Table 3.
The impact of COVID-19 on stress resilience and mental health in parents, children, adolescents, and college students.
| Study | Population | Time period/ wave | Study type and sample size | Objective(s)/Main outcomes | Inclusion criteria | Main findings/Summary |
|---|---|---|---|---|---|---|
| Children and their parents | ||||||
| Moore et al., 2020 | Canadian children 5–17 years old | Precise period unknown, but during the initial period of the COVID-19 crisis | Cross-sectional, N = 1472 (mean age of age group 5–11 years = 8.12 (±2.04), mean age of age group 12–17 years = 14.85 (±1.68), 52.6% female) | The impact of COVID-19 restrictions on movement and play behaviours in children and youth (parent-reported) | Being a volunteer participant of the Manu/Matchbox consumer online database | There was a significant decline in all physical activities in both children and youth. The highest decline was observed in outdoor physical activity and sport. Leisure screen time and social media use was higher than before. |
| Orgiles et al., 2020 | Italian and Spanish children 3 to 18 years old | Italy: March 25 – April 9 2020,, Spain: March 31 – April 15 2020,, data collection in both countries started 15 days after lockdown | Cross-sectional, N = 1143 (mean age 9.08 years (± 4.22), 47.5% female) | Emotional impact of the quarantine on children and adolescents from Italy and Spain (parent-reported) | Unknown | Children had more difficulty concentrating (76.6%), felt more bored than usual (52%), were more irritable (39%), were more restless (38.8%), were more nervous (38%), felt lonelier (31.3%), were more uneasy (30.4%), and more worried. |
| Hiraoka & Tomoda, 2020 | Japanese parents of 0–18 year old children | April 29–30 2020, many children had remained at home from school from March 2 to at least until the end of April 2020 | Cross-sectional, N = 353 (mean age 37.6 (±6.11), 78% female) | Qualitative structure of parenting stress | Unknown | Personal distress scores (Parenting Stress Index- Short Form) before school closures and after school closures were 2.39 (SD = 0.80) and 2.49 (SD = 0.72), respectively. Parents’ current personal distress levels were significantly higher (t = 4.89, P < 0.01, d = 0.12) than before the school closures had occurred. |
| Carroll et al., 2020 | Canadian families of young children | April 20 -May 15 2020, | Cross-sectional, N = 235 mothers and N = 126 father from 254 families (children's mean age = 6 years (±2.0), mothers’ mean age = 37 years (±4.8), fathers’ mean age = 39 years (±5.5)) | Health behaviours, level of stress, financial and food security among Canadian families with young children. | Being a family with at least one child between 18 months and 5 years of age at the time of registration for the study, living within the Guelph-Wellington area in Ontario, being comfortable with English to respond to survey questionnaires | More than half the sample (mothers, 70%; fathers, 60%; children, 51%) stated their eating and meal routines has changed since COVID-19. Screen time increased among 74% of mothers, 61% of fathers, and 87% of children and physical activity decreased among 59% of mothers, 52% of fathers, and 52% of children |
| Patrick et al., 2020 | US parents and their children (aged < 18 years) | June 2020 | Cross-sectional, N = 1011 | Physical and emotional well-being of parents and children through early June 2020, using March 2020 as the reference point for the period before or at the beginning of the pandemic | Being a participating parent in the Ipsos KnowledgePanel and having at least 1 child aged <18 years old in the household | Compared to March 2020, 26.9% of parents reported worsening of mental health, 14.3% reported worsening in their children's behavioural health and 9.6% reported worsening of both their mental health and their children's behavioural health. Female and unmarried parents reported higher rates of worsening of their own mental health. |
| Cusinato et al., 2020 | Italian parents of children aged 5–17 years | April 25 – May 8 2020, | Cross-sectional, N = 463 parents’ (mean age = 43.4 years (±5.88), 90.5% female, children's mean age = 9.72 (±3.29, 43.8% female) | Potential risk and protective factors for parents’ and children's well-being during a potentially traumatic event such as the COVID-19 quarantine | Having at least one child aged 5 to 17 years old living at home and having answered both child behavior questionnaires in their entirety | Confinement measures and changes in daily routine negatively affected parents’ psychological dimensions, thus exposing children to a significant risk for their well-being. |
