1. Introduction
The COVID-19 pandemic caused significant life changes for both adults and children, providing a vast amount of stress and uncertainty at the same time [
1]. Much attention has been paid to the somatic consequences of COVID-19 infection. In most children, the COVID-19 infection was mostly asymptomatic or mild with only certain initial features increasing the risk of moderate to severe disease in selected cases [
2]. While researchers point to a number of psychiatric symptoms (mood disorders, anxiety symptoms, sleep disorders) occurring during the pandemic in the under-18 population they do not provide an elucidation of the genesis of the symptoms. It is the infection itself, or rather, it is associated with a psychological response to a number of problems imposed during epidemiological restrictions [
1,
3,
4] ? The long-term consequences of pandemic social isolation are likely to be observed for many years [
5].
The unprecedented changes brought about by COVID-19, such as social isolation, school closures, and family stress, negatively affect people’s mental health, especially that of children and adolescents [
6]. Most meta-analyses conducted so far have demonstrated the negative impact of the period of epidemiological isolation on mental well-being in the population under 18 years of age, including an increase in the incidence of anxiety, depression, sleep disorders, suicidal behavior, stress-related disorders, attention deficit hyperactivity disorder, and other mental problems [
7,
8,
9,
10]. Researchers have found several variables such as age, grade level, education level, gender, geographic region, and electronic use to be correlated with the incidence of mental health symptoms [
11]. American researchers have also reviewed circadian rhythm disorders in the pediatric population, pointing out that in crisis situations, parameters such as extended sleep time, sleep latency, or wake-up time change, at the same time mentioning that sleep may play a therapeutic role in a previously unknown mechanism [
12,
13]. The concept of loneliness seems to be an important issue in the pediatric population; reviews indicate that it is an important risk factor for the severity of psychopathological symptoms in this group in the era of epidemiological isolation [
14]. Reports from Israel raise alarm about cognitive disorders occurring in children during the pandemic, which not only represent a somatic complication but are also related to the economic and emotional stress of parents [
15]. Few studies indicate the possibility of correlating psychopathological symptoms with possible post-traumatic stress symptoms, indicating the strength of the pandemic stressor in children and adolescents [
16].
The spectrum of suicide and self-harm behavior remains an extremely important issue in the context of the COVID-19 pandemic in people under 18 years of age [
17]. Research results on this topic are inconsistent. However, most of them mention the occurrence of suicidal thoughts themselves and not the frequency of suicidal behavior [
18]. By contrast, the increase in the occurrence of self-harm behavior intensity has been noted in most studies [
19]. All reports emphasize preventive actions related to life-protective factors [
20].
A clearly greater susceptibility to mental health problems was mentioned in children and adolescents with significant psychological or psychiatric problems at the beginning, again emphasizing the importance of support strategies [
21]. The important role of educational institutions as a support tool in the crisis was also emphasized [
22]. Moreover, the summaries made so far regarding the disturbance of mental well-being emphasize protective factors, such as strong and supportive home and peer relationships, as well as the importance of preventive actions and the development of support strategies for children affected by the crisis [
9,
23,
24]. Reports from Montreal show the work–home correlation of parents of children with mental problems, suggesting that the workload and lack of favorable working conditions of a parent during the pandemic worsen the child’s mental well-being [
25].
Most of the available studies conducted on the Polish population during the period of our research concern the population of adults from various age ranges and social groups (medical students, nurses, patients with chronic diseases, pregnant women, and people from the geriatric population) [
26,
27,
28,
29]. Available research from the period of the COVID-19 pandemic regarding its impact on the mental well-being of the Polish population under 18 years of age mainly concerns teenagers and focuses on the severity of depression and anxiety symptoms [
30]. Colleagues from our university, while examining the neuropsychiatric complications of the virus infection itself, also mention cognitive dysfunctions—significant difficulties with concentration and general memory loss—also pointing out that the isolation itself during the pandemic could be a strong enough stressor to cause symptoms of post-traumatic stress disorder [
31]. The role of physical activity as a protective factor against the deterioration of mental health in the adolescent population has also been emphasized [
32,
33]. Colleagues from the center in Bydgoszcz attempted to assess the long-term consequences of social isolation in correlation with the armed conflict in Ukraine but showed that the severity of depressive and anxiety symptoms was moderate [
34]. The few studies on self-aggressive behavior, including suicidal behavior, in the context of the COVID-19 pandemic in Poland indicate the intensification of the phenomenon mainly in adolescents previously undergoing psychiatric treatment, at the same time emphasizing the importance of preventive measures and interventions by pediatricians [
35,
36].
