] Tang, 2020, Mental health and its correlates among children and adolescents during COVID-19 school closure: The importance of parent-child discussion, J. Affect. Disord. source

      The Introduction (page unavailable) discusses children’s concerns and anxiety during home confinement, and the Discussion reports anxiety among children experiencing home quarantine. Neither passage says that children do not know how to communicate their fears or anxieties; the paper instead examines whether parents discussed COVID-19 with them. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
  • Premisecitation

    Confined during a period of quarantine, children and adolescents may experience higher probability of behavioral and emotional disorders, including anxiety.

    “Confined during a period of quarantine, this population may experience higher probability of behavioral and emotional disorders, including anxiety [26].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [26] JJiao, 2020, Behavioral and Emotional Disorders in Children during the COVID-19 Epidemic, J. Pediatr. source

      The Early Investigation section reports behavioral and emotional problems among children and adolescents during COVID-19 restrictions, including some confined at home. The Psychological Distress section discusses anxiety and reports higher rates of fear and anxiety in highly affected areas, but says those differences were not statistically significant. The paper does not establish that quarantine itself increases the probability of these problems compared with not being confined. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
  • Findingown data

    Each additional day in home-quarantine is significantly associated with sleep disturbance (OR = 3.78, 95% CI: 1.09-8.45).

    “Addition of one day in home-quarantine was significantly associated with sleep disturbance (OR = 3.78, 95%CI: 1.09–8.45) and somatic symptoms (OR = 1.80, 95%CI: 1.01–3.08)”
    • Also stated in: § 3. Results · plain
      “Addition of one day in home-quarantine was significantly associated with sleep disturbance (OR = 3.78, 95% CI: 1.09–8.45) and somatic symptoms (OR = 1.80, 95% CI: 1.01–3.08)”
    Quote in the paperSubstantial claim
  • Findingown data

    29% of quarantined adolescents experienced mild, moderate, or severe sleep disturbance.

    “29% suffered from sleep disturbance”
    • Also stated in: § 3. Results · plain
      “29% experienced mild, moderate, or severe sleep disturbance”
    Quote in the paperSubstantial claim
  • May combine two claims. 12
  • Classified as probably not a substantial claim. 13

  • May combine two claims.

    Interpretationcitation

    The present findings are consistent with previous studies demonstrating significant links between anxiety and sleep disturbance and between anxiety and somatic symptoms.

    “Our present findings are consistent with previous studies demonstrating significant links between anxiety and sleep disturbance [8,9,14], and between anxiety and somatic symptoms [28,29].”
    Quote in the paperNot a substantial claim4 of 5 sources checked
    • cites [8] Bates, L.C., Zieff, G., Stanford, K., Moore, J.B., Kerr, Z.Y., Hanson, E.D., Barone Gibbs, B., Kline, C.E., and Stoner, L. (2020). COVID-19 Impact on Behaviors across the 24-Hour Day in Children and Adolescents: Physical Activity, Sedentary Behavior, and Sleep. Children, 7. source

      Section 4, “COVID-19 and Sleep” (page unavailable), states that insufficient sleep can result in anxiety or mood swings, supporting a link between sleep and anxiety. The paper does not report a statistically significant association. The somatic-symptoms clause has separate citations in the citing sentence and is not attributed to this source. (LLM, conf=0.81)

      Experimental — accuracy not yet measured
    • cites [9] 2021, Consequences of COVID-19 Confinement on Anxiety, Sleep and Executive Functions of Children and Adolescents in Spain, Front. Psychol. source
    • cites [14] Zreik, 2020, Maternal perceptions of sleep problems among children and mothers during the coronavirus disease 2019 (COVID-19) pandemic in Israel, J. Sleep Res. source
    • cites [28] Crivelli, 2020, Psychological distress associated with COVID-19 quarantine: Latent profile analysis, outcome prediction and mediation analysis, J. Affect. Disord. source

      The Results (subtypes and prevalence section; page unavailable) report that anxiety and somatization scores vary significantly across distress-severity classes, while sleep disturbances are common. The paper does not establish a significant direct link between anxiety and sleep disturbance, or report a direct anxiety–somatic-symptom association; the class-level findings provide only partial support for the attributed links. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [29] Shevlin, 2020, COVID-19-related anxiety predicts somatic symptoms in the UK population, Br. J. Health Psychol. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A study by Liu et al. (2020) among college and primary school students revealed that stress response to a pandemic as well as decrease in social support may predetermine onset of psychosomatic and somatic symptoms.