| Romero et al., 2020 | Caregivers of Spanish children | April 2020 (precise period unknown, lockdown started on March 142,020 and on March 29, even more restrictive measures were imposed) | Cross-sectional, N = 1049 caregivers (data of N = 1123 children with a mean age of 7.26 years (±2.39), 50% female) | Effects of the Spanish confinement derived from the COVID-19 crisis on children and their families, accounting for child's age | Unknown | Preschool children showed a higher increase (38.2%) in conduct problems and hyperactivity as compared to their school-aged counterparts (20.3–24.4%). Child adjustment was influenced by a chain of effects, derived from parents’ perceived distress and emotional response to the COVID-19 crisis, via parenting distress and specific parenting practices. |
| Tso et al., 2020 | Parents with 2–12 year old children from Hong Kong | March 2020 (precise period unknown) | Cross-sectional, N = 29,202 families (N = 12,163 parents with children aged 2–5 years and N = 17,029 parents with children aged 6–12 years. Mean age children 6.50 years (±2.84), 48.6% female | Characteristics of children vulnerable to the negative impacts of the COVID-19 pandemic factors that can promote psychosocial wellbeing within families during the COVID-1 pandemic (parent-reported) | Being a parent of a child aged 2–12 years | Compared to the reference means, children demonstrated significantly more psychosocial problems measured by the SDQ total difficulties score (12.79 (5.13) for age 2–5 and 11.59 (5.57) for age 6–12), fewer prosocial behaviours measured by the SDQ prosocial behavior score (6.19 (1.97) for age 2–5 and 6.49 (2.00) for age 6–12), and poorer functioning measured by PedsQL total score (79.83 (13.38) for age 2–5 and 79.67 (13.41) for age 6–12). Compared to the reference group, their parents exhibited higher levels of parenting stress measured by the PSS scale (48.88 (10.10) for age 2–5 and 49.72 (10.72) for age 6–12). |
| Garcia de Avila et al., 2020 | Brazilian children aged 6–12 years and their guardians (mean age = 38.97 years (±6.54)) | April 25 – May 25 2020, | Cross-sectional, N = 289 (157 girls and 132 boys, mean age 8.84 years (±2.05), 54.3% female | Prevalence of anxiety (Children's Anxiety Questionnaire; CAQ) among Brazilian children and its associated factors during social distancing during COVID-19 (parent-reported) | Unknown | The prevalence of anxiety among the children during the COVID-19 pandemic in this group was 19.4% (n = 56), according to the CAQ, and 21.8% (n = 63), according to the NRS. These results are higher than the prevalence reported for children under normal conditions (6.5%). |
| Francisco et al., 2020 | Italian, Spanish and Portuguese children and adolescents aged 3–18 years old | 15 days between March and April 2020 (precise period unknown) |
Cross-sectional, N = 1480 children (mean age 9.15 years (±4.27), 47.2& female) | Immediate psychological and behavioural symptoms (anxiety, mood, sleep, behavioural, feeding, and cognitive alterations) associated with COVID-19 quarantine in children and adolescents, its explanatory factors and differences across countries (parent-reported) |
Unknown | An increase in children's psychological and behavioural symptoms, increased screen-time, reduced physical activity, and more sleep hours/night was observed, with Portuguese and Spanish children presenting more psychological and behavioural symptoms compared with Italian children. Having an outdoor exit in the house was associated with lower levels of psychological and behavioural symptomatology. |
| Glynn et al., 2021 | US Mother-child pairs of preschool children in Southern California | May 5 2020, (On March 19 2020,, a state-wide stay at home order was issued which was in place until May 8 2020,) |
Cross-sectional, N = 169 children (mean age 4.1 years (±0.93, 46.7% female) | Mental health symptoms in American preschool children during the COVID-19 pandemic (parent-reported)) | Having completed the survey by June 9, 2020 | 39.9% of the children scored above the recommended cut-off (≥3) for referral for further evaluation for clinical depression. The proportion of children scoring above the cut-off was elevated compared to those reported in a pre-COVID German population–based sample (5.7%; Fuhrmann et al., 2014) and more similar to a pre-COVID high risk US sample enriched for depression (43.7%); Luby et al., 2012). |
