The COVID-19 Pandemic: A Longitudinal Study on the Emotional-Behavioral Sequelae for Children and Adolescents with Neuropsychiatric Disorders and Their Families
Study Aims and Hypotheses
- To investigate the psychological well-being of children and adolescents with psychiatric disorders during the COVID-19 lockdown (T0) and after 4 months (T1). Specific attention was paid to variations in routine, habits, and biological functions, and stress-related symptoms. Moreover, given that an extensive shift to telepsychiatry occurred during the lockdown—with several experts expressing concerns about its potentially negative effects on mental health (e.g., )—we aimed to find out if the means of conducting neuropsychiatric interventions (i.e., continued in person, continued remotely, suspended) significantly affected the psychological adjustment of patients. Subsequently, since in the clinical practice a greater psychological discomfort was observed in children/adolescents suffering from disorders with predominantly behavioral expression (i.e., neurodevelopmental and/or conduct disorders), these patients were compared to those with internalizing symptomatology, to verify the hypothesis of worse outcomes for the former . Finally, changes over time (T0–T1) in the psycho-behavioral profile of patients were monitored; considering that the retest was conducted during the least critical phase of the pandemic in Italy, we expected to detect an improvement in the symptomatology.
- To evaluate the psychological well-being of parents of children/adolescents with neuropsychiatric disorders during the COVID-19 lockdown (T0) and after 4 months (T1), also checking its change over time. Particular attention was paid to stress-related symptoms and elements of resilience. Specifically, according to the literature, an inverse relationship between psychological maladjustment and resilience was hypothesized [22,43]. Then, we expected to observe a decrease in anxiety, depression, and stress symptoms of parents over time, following the easing of the COVID-19 containment measures.
2. Materials and Methods
2.1. Participants and Recruitment Criteria
- Individuals with a psychiatric disorder already monitored at the Neuropsychiatric Unit of the Padua University Hospital (Italy) and receiving pharmacological, psychiatric, and/or psychological treatments, or undergoing psychodiagnostic assessment in March 2020.
- Age between 6 and 18 years.
- Presence of factors that compromise the correct interpretation and compilation of the administered tests, such as severe intellectual disability and important language barriers.
- Psychiatric acute situations and severe decompensation of the disease at the time of recruitment.
- Personal and social data of patients and parents: age of patients, sex, marital/parental status, single- or two-parent family, and socio-economic status (SES). This last one was determined by means of the SES index, which is based on the Hollingshead Four Factor Index of Social Status . This is a tool that enables one to identify the socio-economic level of a person by attributing a score to his/her educational level and profession. Specifically, the educational level is measured on a 7-point Likert scale (1 = primary school, 7 = post-university), and the profession is classified on a 9-point Likert scale that places socially and economically poor jobs at the lowest levels, while those that are more qualified are at the highest levels. Then, a weighted total score is calculated, which provides five different socio-economic levels: low SES = score between 8 and 19, medium-low SES = score between 20 and 29, medium SES = score between 30 and 39, medium-high-SES = score between 40 and 54, high SES = score between 55 and 66.
- Neuropsychiatric problems: ICD-10 diagnoses  and any comorbidities.
- Emotional-affective disorders: affective syndromes with F30–F39 codes (bipolar disorder, depressive disorder) and phobic syndromes, syndromes linked to stress and somatoforms with F40–F48 codes.
- Disorders of behavior and personality: disorders of adult personality and behavior with F60–F69 codes, and behavioral and emotional disorders with onset usually occurring in childhood and adolescence with F90–F98 codes (such as the disorder of activity and attention, conduct disorder, and oppositional disorder).
- Neurodevelopmental disorders and psychosis: non-mood psychotic disorders with F20–F29 codes and disorders of psychological development (specific learning disorders and autism spectrum disorders) with F80–F89 codes.
- Patients’ history of trauma (presence/absence, description of any prior trauma).
- Patients’ ongoing treatments before and during the pandemic (psychiatric, pharmacological, psychological, educational), and changes in the means of conducting these interventions during the lockdown (continued face-to-face or interrupted), specifying if maintained psychiatric interventions were conducted remotely or in person.
- Variations in patients’ biological functions (sleeping-waking rhythms, diet), body weight (measured in kg), general habits (e.g., physical activities), and exposure to screen-based media during the lockdown compared to the previous period.
- Stress-related symptoms in patients and parents, at both T0 and T1: physical symptoms (e.g., headache, stomachache, difficulty breathing, tachycardia, agitation, sleeping difficulties, loss of appetite), behavioral problems (e.g., teeth grinding, compulsive eating, frequent alcohol drinking, difficulty completing tasks), emotional symptoms (e.g., anger, irritability, anxiety, sadness, sense of powerlessness, demotivation) and cognitive symptoms (e.g., problems with making decisions, distraction/inattention, constant worry, lack of creative spirit). The total number of stress-related symptoms was taken into consideration, and four ranges were highlighted: 0 symptoms (range 0), between 1 and 5 symptoms (range 1), between 6 and 10 symptoms (range 2), and more than 10 symptoms (range 3).
- In the data collection sheet administered to parents, some ad hoc questions about resilience were added. To structure such questions, we considered the three components of psychological resilience described by Kosaba : question (1)—commitment (I let myself be involved in activities, I am active, I have goals to achieve); question (2)—control (I do not feel at the mercy of events, I think I can dominate them, I am able to know when to act and when to stop); question (3)—challenge (I accept change and I think it’s an opportunity for growth, I see the bright side rather than the downside of it). Each question provides four possible ways to answer: never, sometimes, often, always. Based on the responses to each item, a level of resilience has been defined as “low” (never, sometimes) or “high” (often, always).
