Cathy Creswell is Professor of Developmental Clinical Psychology in the departments of Psychiatry and Experimental Psychology at the University of Oxford. She is an Honorary Consultant Psychologist and leads The Oxford Psychological Interventions for Children and adolescents (TOPIC) research group . Her research focuses on the development, maintenance and treatment of anxiety disorders and she has published several books for parents and clinicians, including the parent guide Helping Your Child with Fears and Worries.
Prior to the pandemic it was already clear that there was a substantial problem in the prevalence of mental health problems. In 2017, a nationally-representative survey conducted in England found that, among children and young people, one-in-nine had a probable mental health disorder. That reflected a significant increase from previous surveys in 2004.
While there was already reason to be concerned, the pandemic has brought more challenges. Among these were the concerns that participants had about:
There have also been increases in domestic violence and reduced access to support outside the home.
A repeat of the 2017 national survey was carried out in July 2020 and it revealed that 1-in-6 children or young people were now found to have a probable mental health disorder. That was a few months into the pandemic. As restrictions had eased somewhat, it is possible that this may have been an under-representation compared with other points in the pandemic.
Co-SPACE is a longitudinal study launched in March 2020, in which parents and carers of children aged 4-16 years – and the adolescents themselves – were invited to report mental health symptoms on a monthly basis throughout the pandemic. It aims to identify who is experiencing what and the factors which may explain differences.
Now, it should be noted that this is an online survey and not a nationally representative sample. In particular, this is a relatively affluent group compared to the general population. Yet while we cannot use this data to draw conclusions about the general prevalence of mental health problems, it can tell us how things have changed over time among this sample. That can give an indication of what may be going on more broadly. We can also look at how experiences vary across the participants in the study, those who are living in different circumstances or have particular characteristics.
The study found that mental health symptoms have changed through the pandemic. Using the parent report, we have been able to look across that whole age range, both primary and secondary school students. There are quite dramatic shifts, particularly in restlessness and attention difficulties, and these can be seen especially in the times of maximum restrictions. Difficulties increased during the first lockdown, then started to reduce as lockdown was eased, before rising again over the lockdown of early 2021. There has also been, particularly in those of secondary school age, an increase in emotional difficulties.
People might, rightly, say ‘of course they are going to experience different symptoms, just because the environment is so different in the pandemic’, but what the study also points out is that there was also a marked increase in the number of children and young people who were struggling, i.e. where the symptoms were causing interference and having an impact in a negative way on their lives. Again, there are some striking increases in the numbers who were experiencing difficulties among primary school children, particularly in conduct problems, hyperactivity and inattention.
It is important to highlight that, by looking across this whole population, the very different experiences of individuals within the pandemic can get lost. We are very aware that all have had very different experiences, depending on circumstances.
Looking at changes over time, essentially what we found was that there was one group with very low levels of difficulty at the beginning of the pandemic, which continued to be low throughout. That amounted to about 50-60% of the children. Another group was struggling at the beginning of the pandemic and continued to struggle throughout.
Of additional concern was a further group, which started the pandemic with fairly low levels of symptoms, but these increased as time went on. When we look at who the children who have struggled at some point in the pandemic are, and how they differ from the group which has been fine throughout, we find a number of characteristics. They are more likely to be male, when it comes to hyperactivity and attention, but also these children are more likely to be in families that are living on particularly low incomes, to be younger children and to have special educational needs.
We also found some wider family characteristics that were associated with a more negative pattern. That included parents reporting:
There are similar patterns across the different mental health symptoms we have been measuring. For conduct, for example, there is a substantial group which has done very well throughout. There is another group which has struggled throughout. The broad conclusions of course hide the individual experiences of people in the pandemic. The characteristics associated with the groups who have had difficulties in this area during the pandemic are similar to what we have seen before – including children with special educational needs, those living on low incomes, high parent stress at the beginning of the pandemic, higher conflict at the beginning of the pandemic, and so on.
When it comes to emotional symptoms, we have a slightly more complicated pattern but the findings are quite consistent in many ways. A significant group has experienced low levels of difficulties throughout and then there are groups who have experienced difficulties just in the pandemic. Yet there are also groups that reflect increasing or sustained high levels of difficulty. Again, relevant characteristics include: being on a low income, high parent/child conflict at the beginning of the pandemic, presence of special educational needs, higher parental psychological stress and also, in one case, the child having a chronic health condition.
There is increasing evidence, from a range of sources, for an overall negative impact of the pandemic on children and young people, as well as on their parents’ mental health.
Prior to the pandemic, the prevalence of mental health problems in children and young people was already high. There is increasing evidence, from a range of sources, for an overall negative impact of the pandemic on children and young people, as well as on their parents’ mental health.
Pre-existing vulnerabilities were associated with more negative mental health outcomes during the pandemic. That includes poverty and other challenging family circumstances and children’s special educational needs.
This highlights just how critical it is to make sure those children with enduring problems are identified at this stage and that they can access evidence-based support promptly, so that we can shift those negative trajectories.