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Article

Mental Health in Primary School Children Before and During the COVID-19 Pandemic

by
Benito León-del-Barco
*,
María-Isabel Polo-del-Río
,
Santiago Mendo-Lázaro
,
Víctor-María López-Ramos
,
Carolina Bringas-Molleda
and
Julián Álvarez-Delgado
Department of Psychology, Faculty of Teacher Training College, University of Extremadura, 10003 Cáceres, Spain
*
Author to whom correspondence should be addressed.
COVID 2025, 5(11), 189; https://doi.org/10.3390/covid5110189
Submission received: 16 September 2025 / Revised: 21 October 2025 / Accepted: 31 October 2025 / Published: 3 November 2025
(This article belongs to the Section COVID Public Health and Epidemiology)
Review Reports Versions Notes

Abstract

The health crisis caused by COVID-19 led to a series of restrictive measures worldwide. Amongst them, a period of lockdown that resulted in a decrease in social contact, which had a series of effects at the emotional, educational, and social levels, the greatest concern being the mental health effects in minors. The aim of this study is to analyse mental health disorders affecting Primary Education students before and during the pandemic, at emotional, social and behavioural levels. A total of 1045 students from different educational centres, in 5th and 6th year of Primary Education, of both sexes and aged between 10 and 12 years old, took part in the study. The instrument used was the “Strengths and Difficulties Questionnaire, SDQ”, which measures mental health disorders in minors. The results indicate that during the pandemic there was an increase in emotional problems among minors, alongside a decrease in hyperactivity, conduct problems, and peer-related problems. Social distancing during the pandemic may have acted as a key mediating variable in the observed outcomes. It is concluded that these results are important in preventing psychological effects on the mental health of minors in crisis situations.

1. Introduction

Childhood and adolescence are crucial developmental stages shaped by a delicate balance of biological, psychological, social, educational, familial and relational factors [1]. Mental health issues in children and adolescents are a source of major concern within society, as they give rise to suffering, poor educational performance, disability and functional impairment [2]. Due to growing concern over their impact on children’s and adolescents’ development, mental health issues in minors have become an increasingly popular topic of research around the world.
The COVID-19 pandemic declared by the World Health Organisation in 2020 prompted many countries to introduce restrictive measures such as social distancing and limits on social gatherings and mobility, which led to isolation at home and a significant reduction in social and relational activities. Educational institutions were also affected by these measures, which included the suspension of face-to-face teaching.
The specific characteristics of the crisis triggered by the pandemic (lockdowns, limitations on direct social relations, etc.) have had a series of complex, far-reaching emotional, economic and social impacts. This has affected the mental health of a large part of the population as a result of changes to their daily lives [3,4] and led to the emergence of psychological risk factors, including an increase in emotional and behavioural issues among adolescents [5,6,7,8].
While the proportion of children and adolescents suffering from mental health issues stood at 10–20% in recent years [9], this figure has risen significantly due to the negative psychological impact of the COVID-19 pandemic on the general population and on these age groups in particular [10]
According to Pedreira [11], the true impact of the COVID-19 pandemic on children’s and adolescents’ mental health has yet to be evaluated. However, it could manifest in changes to the organisation of their personalities and emotional experiences in the medium and long term. The reduction of social contact, the limitation on attending school, or the restriction of age-appropriate activities can have negative consequences on the emotional and behavioural regulation of children and adolescents [12].
Exposure to uncertainty, worry and stress is associated with high levels of anxiety and/or depression among minors, while experiencing isolation as a traumatic event is associated with a greater likelihood of developing post-traumatic stress disorder [1]. The COVID-19 pandemic caused such widespread uncertainty, fear and emotional distress that it could trigger the emergence of mental illness, especially among minors, who are considered to be particularly vulnerable [13].
In the case of COVID-19, Amorós-Reche et al. [14] conducted a systematic review of studies exploring the emotional repercussions of the first phase of the pandemic on Spanish children and adolescents. These studies agree that the first months of the pandemic had the most negative impact on children and adolescent mental health in Spain. This situation has led to emotional issues such as anxiety, depression, stress and emotional regulation problems.
Other studies have contributed data on the impact of lockdown measures. A study carried out in Spain and Italy concluded that 86% of families observed changes in their children’s emotional state and behaviour during this period [15]. More specifically, lockdown measures have been linked to a rise in stress, anxiety, depression, eating disorders and even suicide [6,16,17]. Meanwhile, other studies have highlighted feelings of loneliness, frustration, fear, anger and melancholy and challenging behaviours as the main side effects of the anxiety caused by the pandemic [10,18].
When normality resumed and schools reopened, the consequences of their experiences during the months of lockdown led to collateral emotional damage among children and adolescents, as indicated in Fundación ANAR’s annual report, “En Tiempos de Pandemia” [16]. Symptoms like anxiety, depression and frustration became more widespread among this population and were expressed through emotional self-regulation mechanisms such as suicidal thoughts, attempted suicide, self-harm and eating disorders. Behavioural problems also worsened and became the main reason for seeking psychological treatment.
Studies conducted by different international organisations such as UNICEF [19] and Save the Children [20] have drawn attention to the impact of the pandemic on children’s and adolescents’ mental health. These studies estimate that anxiety disorders and depression have almost quadrupled (from 1.1% to 4%), while diagnoses of attention deficit hyperactivity disorder (ADHD) and other behavioural disorders have risen from 2.5% to 7%. In a study by UNICEF [19], children and adolescents expressed a diverse range of emotions experienced during the pandemic and conveyed the affective ambivalence that the pandemic had triggered within them (irritability, moodiness, anger, anxiety, loneliness and sadness, which led to mood swings). Older children and adolescents were more severely affected than younger children, with girls displaying more symptoms than boys [14]. With regard to hyperactivity and attention deficit issues, these symptoms diminished in children and adolescents at times when restrictive measures were lifted or relaxed [21].
This cross-sectional study aims to analyse the mental health of students in the final years of primary education, both before the pandemic and during periods when some restrictive measures were still in place but normal life and school routines were gradually resuming. It also seeks to examine how a stressful event of this kind and associated restrictions on social activity can lead to a rise in emotional, social and behavioural problems among schoolchildren. The findings may be useful in preventing or minimising the impact on this age group of future events that entail restrictions on social contact and school attendance.

