Impacts of COVID-19 on children and adolescents: A systematic review analyzing its psychiatric effects

Table 1 Inclusion and exclusion criteria

Inclusion criteria	Exclusion criteria
Types of studies: Quantitative, qualitative, mixed methods, experimental and observational studies, human studies	Articles that were not in English; studies that did not report age; studies that included participants with mental health issues prior to COVID-19
Types of Participants: Studies carried out with children and adolescents (3 to 19 years old) from 2021 to 2022
Interventions: Children and adolescents impacted by COVID-19 and its repercussions on mental health
Types of results: Rates of psychiatric disorders in children and adolescents in times of COVID-19
Secondary outcomes: Fear, anguish, pain and psychic suffering related to the pandemic

COVID-19: Coronavirus disease 2019.

Table 2 Characteristics of included studies (n = 24)

Ref.	Country	Study design	Target population	Total participants	Exposure	Outcomes
Barros et al[19], 2022	Brazil	Cross-sectional-electronic questionnaire	12-17 years	9470 adolescents	COVID-19	The data showed that factors such as: Family problems, female gender, age 15-17 years, learning disabilities, relatives infected with COVID-19, and death of close friends from COVID-19 were factors associated with worsening mental health
Okuyama et al[1], 2021	Japan	Review	Children under 18 years	Studies included (n = 28)	COVID-19	Studies have shown correlation between physical activity and psychological health and sedentary time leading to mood disorders. Some studies on adolescents reported a correlation between physical activity and psychological health and others did not
Demaria and Vicari[2], 2021	Italy	Commentary	NA	NA	COVID-19	The pandemic context, with regard to quarantine, proved to be a psychologically stressful experience
Sayed et al[3], 2021	Saudi Arabia	Cross-sectional-online via social media	12.25 ± 3.77 years	537 children (263 boys and 275 girls)	COVID-19	The data showed that Post-traumatic stress disorder symptoms were not correlated with school grade, sex, age or having a close relative working with people infected by COVID-19
Meherali et al[4], 2021	Canada, Pakistan, Australia	Systematic reviews	5-19 years	Studies included (n = 18)	COVID-19	These studies reported that pandemics cause stress, worry, helplessness, and social and risky behavioral problems among children and adolescents
Bussières et al[5], 2021	Canada	Meta-analysis	5-13 years	Studies included (n = 28)	COVID-19	During the COVID-19 pandemic, the restriction measures imposed had an impact on children’s mental health. During this period, there was also a change in sleep habits. Even so, the results do not show significant differences in relation to the general population
Bentenuto et al[6], 2021	Italy	Retrospective	Children with NDD and TD	Total 164 (NND 82 and TD 82)	COVID-19	Quantitative analyzes demonstrated an increase in children’s externalizing behaviors and parental stress. However, they also showed that parents enjoyed spending more time with their children and strengthening the parent-child relationship. Furthermore, in children with NDD, the reduction in therapeutic measures predisposes to high externalizing behaviors
Burnett et al[7], 2021	Sweden, Australia, Italy	Cross-sectional-online self-reported survey	Parents of children aged 3-18 years	Australia (n = 196); Italy (n = 200)	COVID-19	When compared to other developmental disorders among parents in Australia and Italy, intellectual or learning disorders are the ones that bring them the most suffering
Raffagnato et al[8], 2021	Italy	Longitudinal	Psychiatric patients age between 6 and 18 years and their parents	39 patients and their parents (25 girls and 14 boys)	COVID-19	Patients with behavioral disorders were more impacted when compared to patients with internalizing disorders, who were shown to have adapted better to the pandemic context. In parents, it was possible to observe a protective factor against psychological maladjustment. A decrease in mothers’ anxiety and fathers’ stress over time was also observed
Kerr et al[9], 2021	United States	Cross-sectional-online survey	Parents with at least one child 12 years old or younger	1000 participants	COVID-19	As for the psychological impacts, the data show high levels of stress and low levels of positive behavior in children, and a high rate of parental exhaustion. Still, there is an indirect association between parental behavior and the psychological impacts of COVID-19 and children’s behaviors. The data also showed that the difference in income is a factor that can increase this indirect association
Sesso et al[10], 2021	Italy	Cross-sectional-online questionnaire	Parents of children 6.62 ± 3.12 years with neuropsychiatric disorders	77 participants	COVID-19	Internalizing problems in children during quarantine were the strongest predictor of parental stress
