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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 37  |  Issue : 1  |  Page : 77-81

Psychosocial impact of the COVID-19 lockdown in school-aged children and adolescents in Karaikal – A longitudinal study


Department of Pediatrics, Vinayaka Missions Medical College and Hospital, Karaikal, Puducherry, India

Date of Submission10-Jun-2020
Date of Decision15-Jul-2020
Date of Acceptance18-Aug-2020
Date of Web Publication31-Mar-2021

Correspondence Address:
Dr. Sree Latha B Venkat
No. 36, Second Cross, Nehru Nagar, Karaikal - 609 605, Puducherry
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijsp.ijsp_153_20

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  Abstract 


Background: The pandemic caused by SARS-CoV-2 has forced many nations to complete lockdown. Fear of the infection, financial loss, and insecurity of future, affect human psychology. Children and adolescents are also at risk of psychological disturbances causing behavioral problems. Increasing screen time and parental stresses add to the mental trauma. Objectives: The objectives of this study were to assess the prevalence of behavioral abnormalities in school-aged children and adolescents and the influence of lockdown on their behavior. Materials and Methods: A prospective longitudinal cohort study was conducted in the community setting of homes of healthy children aged 6–12 years (n = 123) and adolescents aged 13–18 years (n = 115) living with parents under the lockdown during March–April 2020 in the low coronavirus disease 2019 transmission district of Karaikal. Change of behavior from the 1st day of lockdown over a month was assessed using parent-completed Strength and Difficulty Questionnaire (SDQ). The total scores of initial assessments and follow-up were calculated. Results: At initial assessment, 4% (n = 3) of the children and 6% (n = 7) of the adolescents had high scores in four-band categorization of the parent-completed SDQ. One month in lockdown, it increased to 17.8% (n = 22) in children and 26.9% (n = 31)) in adolescents. Very high scores were recorded in 1.7% (n = 2) of children and 7.8% (n = 9) of adolescents. Emotional and hyperactivity scores were high in children (P < 0.001), while peer and conduct problems were higher in adolescents (P < 0.001). Longer screen time (P < 0.001), parental conflicts (P < 0.001), and lower socioeconomic state (P < 0.05) correlated with high scores. Conclusion: The psychological impact of lockdown on children and adolescents is high. Longer screen time has a serious impact on the behavior of children as well as adolescents. Parental conflicts correlated positively with adverse behavior in adolescents than children.

Keywords: Behavioral disorders, lockdown, psychosocial impact, SARS-CoV-2, Strength and Difficulty Questionnaire


How to cite this article:
Venkat SL, Ananthakrishnan K R. Psychosocial impact of the COVID-19 lockdown in school-aged children and adolescents in Karaikal – A longitudinal study. Indian J Soc Psychiatry 2021;37:77-81

How to cite this URL:
Venkat SL, Ananthakrishnan K R. Psychosocial impact of the COVID-19 lockdown in school-aged children and adolescents in Karaikal – A longitudinal study. Indian J Soc Psychiatry [serial online] 2021 [cited 2021 Jun 15];37:77-81. Available from: https://www.indjsp.org/text.asp?2021/37/1/77/312857