2. Materials and Methods

2.1. Design

Given the characteristics of the participants and the study objectives, an ex post facto cross-sectional quantitative study design was used, in which a phenomenon that has already occurred and does not continue over time is studied and the study variables are not manipulated. In this cross-sectional study, we compared the mental health of students in the same age group and school year at two different times (before and during the pandemic). So these are two independent cohorts wich different subjects each time. A comparative, associative design was used to study the role of the Pandemic (before vs. during) variable, gender and the interaction between the two in mental health. The odds ratio statistical technique was also applied to analyse the association between the Pandemic (before vs. during) variable and mental health issues. Finally, a questionnaire methodology was used to collect data.

2.2. Participants

The sample was selected using multi-stage cluster sampling and random selection of groups in schools with several groups in Years 5 and 6 at primary level. The cluster sampling was carried out by selecting eight educational institutions at random, four before the pandemic in 2018 (420 students) and another four during the pandemic in 2020 (625 students). The number of participants was determined on the basis of the number of pupils registered at primary and secondary level in public and state-funded private schools in Extremadura (Spain) during the 2017–2018 school year, considering a sampling error of 3% and a confidence level of 96%. The sample was made up of 1045 students. 45% of the sample were enrolled in Year 5 and 55% were in Year 6 at primary level. The average age was 10.81 years old (SD= 0.705; range 10–12); 51.5% (n = 538) were female and 48.5% (n = 507) were male. All students came from a middle socio-economic background.

2.3. Instruments

Strengths and Difficulties Questionnaire, SDQ [22]. The self-report version of the SDQ is a short questionnaire that is very useful for screening for mental health disorders in minors, with outstanding internal consistency in all its scales in both the international [23,24] and the Spanish version of the instrument [1,25]. It comprises 25 items divided into five dimensions or subscales (1. Emotional Symptoms, 2. Conduct Problems, 3. Peer Relationship Problems, 4. Hyperactivity and 5. Prosocial Behaviour). Each of the subscales is assessed via five items. A three-point Likert scale is used to record responses (0 = No, not at all, 1 = Sometimes and 2 = Yes, always). Both the total score from the SDQ and the scores from the various subscales and scales are classified into three categories: Normal, Borderline and Abnormal. In the original scale [22], the Abnormal category encompasses the top 10% of cases (above the 90th percentile), while the Borderline category corresponds to the 10% of cases between the 80th percentile and 90th percentile.
In this study, the following indices were used to analyse the reliability of the different scales (Table 1): Cronbach’s alpha (α) and McDonald’s omega (Ω). Whereas Cronbach’s alpha depends on the number of items and the number of response options, McDonald’s omega is calculated using factor loadings and offers a more precise measure of reliability. Values exceeding 0.70 are considered acceptable. Convergent validity was estimated using average variance extracted (AVE), which should exceed 0.50.

