Mental Health of Children and Adolescents Amidst COVID-19 and Past Pandemics: A Rapid Systematic Review
2.1. Search Strategy
2.2. Types of Participants
2.3. Type of Exposure and Interventions
2.4. Types of Outcomes
2.5. Study Selection
2.6. Data Extraction
2.7. Quality Assessment
2.8. Data Analysis/Synthesis
3.1. Study Characteristics
3.2. Methodological Quality
4. Study Findings
4.1. Impact of the Pandemic on Children’s and Adolescents’ Mental Health
4.2. Impact of Control Measures to Contain the Effect on Children’s and Adolescents’ Mental Health
4.3. Impact of Pandemic/Epidemic Related Stigma on Mental Health
4.4. Interventions Employed during the Previous and Current Pandemic to Promote Children’s and Adolescents’ Mental Health
Limitations and Future Directions
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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|Inclusion Criteria||Exclusion Criteria|
|Types of studies: Quantitative, qualitative, mixed methods studies, experimental (randomized (individually or cluster) and non-randomized controlled trials), observational studies with an internal comparison group (cohort-prospective and retrospective and case-control studies), Human studies|
Types of participants: studies that are conducted on school age children and adolescents (5 to 19 years), living in low-, middle- or high-income countries without any prior mental health disorder.
Type of exposure: Recent COVID-19 or past pandemics (such as SARS-CoV-1, H1N1 influenza, equine influenza, Ebola, MERS-CoV etc.).
Interventions delivered to school age children, adolescents and their families to improve mental health and decrease inclination towards substance abuse.
Types of outcomes: Primary outcomes: rates of anxiety and depression and use of substance abuse.
Secondary outcomes: fear of infection, frustration and boredom, fear of pandemic related uncertainty, fear of running out of basic supplies, and finances.
|Not in English|
Studies that only included adults 18 years old or older
Studies that did not report age
Studies that included participants with prior mental health problems, those diagnosed with mental health disease, those who are homeless, and those with substance abuse issues.
|S #||Author and Year||Country||Study Design||Target Population||Total Participants||Exposure||Intervention||Outcomes|
|1||Decosimo et al., 2019 ||Liberia, West Africa||Pre and Post design||3–18 years||Treatment Group 1 (TG1), (N = 533)|
Treatment Group 2 (TG2), (N = 337)
Total: 870 children
|Ebola epidemic||Playing to live intervention including art therapy, play therapy, yoga therapy, support services, trained community facility, and cultural adaptation and community engagement program. |
TG1 received five months of the program.
TG2 received three months of program
|Statistically significant decrease in psychological stress symptoms over time before and after receiving the intervention in both treatment groups pre- to |
post-intervention and a significant difference in total symptoms over time.
|2||Denis-Ramirez et al., 2017 ||Sierra Leone, West Africa||Qualitative study—Draw-and-write method||8–14 years||24 children||Ebola virus||N/A||Fear, Stigma|
|3||Kamara et al., 2017 ||Sierra Leone, West Africa||Prospective||0–17 years||27 children||Ebola virus||A nurse-led mental health and psychosocial support service via provision of psychotropic medication, psychological intervention, and social intervention||Depression|
A nurse-led approach within a non-specialist setting was a successful model for delivering mental health and psychosocial support services during the Ebola outbreak in Sierra Leone.
|Taylor et al., 2008 ||Australia||Cross sectional—online survey||Under 16 years: 36 children |
16–24 years: 224 participants
|260 participants||Equine influenza||N/A||Psychological distress|
|5||Sprang et al., 2013 ||United States, Canada||Mixed-method approach survey, focus groups, and interviews||Children||586 Participants||H1N1||N/A||PTSD|
|6||Buzzi et al., 2020 ||Italy||Cross sectional—Online survey||13–19 years girls and boys||2064 adolescents||COVID-19||N/A||Consequences on psycho-social well-being|
|7||Chen et al., 2020 ||Guiyang, China||Cross sectional—Online survey||6–15 years||1036 Children Male 531|
|8||Duan et al., 2020 ||China||Cross-sectional online survey design||7 to 18 year||3613 students|
1812 males 1801 females
|COVID-19||N/A||Anxiety Symptoms, Depressive symptoms, Coping mechanisms|
|9||Ellis et al., 2020 ||Ontario, Canada||Cross-sectional online survey design||14–18 years||1054 Participants||COVID-19||N/A||Stress, Loneliness, Depression|
|10||Liang et al., 2020 ||China||Cross-Sectional online survey||14–20 years||130 youths||COVID-19||N/A||PTSD, Coping styles, Mental health|
|11||Liu et al., 2020a ||Sichuan, China||Cross-sectional online survey||10–12 years|
|209 primary school students|
|COVID-19||N/A||Psychosomatic symptoms, Psychological distress|
|12||X. Liu et al., 2020b ||China||Cross-sectional online survey design||Below 18 years||34 participants||COVID-19||N/A||Anxiety, Depression, Psychological abnormalities|
|13||Oosterhoff et l., 2020 ||United|
|Cross sectional—Online survey||13–18 years||683 adolescents||COVID-19||N/A||Anxiety symptoms. Depressive symptoms burdensomeness, belongingness|
|14||Saurabh et al., 2020 ||India||Cross sectional—survey questionnaire||9–18 years||252 children and adolescents||COVID-19||N/A||Worry, Helplessness, Fear|
|15||Tian et al., 2020 ||China||Cross-sectional online survey||Children under 18 years||22 participants||COVID-19||N/A||Psychological symptoms|
|16||Wang et al., 2020 ||China||Cross-sectional online survey design||12–21.4 years||344 participants||COVID-19||N/A||Stress, Anxiety, Depression|
|17||Zhou et al., 2020 ||China||Cross-sectional—online survey||12–18 years||8079 participants||COVID-19||N/A||Depression, Anxiety|
|18||Xie et al., 2020 ||Hubei, China||Cross-sectional online survey design||Children grade 2–6||1784 Students||COVID-19||N/A||Anxiety Symptoms, Depressive symptoms|
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Meherali, S.; Punjani, N.; Louie-Poon, S.; Abdul Rahim, K.; Das, J.K.; Salam, R.A.; Lassi, Z.S. Mental Health of Children and Adolescents Amidst COVID-19 and Past Pandemics: A Rapid Systematic Review. Int. J. Environ. Res. Public Health 2021, 18, 3432. https://doi.org/10.3390/ijerph18073432
Meherali S, Punjani N, Louie-Poon S, Abdul Rahim K, Das JK, Salam RA, Lassi ZS. Mental Health of Children and Adolescents Amidst COVID-19 and Past Pandemics: A Rapid Systematic Review. International Journal of Environmental Research and Public Health. 2021; 18(7):3432. https://doi.org/10.3390/ijerph18073432Chicago/Turabian Style
Meherali, Salima, Neelam Punjani, Samantha Louie-Poon, Komal Abdul Rahim, Jai K. Das, Rehana A. Salam, and Zohra S. Lassi. 2021. "Mental Health of Children and Adolescents Amidst COVID-19 and Past Pandemics: A Rapid Systematic Review" International Journal of Environmental Research and Public Health 18, no. 7: 3432. https://doi.org/10.3390/ijerph18073432