Table I.

Study Characteristics and Main Findings

Study	Location and pandemic	Study quality score and missing items	Population and sampling technique	Age of child and/or parent	Timing of assessment	Control or comparison group?	Research type/study design	Primary outcome measures	Main findings	Recommendations
Koller et al. (2006)	Toronto, Canada; SARS	100%	Pediatric patients admitted to hospital for suspected SARS; purposive sampling	Children (N = 5) aged 6–18 years; parents (N = 10)	A month after hospital discharge during the SARS outbreak in 2003	No	Qualitative study; interviews	Interviews focused on knowledge of SARS, understanding of infection policies, and coping; Thematic analysis was used.	Themes identified in the interviews related to negative emotional impacts, communication difficulties, and changes in parental and professional roles.	Despite isolation, family members need to make use of technology to keep in contact with their social networks. Emphasis on family-centered care and shared decision making between health care professionals and parents.
Dodgson et al. (2010)	Hong Kong; SARS	80%; missing detailed information about data analysis methods	Chinese mothers who delivered healthy infants during the SARS outbreak; purposive sampling	Mothers (N = 8) aged between 28 and 38 years; infants had a mean age of 38.36 weeks	Specific date not provided but occurred during the outbreak	No	Qualitative study: interviews	Interviews focused on mothers’ experiences of parenting and the impact of the pandemic on post-partum mothering; thematic analysis was used.	Themes identified were living with uncertainty, heightened vigilance, financial burden, and isolation.	Parents expressed a need for information regarding how to care for themselves and their children during pandemics. Health care providers need to address parents’ anxieties and fears that impact the quality of life of their children, family, and themselves.
Fung and Loke (2010)	Hong Kong; SARS	60%; sample representativeness; lack of validated measures	Hong Kong families with young children; convenience sampling	The majority of parents (N = 198) were aged 26–35 years; children aged 1–15 years	Between March and September in 2008	No	Quantitative study; cross-sectional	Parent-reported questionnaire: disaster preparedness, sources of information.	Families’ information needs prioritize how to keep their families safe during emergency crisis situations. Families report the television and radio as major sources of their information.	Many parents feel unprepared during these times. Public health agencies need to provide information to families on how to adequately prepare and should use checklists and guidelines to support decision-making.
Effler et al. (2010)	Perth, Western Australia; H1N1	60%; non-response bias and lack of validated measures	Parents of children who experienced school closures in response to the pandemic; stratified sampling	Parents (N = 233) of children aged 5–13 years	June 22, 2009 to July 3, 2009	No	Quantitative study; cross-sectional	Parent-reported questionnaire: the need for special childcare arrangements due to school closure, child’s compliance with social distancing.	90% of parents reported that the pandemic caused minimal or no anxiety for their children. Based on parent reports, children exhibited low compliance with social distancing recommendations (25%). 50% of parents reported missing work.	Given low compliance of social distancing in children, public health officials need to inform parents about why quarantine during school closures is essential for the survival and health of the community.
Kavanagh et al. (2011)	Melbourne, Australia; H1N1	60%; non-response bias; lack of validated measures	Parents of children who experienced school closures in response to the pandemic; stratified sampling	Parents (N = 314) of school age children	November to December 2009	No	Quantitative study; cross-sectional	Parent-reported questionnaire: understanding of quarantine recommendations, information sources, perceptions of usefulness of information, and child’s compliance with social distancing.	Major sources of parents’ information come from the schools, health department, and the media.	Consistent messages across media sources is crucial. The government should work collaboratively with the media to provide clear, accurate, and consistent information.
Chen et al. (2011)	Taiwan; H1N1	60%; non-response bias; lack of validated measures	Caregivers of children who experienced school closures in response to the pandemic; convenience sampling	Caregivers (N = 232) of children in one randomly selected class in each grade from kindergarten to grade 6.	June 1, 2009	No	Quantitative study; cross-sectional	Caregiver-reported questionnaire: child’s compliance with social distancing, childcare arrangements, economic impact of workplace absenteeism, wage loss, childcare expenses.	Parents reported workplace absence (27%), wage loss (18%), and expenses related to childcare (2%). They also reported concerns over their child’s education and missed school work.	Despite school closures, teachers may support families by continuing with remote teaching and monitoring of children during this time.