2.4. Procedure

This study is part of a larger project whose proposal was approved by the Bioethics and Biosafety Committee of the University of Extremadura (No. 0063/2018), on 22 May 2018. Our interest in the effects of COVID on students’ mental health led us to begin the study once the second participant sample was obtained in September 2020, following the students’ return to the classrooms. They were provided with the same assessment scale as the first group, who at that time were part of other research objectives. We followed the ethical guidelines established by the American Psychological Association with regard to informed consent from parents, as all participants were underage. Firstly, we contacted the schools to explain the objectives of the study and request authorisation to complete the questionnaires. Then, we administered the questionnaires by class group. In this way, we were able to guarantee the anonymity of the responses, the confidentiality of the data obtained and the exclusive use of this data for research purposes. The questionnaires were administered during school hours; the process took around 25 min in an appropriate setting without distractions.

2.5. Data Analysis

Before the analytical process began, a missing data analysis was performed with the variables included in the models analysed. The statistical analysis was completed using the SPSS 21.0 package for PC. It included reliability analyses for the instrument (SDQ), multivariate analysis of variance and odds ratio measure of association (OR).
Subsequently, two statistical analyses were conducted in the study:
(1)
MANOVA with partial eta-squared effect size test to determine the role of the Pandemic (before vs. during) variable and gender and the interaction between the two in the mean scores on the Emotional Symptoms, Hyperactivity, Peer Relationship Problems and Conduct Problems scales.
(2)
Chi-square test analysis to determine the association between the Pandemic (before vs. during) variable and mental health issues using odds ratio statistical. These variables were converted into dichotomous variables from the 80th percentile (P ≥ 80 = “Experiencing Problems”; P < 80 = “Not Experiencing Problems”).

3. Results

3.1. Role of the Pandemic (Before vs. During) Variable and Gender in Mental Health Issues: Multivariate Analysis

Before analysing the role of the Pandemic (before vs. during) variable and gender and the interaction between the two in the study variables, multivariate comparisons of the mean scores on the “Emotional Symptoms”, “Hyperactivity”, “Peer Relationship Problems” and “Conduct Problems” scales were carried out (Table 2). The multivariate analysis (MANOVA) showed a significant main effect of the Pandemic variable (Wilks λ = 0.472, F(4, 920) = 257.227, p < 0.001, ƞ = 0.528) and gender (Wilks λ = 0.968, F(4, 920) = 7.627, p < 0.001, ƞ = 0.032), but not of the interaction between the Pandemic variable and gender (Wilks λ = 0.991, F(4, 920) = 2.189, p = 0.068, ƞ = 0.009).
The univariate contrasts show the following results.
With regard to the “Emotional Symptoms” variable, students obtained higher scores during the pandemic than before the pandemic (F(1, 920) = 3.947, p = 0.047, ƞ = 0.004); there were no significant differences by gender but there were in the pandemic/gender interaction (F(1, 920) = 4.283, p = 0.039, ƞ = 0.005). Girls scored higher during the pandemic than before the pandemic.
As for the “Hyperactivity” variable, students obtained lower scores during the pandemic (F(1, 920) = 156.738, p < 0.001, ƞ = 0.145). Boys obtained higher scores than girls (F(1, 920) = 5.284, p = 0.022, ƞ = 0.006), with no pandemic/gender interaction.
In the case of the “Peer Relationship Problems” variable, the data show that students obtained lower scores during the pandemic (F(1, 920) = 771.806, p < 0.001, ƞ = 0.455). There were no significant differences by gender, nor in the pandemic/gender interaction.
Finally, with regard to the “Conduct Problems” variable, students obtained lower scores during the pandemic (F(1, 920) = 31.358, p < 0.001, ƞ = 0.033). There were significant differences by gender, with boys obtaining higher scores than girls (F(1, 920) = 25.837, p < 0.001, ƞ = 0.027), but there was no pandemic/gender interaction.

