Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Reviews
Year : 2022 | Month : March | Volume : 16 | Issue : 3 | Page : VE01 - VE03 Full Version

Impact of COVID-19 on Mental Health of Children and Adolescents: A Narrative Review


Published: March 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/52034.16176
Sharika Ashraf, Arjimand Yaqoob

1. PhD Scholar, Department of Zoology, Deshbhagat University, Mandi Gobindgarh, Gobindgarh, Punjab, India. 2. Senior Resident, Department of Neurology, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India.

Correspondence Address :
Sharika Ashraf,
Skims, Soura, Srinagar, Jammu and Kashmir, India.
E-mail: drarjimandyaqoob@gmail.com

Abstract

Coronavirus Disease 2019 (COVID-2019) pandemic created havoc on our planet, affecting all aspects of human life. It has resulted in human mortality and morbidity worldwide. It did not spare social and economic fabric of societies. It has resulted in huge psychosocial impact on human race. Various disease containment measures such as quarantine, physical distancing, complete lockdowns imposed by Governments across the globe has severely affected mental health of children and adolescents. The present article is aimed at reviewing various articles published regarding COVID-2019 pandemic impact on mental health of children with or without previous mental health problems. Different electronic databases, such as Science Direct, PubMed and Google Scholar were searched for articles describing impact on mental health of children and adolescents with/without previous mental health problems due to COVID-19. Search strategies included terms such as: “COVID-19”, “SARS-CoV-2”, “mental health”, “children”, “adolescent”, “behavioural impact”, “depression” and “anxiety.” The majority of children and adolescents experienced deterioration in their mental health as emergency measures were implemented throughout the world. Children diagnosed with pre-existing mental health problems or Autism Spectrum Disorder (ASD) experienced more negative changes compared with children/adolescents without pre-existing psychiatric diagnosis. There is increased anxiety, depression, irritability, sleep disorders, lethargy, dissatisfaction and fear of death. There is need to plan and implement strategies to provide easy and early access to mental health services for which various stakeholders should come together.

Keywords

Anxiety, Coronavirus disease-2019, Lockdown, Loneliness, Pandemic, Physical distancing, Quarantine

Outbreak of COVID-2019 came to limelight on December 31, 2019 when World Health Organisation (WHO) was appraised by China about cluster of cases of pneumonia in Wuhan city in Hubei province of unknown cause. Subsequently, more provinces in China got involved, and spread to the rest of the world from Thailand, Japan, the Republic of Korea, to the United States, Vietnam, Singapore, Australia, Nepal, Europe (first cases in France and later in Finland, Germany Italy etc.), Canada, Malaysia, the Middle East, and other countries of the Western Pacific Region and South-East Asia Region, and onwards to Russia, Africa, and Latin America (1). The WHO declared it as pandemic. The virus was named Severe Acute Respiratory Syndrome 2 (SARS-CoV-2) and the disease is now called Coronavirus Disease 2019 (COVID-19) (1).

Globally, as on 2nd June 2021, there have been 170,812,850 confirmed cases of COVID-19, including 3,557,586 deaths, reported to WHO. As of 1st June 2021, a total of 1,581,509,628 vaccine doses have been administered (2). SARS-CoV-2, the virus that led to COVID-19 pandemic, has had a major impact on human health. Large number of people have been infected, causing severe disease and subsequent long-term health sequelae, resulting in death and excess mortality, especially vulnerable and older populations and also causing disruptions to travel, trade, education, interrupting routine healthcare services, and many other societal functions and leaving negative impact on peoples physical and mental health (3). In order to contain the disease, governments all over the globe are implementing various measures such as school closures, physical distancing, home quarantine and complete lockdowns. In India, lockdown was announced on 24th March 2020. Lockdown measures have limited opportunities for social interaction effecting mental well being as ability to receive the social support has decreased (4). Schools have been closed, leading to disruption of daily routine of children and they are not able to take part in day-to-day activities and there is loss of social connection with friends which is further detrimental to their mental health and increases feeling of loneliness (5). School children of primary classes might be most affected by suspension of outdoor activities or school closures as interpersonal relationships and autonomous, extra-family experiences are important in this stage of development in life (6). Even young children aged 2-5 years were aware of the virus and considered it bad, children aged 6-10 years seem to be more aware about psychological and medical impact due to COVID-19 pandemic (7). The aim of the present review was to analyse and evaluate the data published regarding the impact of COVID-19 on mental health of children and adolescents with or without previous mental health problems.

LITERATURE SEARCH

Different electronic databases, including Science Direct, PubMed and Google Scholar were searched, from January, 2020 till May, 2021 for articles describing impact on mental health of children and adolescents with/without previous mental health problems due to COVID-19. Search strategies included terms such as: “COVID-19”, “SARS-CoV-2”, “mental health”, “children”, “adolescent”, “behavioural impact”, “depression” and “anxiety.” Our search showed 102 results. Studies were selected according to the following inclusion criteria: Published between January 2020 to May 2021, included children and adolescents and based on these inclusion criteria, 14 articles were included (6),(7),(8),(9),(10),(11),(12),(13),(14),(15),(16),(17),(18),(19). Exclusion criteria comprise of the studies that included adults or older people. Bibliographic references in the articles were manually searched and reviewed.

IMPACT ON YOUNG CHILDREN

Implementation of containment measures have major impacts on the psychology of young children. Several studies have shown the negative effects on the mental health in children (6),(7),(8),(9),(10),(11),(12),(13),(17),(18),(19). Anxiety, depression, lethargy, agitation and inattention, impaired social interaction, clinginess, and separation problems, poor sleep including nightmares, reduced appetite, are commonly reported manifestations (9),(10),(11),(13).

