IMPACT OF COVID-19 PANDEMIC ON MENTAL AND EMOTIONAL WELLBEING AMONG CHILDREN: A SYSTEMATIC REVIEW

Dior Manta Tambunan*1,2, Nunung Nurjanah3, Siti Dewi Rahmayanti3, Rahmi Imelisa4 , Faridah binti Mohd Said5, Bibi Florina Abdullah5

1Nursing Student at Lincoln University College, Malaysia

2STIKes Murni Teguh Medan, 20371, Indonesia

3STIKes Jenderal Achmad Yani Cimahi, 40633, Indonesia.
4STIKes Jenderal Achmad Yani Cimahi, 40633, Indonesia
5Faculty of Nursing, Lincoln University College, Malaysia

*Corresponding Author’s Email:dior.endlessbay@gmail.com

ABSTRACT

Background: Coronavirus pandemic represents a huge threat and phenomenal risks on mental and emotional wellness among children. This systematic review expects to integrate academic research literature that provides details regarding the impact of COVID-19 on emotional wellbeing and mental status among children.

Methods: A systematic research engine was escorted on PubMed, Proquest, ScienceDirect, and Google Scholar with keywords: Children, COVID-19, Mental Status, Psychological Status from December 2019 to 18 November 2020 following the PRISMA guidelines. Articles were chosen dependent on the predetermined eligibility criteria. The included articles to review used the Quality Assessment Tool Adapted from the National Institutes of Health (NIH).

Results: A total of 17,059 records were identified using the keywords. After removal of duplicates and initial screening, seven articles met the inclusion criteria of COVID-19 influence on mental and emotional wellbeing among children. The research design was a longitudinal and cross- sectional online survey with the children age range was 3 – 18 years old.

Conclusions: COVID-19 Pandemic has a significant influence on mental and emotional wellbeing among children. Some children experienced depressive indication, difficulty concentrating, anxiety, touchy and easy to get irritated.

Limitations: Online survey generalized the results, younger children might need assistance from parents during filling up the questionnaire, small sampling size.

Keywords: Children; COVID-19; Mental Status; Psychological Status

INTRODUCTION

Infectious illnesses stay perhaps the greatest danger to the wellbeing and prosperity of humankind. Since December 2019, novel COVID-19 contamination has spread quickly all over China and universally (Cao et al., 2020). There are more than 2.2 billion children on the planet who establish around 28% of the total populace. Those who matured between 10 to 19 years make up 16 % of the total populace (UNICEF, 2019). During the most recent couple of months, children around the globe have encountered a significant interruption of children’s regular day-to-day existences and daily schedules because of the COVID-19 pandemic.

There is a lack of persuasive evidence of the influence of the Covid-19 pandemic on mental and psychological status among children. Routines, social connections, and companionships are among the main elements liable for children’s normal emotional wellbeing and development. Being stayed at home or social distancing frequently breaks children’s standard schedules and can make the ongoing difficult condition far more challenging in long term adverse consequences for children (Lee, 2020; Liu et al., 2020; Shen et al., 2020; & Imran et al., 2020). The objective of this systematic review expects to integrate academic research literature that provides details regarding the impact of COVID-19 on emotional wellbeing and mental status among children.

METHODOLOGY

Search Strategy

A systematic research engine was escorted on PubMed, Proquest, ScienceDirect, and Google Scholar from December 2019 to November 2020 following the PRISMA flow diagram as seen in Figure 1. It was searched using the following keywords: (Children) AND (COVID-19) and (Mental Status) AND (Psychological Status). A total of 17,059 records were identified using the keywords from December 2019 to November 2020. Records were n=1,538 after removing irrelevant records (n=15,521). After 603 duplicates records were removed and 935 records screened for titles and abstract screening and full-text articles assessed for eligibility were n=91 only after tracing out records that did not match eligibility were n=844. However, 84 full-text articles were excluded for reasons: healthcare population, mental disorder, review paper, and population on quarantine. Finally, this review included 7 studies in synthesizing.

Figure 1: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Study Selection flow Diagram. (For Interpretation of the References to Color in this figure Legend, the Reader is Referred to the Web Version of this Article.)