3.2. Pandemic (Before vs. During) Variable and Mental Health Issues: Odds Ratio Measure of Association (OR)

Our main aim was to determine the association between the Pandemic (before vs. during) variable and mental health issues using odds ratio statistical techniques. To do so, the scores for the SDQ scales were used as dependent variables: “Emotional Symptoms”, “Hyperactivity”, “Peer Relationship Problems” and “Conduct Problems”. These variables were converted into dichotomous variables from the 80th percentile (P ≥ 80 = “Experiencing Problems”; P < 80 = “Not Experiencing Problems”), while the subjects in the “Abnormal” and “Borderline” categories on the original scale were grouped together. The dichotomous variable Pandemic (before vs. during) was used as an independent variable.
Table 3 shows a significant association between the Pandemic (before vs. during) variable and the “Emotional Symptoms”, “Hyperactivity” and “Peer Relationship Problems” variables. With regard to the association with the “Emotional Symptoms” variable, the OR was 1.499, the limits of the ratios at 95% confidence did not contain the unit and the result of the chi-squared test was 8.810, confirming the significance of the results (p = 0.003). As for the association with the “Hyperactivity” and “Peer Relationship Problems” variables, both the limits of the ratios and the chi-squared test confirmed the significance of the results (p < 0.001).
The odds ratios indicate that: (1) The likelihood of experiencing emotional symptoms was 1.5 times higher during the pandemic than before the pandemic; (2) The likelihood of experiencing hyperactivity was 2.2 times higher before the pandemic than during the pandemic; (3) The likelihood of experiencing peer relationship problems was 9.8 times higher before the pandemic than during the pandemic.

4. Discussion

The aim of this study was to explore the mental health of students in the last two years of primary education before and during the pandemic. With regard to the role of the Pandemic (before vs. during) variable in mental health issues, the results point to an increase in emotional symptoms among pupils during the pandemic. These findings corroborate other studies, such as those by Paricio et al. [10]; Amorós-Reche et al. [14] and Orgilés et al. [15], who consider emotional symptoms to be psychological risk factors in adolescents and identify the early months of the pandemic as the period when these symptoms were most noticeable. When it comes to gender, the results of the study show that girls experienced more emotional symptoms during the pandemic than before the pandemic. To explain this, Bar-On [26] suggests that social challenges such as those that emerged during the pandemic tend to be handled differently by boys and girls, the latter of whom are more aware of their emotions and display a greater sense of social responsibility and empathy. The results of this study highlight differences in the emotional states of boys and girls that were accentuated by the pandemic. For these reasons, and as Usall [27] suggests, it is important for the public health system to adopt a gender-sensitive approach.
Moving on to the results obtained for the other variables, there was a decrease in hyperactivity, peer relationship problems and conduct problems among students during the pandemic. There was no interaction between pandemic and gender in any of the variables. With regard to hyperactivity, our study shows higher scores among boys and a decline in hyperactivity during the pandemic. This is corroborated by several other studies, which point to a decrease in symptoms during the pandemic, especially at times when restrictions were being lifted. Some studies even observe an improvement in symptoms, which parents attributed to greater flexibility in organising their daily lives and greater ease of adaptation due to limited distractions and increased parental availability [21,28]. Therefore, in conditions similar to those experienced during the pandemic, students who display symptoms of hyperactivity and whose social functioning is a source of conflict and stress must be given extra support to return to school and their return must be carefully prepared [28].
The decrease in peer relationship problems observed in this study may be explained by the lack of direct social contact between students during the pandemic, and especially during the lockdown period. According to Tomé et al. [29], “social distancing from peers”, in general, reduces certain risks such as involvement in violence (fights, bullying and injury). Finally, like peer relationship problems, conduct problems also became less prevalent among the students in the study sample. Paradoxically, this study indicates that the likelihood of experiencing conduct problems rose during the pandemic, although the data show no statistically significant differences between the two periods analysed. In any case, the decrease in conduct problems may be attributed to low levels of exposure to different forms of conflict during the lockdown period. It also owes to a rise in proactive behaviours such as involvement in social movements, family cooperation and emotional support for others. Despite their negative experiences during the pandemic, adolescents also began to place greater value on actions benefiting others and to consider them a key component of their social wellbeing [12]. Boys displayed more conduct problems than girls, corroborating previous studies that point to a higher prevalence of these problems among boys, especially in adolescence [30], and confirm that, regardless of the version of the SDQ used (parents, teachers or self-report), boys score higher on external symptoms such as conduct problems and hyperactivity [2,31,32,33,34].