Li and Zhou[11], 2021	China	Cross-sectional-online questionnaire	5-8 years: 647 children; 9-13 years: 245 adolescents	892 valid questionnaires (mothers 662 and fathers 230)	COVID-19	Concerning the data, it was possible to observe that parents are worried about their children’s internalization and externalization problems. It was observed that, in elementary school, significant and negative relationships were observed between family-based disaster education and internalizing and externalizing problems
Bate et al[12], 2021	United States	Cross-sectional-online via social media	Parents of children (6-12 years)	158 parents of children (151 mothers and 7 fathers)	COVID-19	It was observed that the biggest EH problems of parents were due to the impact of COVID-19. Parents’ EH was a positive predictor of children’s EBH
Kim et al[13], 2021	Suwon, South Korea	Cross-sectional-web based questionnaire	Parents of children aged 7-12 years	217 parents	COVID-19	With schools closed, children had body weight gain, spent less time doing physical activities and more time using the media. In addition, an association can be observed between parental depression and children’s sleep problems, TV time, tablet time and behavior problems
Minozzi et al[14], 2021	Italy	Systematic review	Pre-school children, children 5-12 years and adolescents	Studies included (n = 64)	COVID-19	Studies have reported an increase in suicides, reduced access to psychiatric emergency services, reduction in allegations of maltreatment. The prevalence of anxiety among adolescents varied considerably, as did depression, although in a lower percentage
Backer et al[15], 2021	Netherlands	Cross-sectional-questionnaire	0-4, 5-9, 10-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80-89 and ≥ 90 years	7250 participants	COVID-19	During the physical distancing restriction measures, it is possible to observe that community contacts in all age groups were restricted to an average of 5 contacts. After relaxation, it was observed that the children returned to maintain their normal contact number, while the elderly maintained their restricted contact numbers
Qin et al[16], 2021	Guangdong province, China	Cross-sectional-electronic questionnaire	School-aged students [12.04 (3.01) years]	1 199 320 children and adolescents	COVID-19	Among those who reported psychological distress, the risk of psychological distress was analyzed among high school and elementary school students, among students who never used a mask and those who did, and among students who spent less than 0.5 h exercising and those who spent more than 1 h
Lu et al[17], 2021	China, United Kingdom	Systematic review and meta-analysis	children and adolescents (0-18 years)	Studies included (n = 23)	COVID-19	Studies show a combined prevalence of depression, anxiety, sleep disorders, and post-traumatic stress symptoms
Ma et al[18], 2021	China, United States	Cross-sectional-online self-report questionnaires	6-8 years	17740 children and adolescents	COVID-19	The data reported that depressive, anxiety, compulsive, inattentive and sleep-related problems were more expressive when compared to before the COVID-19 outbreak
Spencer et al[23], 2021	United States	Cohort study	5-11 years	Caregivers of 168 children (54% non-Hispanic black, 29% Hispanic, and 22% non-English speaking)	COVID-19	Children had significantly higher emotional and behavioral symptoms mid-pandemic vs pre-pandemic in all scenarios
Han and Song[20], 2021	South Korea	Retrospective	Middle and high school students	54948 students	COVID-19	The data showed, through multivariate logistic regression, that there was a correlation between the perception of the economic situation of the family and the prevalence of depressive symptoms and suicidal ideation
Giannakopoulos et al[21], 2021	Greece	Quality study-interviews	12-17 years	09 psychiatric inpatients	COVID-19	Patients identified that the state of quarantine caused negative changes in personal freedom and social life, as well as excessive contact with family members during social isolation
Almhizai et al[22], 2021	Saudi Arabia	Cross sectional study-online self-administered questionnaire	0-17 years	1141 respondents, 454 were < 18 years old and 688 children’s parents	COVID-19	Among the data presented, age was a factor for sleep disorders, nervousness and malaise; aggressive behaviors were also associated with an increase in negative behaviors during the pandemic compared to the previous period
Maunula et al[24], 2021	Northern prairie communities, Canada	Multi-method study, focus groups, and interviews	Children grade 4-6 and their parents	31 patients (16 children and 15 parents)	COVID-19	Children were subjected to sudden and stressful changes in their routines. In addition, loneliness and increased screen time were a result of limited social interaction

NDD: Neurodevelopmental disorder; TD: Typical developing; EBH: Emotional and behavioral health; EH: Emotional health; COVID-19: Coronavirus disease 2019.