| Adolescents | ||||||
| Duan et al., 2020 | Chinese children and adolescents | During the COVID-19 outbreak (precise period unknown) | Cross-sectional, N = 3613 (9.9% aged 7–12 years, 90.1% aged 13–18 years, 49.9% female) | Psychological effects on children and adolescents associated with the early phase of COVID-19 pandemic | Being in high school (grade one to grade three; aged 7–18 years) in mainland China | Findings indicate that the COVID-19 outbreak has had a significant psychosocial impact on children and adolescents. 22.28% was suffering from depressive symptoms and levels of anxiety in children and adolescents during the epidemic were much higher than before the pandemic. |
| Xie et al., 2020 | Chinese children | February 28 – March 5 2020,, participants had been restricted to home for a mean (SD) of 33.7 (2.1) days when completing the survey | Cross-sectional, N = 1784 (43.3% female) | Depressive and anxiety symptoms among adolescents in Hubei province, China | Being in primary school (grade 2 through 6) in Hubei province | 22.6% and 18.9% of adolescents reported having depressive symptoms and anxiety symptoms, respectively. |
| Li, W. et al., 2021 | Chinese high school students | March 30 - April 7 2020, (quarantine was imposed in Wuhan from January 23, 2020, to April 8, 2020) | Cross-sectional, N = 7890 (37.6% aged 12–14 years, 35.1% aged 15–16 years, 27.2% aged 17–18 years, 52.1% female) | Prevalence of depression and anxiety and their associations with lifestyle changes among adolescents in Wuhan | Being a current resident in Wuhan, aged 12–18 years old, not having a diagnosis of COVID-19 | During the COVID-19 quarantine period, more than 20% of adolescents had anxiety and depression. The prevalence was 21.7% (n = 1708) for anxiety and 24.6% (n = 1941) for depression. |
| The Swiss Corona Stress Study: second pandemic wave, November 2020 (pre-print: https://osf.io/6cseh/) | General Swiss population aged ≥14 years | November 11–19 2020 (during the second pandemic wave) | Cross-sectional, N = 11,612 (mean age 39.3 years (±13.4), 73.8% female) | Stress levels and depressive symptoms (PHQ-9) in comparison to the first survey during lockdown in April 2020 | Living in Switzerland, being ≥14 years | While the proportion of people reporting maximum stress levels was around 11% during the April lockdown, it rose to 20% in the second pandemic wave in November. The proportion of respondents with moderately severe or severe depressive symptoms was 3% before the pandemic, 9% during the April lockdown, and 12% during May, it increased to 18% in November. |
| Zhou, S. J. et al., 2020 | Chinese adolescents | March 8 - 15 2020 | Cross-sectional, N = 8079 (median age 16 years, 53.5% female) | Prevalence rate and socio-demographic correlates of depressive and anxiety symptoms | Having an age of 12–18 years | The prevalence of depressive symptoms, anxiety symptoms, and a combination of depressive and anxiety symptoms was 43.7%, 37.4%, and 31.3%, respectively, among Chinese high school students during the COVID-19 outbreak. |
| Chen et al., 2020 | Chinese children and adolescents |
April 16 - 23 2020 | Cross-sectional, N = 1109 (n = 343 aged 6–8 years, n = 310 ages 9–12 years, n = 353 13–15 years, 45.5% female) | Prevalence of depression and anxiety among Chinese children and adolescents |
Unknown | 112 (11.78%) adolescents with depression, 196 (18.92%) adolescents with anxiety, and 68 (6.56%) adolescents with both depression and anxiety were identified. |
| Qi et al., 2020 | Chinese adolescents | March 8 - 15 2020 |
Cross-sectional, N = 7202 (median age 16.0 years (interquartile range [IQR] = 2.0, range 14.0–18.0), 53.6% female) | The association between the levels of social support and mental health) among Chinese adolescents | Being a junior high school or senior high school student, being a WeChat or QQ user, having submitted only one survey using the same IP address | COVID-19 exposure was associated with a higher prevalence of depression symptoms (OR = 1.38, 95% CI: 1.14–1.66) and anxiety symptoms (OR = 1.26, 95% CI: 1.04–1.52). Only 24.6% of adolescents reported high levels of social support. |