Study Selection and Eligibility Criteria

Titles and abstracts of every distribution were screened for pertinence. Full-text articles were examined for qualification after the underlying screening. Studies were eligible for:

Inclussion Criteria were:

1. Full-text and open access articles

2. Range from December 2019 to November 2020

3. English-only articles

4. Flowed quantitative: cross-sectional and longitudinal study design

5. Studies assessed the mental and psychological wellbeing among children during the COVID- 19 pandemic.

6. Children’s age <18 years.

Exclusions Criteria were:

1. Studies that were not assessed for mental and psychological wellbeing effect on COVID-19 pandemic among children.

2. Unreliable data collections, duplicate, and overlapping articles.

3. Review articles, not fully accessible research articles, book subsidiaries, conference papers, abstract-only articles, and animals related studies

Data Extraction

Data extraction form was used to include relevant data: (1) Thematic area, (2) Lead author/year/country, (3) Study design, (4) Sample size, (5) Sample characteristics, (6) Assessment tool, (7) Summary of results, and (8) Limitation.

Quality Assessment Tool

The included articles to review used the Quality Assessment Tool Adapted from the National Institutes of Health (NIH) in Table 1. The quality assessment was conducted by two authors (SR) and the overall quality of the included studies is Rated fairly, with a total score of 45 out of 14 questions for 7 articles. There were 5 questions with fully (7 articles) answered Yes, 2 questions were answered yes with 4 articles, and 1 question was answered yes with 1 only article. While the rest of the question was answered with No, CD, NR, and NA with scored with Nol.

Table 1: Quality Assessment Tool Adapted from National Institutes of Health (NIH)

Note: Exposure measures indicate independent variables.

*CD = cannot determine; NA = not applicable; NR = not reported

RESULTS AND DISCUSSION

This review investigated the mental and emotional wellbeing or status of children during the COVID-19 pandemic. We recognized a surprising deficiency of information on the impact of the COVID-19 Pandemic on children during disease outbreaks. It was astounding that the dominant part of studies we found, were for the quickly arising COVID-19 Pandemic as opposed to past SARS or MERS flare-ups (Orgilés et al., 2020; Pisano, Galimi & Cerniglia, 2020).

Study Characteristics

Study characteristics and primary study findings are summarized in Table 2. The sampling size of the 7 studies ranged from 190 to 3,613 respondents, with a total of 7,813 respondents. A majority of studies where children as participants were between 3 - 18 years old. All studies followed a quantitative with cross-sectional and longitudinal online study design. The 7 studies were conducted in 6 different countries and each study including Spain, Italy, Bangladesh, Greece, South Western Ontario, and 2 studies was in China. The main results picked in the included studies varied across studies. Thematic of the studies included thematic on lockdown and mental health (n=2), psychological impact/effect (n=2), mental health impact (n=2), and mental health investigation (n=1).

Table 2: Articles Influence COVID-19 Pandemic on Mental and Emotional Wellbeing among Children

Measurement Tools

Varieties of scale were adopted in the studies (n = 19) for assessing the impact of the COVID-19 pandemic on mental health and psychological state among children. The Strengths and Difficulties Questionnaire (SDQ), CoRonavIruS health and Impact Survey (CRISIS) ), Short Mood and Feelings Questionnaire (SMFQ), and Affective Reactivity Index (ARI) were used for measuring children’s mental health, mental distress, and existing mood or mood disorder. Brief Resilience Scale (BRS) was used for measuring resilience “an individual’s ability to bounce back or recover from stress”, while the Impact of Event Scale (IES) was used for measuring psychological responses to trauma. Coping Style Questionnaire (CSQ) or Coping Style Scale (CSS) were used for measuring active/passive coping, and on the other hand, Child Behavior Checklist (CBCL) was used for assessing children’s behavior/emotional problems. The scale used in measuring depression, anxiety, stress, and posttraumatic stress disorder were 21-item Depression Anxiety Stress Scale (DASS-21), Revised Child Anxiety and Depression Scale (RCADS), Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), Screen for Child Anxiety Related Emotional Disorders (SCARED), Spence Child Anxiety Scale (SCAS), Child Depression Inventory (CDI), Survey Development Questionnaire, and Child PTSD Symptom Scale for DSM- 5 (CPSS-5). Last but not the least, assessing the prevalence of smartphone addiction were used Short Version of Smartphone Addiction Scale (SV-SAS) and Internet Addiction Scale (IAS).