Study Limitations and Future Directions

This study has several limitations, the most important of which is the use of self-reports as a data collection method. Self-reports of mental health are based on students’ temporary, subjective perceptions. Additionally, two of the mental health subscales—problems with peers and conduct problems—show lower reliability coefficients, although they remain within the range considered acceptable. The cross-sectional design is another limitation, making it difficult to draw further inferences about the relationship between the study variables. Moreover, in this cross-sectional study, we compared mental health at two different points in time among students from the same age group and school year, although they were not the same students. This study does not include socio-demographic data (such as race, ethnicity, or parents’ educational level) because these factors were not the primary focus of the research. While they may have a relevant impact on the variables analysed, their exclusion was a methodological decision to delimit the scope of the study. Future research is encouraged to incorporate these variables to gain a deeper understanding of their influence on the phenomena under study. It would also be valuable to examine the long-term effects of the pandemic on children’s and adolescents’ emotional and behavioural well-being. Regarding gender-specific results, it would be relevant to design and evaluate interventions that address emotional symptoms and behavioural problems according to gender for the age groups under study. Finally, cultural differences mean that caution should be exercised when extrapolating the results to other countries, especially non-Western countries.

5. Conclusions

Research has highlighted the problems caused by the COVID-19 pandemic, which has triggered serious mental health issues among children and adolescents. Against this backdrop, the main objective of this study was to determine the association between two different points in the pandemic (before vs. during) and mental health issues in a large sample of schoolchildren aged 10–12 years old. The results allow us to conclude that students, especially girls, were more likely to experience emotional symptoms during the pandemic than before the pandemic, while hyperactivity, peer relationship problems and conduct problems were more likely to occur before the pandemic. In terms of differences by gender, boys displayed higher levels of hyperactivity and conduct problems. These results may prove useful in preventing or minimising the impact of future events like the COVID-19 pandemic and restrictions on social contact and school attendance on pupils in the final years of their primary education. This study demonstrates that emotional and behavioural development in boys and girls aged 10 to 12 is sensitive to crisis contexts, such as the COVID-19 pandemic, showing significant gender differences, which enhances our understanding of psychological development in childhood. The results highlight the importance of incorporating gender-differentiated socio-emotional support strategies within the educational system and reinforce the school’s role in the early detection and intervention of mental health problems at these ages. Educational protocols and systematic mental health monitoring are necessary for emergency situations (such as pandemics) to maintain learning continuity and emotional support for students. Furthermore, public health policies should promote campaigns for parents and caregivers on how to emotionally support children during times of uncertainty or confinement.

Author Contributions

Conceptualization, B.L.-d.-B., M.-I.P.-d.-R., S.M.-L., V.-M.L.-R., C.B.-M. and J.Á.-D.; methodology, B.L.-d.-B. and S.M.-L.; formal analysis, B.L.-d.-B. and S.M.-L.; investigation, M.-I.P.-d.-R., V.-M.L.-R., C.B.-M. and J.Á.-D.; resources, J.Á.-D.; data curation, B.L.-d.-B.; writing—original draft preparation, B.L.-d.-B., M.-I.P.-d.-R., S.M.-L., V.-M.L.-R., C.B.-M. and J.Á.-D.; writing—review and editing, B.L.-d.-B., M.-I.P.-d.-R., S.M.-L., V.-M.L.-R., C.B.-M. and J.Á.-D.; visualization, B.L.-d.-B., M.-I.P.-d.-R. and V.-M.L.-R.; supervision, B.L.-d.-B. and C.B.-M.; funding acquisition, V.-M.L.-R. All authors have read and agreed to the published version of the manuscript.

Funding

This publication has been co-financed 85% by the European Union, the Regional Development Fund and the Junta de Extremadura. Managing Authority: Ministry of Finance. File: GR24149.