| Guo et al., 2020 | Chinese adolescents | February 8 −27 2020 | Cross-sectional, N = 6196 (age range 11–18 years, 52.10% female) | Levels of anxiety and post-traumatic stress symptoms and whether pre-pandemic maltreatment experiences exacerbate this impact on mental health in adolescents | Being a student at one of the selected high school and middle schools in Zhenping County of Henan Province | Exposure to COVID-19 predicted higher levels of PTSS and anxiety with effect sizes ranging from 0.06 to 0.15 (standardized betas). The largest variance in PTSS and anxiety problems was explained by adverse childhood events (ACEs), with more pre-pandemic maltreatment experiences predicting more PTSS and more anxiety. |
| Magson et al., 2020 | Australian adolescents | Two waves; T1 (12 months leading up to the COVID-19 outbreak) and T2 (two months following the implementation of government restrictions and online learning). | Longitudinal, N = 248 (mean age 14.4 years (± 0.5), 51% female, 81.8% Caucasian) | The impact of the COVID-19 pandemic on adolescents’ mental health | Being part of the larger longitudinal Risks to Adolescent Wellbeing Project (the RAW Project) | Significant increases in adolescents’ symptoms of depression, (t(1, 247) = 6.26, p < 0.001, d = 0.15), and anxiety, (t(1, 244) = 5.26, p < 0.001, d = 0.40), and a significant decrease in life satisfaction, (t(1, 244) = −5.26, p < 0.001, d = 0.61) from T1 (before the pandemic) to T2 (2 months into the pandemic) was observed. |
| Wiguna et al., 2020 | Indonesian adolescents | April 15 - May 10 2020, | Cross-sectional, N = 113 mean age 14.07 years (±2.18), 46.9% female) | Behavioural and emotional problems during the pandemic | Being a family with at least one child of 11–17 years old, informed consent by parents and child | 10.6% of the participating adolescents were at risk for emotional problems, 15.0% for conduct behavior, 38.1% for peer-relationship problems, 8% for hyperactivity behavior, and 28.3% for pro-social behavior problems. |
| Penner et al., 2020 | US adolescents | Baseline measure (January 2020, prior to the spread of COVID-19 in the United States) and follow-up measures (mid-April 2020, 1 Month After School In-Person Closure) | Longitudinal, N = 322 (mean age 11.99 years (± 1.16), 55.0% female, 72.7% Hispanic/Latin, 9.3% = Black or African American, 5.9% Multiple Races, 5.0% Asian, 1.6% White, 1.2% American Indian, and 4.3% ‘other’ | Longitudinal change in mental health before and during the pandemic | Being a public school student (grade 5–8) | For adolescents who had elevated levels of internalizing, attention, externalizing, or total problems before the pandemic, a significant reduction in mental health problems from baseline to follow-up measures was observed, controlling for age and gender. |
| Yang, S. et al., 2020 | Chinese adolescents | Early May 2020 (precise period unknown) | Cross-sectional, N = 10,082 (mean age 17.5 years (±1.2), 71.7% female) | The impact of the pandemic on obesity, weight, BMI and activity patterns among youth | Unknown | During the COVID-19 lockdown, the prevalence of overweight/obesity and obesity significantly increased in all participating adolescents and significant changes were observed in patterns of all forms of physical activity, with more adolescents having increased their sedentary, sleeping, and screen time. |
| Pigaiani et al., 2020 | Italian adolescents | April 1 – 10 2020 | Cross-sectional, N = 306 (mean age 18.1 years (±0.9), 27.1% female) | Lifestyle behaviours, coping strategies and well-being among Italian adolescents | Being 18 years or older, being a student at one of the three participating high schools located in Verona, Milan and Rome | Although most students (50.7%))did not report or reported only a little change in subjective well-being, 49.4% and 39.9% reported a change in subjective well-being and symptoms of anxiety respectively. Factors predicting a change in subjective wellbeing included adaptive coping strategies (physical activity, engaging in different activities than before), family issues (finding hard to stay at home, having quarrels), school-related behaviours (fearing a negative educational outcome) and female gender. |
| Marchini et al., 2020 | Italian, Belgian adolescents | April 7 - May 4 2020, (just after the enactment of lockdown measures in Italy (March 9) and Belgium (March 18)) | Cross-sectional, N = 825 (median age 20 years (IQR 20–24 years), 74.7% female, 53.7% living in Belgium, 46.3% living in Italy) | The relationship between resilience and loneliness and the emergence of new or increased mental health care needs (MHCNs) during lockdown measures | Speaking French or Italian, being a resident in Belgium or Italy | More loneliness, and lower resilience was observed in youth who needed help prior/during lockdown. |