Populaces with More Noteworthy Vulnerable

Although children are powerless against ecological dangers yet measurements concerning the mental and emotional wellness effect of remaining at home, and social distancing in children as an activity to deal with the COVID-19 spreading are elusive, and not many investigations address this significant angle. Its only 2 studies precisely mentioned that the respondents were started from age 3 and 5 years (Orgilés et al., 2020; Yeasmin et al., 2020). And 1 study was started investigating at age 7 years (Duan et al., 2020), while Mactavish et al., 2020 picked the age at 8 years. However, the data in this review was within the limit of vulnerable age in children who were below 18 years old. There were 6 studies were mentioned that parents where assisted children as respondents and 1 study were targeted the high school students. The total mean age as mentioned 9.08 years (Orgilés et al., 2020), 10.83 years (Mactavish et al., 2020), 13.9 years ( Ezpeleta et al., 2020), and 15.58 years (Zhang et al., 2020). While there were 2 studies given in percentage < 13 years with 70.4 % (Magklara et al., 2020 ), 13 - 18 years with 90.06 % (Duan et al., 2020), and 1 study by Yeasmin et al., 2020 was not specifically noted either mean or percentage age.

Mental Health

Lockdown in Greece has one of the significant worries of the caregivers was the social disconnection of their children. In numerous nations around the globe children and adolescents have encountered a startling and delayed time of actual disconnection from their companions, peers, educators, more distant family, and different network organizations. Roughly 35.1% of caregivers reported that the mental well-being of their children was impressively influenced (Magklara et al., 2020). Literature shows that detachment related to isolate measures has negative mental impacts on grown-ups, including disarray, outrage, and post-awful trouble (Brooks et al., 2020). Dejection may be a significant issue related to social detachment. Forlornness is conceptualized as the contrary feeling of an error between the social contact experienced by an individual and the craving for it (Perlman & Peplau, 1981). Social separation isn't trailed by dejection. In any case, early proof shows that more than 33% of adolescents report elevated levels of forlornness, while previous literature review reported that social separation and dejection build the danger of sadness and perhaps tension (Loades et al., 2020).

The SDQ questionnaire in Spain explored that Adolescents had the worst psychological wellbeing during the COVID-19 outbreaks and it was connected to unhealthy activities such as doing online study in a stagnant position, decrease in physical activity, or no physical exercise along with friends as they usually did at the school before the pandemic; an excessive amount of schoolwork or increased screen time (Magklara et al., 2020; Xiang & Zhang, 2020) as per parents reported were 95 %. It brought negative interference, difficulties in sleeping, and changes in body weight as per parents conveyed the changes in significant physiological capacities, for example, eating and sleeping, merit some remark, as they influenced about a 20% of the example. At the point when children are not at school, for instance at the end of the week or in the special seasons, they will, in general, change their schedules and are normally less genuinely dynamic, they invest more energy on screens, and their rest examples and diets are modified, bringing about weight gain (Wang et al., 2020); intensive and frequent of family discussion which made mood changes; worse relationships with others such parents and sibling; and experienced useless nurturing style and it could be as an overburdening to around 40 % parents who helped with the children’s homework (Ezpeleta et al., 2020).

Demonstrate that the COVID-19 episode has had a huge psychosocial sway on children. The anxiety rate (22.28%) of respondents were in the misery of depressive indications. During the scourge, 29.58% of respondents announced that they went through over five hours out of each day on the web, which could be a potential danger factor for dependence on the Internet or cell phones (Duan et al., 2020). Studies have demonstrated that smartphone/Internet abuse may prompt mental or conduct issues, causing horrible performance in the examination, diminished genuine social communication, ignoring individual life, relationship problems, and state of mind brokenness (Kahraman & Demirci, 2018; Soni, Upadhyay & Jain, 2017). Another finding of Orgilés et al., (2020) reported on their studies that 85.7% of the parents reported changes in their children’s emotional state and behaviors during the COVID-19 pandemic. The most frequent symptom was difficulty concentrating, with 77% of the parents reporting this symptom. Boredom, irritability, restlessness, nervousness, feelings of loneliness, and being more uneasy and more worried were reported by more than 30% of parents. As expected, and according to the study of Xie et al. (2020) with Chinese children, the COVID-19 confinement also impacts negatively on the Italian and Spanish children’s wellbeing.