Remmerswaal and Muris (2011)	Netherlands; H1N1	80%; non-response bias	Parents of children from 3 primary schools in the Netherlands; convenience sampling	Parents and their children (N = 223) aged 7–12 years	November 2009 at the peak of the Swine Flu	No	Quantitative study; cross-sectional	Parent and child-reported on the following measures: Fear of Swine Flu Questionnaire (FSFQ), Sources of Information about the Swine Flu Scale (SISFS), and the Fear Survey Schedule for Children-Revised (FSSC-R).	Parent and child fear of the H1N1 were positively correlated. Parent delivery of threat information was positively correlated with children’s fear even after controlling for other sources (e.g. friends, media, school).	Parents need to be cognizant of the developmental level of their child when they communicate potentially threatening information about pandemics in their households.
Basurto-Dávila et al. (2013)	Argentina; H1N1	60%; non-response bias; lack of validated measures	Households of children who experienced school closures in response to the pandemic; convenience sampling	Parents (N = 266) of children aged 6–15 years	September 7–18, 2009	No	Quantitative study; cross-sectional	Parent-reported questionnaire: childcare arrangements and costs, wage loss, and child compliance with social distancing.	Families report a substantial financial burden as a result of pandemics. Non-childcare expenses and loss of wages were more common in low SES families. Parents are very concerned about their child’s education during school closures.	Distance learning may be more feasible in middle- and high-income households. Policies need to address the disproportionate impact on low SES families in their strategies.
Sprang and Silman (2013)	United States and Mexico; H1N1	60%; limited reporting and description of qualitative analytic methods and results	Parents from 8 sample states; “Follow the virus” sampling method with an emphasis on areas most severely impacted by H1N1	Parents (N = 398) aged 18–67 years	Spring 2009	Yes; comparison group from Toronto, Canada	Mixed Methods; interviews, focus groups, surveys	Parent-reported questionnaire: experiences and anticipated needs during the pandemic, experiences with isolation, sources of trust in information, UCLA Posttraumatic Stress Disorder Reaction Index (PTSD-RI), PTSD Check List-Civilian Version (PCL-C); interviews focused on psychosocial impact on children and parents.	Children and parents who were quarantined were more likely to meet clinical criteria for PTSD. Parent and child PTSD symptoms were found to be correlated.	Social isolation and quarantine measures need to ensure they minimize negative mental health impacts in children and families. Screening for PTSD may be required in both children and their parents.
Mizumoto et al. (2013)	Japan; H1N1	60%; response rate was not provided; lack of validated measures	Parents of children who experienced school closures during the pandemic; respondent-driven sampling	Parents (N = 181) of children aged 4–17 years	October 2009 to May 2010	No	Quantitative study; cross-sectional	Parent-reported questionnaire: child compliance with social distancing, parental absenteeism, childcare arrangements.	Families with younger children were more likely to be absent from work for a longer duration especially those requiring special childcare arrangements.	Government policies need to support families especially with younger children by providing a paid leave of absence during school closures.
King et al. (2018)	Sydney, Australia; H1N1	60%; non-response bias; lack of validated measures	Parents from childcare centers were surveyed and interviewed; convenience sampling	37 parents participated in the interviews; 431 parents completed the survey; majority of parents aged between 31 and 40 years; children aged 6 months–5 years	Survey: November—December 2009 Interview: June 2009—May 2011	No	Mixed methods; surveys and interviews	Parent-reported questionnaire: parental information seeking, trusted sources and information needs; interviews focused on parental experiences of the pandemic.	Doctors and nurses were among the “trusted” sources of information. The interviews revealed themes around information needs (preference for checklists for symptoms) and impacts of the pandemic on their well-being.	Need for telephone hotlines supervised by doctors and nurses may help disseminate accurate and helpful information.
Chan et al. (2007)	Hong Kong; SARS	80%; missing detail about analysis procedures	Parents of children hospitalized in a pediatric outpatient clinic in Hong Kong; convenience sampling	Parents (N = 8) of children aged 3–14 years	July 2003	No	Qualitative study; semi-structured interviews	Interviews focused on parents’ needs at and during their child’s hospitalization, perceptions of the care provided, and other experiences of parenting during the pandemic.	Four themes were identified: fear of immediate isolation and infection control procedures, sources of anxiety, coping, and experience with health care professionals.	Measures should be taken to alleviate parental uncertainty and anxiety during future infectious disease outbreaks. Importance of technology to facilitate coping for children isolated from caregivers.
