Anxiety increased among children and adolescents during pandemic-related school closures in Europe : a systematic review and meta-analysis
© 2023. The Author(s)..
BACKGROUND: Considering the heterogenous evidence, a systematic review of the change in anxiety in European children and adolescents associated with the COVID-19 pandemic is lacking. We therefore assessed the change compared with pre-pandemic baselines stratified by gender and age as well as evaluated the impact of country-specific restriction policies.
METHODS: A registration on the 'International Prospective Register of Systematic Reviews' (PROSPERO) occurred and an a priori protocol was published. We searched six databases (PubMed, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, WHO COVID-19) using a peer-reviewed search string with citation tracking and grey literature screening. Primary outcomes were: (1) general anxiety symptoms; and (2) clinically relevant anxiety rates. We used the Oxford COVID-19 Stringency Index as an indicator of pandemic-related restrictions. Screening of title/abstract and full text as well as assessing risk of bias (using the 'Risk of Bias in Non-randomized Studies of Exposure' [ROBINS-E]) and certainty of evidence (using the 'Grading of Recommendations Assessment, Development and Evaluation' [GRADE]) was done in duplicate. We pooled data using a random effects model. Reporting is in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement.
RESULTS: Of 7,422 non-duplicate records, 18 studies with data from 752,532 pre-pandemic and 763,582 pandemic participants met full inclusion criteria. For general anxiety symptoms the total change effect estimate yielded a standardised mean difference (SMD) of 0.34 (95% confidence interval [CI], 0.17-0.51) and for clinically relevant anxiety rates we observed an odds ratio of 1.08 (95%-CI, 0.98-1.19). Increase in general anxiety symptoms was highest in the 11-15 years age group. Effect estimates were higher when pandemic-related restrictions were more stringent (Oxford Stringency Index > 60: SMD, 0.52 [95%-CI, 0.30-0.73]) and when school closures (School Closure Index ≥ 2: SMD, 0.44 [95%-CI, 0.23-0.65]) occurred.
CONCLUSION: General anxiety symptoms among children and adolescents in Europe increased in a pre/during comparison of the COVID-19 pandemic; particularly for males aged 11-15 years. In periods of stringent pandemic-related restrictions and/or school closures a considerable increase in general anxiety symptoms could be documented. PROSPERO registration: CRD42022303714.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:17 |
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| Enthalten in: |
Child and adolescent psychiatry and mental health - 17(2023), 1 vom: 21. Juni, Seite 74 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Ludwig-Walz, Helena [VerfasserIn] |
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| Links: |
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| Themen: |
Adolescent |
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| Anmerkungen: |
Date Revised 01.07.2023 published: Electronic Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1186/s13034-023-00612-z |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM358463432 |
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| 100 | 1 | |a Ludwig-Walz, Helena |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Anxiety increased among children and adolescents during pandemic-related school closures in Europe |b a systematic review and meta-analysis |
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| 500 | |a published: Electronic | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © 2023. The Author(s). | ||
| 520 | |a BACKGROUND: Considering the heterogenous evidence, a systematic review of the change in anxiety in European children and adolescents associated with the COVID-19 pandemic is lacking. We therefore assessed the change compared with pre-pandemic baselines stratified by gender and age as well as evaluated the impact of country-specific restriction policies | ||
| 520 | |a METHODS: A registration on the 'International Prospective Register of Systematic Reviews' (PROSPERO) occurred and an a priori protocol was published. We searched six databases (PubMed, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, WHO COVID-19) using a peer-reviewed search string with citation tracking and grey literature screening. Primary outcomes were: (1) general anxiety symptoms; and (2) clinically relevant anxiety rates. We used the Oxford COVID-19 Stringency Index as an indicator of pandemic-related restrictions. Screening of title/abstract and full text as well as assessing risk of bias (using the 'Risk of Bias in Non-randomized Studies of Exposure' [ROBINS-E]) and certainty of evidence (using the 'Grading of Recommendations Assessment, Development and Evaluation' [GRADE]) was done in duplicate. We pooled data using a random effects model. Reporting is in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement | ||
| 520 | |a RESULTS: Of 7,422 non-duplicate records, 18 studies with data from 752,532 pre-pandemic and 763,582 pandemic participants met full inclusion criteria. For general anxiety symptoms the total change effect estimate yielded a standardised mean difference (SMD) of 0.34 (95% confidence interval [CI], 0.17-0.51) and for clinically relevant anxiety rates we observed an odds ratio of 1.08 (95%-CI, 0.98-1.19). Increase in general anxiety symptoms was highest in the 11-15 years age group. Effect estimates were higher when pandemic-related restrictions were more stringent (Oxford Stringency Index > 60: SMD, 0.52 [95%-CI, 0.30-0.73]) and when school closures (School Closure Index ≥ 2: SMD, 0.44 [95%-CI, 0.23-0.65]) occurred | ||
| 520 | |a CONCLUSION: General anxiety symptoms among children and adolescents in Europe increased in a pre/during comparison of the COVID-19 pandemic; particularly for males aged 11-15 years. In periods of stringent pandemic-related restrictions and/or school closures a considerable increase in general anxiety symptoms could be documented. PROSPERO registration: CRD42022303714 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Review | |
| 650 | 4 | |a Adolescent | |
| 650 | 4 | |a Anxiety | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a Child | |
| 650 | 4 | |a Communicable disease control | |
| 650 | 4 | |a Europe | |
| 650 | 4 | |a Evidence-informed decision-making | |
| 650 | 4 | |a Health policy | |
| 650 | 4 | |a Lockdown | |
| 650 | 4 | |a Meta-analysis | |
| 650 | 4 | |a Pandemic preparedness | |
| 700 | 1 | |a Dannheim, Indra |e verfasserin |4 aut | |
| 700 | 1 | |a Pfadenhauer, Lisa M |e verfasserin |4 aut | |
| 700 | 1 | |a Fegert, Jörg M |e verfasserin |4 aut | |
| 700 | 1 | |a Bujard, Martin |e verfasserin |4 aut | |
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