    “A study by Liu et al. (2020) that was conducted among college and primary school students revealed that stress response to a pandemic as well as decrease in social support may predetermine onset of psychosomatic and somatic symptoms.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Liu et al. (2020) source

      The Discussion (Summary; page not provided) says uncontrolled stress can lead to psychosomatic and somatic symptoms, and reports different pandemic stress responses among college and primary school students. It suggests that sources of support may help explain those differences, but the survey did not establish a decrease in social support or show that such a decrease preceded symptom onset. (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Previous studies showed a prevalence of anxiety symptoms as well as depressive symptoms and posttraumatic stress disorder among children who have been quarantined during pandemic disease.

    “Previous studies showed a prevalence of anxiety symptoms as well as depressive symptoms and posttraumatic stress disorder among children who have been quarantined during pandemic disease [26,27].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [26] JJiao, 2020, Behavioral and Emotional Disorders in Children during the COVID-19 Epidemic, J. Pediatr. source

      The “Psychological distress in Children Exposed to Adverse Events” section says anxiety and depression are commonly reported responses to adverse events and notes that children may face enforced isolation during epidemics. It does not report the prevalence of these symptoms specifically among quarantined children or identify posttraumatic stress disorder in that group. No page number is available in our copy. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [27] Sprang, 2013, Posttraumatic Stress Disorder in Parents and Youth After Health-Related Disasters, Disaster Med. Public Health Prep. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Previous studies on the general population in China reported changes in sleep quality, sleep disturbance, and insomnia among participants suffering from anxiety symptoms.

    “Previous studies on the general population in China reported changes in sleep quality, sleep disturbance, and insomnia among participants suffering from anxiety symptoms [26,30].”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [26] JJiao, 2020, Behavioral and Emotional Disorders in Children during the COVID-19 Epidemic, J. Pediatr. source

      The Early Investigation section describes a questionnaire for children in Shaanxi, China that investigated both anxiety-related concerns and poor sleep, including nightmares. It does not report sleep changes or insomnia among participants with anxiety symptoms, and its sample was children rather than the general population. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [30] Wang, 2021, The impact of quarantine on mental health status among general population in China during the COVID-19 pandemic, Mol. Psychiatry source

      The Methods (Outcomes and covariates; page not available) identify anxiety and insomnia as measured outcomes, and the Results (The psychological impact of quarantine; page not available) report both by quarantine status. The paper does not report sleep quality or sleep disturbance among participants with anxiety symptoms, nor does it present an analysis of insomnia specifically in that subgroup. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Lavigne-Cerván et al. (2021) reported that among adolescents aged 13-18, sleep problems were more severe, resulting in decreased energy and higher rates of apathy and inattention.

    “Interestingly, contrary to our present results highlighting possible protective effects of older age, Lavigne-Cerván et al. (2021) reported that among adolescents aged 13–18, sleep problems were more severe, resulting in decreased energy and higher rates of apathy and inattention.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Lavigne-Cerván et al. (2021) source

      The Abstract and Discussion report greater sleep disturbances among adolescents aged 13–18 than among younger groups. The Discussion mentions possible difficulties concentrating, but does not establish that sleep problems caused inattention; our copy does not report decreased energy or higher rates of apathy in those adolescents. (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Parents' perceptions of their child's symptoms may influence healthcare utilization and quality of care provided to the child.

    “Even so, parents’ perceptions of their child’s symptoms should be taken into account, because they may influence healthcare utilization and quality of care provided to the child [18,19].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [18] Birnie, 2020, Factors Related to Agreement between Child and Caregiver Report of Child Functioning with Chronic Pain: PROMIS Pediatric and Parent Proxy Report, Clin. J. Pain source
    • cites [19] Irwin, 2012, Development of six PROMIS pediatrics proxy-report item banks, Health Qual. Life Outcomes source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Anxiety has a complex and bidirectional relationship with sleep disorders.

    “Anxiety has a complex and bidirectional relationship with sleep disorders [9].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [9] 2021, Consequences of COVID-19 Confinement on Anxiety, Sleep and Executive Functions of Children and Adolescents in Spain, Front. Psychol. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Use of electronic resources such as mobile phones and computers contribute to the decrease in quality and hours of sleep among adolescents.

    “Use of electronic resources such as mobile phones and computers contribute to the decrease in quality and hours of sleep among adolescents [9].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [9] 2021, Consequences of COVID-19 Confinement on Anxiety, Sleep and Executive Functions of Children and Adolescents in Spain, Front. Psychol. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A study by Shevlin et al. (2020) determined that a state of anxiety during COVID-19 was associated with increased somatic symptoms within the UK general population.