Many review articles covering existing research point to the inconsistency of reports, pointing to the lack of a clear narrowing of the population, the fact that the tools used were not adapted to the specific conditions of the pandemic, and the lack of direct measurement during the crisis as weak points [
37,
38]. Thus, the study aimed to assess the prevalence of mental health problems in Polish children and adolescents with a focus on suicidal and self-harm behavior and the frequency of reported symptoms.
4. Discussion
The COVID-19 pandemic has led to disruptions in family and social life around the world due to social isolation, school closures, and growing concerns about health and material existence [
24]. Although the long-term consequences of epidemiological prevention activities are not yet known, there are many studies documenting a clear impact on the mental well-being of children and adolescents under 18 years of age [
5]. Many of the studies reporting the overall mental state in society have focused on children and adolescents, particularly with regard to increased emergency department visits and suicide attempts [
40].
In our project, we investigated parameters of psychological well-being in the population of Lodz voivodship aged up to 18 years before and during the COVID-19 pandemic. The questions contained in the survey concerned both the current situation and, retrospectively, the situation preceding the pandemic; this is a limitation of the study, as the data from before the pandemic were not collected at that time. However, the inclusion of questions about both the period preceding and the period of the pandemic gave an overview of the emotions, mental state, and situation of children and adolescents during this crisis period. The pandemic period was inextricably linked to home isolation and thus remote learning in many Polish schools but also more frequent and prolonged contact with family members and other household members, which could either be a protective factor or cause psychopathological symptoms [
41].
The process of growing up and, therefore, belonging to a group of children or adolescents has a clear impact on the frequency of occurrence of certain psychopathological symptoms; therefore, we decided to analyze the results we collected in two subgroups, age ≤ 12 and age > 12, to better analyze mental health problems by age group [
42].
No study has shown the positive or lack of impact of the COVID-19 crisis on the general and mental health of the pediatric population [
43]. The research conducted so far clearly shows an increase in the frequency of children seeking psychological support [
44]. However, Boston researchers have shown that in the long run, in younger patients, the help initiative from adults is more important, and their cognitive flexibility and educational involvement lead to a reduced risk of symptoms of depression and anxiety in children [
45]. In the pediatric population data we received, we did not note any change in the frequency of admissions due to new psychiatric problems or the exacerbation of existing ones. Contrary to global reports, researchers from Tuscany recorded a 200% increase in hospital admissions due to newly occurring psychiatric problems [
45]. One possible explanation might be the difference in access to professional mental health help in different regions, both before and during the pandemic, including some limitations to hospital admittance due to epidemiological restrictions. Generally, an increasing number of studies have reported higher levels of anxiety, depression, and stress among children (ages 6–12 years) who experienced family isolation and school closures during COVID-19, which is also proven by our results [
46]. Attention is also drawn to the strong sense of loneliness associated with social isolation among children, which intensifies depressive and anxiety symptoms [
14].
Among self-aggressive behaviors in the children’s population, we only noted an increase in the frequency of thinking about death; none of the surveyed children attempted suicide or showed such tendencies. Global reports in this area are inconsistent and indicate schools as potential sources of mental psychopathology symptoms. For example, researchers from Alicante reported a significant increase in both suicidal thoughts and suicide attempts among children [
47]. In turn, Welsh research mentioned a constant upward trend in this area, not strictly related to the COVID-19 pandemic crisis [
48]. Researchers point to a correlation between mental disorders that lead to suicidal thoughts and tendencies in children. It should be noted that in our study population <12 years of age, no mental disorders were noticed among the respondents, which may explain the milder consequences in the form of suicidal thoughts only without self-aggressive behavior [
49].
Research on the psychophysical condition of teenagers has also confirmed the lack of well-being and psychological consequences in this age group—depressive disorders, anxiety, and sleep problems are just some of those caused by pandemics [
50].
Researchers have pointed out how important the role of parents is, as they are a stable base in not only a teenager’s crisis but also a situational crisis such as a pandemic [
51,
52]. While the research studies available so far indicate a clear increase in the frequency of seeking help in the field of mental health among adolescents, some of them indicate a delayed availability of help due to epidemiological restrictions [
53,
54]. This is an important point for developing aid strategies for the future so that no one is left without help [
55]. Some researchers have pointed out the significant role of social media in helping teenagers in times of crisis through quick availability and wider access to a dedicated support group [
56,
57]. We can use this for psychoeducational and support purposes. Global research has also confirmed the increase in the number of hospitalizations of adolescents during the COVID-19 pandemic, mentioning that they most often concern teenagers with eating disorders and self-harm [
58,
59,
60].