| Isumi et al., 2020 | Japanese adolescents | January 2018 - May 2020 | Cross-sectional, N = 138 | Suicide rates per month between January 2018 and May 2020 from public data on suicide statistics compiled by the Ministry of Health, Labor and Welfare | Being younger than 20 years old | During the school closure due to the COVID-19 crisis (March to May 2020), no significant change of suicide rates was found (incidence rate ratio (IRR) =1.15, 95% confidence interval (CI): 0.81 to 1.64), compared with the same months in 2018 and 2019. |
| Oosterhoff, B. et al., 2020 | US adolescents | March 29–30 2020 (two weeks after COVID-19 was declared a national emergency in the US) | Cross-sectional, N = 683 (mean age 16.35 years (±1.13), 75.3% female, 77.0% white/Caucasian, 15.5% Hispanic/Latino, 5.6% African-American/Black, 11.2% Asian American/Pacific Islander, 3.2% American Indian/Alaskan Native, 2.9% other | Connections between social distancing motivation, anxiety and depressive symptoms and social health (belongingness and burdensomeness) | Being 13 – 18 years old | Almost all respondents (98.1%) reported engaging in at least a little social distancing. No evidence of an association between degree of social distancing engagement and any indicator of mental or social health was found. |
| College students | ||||||
| Odriozola-Gonzalez et al., 2020 | Spanish university members | March 28 – April 4 2020, (during the first days of confinement | Cross-sectional, N = 3707 (mean age 27.9 years (±12.4), 66,1% female, 76.8% students) | The emotional impact of COVID-19 in the university community, using the Depression Anxiety Stress Scale (DASS-21) and the Impact of Event Scale (IES) | Being a university member living in Spain | 50.43% of the participating university members reported moderate to severe emotional impact of the COVID-19 outbreak 21.34%, 34.19% and 28.14% of the respondents reported moderate to extremely severe scores of anxiety, depression and stress, respectively. |
| Liu, S., et al., 2020 | Chinese primary and university students | February - March 2020 (precise period unknown) | Cross-sectional, N = 407 (N = 209 primary school, N = 198 college, 60.4% female) | The impact of the COVID −19 pandemic on primary and university students | Being a university or primary school student in Sichuan Province | Somatic symptoms were observed in 34.85% of the college students and in 2.39% of the primary school students. Somatic symptoms were associated with concerns about COVID-19. |
| Islam et al., 2020 | Bangladeshi university students | May 6 – 12 2020 (all education institutions were closed initially from March 18 to March 31, 2020 and later extended to the mid of June 2020 in phases) | Cross-sectional, N = 476 (24.2% aged 17–20 years, 67% aged 21–24 years, 8.8% aged >24 years, 32,8% female)) | The prevalence of depression and anxiety of university students in Bangladesh | Being a university student | During the ongoing COVID-19 pandemic, a large percentage of Bangladeshi university students have been suffering from depression and anxiety symptoms with 82.4% of the students reported to have mild to severe depressive symptoms and 87.7% reported to have mild to severe anxiety symptoms. |
| Wathelet et al., 2020 | French university students | April 17 2020, - unknown | Cross-sectional, N = 69,054 (median age 20 years (IQR 18–22 years), 72,8% female) | The prevalence of self-reported suicidal thoughts and symptoms of distress, stress, depression, and anxiety in university students during the COVID-19 pandemic. | Being a university student | Prevalence rates were 11.4%, for suicidal thoughts, 22.4%, for severe distress, 24.7%, for high levels of perceived stress, 16.1% for severe depression, and 27.5% for high levels of anxiety. Factors associated with all mental health issues were having a low level of physical activity, not living with family, having a weak sense of integration, having a low quality of social relations, and receiving low-quality information. |