    “Similar to our results, a study by Shevlin et al. (2020) determined that a state of anxiety during COVID-19 was associated with increased somatic symptoms within the UK general population.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Shevlin et al. (2020) source

  • May combine two claims.

    Interpretationcitation

    Somatic symptoms may appear during the home-quarantine period, which causes prolonged stress among adolescents and prevents continuous support provided by their parents and siblings.

    “Similarly, somatic symptoms may appear during the home-quarantine period, which causes prolonged stress among adolescents and prevents continuous support provided by their parents and siblings.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Total isolation from household members during home-quarantine may cause anxiety, sleep disturbance, and somatization among adolescents.

    “Total isolation from household members during home-quarantine may cause anxiety, sleep disturbance, and somatization among adolescents.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The study was conducted online, and the response rate could not be calculated, potentially causing selection bias.

    “The study was conducted online, and the response rate could not be calculated, potentially causing selection bias.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    Due to the cross-sectional study design, the temporal ordering of the variables could not be established, and causation between variables cannot be fully indicated.

    “Due to the cross-sectional study design, the temporal ordering of the variables could not be established, and so causation between variables cannot be fully indicated.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationreasoning

    In this setting, younger children find themselves for the first time separated from their parents, a situation that can increase their anxiety state and sleep deprivation.

    “In this setting, younger children find themselves for the first time separated from their parents, a situation that can increase their anxiety state and sleep deprivation.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The PHQ-15 and proxy form had Cronbach's alphas of 0.84 and 0.81 in the current sample.

    “In the current sample, the Cronbach’s alphas of the PHQ-15 for children and the proxy form for the parents were 0.84 and 0.81, respectively.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The study did not collect information regarding medical background of participants and was not able to indicate a pre-COVID-19 history of anxiety and mood disorder.

    “We did not collect information regarding medical background of the participants and were not able to indicate a pre-COVID-19 history of anxiety and mood disorder.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    Parents may feel pressured in light of the new reality in which they have to cope with their children quarantine process and balance personal life, work, and parenting.

    “Parents may feel pressured in light of the new reality in which they have to cope with their children quarantine process and balance personal life, work, and parenting.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The PROMIS Anxiety Short Form and proxy form had Cronbach's alphas of 0.95 and 0.90 in the current sample.

    “In the current sample, the Cronbach’s alphas of the Anxiety Short Form for children and the proxy form for the parents were 0.95 and 0.90, respectively.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    The discrepancy between our results and Lavigne-Cerván et al. might be explained by different study settings and reference periods.

    “This discrepancy might be explained by different study settings and reference periods.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The National Child Traumatic Stress Network (2021) highlighted that psychological response to COVID-19 may vary with age.

    “The National Child Traumatic Stress Network (2021) highlighted that psychological response to COVID-19 may vary with age.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites The National Child Traumatic Stress Network (2021)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationcitation

    This pressure may weaken parents' ability to be supportive caregivers and violate parent-child relationship, leading to poor recognition of child distress and anxiety.

    “This may weaken parents’ ability to be supportive caregivers and violate parent-child relationship [32], leading to poor recognition of child distress and anxiety.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [32] Uzun, 2021, Assesment of parent-child relationship in Covid-19 pandemic, Child. Youth Serv. Rev. source
21 of 21

  • The paper relies on this without support.

    The correlation between anxiety, sleep patterns, and somatic symptoms is still inconsistent.

    “However, the correlation between anxiety, sleep patterns, and somatic symptoms is still inconsistent.”
1 of 1

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • An anxiety T-score of 55 falls in two severity categories

    Minor

    The stated ranges classify a T-score of exactly 55 as both no-to-slight anxiety and mild anxiety.

  • Somatic symptom scores are called T-scores despite a different scoring method

    Minor

    The results say all three domains were determined using adjusted T-scores, but the methods specify that somatic symptom scores were prorated to a score out of 30. No T-score conversion is described for that domain.

2 of 2

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Related

Authors
Gendler, Y., & Blau, A.
Affiliations
Ariel University (IL)
Corresponding author
Gendler, Yulia
ORCID
Venue
Children
Publisher
MDPI AG
Published
2022-05-17
Volume
9
Issue
5
Pages
735
ISSN
2227-9067 (ISSN-L)
DOI
10.3390/children9050735
PMC
PMC9139826
OpenAlex
W4280646231
Cited by
3
References
31
Citations by year
2024: 1 · 2023: 1 · 2022: 1
FWCI
0.64
Type
journal article
Language
en
Open access
Licence
Locations
  • Children (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
Keywords
COVID-19 pandemic, home quarantine, adolescent anxiety, sleep disorders, somatic symptoms, somatization, gender differences, psychological effects of isolation

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