It is About 12% of the Italian and Spanish guardians reported their children as more fretful, irate, and touchy. Staying at home without the opportunity to go outside may build reactions of uneasiness and other related issues, for example, rest issues, actual protests, and stresses and conduct issues that include the family, such as contending with different family members, possibly because the children should be all the more genuinely dynamic. Children got more troubled, and forlorn, perhaps because of the more extended span of the pandemic in Italy contrasted with Spain. True to form, schedules likewise changed during the pandemic for the offspring of the two nations, investing more energy utilizing screens, investing less time doing the actual movement, and dozing more hours. For example, during the isolate, just 14.8% of the adolescent practice in any event 60 min of actual movement, as suggested by the WHO for youngsters somewhere in the range of 5 and 17 years of age, contrasted with before the isolate, when that rate arrived at 54.1%. This finding is likewise following different reflections that caution about the outcomes of children’s home restriction, explicitly influencing their mental prosperity as well as their weight status and the danger of expanding screen time (The Lancet Child & Adolescent Health, 2020).

Emotional Wellness

Using DASS-21 and found that more than one-fifth of respondents' emotional wellbeing was influenced. The paces of depression indications (20.9% for junior school understudies and 29.7% for secondary school understudies) and anxiety manifestations (25.4% for middle school understudies and 28.4% for secondary school understudies) were higher than the rates revealed by late investigations that didn't include any scourge or pandemic (Zhang et al., 2020). For example, an ongoing report was led with an example of 2,679 children matured 10-15 years of age from 25 territories in China, and the outcomes uncovered that the paces of depressive indications are essentially lower in metropolitan zones with 14% than in-country zones with 23% (Zhou et al., 2018). Another similar research reviewed 1,597 middle school understudies matured 10-17 years in ShangHai City (a metropolitan territory in China), and the outcomes demonstrated that the paces of anxiety indications and depressive indications were 16.4% and 17.2%, separately (Liu, Zhang & Cai, 2017). These results can be utilized to formulate psychological management to improve emotional wellness.

The study in Bangladesh among parents who had children at least age 5-15 years explored that exhibit that huge extents of children are experiencing emotional wellbeing disruption during the lockdown period. Children's emotional wellness (despondency, nervousness, and dozing disorder) scores were ordered into four gatherings: sub-edge, mellow, moderate, and extreme unsettling influence. The most noteworthy level of children are experiencing sub-limit aggravation (43%), and 30.5% had mellow unsettling influences, 19.3% had moderate aggravations, and 7.2% had serious aggravations. However, execution of legitimate mental management strategies and improvement in family monetary conditions, parents’ education, looking after children appropriately, expanding job stability, and adaptability of parents may help in improving the wellbeing status of children (Yeasmin et al., 2020). The study in Ontario described It distinguishes powerful, expansive mental distress counting diminished prosperity overall records assessed and higher irritability, anxiety, and depressive indications after the COVID-19 pandemic. Records wide intense effect on the mental wellbeing of children since that it needs expansive psychosocial supports and assets to assist children with recuperating from the COVID-19 pandemic. Children in the current investigation revealed burdensome and uneasiness manifestations were 25.64% and 21.52% which were over a clinically-characteristic edge, individually (Mactavish et al., 2020). Predictable with another study of children in China during the COVID-19 pandemic, in which 22.6% and 18.9% revealed raised burdensome and tension indications (Xie et al., 2020).

Limitation

All studies were conducted utilizing online surveys autonomously by the study respondents, which raises two concerns: (1) individual reactions in self-evaluation shift in objectivity when oversight from an expert specialist/questioner is absent, (2) individuals with helpless web openness were likely excluded from the examination, making a choice predisposition in populace considered. Online studies presented tremendous difficulties for the usage of children as respondents. Online survey with generalizability of the study. Importantly, studies were led in a predetermined number of nations. A greater example size for results approval.

CONCLUSION

This systematic review proposes that the COVID-19 pandemic is related to an extensive and critical negative impact on emotional wellness and mental prosperity among children. Our study summarized significant and accessible information on children’s mental and emotional wellness such as depression, anxiety, feeling lonely, and excessive using screen time during the COVID-19 pandemic. Psychological wellness is a critical concern in a pandemic's situation. Children are viewed as a vulnerable subgroup and there is a need to mitigate the emotional wellness and mental prosperity burden of this pandemic. This investigation can be utilized to figure psychological interventions to improve the emotional wellness and mental prosperity among children during the COVID-19 pandemic.

Conflict of Interest

The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

ACKNOWLEDGEMENT

The authors would like to acknowledge the efforts of the research assistant who helped in the data collection and publishing of this paper.

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