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Table of Contents
PERSPECTIVE/VIEWPOINT - SPECIAL POPULATIONS
Year : 2020  |  Volume : 2  |  Issue : 2  |  Page : 148-151

Growing up in a Pandemic: Biomedical and Psychosocial Impacts of the COVID-19 Crisis on Children and Families


1 Department of Psychiatry, Institut universitaire en santé mentale de Montréal; Department of Psychiatry and Addictology, Université de Montréal, Montreal, Canada; Department of Psychiatry and Behavioral Sciences, The George Washington University, Washington, DC, USA; President, Canadian Association of Social Psychiatry; President Elect, World Association for Social Psychiatry
2 Child and Adolescent Psychiatry Fellow, Boston Children's Hospital; Clinical Fellow in Psychiatry, Harvard Medical School, Boston, MA, USA

Date of Submission26-May-2020
Date of Acceptance29-May-2020
Date of Web Publication14-Aug-2020

Correspondence Address:
Prof. Vincenzo Di Nicola
Institut universitaire en santé mentale de Montréal, 7401, rue Hochelaga, Montréal, Québec H1N 3M5, Canada

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/WSP.WSP_52_20

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  Abstract 


The COVID-19 pandemic creates a cascade of social and mental health consequences for children, adolescents, and their families. After reviewing the known pediatric and epidemiological data on children, we discuss key features of children's mental health in response to this crisis, their specific needs, and the impacts of social distancing, confinement, and adverse childhood events. While acknowledging potential long-term consequences in this psychosocially vulnerable population, we also caution health and social care workers against pathologizing normal reactions to an abnormal global crisis.

Keywords: Adverse childhood events, child and adolescent psychiatry, children, COVID-19, families, mental health, narrative resources, pandemic, psychosocial support


How to cite this article:
Di Nicola V, Daly N. Growing up in a Pandemic: Biomedical and Psychosocial Impacts of the COVID-19 Crisis on Children and Families. World Soc Psychiatry 2020;2:148-51

How to cite this URL:
Di Nicola V, Daly N. Growing up in a Pandemic: Biomedical and Psychosocial Impacts of the COVID-19 Crisis on Children and Families. World Soc Psychiatry [serial online] 2020 [cited 2020 Sep 25];2:148-51. Available from: http://www.worldsocpsychiatry.org/text.asp?2020/2/2/148/292140




  Epidemiology: What Is Known Top


As of this date – May 17, 2020 – there have been 4,534,731 confirmed cases of COVID-19 worldwide, including 307,537 deaths, reported to the World Health Organization.[1] Data about children are limited. In Wuhan, China, children under 10 and youths 10–19 years old each represent 1% of the total of over 72,000 cases of COVID-19. By contrast, in Korea, the proportion of cases 0–19 is 4.8%, while in Canada, it is 4.7% and 5% in the USA. While variant testing practices may account for variable proportions of pediatric cases in different countries, epidemiological data demonstrate that children and youth comprise a minority of diagnosed COVID-19 cases in high- and middle-income countries. Both severity and mortality among children and youth are lower than in adults. What is known is that coexisting conditions increase risks dramatically. Comparable data from low-income countries are not available. The obverse is that the great majority of disease occurs in adults, with those living in community, group, and long-term care settings at highest risk, the risk increasing with age, especially over 60 years.[2],[3],[4] Just emerging from Bergamo, Italy is a report of 10 cases of pediatric multisystem inflammatory syndrome, a Kawasaki-like illness triggered by SARS-CoV-2, the virus which causes COVID-19, with some 50 cases reported elsewhere in Europe and 100 cases in the USA.[5]


  Children's Social and Mental Health Reactions Top


The above refers only to strictly medical aspects. We must also consider children's social and mental health. Coexisting mental health problems, which often have their roots in childhood and youth, will amplify the impact of this virus on current and future mental health of young people.[6] The pandemic increases anxieties due to its unpredictability, among other things. There may be a fear of dying or losing a loved one to COVID-19. A recent study from China that looked at the impact of COVID-19 on college students found that having relatives or acquaintances infected with the virus was a risk factor for increased anxiety.[7] Young children with concrete thinking may wonder what summer will be like or when they will see their friends again. Older children with more cognitive and empathic capacities may wonder when and how this pandemic will end. For youth in college, the stress of examinations and the uncertainty of the job market[8] adds significantly to the emotional problems associated with worsening economic conditions.[6] The pandemic has led many children and families to face loss or the possibility of loss. Loss is subjective and multifaceted and augmented by the child's attachment and well-being of her attachment figures.

