BOSTON – New research has determined that the first year of the COVID-19 pandemic led to increased depression, anxiety and social risks among urban, racial, and ethnic minority children aged five to 11 years old compared to the prior six months. Led by researchers at Boston Medical Center, study findings show that a reduction in school assignment completion, increased screen time, and caregiver depression are all significantly associated with worse mid-pandemic mental health in children.
Published in Child and Adolescent Psychiatry and Mental Health, this study is one of the first to quantify the negative psychosocial impact of the COVID-19 pandemic on urban children using pre and mid-pandemic data. Rates of depression and anxiety problems had increased from 5 percent before the pandemic to 18 percent during the pandemic. This study also examined the social risks of these families throughout the pandemic, with caregivers reporting higher social risks compared to before the pandemic, including food and housing insecurity. Fifty percent of families reported food insecurity during the pandemic, compared to 16 percent before.
“Our fear is that the pandemic has led to a mental health crisis for both caregivers and children following the incredible stressors that COVID-19 has put on families,” says Andrea Spencer, MD, an adult, child and adolescent psychiatrist at Boston Medical Center. “We specifically looked at our urban and diverse patient population who are already at higher psychosocial risk and also most susceptible to the impacts of the pandemic, therefore raising particular concern for their mental health.”
Fifty-four percent of the caregivers in this study identified as non-Hispanic Black, 29 percent Hispanic and 22 percent were non-English speaking. The study visits were conducted in three languages, of which 79 percent were in English, 16 percent in Haitian Creole and 5 percent in Spanish.
Social risk was determined using BMC’s THRIVE screener, a social determinants of health screener used to better identify and address patients’ unmet social needs. The screener is filled out by patients and entered into their electronic health record (EHR). This model allows patients to identify their needs and request assistance for specific things, such as food and housing insecurity. Because the information is embedded into the EHR, providers can easily facilitate referrals to resources both at BMC and in the community to help address the patients’ needs, with the goal of improving overall health.
Mental health symptoms were significantly correlated with the number of social risks before the pandemic, but the study found that this was not the case at the time of the mid-pandemic survey. Mental health symptoms in children are worse due to factors beyond those unmet social needs. With the exception of transportation, all THRIVE items were significantly more prevalent mid-pandemic compared to before the pandemic, highlighting the social and financial impacts that these urban and diverse families were experiencing.
This cohort study was conducted between September 2019 and January 2021 and included 168 child caregivers from an urban safety-net hospital-based pediatric program. The Pediatric Symptom Checklist (PSC), measured emotional and behavioral symptoms including attention, internalizing and externalizing symptoms. The children that were eligible for this study had attended a pre-pandemic well-visit with their primary care physician between September 1, 2019 and March 1, 2020 and their PSC results were obtained from their EHR. The initial mid-pandemic assessment was completed between August 2020 and January 2021 by caregivers and included the PSC, THRIVE, and items on school participation, screen time, and COVID exposure. Caregiver mental health was assessed using the General Anxiety Disorder-2 and Patient Health Questionnaires. Analyses compared pre-pandemic to mid-pandemic mental health and social risks. Path-analysis was then used to examine the relationship between patients’ mental health and their social risks before and throughout the pandemic.
“These findings point to the critical need for public health efforts to mitigate the psychosocial effects of the pandemic on racial and ethnic minority children and communities while searching for solutions to support the increased demand,” says Spencer, also an assistant professor of psychiatry at Boston University School of Medicine. “We need new or expanded community-based, school-based, family-based, and trauma-informed treatment and prevention programs to reach the most affected families.”
Researchers recommend that future studies focus on the pandemic’s long-term influence on child screen time use, social engagement, participation in activities, and mental health outcomes.
Funding for this study was supported by the National Institute of Mental Health, grant K23MH118478, and by the National Center for Advancing Translational Sciences, National Institutes of Health, through BU-CSTI, grant 1UL1TR001430.
About Boston Medical Center
Boston Medical Center (BMC) is a private, not-for-profit, 514-bed, academic medical center that is the primary teaching affiliate of Boston University School of Medicine. It is the largest and busiest provider of trauma and emergency services in New England. BMC offers specialized care for complex health problems and is a leading research institution, receiving more than $166 million in sponsored research funding in fiscal year 2019. It is the 13th largest funding recipient in the U.S. from the National Institutes of Health among independent hospitals. In 1997, BMC founded Boston Medical Center Health Plan, Inc., now one of the top ranked Medicaid MCOs in the country, as a non-profit managed care organization. Boston Medical Center and Boston University School of Medicine are partners in Boston HealthNet – 12 community health centers focused on providing exceptional health care to residents of Boston. For more information, please visit http://www.bmc.org.
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