Institutional Review Board Statement

This study was approved by the Bioethics and Biosafety Committee of the University of Extremadura (No. 0063/2018), on 22 May 2018.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The datasets generated and/or analysed during the current study are not publicly available due to ethical and legal restrictions related to the confidentiality of participant information. Access to the data is therefore limited in order to protect the privacy of the individuals involved.

Conflicts of Interest

The authors declare no conflicts of interest.

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Table 1. AVE, Ω and α values for the SDQ scales.
Table 1. AVE, Ω and α values for the SDQ scales.
Average Variance
Extracted		McDonald’s
Omega		Cronbach’s
Alpha
Emotional Symptoms scale0.5420.8120.806
Hyperactivity scale0.5570.8340.791
Peer Relationship Problems scale0.4290.6930.682
Conduct Problems scale0.3630.6620.661
Table 2. Descriptive statistics for the study variables Emotional Symptoms, Hyperactivity, Peer Relationship Problems and Conduct Problems by gender before the pandemic vs. during the pandemic.
Table 2. Descriptive statistics for the study variables Emotional Symptoms, Hyperactivity, Peer Relationship Problems and Conduct Problems by gender before the pandemic vs. during the pandemic.
VariablesGenderBefore Pandemic (n = 420)During Pandemic (n = 625)Total
(n = 1045)
MSDMSDMSD
Emotional
Symptoms 		Female2.532.033.142.382.812.21
Male2.832.202.822.212.822.21
Total2.632.092.962.292.812.21
HyperactivityFemale5.501.713.522.394.622.26
Male5.691.794.012.444.562.38
Total5.561.743.802.434.592.32
Peer Relationship ProblemsFemale4.461.301.611.673.192.05
Male4.521.141.781.602.681.95
Total4.481.251.711.632.952.02
Conduct
Problems		Female2.571.241.881.772.271.54
Male3.081.562.521.892.701.80
Total2.751.382.251.862.471.68
Table 3. Chi-square test results and Odds ratio according to the dependent variables (Emotional Symptoms, Hyperactivity, Peer Relationship Problems and Conduct Problems) and the Pandemic variable.
Table 3. Chi-square test results and Odds ratio according to the dependent variables (Emotional Symptoms, Hyperactivity, Peer Relationship Problems and Conduct Problems) and the Pandemic variable.
SDQPandemic% Experiencing
Problems		χ2pOR95% C.I.
Emotional
Symptoms 		Before35.08.8100.0031.4991.1471.960
During65.0
HyperactivityBefore56.625.917<0.0012.1761.6072.946
During43.4
Peer Relationship
Problems		Before81.5175.129<0.0019.8296.72914.356
During18.5
Conduct
Problems		Before400.4260.5140.9070.6771.216
During60
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León-del-Barco, B.; Polo-del-Río, M.-I.; Mendo-Lázaro, S.; López-Ramos, V.-M.; Bringas-Molleda, C.; Álvarez-Delgado, J. Mental Health in Primary School Children Before and During the COVID-19 Pandemic. COVID 2025, 5, 189. https://doi.org/10.3390/covid5110189

AMA Style

León-del-Barco B, Polo-del-Río M-I, Mendo-Lázaro S, López-Ramos V-M, Bringas-Molleda C, Álvarez-Delgado J. Mental Health in Primary School Children Before and During the COVID-19 Pandemic. COVID. 2025; 5(11):189. https://doi.org/10.3390/covid5110189

Chicago/Turabian Style

León-del-Barco, Benito, María-Isabel Polo-del-Río, Santiago Mendo-Lázaro, Víctor-María López-Ramos, Carolina Bringas-Molleda, and Julián Álvarez-Delgado. 2025. "Mental Health in Primary School Children Before and During the COVID-19 Pandemic" COVID 5, no. 11: 189. https://doi.org/10.3390/covid5110189

APA Style

León-del-Barco, B., Polo-del-Río, M.-I., Mendo-Lázaro, S., López-Ramos, V.-M., Bringas-Molleda, C., & Álvarez-Delgado, J. (2025). Mental Health in Primary School Children Before and During the COVID-19 Pandemic. COVID, 5(11), 189. https://doi.org/10.3390/covid5110189

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