  Introduction Top


Coronavirus disease 2019 (COVID-19) is an infection caused by the SARS-CoV-2 virus having positive, single-stranded RNA of Coronaviridae family. Its origin in Wuhan city of China is yet to be analyzed, though bats have been implicated.[1] It affects the respiratory and gastrointestinal systems of humans. Infections may vary from being asymptomatic to mild respiratory symptoms resembling flu. A small percentage develop pneumonia and even smaller section of those infected end up in multiorgan failure due to the cytokine storm.[2],[3] Mortality is high in individuals with comorbidities such as uncontrolled diabetes, hypertension, coronary artery disease, and cancer.[4] Person-to-person transmission through droplet secretions and fomites has been recognized.[5] Airborne transmission though speculated, has not been identified.[6] The World Health Organization declared the SARS-CoV-2 infection as a pandemic in March 2020.[7] Since then, several countries including India introduced measures to slow down the transmission of the virus in their community. These included social distancing, identification of cases and their isolation, contact tracing and containment of high transmission zones, and personal and environmental disinfection. Countrywide lockdown is one method to bring about all the above-mentioned measures. India went into a lockdown from March 25, 2020, with restrictions in all areas except for essential commodities and health care. Slow relaxations of the lockdown started from May 4, 2020, with only minimal activities in the community. Schools and other educational institutions, playgrounds, and entertainment centers for children and adults are shut from the beginning.[8] During the period of lockdown, people suffer psychologically due to the fear of contracting the infection, monetary loss, uncertainty of future, and lack of vent for their stresses. Depression, anxiety, and panic disorders are common psychiatric manifestations in lockdown, as evidenced by a Chinese study.[9] Mental effects of children quarantined away from parents and caregivers have revealed that they suffer from several psychiatric issues reflected in their behavior.[10] Psychologists and psychiatrists have proposed methods to prevent psychological disruptions in children that may surface during the period of lockdown.[11] It is quite early to come out with studies that measure the mental trauma in children living in the company of their parents and close family members under lockdown. School-aged children and adolescents who enjoyed their companionship with peer group would also suffer mentally under the lockdown that may be reflected in their behavior. This is expected to be more prevalent in families having a single child. Although the initial periods would not have created much impact on the behavior of children, continued restrictions and mounting family stress under the prolonged lockdown would affect the psychology of both adults and children. Strength and Difficulty Questionnaire (SDQ) is a brief behavioral screening questionnaire useful in individuals aged 3–16 years. It has 25 items on psychological attributes including five items in each of emotional, conduct, peer relationship, hyperactivity problems, and prosocial behavior.[12] Its Tamil version is validated.[13] The present article is a pilot study to assess behavioral changes in children living under lockdown with their parents and family members.

The general objective of the study was to assess the behavioral change in school-aged children and adolescents living under lockdown and to identify the factors that predisposed these children to such behavioral change.


  Materials and Methods Top


Study area

Community settings of homes of children and adolescents under the lockdown in the low COVID-19 transmission area of Karaikal.

Study design

Prospective longitudinal cohort study.

Study population

School children aged between 6 and 12 years (n = 123) and adolescents aged 13–18 years (n = 115) living with their parents under lockdown. A total of 238 Tamil-speaking families of healthy children were randomly selected within the district of Karaikal.

Data collection

After obtaining consent from the parents and children above 7 years of age, the SDQ completed by parents was filled up once on March 25, 2020, the 1st day of lockdown, and subsequently on April 25, 2020, 1 month after the lockdown. Electronic media was used for completing a pretested structured questionnaire containing basic information of the child and family members, socioeconomic status of the family, financial security of the family in the lockdown, job security of the earning members of the family during the lockdown, conflicts among family members, and perceived stress scale of mother. Parent-filled SDQ shared in electronic media was completed twice.

Data analysis

The collected data were analyzed for errors; Pearson's correlation was obtained, coded, and evaluated using SPSS statistics version 21 IBM India. Numerical outcomes were predicted using linear regression analysis.

Ethical clearance

Clearance from the ethical committee was obtained before the commencement of the study. The parents were informed about the privacy of identity, participation only under willingness, and their right to discontinue from the study anytime.


  Results Top


A total of 150 school-aged children and 150 adolescents were electronically approached to assess their parent-measured behavior. Among those who responded, children whose family members were stranded in the lockdown, either of whose parents was away from home, whose family member living close or faraway suffered from COVID-19, who were ill with chronic diseases, and who were on long-term medications were excluded from the study. A final number of 123 school-aged children and 115 adolescents were included as participants. Demographic features of the participants were collected, and standard error of regression was ensured to remain low. The demographic characteristics of the participants are shown in [Table 1].
Table 1: Demographic characteristics of the participants

