Has Covid-19 caused anxiety amongst children?

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Moms and dads across the world never imagined that they would be balancing full-time jobs, working from home and handling the roles of home-school teachers, and yet that’s exactly what 2020 gave us. When schools reopened, we breathed a collective sigh of relief – kids were excited to see their friends and get out of the house (and possibly even to go back to their lessons) and things started going back to normal. Or did they?

In workplaces across South Africa mental health and wellness took top priority as anxiety soared. But has this same focus been given to children?

According to Stephan Steyn, a pharmacist and senior lecturer at North-West University, pediatric depression is one of the most commonly diagnosed mental disorders in school-aged children.  In fact, it is the fourth leading cause of global illness and disability among adolescents aged 15 to 19, and the fifteenth in those younger than 14 years – and that’s pre-global pandemic.

“The pandemic has resulted in an increase in pediatric depression as well as mood disorders in general,” says Steyn. “Unfortunately, social isolation and inactivity are key contributors to the overall mood of children. Being isolated from friends for prolonged periods of time and in many cases not being able to play and run due to logistical and safety reasons means that children cannot develop in the same way that they did prior to the pandemic.”

The anxiety and depression that the lockdowns have caused won’t go away overnight, even if children are back at school. The uncertainties of who may or may not get sick around them also impact children, particularly if there have been Covid-19 related deaths in their circles.

“This is a time of life characterised by social stress to conform with peers, the desire for greater autonomy, exploration of sexual identity, socioeconomic factors and genetic susceptibility to depression or mood disorders. The added strain of Covid-19 and performing academically after such a disrupted year and a half should not be downplayed.”

The good news, says Steyn, is that unlike a few years ago, parents today are generally more aware of their children’s emotions and can therefore recognise if their children are struggling with anxiety or depression. What is less clear is what they can do about it.

“I do not think we fully realise the psychological impact that the current pandemic has had on the general mood and wellbeing of adults, let alone children,” he says. “With adults being uncertain about their own futures from both a financial and health perspective, these emotions spill over to the children, adding to their own uncertainties. It’s generally unintentional, but the result is the same. This can be especially problematic when mom or dad gets infected with Covid-19 and a child is left to make their own conclusions based on what is communicated via social media or their immediate community.”

Recognising pediatric depression

The diagnosing criteria for pediatric depression is similar to that for adult patients and includes diminished interest or pleasure in activities that used to be enjoyed, altered weight gain or loss and appetite, changes in sleep patterns, reduced energy, impaired cognitive function (including thinking and making decisions), feelings of worthlessness and a depressed mood.

However, irritability, which is a key diagnostic symptom, can present in the place of a depressed mood with children. “Distinguishing these changes from ‘normal’ teenage behaviour can be difficult,” says Steyn. “It’s vital for parents to really understand the social and psychological status of their child to distinguish ‘normal’ teenage behaviour from abnormal behaviour. And if you are concerned, call on professional help. Don’t ignore symptoms.”

Steyn offers the following advice in recognising and treating anxiety or depression in children:

  • All children must be routinely screened for mood alterations, primarily by their parents or primary care provider to identify any changes.
  • Optimal dietary habits, sufficient sleep and physical activity are not only effective preventative measures13 but are also suggested as first-line therapy in mild to moderate depression.
  • Pharmacological interventions are then also available, with only fluoxetine and escitalopram (both serotonergic-enhancing antidepressants) being approved for juvenile depression.
  • However, none of these options are effective if not adhered to and done in combination with emotional support and identification of the causative problem.

References

Centers for Disease Control and Prevention.
World Health Organization.
South African Depression and Anxiety Group.
Selph et al. 2019. Am Fam Physician, 100(10):609-17.
Cree et al. 2018. MMWR Morb Mortal Wkly Rep, 67(50):1377-83.
Bitsko et al. 2018. J Dev Behav Pediatr, 39(5):395-403
Haines et al. 2019. Int J Adolesc Med Health, 20190037.
American Psychiatric Association: DSM-V. 2013. 160-1.