Furthermore, social isolation affects young people differentially due to age, gender, family, and relational factors. For example, younger kids tend to be more attached to their family of origin and may regress in their psychosocial growth. Not attending school limits not only academic progress but also prosocial skills. Adolescents' identity, so dependent on peer relations, is especially vulnerable due to confinement and social isolation.[9] All of these issues may be fruitfully seen as a reciprocally influencing cascade of consequences.[10]


  Children's Needs: “same Storm, Different Boats” Top


Those of us doing follow-through care in child psychiatry are not surprised to learn that each family seems to be adapting in its own way, with some common themes emerging. As an editorial cartoon put it: we are all in the same storm, but not in the same boat.

Children need structure and predictability. While some schools have shifted to virtual classes, others have closed altogether for the rest of the academic year.[11] As of April 2020, schools have been suspended in 188 countries, leaving 1.5 billion young people out of school. School closures mean families have to compensate for the lack of structure and routines that schools were providing. Normally, schools provide structure not only through schedules and performance measures but also by setting expectations with regard to social behavior. School routines also provide coping mechanisms for young people with mental health issues.[11],[12] How are children and families coping without this structure? Those of us working with children and families have noticed that some children are more anxious and irritable or less motivated and enthusiastic.

Parents and other caregivers are possibly more overwhelmed than children. Confined at home, many parents are at a loss to structure their day and set goals and may have trouble conveying such basic skills to their children. Psychologist Jerome Bruner identified “narrative resources” on a higher conceptual level, but some families struggle to transmit basic tasks of daily living.[13] Without basic living skills or the narrative resources that give sense and structure to life to make it meaningful, we are reduced to “bare life” and mere survival, as philosopher Foucault et al. reflected on the pandemic in Italy.[14]

Aside from structure and routines, other things that children may need during this pandemic include age-appropriate information and reassurance about the situation. Families, with the support of health-care providers, must navigate how to talk to children about the crisis, answer their questions in a developmentally appropriate way, and manage their exposure to media.[15] There websites offer specific tips on developing routines[16] and activities for children and coping strategies for parents, including how to talk to children about COVID-19.[17]


  the Longest Shadow Top


Along with social distancing and confinement, the pandemic is an adverse childhood event (ACE) that may cast a long shadow on the lives of children.[18] The social and mental health impacts of the virus and of the confinement are disquieting:

  • A disconcerting issue is the increase in violence and abuse toward women and children,[19] due to a combination of increased stress, increased time spent in the home, and decreased access to community resources
  • School closures have increased the burden on parents which reflects a steep social gradient with a greater burden falling on parents who have fewer resources or are out of work
  • Senior care has reached such a critical level that families cannot see their loved ones in these facilities and children are separated from their grandparents.


Finally, the psychosocial impacts are complex and must be seen as heterogeneous, affecting age groups, genders, family configurations, social class, and culture differentially. While it is a shared natural occurrence, it is not experienced in the same way. Furthermore, it is not a unitary, one-time experience but a varied and cumulative set of psychosocial impacts. We highlight three key features here in a cascade of consequences:

  • Social distancing – the impact on the development of prosocial skills in young children and maintaining and expanding such skills in youth is being critically impeded by the impact of social distancing and home confinement
  • Confinement – there is a great difference between choosing a limited social lifestyle and having it imposed on individuals, families, and entire communities. Its impact on families varies on family unity and level of functioning along with social values and cultural differences. Many parents are reporting that their children are spending even more time in their rooms, stuck to their screens, and addicted to video games
  • Adverse child events – “the longest shadow” – the pioneering ACE study clearly demonstrates a linear gradient between adverse events in childhood with poorer lifelong health, mental health, and social outcomes in what we characterize as “the longest shadow.”[18] Whether children and youth themselves fall sick or not, through their families, friends, and neighbors, they will all be exposed to a series of adverse events so that the COVID-19 pandemic will cast a dark shadow over their lives for a long time to come.



  Conclusions: “watchful Waiting, Facilitating Growth” Top


Along with the rest of society, children are vulnerable to the ravages of the COVID-19 pandemic, not just biologically but psychosocially as well. The psychosocial impacts are complex and heterogeneous, affecting age groups, genders, family configurations, social classes, and cultures differentially. While it is a shared natural occurrence, it is not experienced in the same way by everyone – “same storm, different boats.” The pandemic is not a unitary, one-time experience but an ongoing cumulativecascade of consequences.

