Psychosocial consequences of COVID‐19 in children, adolescents and young adults: A systematic review

This Letter presents the main findings of a systematic review of 21 studies (n = 33 398) on the psychosocial consequences of COVID‐19 in children, adolescents, and young adults, following the PRISMA guidelines; the background, methods and results are presented as an online Supplement. According to our findings, excess worrying, irritability, home confinement, and fear of COVID‐19 infection and transmission are associated with mild to severe anxiety symptoms during the COVID‐19 epidemic. ¹ Isolation could be a risk factor for deterioration in mental health, including depressive and anxiety symptoms, distress, fear, post‐traumatic stress, and insomnia. ²

Regarding anxiety disorders, the fear of COVID‐19, widely known as ‘coronaphobia,’ has enhanced anxiety symptoms, with a further aggravating role mediated by isolation at home. ² Individuals with anxiety disorders tend to be preoccupied with excessive hand‐washing, extreme cautiousness, social distancing measures and unnecessary shopping. ³ Furthermore, a strong correlation between family relations and fear of contracting COVID‐19 was noted. ⁴ Focusing especially on COVID‐19‐infected patients, they were also affected, expressing high anxiety levels, as reported in SARS and MERS patients in the past. ⁵

Mild to moderate depressive symptoms were also often expressed, ¹ similarly to those recorded in the SARS and MERS periods, ⁶ but at a geographically larger extent. According to the findings, the situation imposed by social distancing and isolation has affected the emotional reaction of the public broadly, causing not only distress, but also frustration, irritability, hopelessness, little interest or pleasure in activities, reduction in outdoor activities, extensive mobile phone use, and negative emotions about COVID‐19. ¹ , ² , ⁷ Moreover, an increase in violence during the pandemic, especially in adolescents and young adults, has been reported in the USA. ⁸

During the COVID‐19 pandemic period, behavioral changes have also been identified in children and adolescents with autism spectrum disorder (ASD) and attention‐deficit/hyperactivity disorder (ADHD). Children with ASD, monitored by their parents, more frequently failed to follow through simple instructions, lost their independence and communication skills, engaged in problematic interactions with their parents, and performed pranks for attention. ⁹ A series of guidelines, techniques, and physical exercises have been promoted in order to help ASD children remain calm during the pandemic. ⁹ Children with ADHD, on the other hand, have been reported by their parents as uncontrollably angry, and unable to stay focused and perform everyday routines. ¹⁰ New guidelines have been established to help address the mental health issues of children, proposing that monitoring medication and maintaining a strict sleep schedule could be beneficial. ¹⁰ , ¹¹ Although online therapy sessions have been available and are considered adequate, lack of face‐to‐face clinical evaluation has limited their effectiveness. ¹²

Furthermore, according to our findings, children, adolescents, and young adults have stayed home, restricting their mobility to absolute necessity and practicing social distancing due to school and university closure. ¹³ The loss of everyday peer‐to‐peer contact, uncertain academic career, and use of online learning have created a new reality also in education. Screen time, not only for educational purposes, but also leisure activities, has increased, with excessive use of social media, online gaming, and watching movies being more frequent. ¹³ Thus, physical activity has been minimized and physicians have suggested daily activities, such as aerobic, strength activities, or bone strengthening, in order to avoid consequences of inactivity.

Children and parents have experienced everyday challenges and one important finding was that parents seemed to be more anxiety‐stricken than their children. ⁴ Crucial efforts by parents have been made in introducing stress‐relief activities, including reading and exercising, with online sources providing tips and activities. Also, parents of children with special needs have experienced more mood swings and excessive concern about the COVID‐19 impact according to the main findings. ⁴

The use of technology has made a significant impact in the well‐being of individuals, with health workers (such as doctors, psychiatrists, psychologists, social workers, and others) being available through online services. Despite the limitations of no physical interaction, telehealth has been reported as effective in diminishing and managing emotional and anxiety symptoms, not only in youth, but also in parents. ² , ⁴ , ⁶ , ¹³

In conclusion, a deterioration in mental health is highlighted, encompassing anxiety and mood symptoms, and developmental, stressor‐related, and eating disorders among children, adolescents, and young adults during the COVID‐19 pandemic. The new reality in everyday life and education due to COVID‐19 has burdened the existing conditions, especially in children with neurodevelopmental disorders, where an enhancement in dysfunctional behaviors has been noted. COVID‐19 is a rapidly evolving scientific and social field; therefore, further results are anticipated to rapidly accumulate.

Disclosure statement

The authors declare no conflicts of interest.

Supporting information

Appendix S1. Supporting information.