Global reports, as well as the results of our research, indicate that the main problem that has become more intense is self-aggressive behavior [
61,
62]. Koreans reported that girls were much more likely to seek help in this area [
63]. There is also an increase in the frequency of thinking about death and the occurrence of suicidal thoughts. The greatest intensity was observed in self-harm for the purpose of reducing tension, which is in line with the results obtained in our study [
64]. At the same time, self-harm in Canada during the COVID-19 pandemic was the fourth cause of hospital admissions among teenagers [
65]. Moreover, a publication by scientists from Louisiana indicated a clear correlation between engaging in suicidal behavior and the experience of bullying at school in the adolescent population [
66]. Teenagers experiencing peer violence are more likely to think about death or engage in suicidal behavior [
67]. The problem seems to be more severe in developing countries such as Liberia, Chile, and Indonesia [
68,
69,
70]. Potentially limiting peer contacts may be a protective factor in engaging in suicidal Potentially limiting peer contacts may be a protective factor in engaging in suicidal behavior. Similarly, in the pediatric population, a constant upward trend in self-aggressive behavior similar to the abovementioned trends in suicidal thoughts and attempts that have been occurring for several years, unrelated to the pandemic period itself, is emphasized [
71].
Other psychiatric symptoms occurring in people under 18 years of age, such as psychosis or tics, as well as the use of psychoactive substances, are also important. Canadian reports show a 66% increase in the incidence of psychosis during a pandemic in the adolescent population, which was not proven by our research [
72]. Our results also did not show that the severity of tics during isolation was related to the COVID-19 pandemic; meanwhile, Danish researchers indicated that in 40% of the population of teenagers diagnosed with tics they studied, the trigger to recurrence or exacerbation was epidemiological isolation [
73].
Analyzing our results, we can notice a slight increase in the use of psychoactive substances only in the adolescent population, which is consistent with global reports. American researchers showed an increase in the use of ethanol, cannabinoids, and opiates related to the immediate outbreak of the pandemic [
74]. A slightly different effect was shown by researchers from Iceland, who demonstrated an increase in recreational alcohol consumption related to the loosening of pandemic restrictions and the possibility of renewed social contacts without restrictions [
75]. In Poland, many places selling alcohol were closed for a long time. A clear increase in externalizing behaviors (self-harm or the use of psychoactive substances), especially in the adolescent population, proves the reactive nature of the above symptoms, thus indicating a special area for preventive actions.
It is undeniable that the pandemic has impacted the physical and mental well-being of the under-18 population. It is important to pay attention to the dynamics of problems and appropriate preventive actions, as well as help in difficult situations as quickly as possible, in order to prevent the long-term consequences of similar global crises in the future.
It is important to mention the limitations of the presented research. Because the survey was conducted online, it is difficult to verify the respondents and their affiliation with the target group. On the other hand, the form was forwarded directly to parents of students from specific educational institutions, which limits the aforementioned inadequacy of responses. Direct access to the questionnaire by parents could theoretically limit access to the questionnaire by children from violent families due to the deliberate concealment of the phenomenon occurring at home, despite the anonymity of the questionnaire. The age of the studied population covered a relatively wide range, which can be considered both an advantage and a limitation of the study. The degree of understanding and interpretation of the questions included in the questionnaire might have been different depending on the age of responders and limited especially in younger children. Due to the design of the study itself, it is burdened, as it is not a prospective observational study. The partially retrospective character of the study can also be considered a limitation. Participants during the pandemic answered questions regarding the present time (COVID-19 pandemic) and were asked to assess the situation before the pandemic retrospectively. Therefore, the retrospective answers could have been influenced by the time that passed from individuals’ experiences; the answers could have been diminished or exaggerated, and thus the results obtained in the study should be interpreted with caution, taking into consideration this limitation of the study design.
Unfortunately, very little has been publicized about children between birth and 5 years of age, who may be among the most vulnerable to the psychosocial impacts of COVID-19 [
76]. Our research was conducted in the Polish student population, so it also does not cover children under 6 years of age.
Despite reports from many countries around the world, it seems reasonable to collect data locally, as occurred in our study. This makes it possible to analyze the cultural context and the specific functioning of family systems. This allows for a more accurate assessment of needs and the optimal adjustment of preventive interventions.