Xie et al. (2020)	Hubei, China; COVID-19	100%	Students in grades 2 through 6 from Wuhan and Huangshi were invited to complete the survey; purposive sampling	Huangshi: Children (N = 1109) in grades 2 to 6; Wuhan: children (N = 675) in grades 2 to 6	February 28 to March 5, 2020	Yes; comparisons made between children from Wuhan (epicenter) and Huangshi	Quantitative study; cross-sectional	Children self-reported on the following measures: Children’s Depression Inventory-Short Form (CDI-S) and the Screen for Child Anxiety Related Emotional Disorders.	22.6% of students reported depressive symptoms, while 18.9% reported anxiety symptoms. Students in Wuhan reported higher depression scores than those in Huangshi. Students in Wuhan stayed in isolation for a longer period of time, starting quarantine earlier and ending it later.	In order to structure interventions around quarantine-related mental health issues in children, it is advisable to develop a greater understanding about how severe epidemics like COVID-19 impact students’ mental health.
Oosterhoff et al. (2020)	United States; COVID-19	80%; response rate not provided	Adolescents were recruited via social media from across the US; voluntary response sampling	Adolescents (N = 683) aged 13–18 years	March 29 to March 30, 2020	No	Quantitative study; cross-sectional	Adolescents self-reported on the following measures: social distancing behaviors and motivation, anxiety and depression as measured by the Patient-Reported Outcomes Measurement Information System.	Those who engaged in social distancing due to a personal fear of becoming ill reported higher levels of anxiety, as did those who did so in order to avoid social judgment.	Parents, teachers, and policy makers can play an important role in motivating youth to comply with social distancing guidelines while still finding ways to reduce anxiety and depressive symptoms.
Saurabh and Ranjan (2020)	India; COVID-19	60%; response rate not provided; missing demographic information	Adolescents who did and did not quarantine during COVID-19 in India; convenience sampling	Adolescents (N = 121) aged 9–18 years who were quarantined	Date not provided (during COVID-19)	Yes; 131 adolescents who were not quarantined	Qualitative study; interviews	Interviews focused on child and parent understanding and compliance of quarantine measures and the psychological impacts of quarantining.	Adolescents in quarantine reported more negative psychological effects, specifically anxiety, annoyance, boredom, insomnia, sadness, and helplessness compared to non-quarantined adolescents. Low compliance with quarantine guidelines.	Social media platforms can help quarantined individuals stay in touch with family and friends virtually, while comic books and videos can be useful in disseminating disease-related information to children and adolescents, which can help reduce their psychological symptoms.
Seçer and Ulaş, (2020)	Turkey; COVID-19	60%; sample representativeness; missing demographic information	Adolescents from all 7 regions of Turkey were invited to participate; convenience sampling	Adolescents (N = 598) aged 14–18 years	Date not provided; data collection completed over a span of 15 days during the COVID-19 pandemic	No	Quantitative study; cross-sectional	Adolescents self-reported on the following measures: Obsessive Compulsive Inventory-Child Version, Emotional Reactivity Scale, Depression and Anxiety Scale for Children, The Fear of COVID-19 Scale, and the Experiential Avoidance Questionnaire.	A greater fear of COVID-19 is associated with higher levels of anxiety and depression, which is also linked to an increase in OCD-like behaviors. Negative emotional reactivity exacerbates negative outcomes. Experiential avoidance (wariness toward experiencing negative situations) mediates the relationship between COVID-19 and symptoms of OCD.	The elevated risk for OCD symptoms in adolescents due to COVID-19 indicates that interventions should address virus-related fears and depression, which could trigger OCD, as well as help individuals find a balance between taking necessary safety precautions and engaging in unhealthy avoidance behaviors.
Zhou et al. (2020)	China; COVID-19	80%; response rate was not provided	Junior and senior high school students across 21 provinces in China were invited to participate; voluntary response sampling	Adolescents (N = 8079) aged 12–18 years	March 8 to March 15, 2020	Yes; adolescents from Hubei region	Quantitative study; cross-sectional	Adolescents self-reported on the following measures: Patient Health Questionnaire (PHQ-9) to measure depressive symptoms and the Generalized Anxiety Disorder scale (GAD-7) to assess anxiety symptoms.	Elevated rates for depression and anxiety were found among female students, those living in rural areas and Hubei province, and students in higher-grade levels. A protective factor appeared to be greater awareness of COVID-19 (knowledge, prevention, control measures, and projections of COVID-19).	Awareness of COVID-19 and how to prevent/manage it can be a protective factor against mental health problems. Measures should be taken to increase adolescents’ understanding of the virus in order to reduce their risk of depression and anxiety.