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At the beginning of the lockdown, the parent-completed SDQ revealed high scores in 4% (n = 3) of children and 6% (n = 7) of adolescents in four-band categorization. One month after the lockdown, high scores were recorded in 17.8% (n = 22) of children and 26.9% (n = 31) of adolescents. About 1.7% (n = 2) of the children recorded very high scores as compared to 7.8% (n = 9) of the adolescents. The escalation of high SDQ scores is revealed in [Figure 1]. Emotional and hyperactivity scores were statistically significantly high in school-aged children (P < 0.001), while peer problems and conduct problems were higher in adolescents (P < 0.001) [Figure 2]. Screen time beyond 5 h in a day strongly correlated with high and very high scores in both the age groups (P < 0.001). Parental conflicts in the presence of children more than 3 days a week strongly correlated with high and very high scores in adolescents (P < 0.001) than that in children (P < 0.05). Lower ranks in social scales were significantly associated with high scores. Single-child families and nuclear families were not considerably related to higher SDQ scores. Factors that predict higher SDQ scores are shown in [Table 2].
Figure 1: Escalation of parent-completed Strength and Difficulty Questionnaire scores was steep in children and adolescent for high scores, but marginal in adolescents alone for very high scores

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Figure 2: Emotional score in school-aged children and new-onset prosocial behavior in adolescents are characteristic

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Table 2: Factors influencing high Strength and Difficulty Questionnaire scores in lockdown

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  Discussion Top


As anticipated by psychiatrists and pediatricians, the lockdown has affected the psychology of children and adolescents to a greater extent than predicted. The present study has brought out the magnitude of psychological impact reflected in the behavior of children and adolescents. Lack of outdoor play and company of friends, fear reflected by the family members and media, unnecessary overfeeding of children with frightening information, parental stress, and financial recession in the family affect children directly or indirectly.[14] The duration of such impact, the degree to which it is likely to perpetuate, and scope for reversal of these changes are yet to be followed up. Follow-up 1 year after the SARS outbreak revealed the continuation of the psychological impact even after 1 year.[15] Several psychological helplines introduced at national and state levels to prevent and overcome these disturbances came into vogue in view of the corona pandemic. These include child helpline 1098 and Mastermind foundation which offers free counseling services in view of the COVID-19 pandemic.[16],[17] The observations of the present study were in accordance with that of a Chinese study conducted on children quarantined away from family members and parents. The degree of trauma was even greater in those children who typically suffered posttraumatic stress disorder. Separation was the main factor affecting the children involved in the study population.[10] A study by Taylor et al. 2008, brought out higher psychological impact in people living in high and moderate transmission zones of the influenza pandemic. This could not be matched with the present study because a comparison score in high transmission zones of COVID-19 pandemic is not available and psychological score in the present study population in low transmission area itself is high.[18] A study by Jeong et al. revealed anxiety and anger as the common psychological impacts affecting people under isolation during the epidemic of Middle East respiratory syndrome in 2015. Inadequate supplies of essential commodities, inadequate networks, and financial loss were found to be risk factors in their study population. This is in contrast to the present study that only lower level of income status was correlated with high scores of psychological impacts in children. This could be a reflection of greater financial loss in this sector.[19] The present study revealed that more than loss of life and health, mere home confinement increased parental conflicts, increased screen time of children and adolescents, and financial crunches at lower economic levels imposed serious injuries to the mental health of children.

The limitations of the present study are the small sample size, use of parent-completed questionnaire alone to analyze the behavioral changes, lack of clinical evaluation in the lockdown, and comparison with similar children living in high transmission zones.