2.4. Data Analysis
3.1. Description of the Socio-Demographic and Clinical Characteristics of the Sample at T0
- 38 patients (67.9%) suffering from “emotional-affective disorders”, corresponding to clinical situations of mood disorders (ICD-10 F30–39, in particular depressive disorder, mixed affective disorder) and neurotic disorders, related to stress and somatoforms disorders (ICD-10 F40–48, including anxious disorders, mixed anxious-depressive, and obsessive-phobic disorders).
- 7 patients (12.5%) with “behavior and personality disorders”, with ICD-10 codes F60–69 and F90–98; personality disorders, attention deficit hyperactivity disorder (ADHD), conduct disorder (DC), and oppositional defiant disorder (PDO) are detected.
- 11 patients (19.6%) with neurodevelopment disorders and psychosis, with ICD-10 codes F80–89 and F20–29, such as autism spectrum disorders and psychotic syndromes.
3.2. Differences in the Psycho-Behavioral Profile of Patients According to Diagnostic Category and Type of Treatment at T0
3.3. Relationship between Parents’ Well-Being and Resilience at T0
3.4.1. Description of the Clinical Features of the Sample at T1
3.4.2. Differences in the Psycho-Behavioral Profile of Patients According to Diagnostic Category at T1
3.4.3. Relationship between Parents’ Resilience and Well-Being at T1
3.4.4. Change Over Time (T0–T1) in the Emotional-Behavioral State of Patients and Their Parents
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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(N = 41)
|CBCL Mothers |
(N = 55)
|CBCL Fathers |
(N = 55)
|M (SD)||M (SD)||M (SD)|
|Total Problems||57.9 (9.58)||63.0 (9.32)||60.1 (10.72)|
|Externalizing Problems||52.8 (8.21)||58.3 (9.83)||54.8 (10.21)|
|Internalizing Problems||60.4 (11.72)||66.9 (10.46)||62.3 (11.56)|
|PTSP||59.7 (7.19)||67.8 (11.03)||65.1 (10.31)|
|Marital Status||Conjugated (%)||82.1||82.1|
|Working modalities||As usual (%)||37.3||41.2|
|Working remotely (%)||23.5||31.4|
|M (SD)||M (SD)|
|Depression||49.9 (9.95)||48.6 (9.83)|
|Anxiety||49.4 (13.5)||45.1 (11.5)|
|Stress||51.7 (10.2)||48.1 (9.73)|
|ANX Mother||STRESS Mother||DEP Father||ANX Father||STRESS Father|
|Resilience 1||−0.51 **||−0.23||−0.43 **||−0.30 **||−0.45 **||−0.28|
|Resilience 2||−0.42 **||−0.36 *||−0.22||−0.40 *||−0.24||−0.40 *|
|Resilience 3||−0.43 **||−0.32 *||−0.60 **||−0.43 *||−0.31 *||−0.48 *|
(N = 31)
|CBCL Mothers |
(N = 39)
|CBCL Fathers |
(N = 39)
|M (SD)||M (SD)||M (SD)|
|Total Problems||55.9 (9.06)||61.3 (9.27)||57.7 (10.3)|
|Externalizing Problems||51.2 (7.82)||56.1 (8.95)||53.9 (9.49)|
|Internalizing Problems||58.8 (11.09)||64.4 (10.06)||60.7 (11.4)|
|PTSP||59 (7.80)||64.3 (10.03)||62.4 (10.3)|
|M (SD)||M (SD)|
|Depression||47.5 (7.01)||45.9 (7.39)|
|Anxiety||44.5 (7.35)||42.1 (3.99)|
|Stress||48.1 (7.94)||46.1 (7.67)|
|DEP Mother||ANX Mother||STRESS Mother||DEP Father||ANX Father||STRESS Father|
|Resilience 1||−0.31||−0.30||−0.30||−0.36 *||−0.22||−0.23|
|Resilience 2||−0.32||−0.28||−0.29||−0.25||−0.36 *||−0.39 *|
|Resilience 3||−0.08||−0.21||−0.36 *||−0.60 **||−0.34 *||−0.38 *|
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Raffagnato, A.; Iannattone, S.; Tascini, B.; Venchiarutti, M.; Broggio, A.; Zanato, S.; Traverso, A.; Mascoli, C.; Manganiello, A.; Miscioscia, M.; Gatta, M. The COVID-19 Pandemic: A Longitudinal Study on the Emotional-Behavioral Sequelae for Children and Adolescents with Neuropsychiatric Disorders and Their Families. Int. J. Environ. Res. Public Health 2021, 18, 9880. https://doi.org/10.3390/ijerph18189880
Raffagnato A, Iannattone S, Tascini B, Venchiarutti M, Broggio A, Zanato S, Traverso A, Mascoli C, Manganiello A, Miscioscia M, Gatta M. The COVID-19 Pandemic: A Longitudinal Study on the Emotional-Behavioral Sequelae for Children and Adolescents with Neuropsychiatric Disorders and Their Families. International Journal of Environmental Research and Public Health. 2021; 18(18):9880. https://doi.org/10.3390/ijerph18189880Chicago/Turabian Style
Raffagnato, Alessia, Sara Iannattone, Benedetta Tascini, Martina Venchiarutti, Alessia Broggio, Silvia Zanato, Annalisa Traverso, Cataldo Mascoli, Alexa Manganiello, Marina Miscioscia, and Michela Gatta. 2021. "The COVID-19 Pandemic: A Longitudinal Study on the Emotional-Behavioral Sequelae for Children and Adolescents with Neuropsychiatric Disorders and Their Families" International Journal of Environmental Research and Public Health 18, no. 18: 9880. https://doi.org/10.3390/ijerph18189880