Responding to children's needs requires sensitivity to their cognitive, emotional, and social capacities. Besides being well-informed about the pediatric and epidemiological aspects of the pandemic, working with children means helping parents talk to their children about the pandemic and maintain healthy home environments for all family members. Although children may display increased psychological distress, we caution health and social care workers against pathologizing relatively normal reactions to an abnormal and unprecedented global crisis. Our catchphrase for child care – even during the pandemic crisis – should be hopeful: Watchful vigilance balanced by facilitating healthy growth.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

COVID-19 Resources for Pediatric Care and Mental Health



https://www.thelancet.com/journals/lancet/article/PIIS0140-6736 (20) 30547-X/fulltext [Last accessed on 2020 May 17]



 
  References Top

1.
WHO. WHO Coronavirus Disease Dashboard. Available from: https://covid19.who.int [Last accessed on 2020 May 17].  Back to cited text no. 1
    
2.
Canadian Pediatric Society. Current Epidemiology and Guidance for COVID-19 in Children and Youth; March, 2020. Available from: https://www.cps.ca/en/documents/position/current-epidemiology-and-guidance-for-covid-19-march-2020#ref1 [Last accessed on 2020 May 17].  Back to cited text no. 2
    
3.
Canadian Pediatric Society. Update on COVID-19 Epidemiology and Impact on Medical Care in Children; April, 2020. Available from: https://www.cps.ca/en/documents/position/update-on-covid-19-epidemiology-and-impact-on-medical-care-in-children-april-2020 [Last accessed on 2020 May 17].  Back to cited text no. 3
    
4.
Centers for Disease Control. Caring for Children. Available from: https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/children.html [Last accessed on 2020 May 17].  Back to cited text no. 4
    
5.
Verdoni L, Mazza A, Gervasoni A, Martelli L, Ruggeri M, Ciuffreda M, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: An observational cohort study. Lancet 2020;395:1771-8. Available from: https://doi.org/10.1016/S0140-6736(20) 31103-X [Last accessed on 2020 May 17].  Back to cited text no. 5
    
6.
Golberstein E, Gonzales G, Meara E. How do economic downturns affect the mental health of children? Evidence from the National Health Interview Survey. Health Econ 2019;28:955-70.  Back to cited text no. 6
    
7.
Cao W, Fang Z, Hou G, Han M, Xu X, Dong J, et al. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Res 2020;287:112934.  Back to cited text no. 7
    
8.
Lee J. Mental health effects of school closure during COVID-19. Lancet Child Adol Health 2020;4:421. [doi: 10.1016/S2352-4642 (20) 30109-7].  Back to cited text no. 8
    
9.
Gilligan C. In a Different Voice: Psychological Theory and Women's Development. Cambridge, MA: Harvard University Press; 1982.  Back to cited text no. 9
    
10.
Di Nicola V. A Canadian perspective on the biomedical and psychosocial impacts of the COVID-19 pandemic on children and families. Global Ment Health Psychiatry Rev 2020;1:6-7.  Back to cited text no. 10
    
11.
Golberstein E, Wen H, Miller B. Coronavirus disease 2019 (COVID-190 and mental health for children and adolescents. JAMA Pediatr Published online April 14, 2020. doi:10.1001/jamapediatrics.2020.1456.  Back to cited text no. 11
    
12.
Wang G, Zhang W, Zhao J, Zhang J, Jiang F. Mitigate the effects of home confinement on children during the COVID-19 outbreak. Lancet 2020;395:945-7.  Back to cited text no. 12
    
13.
Mattingly C, Lutkehaus NC, Throop CJ. Bruner's search for meaning: A conversation between psychology and anthropology. Ethos 2008;36:1-28.  Back to cited text no. 13
    
14.
Foucault M, Agamben G, Nancy JL, Esposito R, Benvenuto S, Dwivedi D, et al. Coronavirus and philosophers. Zhang J, Jiang F. Available from: https://www.journal-psychoanalysis.eu/coronavirus-and-philosophers [Last accessed on 2020 May 17].  Back to cited text no. 14
    
15.
Available from: https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/talking-with-children.html [Last accessed on 2020 May 17].  Back to cited text no. 15
    
16.
17.
18.
Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med 1998;14:245-58.  Back to cited text no. 18
    
19.
Graham-Harrison E, Giuffrida A, Smith H, Ford L. Lockdowns Around the World Bring Rise in Domestic Violence. The Guardian 2020; 28 March, 2020. Available from: https://www.theguardian.com/society/2020/mar/28/lockdowns-world-rise-domestic-violence [Last accessed on 2020 May 17].  Back to cited text no. 19
    




 

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Epidemiology: Wh...
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the Longest Shadow
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