School Closures During Social Lockdown and Mental Health, Health Behaviors, and Well-being Among Children and Adolescents During the First COVID-19 Wave

A Systematic Review

Russell Viner, PhD1; Simon Russell, PhD1; Rosella Saulle, MD2; et alHelen Croker, PhD1; Claire Stansfield, PhD3; Jessica Packer, MSc1; Dasha Nicholls, MD(Res)4; Anne-Lise Goddings, PhD1; Chris Bonell, PhD5; Lee Hudson, PhD1; Steven Hope, PhD1; Joseph Ward, MBBS1; Nina Schwalbe, MPH6; Antony Morgan, PhD7; Silvia Minozzi, MD2Author AffiliationsArticle Information JAMA Pediatr. Published online January 18, 2022. doi:10.1001/jamapediatrics.2021.5840

Key Points

Question  Is there an association between school closure during broader social lockdown measures during the COVID-19 pandemic and mental health symptoms, health behaviors, and well-being of children and adolescents, aged 0 to 19 years?

Findings  In this systematic review of 36 studies from 11 countries, school closures and social lockdown during the first COVID-19 wave were associated with adverse mental health symptoms (such as distress and anxiety) and health behaviors (such as higher screen time and lower physical activity) among children and adolescents. The effects of school closures could not be assessed separately from broader social lockdown measures.

Meaning  The potential epidemiologic benefits of school closures during broader social lockdown measures for controlling infectious diseases should be balanced with the potential for adverse mental health symptoms and health behaviors among children and adolescents. Abstract

Importance  School closures as part of broader social lockdown measures during the COVID-19 pandemic may be associated with the health and well-being of children and adolescents.

Objective  To review published reports on the association of school closures during broader social lockdown with mental health, health behaviors, and well-being in children and adolescents aged 0 to 19 years, excluding associations with transmission of infection.

Evidence Review  Eleven databases were searched from inception to September 2020, and machine learning was applied for screening articles. A total of 16 817 records were screened, 151 were reviewed in full text, and 36 studies were included. Quality assessment was tailored to study type. A narrative synthesis of results was undertaken because data did not allow meta-analysis.

Findings  A total of 36 studies from 11 countries were identified, involving a total of 79 781 children and adolescents and 18 028 parents, which occurred during the first wave of the COVID-19 pandemic (February to July 2020). All evaluated school closure as part of broader social lockdown during the first COVID-19 wave, and the duration of school closure ranged from 1 week to 3 months. Of those, 9 (25%) were longitudinal pre-post studies, 5 (14%) were cohort, 21 (58%) were cross-sectional, and 1 (3%) was a modeling study. Thirteen studies (36%) were high quality, 17 (47%) were medium quality, and 6 (17%) were low quality. Twenty-three studies (64%) were published, 8 (22%) were online reports, and 5 (14%) were preprints. Twenty-five studies (69%) concerning mental health identified associations across emotional, behavioral, and restlessness/inattention problems; 18% to 60% of children and adolescents scored above risk thresholds for distress, particularly anxiety and depressive symptoms, and 2 studies reported no significant association with suicide. Three studies reported that child protection referrals were lower than expected number of referrals originating in schools. Three studies suggested higher screen time usage, 2 studies reported greater social media use, and 6 studies reported lower physical activity. Studies on sleep (10 studies) and diet (5 studies) provided inconclusive evidence on harms.

Conclusions and Relevance  In this narrative synthesis of reports from the first wave of the COVID-19 pandemic, studies of short-term school closures as part of social lockdown measures reported adverse mental health symptoms and health behaviors among children and adolescents. Associations between school closure and health outcomes and behaviors could not be separated from broader lockdown measures.

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