| Son et al., 2020 | US undergraduate students | One month after the stay-at-home order in April 2020 (precise period unknown) | Cross-sectional, N = 195 (mean age = 20.7 years (± 1.7), 56,9% female) | The impact of the pandemic on the mental health of college students (general stress, depressive and suicidal thoughts) | Being a undergraduate student | 71% of the students reported that their stress and anxiety had increased due to the COVID-19 pandemic, 91% indicated that the pandemic increased the level of fear and worry about their own health and the health of their loved ones, 86% reported disruptions to their sleep patterns caused by the COVID-19 pandemic, 44% mentioned having experiencing some depressive thoughts during the COVID-19 pandemic, and 8% stated that the pandemic has led to some suicidal thoughts. |
| Cao et al., 2020 | Chinese college students | During the COVID-19 outbreak (precise period unknown) | Cross-sectional, N = 7143 (69.65% female) | The impact of the pandemic on the mental health of college students | Being a college student | 24.9% of college students experienced COVID-19 related anxiety. Living in urban areas (OR= 0.810, 95% CI = 0.709 - 0.925), stability of students’ family income (OR= 0.726, 95% CI = 0.645 - 0.817), and living with parents (OR= 0.752, 95% CI = 0.596 - 0.950) were protective factor against anxiety. |
| Taquet et al., 2020 | Dutch students | March 16 – 29 2020 (ecological momentary assessment 4 times every day) | Longitudinal, N = 78 (mean age 20.4 years (± 3.7), 76% female) | Mood homeostasis | Being a student | Mood homeostasis was significantly higher before than during lockdown with mood homeostasis decreasing significantly more among people with vs without a history of mental illness. |
| Nania et al., 2020 | Italian students | March –April 2020 (precise period unknown but during the peak of COVID-19 in Italy) | Cross-sectional, N = 934 (mean age 23.6 years (± 4.9), 79,6% female) | Risk and protective factors associated with PTSD during the peak of COVID-19 in Italy | Being a university student | Students’ COVID-19 related concerns increased by 30% the likelihood of having PTSD. However, when the interaction of health engagement with risk and protective factors was taken into account, the association between concerns and PTSD decreased by roughly 20%. |
| Copeland et al., 2021 | US college students) | Two waves; T0 (beginning of the Spring semester 2020), T1 (end of the Spring semester 2020) and daily surveys across the school year | Longitudinal, N = 675 (91.4% aged 18 years, 7.6% aged 19 years, 0.6% aged 20 years, 0.3% aged 21 years, 74,1% female) | The impact of the pandemic on the mental health of college students | Being a full-time, first-year UVM undergraduate student, being aged 18 to 25 years old, having an iPhone 5 or newer (for app compatibility) | Students reported how disruptive COVID had been to them personally. The mean level of disruptiveness (total score ranging from 0 to 10) was 7.8 (SD=2.1),with 87.3% reporting a score of 6 or greater. After the onset of the COVID-19 pandemic, externalizing problems and attention problems increased after the onset of COVID, while internalizing symptoms did not increase. |
| Waselewski et al., 2020 | US youth | March 20 2020, | Cross-sectional, N = 950 (mean age 18.9 years (±2.8), 52.1% female), 67.7% White, 14.5% Black, 5.4% Asian, 12.4% other race) | The needs, emotions, and coping behaviours of US youth during COVID-19 | Being part of the MyVoice cohort | 32.6% of the respondents felt resources they needed, or could need, were readily available, while 35.2% of participants felt resources were difficult to access or unavailable. Respondents described both emotional responses (27.4%) and coping strategies (69.8%) to handle the impact of COVID-19. |
| Shanahan et al., 2020 | Swiss young adults | Two waves; T0 (before COVID when participants were 20 years old, precise period unknown) and T1 (April 11 – 18 2020, during week 4 of the Swiss national lockdown) | Longitudinal, N = 768 (48.1% female) | The influence of previous distress and stressors in emotional distress (PSS) during the COVID-19 pandemic and to investigate how COVID-19-related stressors and coping strategies are associated with emotional distress when pre-pandemic distress was accounted for |
Being a participant of the ‘age 20 assessment’ (wave 8) of the Zurich Project on the Social Development from Childhood to Adulthood (z-proso) | Perceived stress (M = 2.91, SD=0.92) and anger (M = 2.59, SD=0.95) during the pandemic was higher compared to perceived stress (M = 2.79, SD=0.95) and anger (M = 2.37, SD=0.75) in the pre-pandemic period (wave 8 z-proso), although no increase in internalizing symptoms was observed. The largest risk factor for emotional distress during COVID-19 was previous emotional distress. |