  Conclusion Top


Environment plays a great role in the behavior of children and adolescents and even a short-term environmental stress has a great impact on the behavior of children. Whether these behavioral changes would disrupt the long-term personality of the child is yet to be identified.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Coronavirus Disease 2019 (COVID-19) WHO Situation Report 94. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200423-sitrep-94-covid-19. [Last accessed on 2020 May 11].  Back to cited text no. 1
    
2.
Nishiura H, Kobayashi T, Miyama T, Suzuki A, Jung SM, Hayashi K, et al. Estimation of the asymptomatic ratio of novel coronavirus infections (COVID-19). Int J Infect Dis 2020;94:154-5.  Back to cited text no. 2
    
3.
Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020;323. p.1574-81.  Back to cited text no. 3
    
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Zhao X, Zhang B, Li P, Ma C, Gu J, Hou P, et al. Incidence, clinical characteristics and prognostic factor of patients with COVID-19: A systematic review and meta-analysis. MedRxiv 2020.  Back to cited text no. 4
    
5.
World Health Organization. Modes of Transmission of Virus Causing COVID-19: Implications for IPC Precaution Recommendations: Scientific Brief, 27 March 2020. Head Quarters, Geneva: World Health Organization; 2020.  Back to cited text no. 5
    
6.
National Academies of Sciences, Engineering, and Medicine. Rapid Expert Consultations on the COVID-19 Pandemic: March 14, 2020-April 8, 2020. Washington D.C: National Academies Press; 2020.  Back to cited text no. 6
    
7.
WHO Director-General's Opening Remarks at the Media Briefing on COVID-19. 11 March, 2020. Available from: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19. [Last accessed on 2020 May 11].  Back to cited text no. 7
    
8.
Lancet T. India under COVID-19 lockdown. Lancet (London, England). 2020;395:1315.  Back to cited text no. 8
    
9.
Qiu J, Shen B, Zhao M, Wang Z, Xie B, Xu Y. A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: Implications and policy recommendations. Gen Psychiatr 2020;33: e100213.  Back to cited text no. 9
    
10.
Liu JJ, Bao Y, Huang X, Shi J, Lu L. Mental health considerations for children quarantined because of COVID-19. Lancet Child Adolesc Health 2020;4:347-9.  Back to cited text no. 10
    
11.
Xie X, Xue Q, Zhou Y, Zhu K, Liu Q, Zhang J, et al. Mental health status among children in home confinement during the coronavirus disease 2019 outbreak in Hubei Province, China. JAMA Pediatr 2020.  Back to cited text no. 11
    
12.
Goodman R. The Strength and Difficulty Questionnaire: A research note. J Child Psychol Psychiatry 1997;38:581-6.  Back to cited text no. 12
    
13.
Lukumar P, Wijewardana K, Hermansson J, Lindmark G. Validity and reliability of Tamil version of Strength and Difficulty Questionnaire self-report. Ceylon Med J 2008;53:48-52.  Back to cited text no. 13
    
14.
Briefing Note on Addressing Mental Health and Psychosocial Aspects of COVID-19. Available from: https://interagencystandingcommittee.org/other/interim-briefing-note-addressing-mental-health-andpsychosocial-aspects-covid-19-outbreak. [Last accessed on 2020 May 11].  Back to cited text no. 14
    
15.
Lee AM, Wong JG, McAlonan GM, Cheung V, Cheung C, Sham PC, et al. Stress and psychological distress among SARS survivors 1 year after the outbreak. Can J Psychiatry 2007;52:233-40.  Back to cited text no. 15
    
16.
Available from: https://www.childlineindia.org/a/covid19. [Last accessed on 2020 May 11].  Back to cited text no. 16
    
17.
Managing Mental Stress and Depression during Lockdown MOHFW, GOI. Available from: https://youtu.be/wRYP0vjOeck. [Last accessed on 2020 May 11].  Back to cited text no. 17
    
18.
Taylor MR, Agho KE, Stevens GJ, Raphael B. Factors influencing psychological distress during a disease epidemic: Data from Australia's first outbreak of equine influenza. BMC Public Health 2008;8:347.  Back to cited text no. 18
    
19.
Jeong H, Yim HW, Song YJ, Ki M, Min JA, Cho J, et al. Mental health status of people isolated due to Middle East respiratory syndrome. Epidemiol Health 2016;38:e2016048.  Back to cited text no. 19
    


    Figures

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    Tables

  [Table 1], [Table 2]



 

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