A preliminary study conducted in China showed children belonging to younger age group (3-6 years) were more likely than older children to manifest symptoms, such as clinginess and fear that family members could contract the infection (8). A study in Ireland, concluded that children’s adverse mental conditions were provoked by the lack of social interaction with their peers. Stress to complete their home-schooling was another cause of negative mental health outcome. Coverage by media about pandemic and the lack of access to family and friends facilitated anxiety among children (9). A Canadian study revealed that many children and adolescents had deterioration across various mental health domains. Mental health experienced negative impact in about two thirds of children and adolescents in that study.

Children in age group of 6 to 9 years were mostly affected leading to anxiety and irritability. Lowest rates of deterioration and highest rates of improvement was seen in preschool children. Thus, greater impact on mental health was seen in school-aged children. Experience of increased stress from social isolation resulting from loss of in-person social interactions was found to be as the strongest predictor of deterioration of mental health (10). One study in the Netherlands, revealed that mental and social health of children and adolescents during the COVID-19 lockdown was poor as compared to before. In addition to the effects on anxiety and depressive symptoms, anger, sleep related impairment and peer relationships were negative impacts due to lockdown. Children and adolescents with certain risk factors like negative change in work situation of parents due to COVID-19 regulations, family composition (children from single-parent family or families with three or more children), relative or friend infected with COVID-19 are more vulnerable to mental health problems. Negative impact of the COVID-19 regulations was reported by majority of children on their daily life, missing contact with friends was most important, closure of schools, sense of absence of freedom, closure of sports activities, missing social and joyful activities (for example, holidays, birthdays, shopping, parties), difficulties and disorientation with home-schooling, missing support of extended family, and boredom were the other impacts (11). Younger children are more negatively impacted by the pandemic than older children but emotional problems in girls seem to increase by age during the pandemic (12).

The prevalence of mental health problems has increased from 7.4% before pandemic to 26.8% during pandemic in 7 to 10-year-old in one of the studies carried out in Germany. Children with low parental education, low socio-economic status, and migrant status are more affected by the pandemic. This study did not found any increased incidence of depression during the COVID-19 lockdown but there was a greater level of generalised anxiety. Although clinically relevant depressive symptoms did not increase, but findings reveal that children feel highly burdened and have a significantly increased risk of mental health problems and children particularly young suffer from psychosomatic complaints (12).

In another study in Chinese students, 20.7% children experienced Post-Traumatic Stress Disorder (PTSD) and 7.16% depressive symptoms due to the COVID-19 pandemic. The PTSD symptoms were found to be more prevalent in boarding school and middle school students, while symptoms were less in day school and primary school students. Living status, provincial background and profession of father, school system (day or boarding school), education level (primary or middle school) are significantly linked with PTSD symptoms. Study revealed that, one in 14 children showed depressive symptoms and one in five children were found to have PTSD (13).

IMPACT ON ADOLESCENTS

Adolescents experience negative mental health issues like younger children, but they exhibit mental health experiences differently (9). One of the studies carried out in China, showed lifestyle changes and fear of getting infected may cause anxiety among adolescents. The elder adolescents aged 13-14 years were more depressed than the younger ones aged 9-12 years. Also, female adolescents showed higher risk of depression and anxiety than males. Depression and anxiety during COVID-19 was found more in adolescents without companion on workdays. Adolescents who were involved in some sort of physical exercise showed fewer depressive symptoms and anxiety (14). A study published in January 2021 in Ireland, showed depression and anxiety as commonly reported experiences for adolescents during the lockdown. The closure of schools, lack sense of freedom and home quarantine due to restrictions increases loneliness and anxiety among adolescents. Mental health was negatively impacted due to loss of routine activities and cancellation of milestone events. There was increase in screen time correlating with disruption of routine activities (9).

In study carried in Canada, depression was highest reported among 10-12 years children while attention problems, obsession/compulsions and hyperactivity were found to be highest in adolescents 13-18 years (10). In another study in Germany, there was an increase in the prevalence of noticeable mental health problems from 12.8% before the pandemic to 14.5% during pandemic in 11-13 years. Adolescents aged between 11-17 years self-reported substantial psychosomatic complaints like irritability, sleeping problems, headaches, feeling low and stomach aches. Headaches, stomach aches and feeling low were found to be more in girls than boys (12). In a Chinese study, results showed symptoms of depression in 20.9% of junior high school students and 29.7% of high school students. Prevalence of anxiety symptoms was higher (28.4%) in high school students than junior high school students (25.4%) (15). One study carried out by Zhou S et al., (2020), revealed that among children 12-18 years, 43.7% showed significant rates of depression and 37.4% reported clinically significant rates of anxiety (16).

IMPACT ON CHILDREN AND ADOLESCENTS WITH PRE-EXISTING MENTAL HEALTH CONDITIONS

A study carried out in China, showed that loss of daily routine, lack of interpersonal, social interaction and parent’s mood state could work as potential risk factors that could worsen Attention-Deficit Hyperactivity Disorder (ADHD) symptoms. This study also revealed that with longer study time, there was reduction in ADHD symptoms (17). Another study in Canada, showed worsening in attention, depression, hyperactivity and irritability highest among children and adolescents diagnosed with Autism Spectrum Disorder (ASD) while among children and adolescents with mental health+ASD diagnosis deterioration in anxiety and obsession/compulsions was highest (10).

One of the studies in Italy, indicated that the pandemic led to increased difficulty in managing daily activities and more intense behavioural problems in children with ASD individuals. The study also suggested that compared to young children, behavioural problems may be less in older. Another finding was that children living with single or separated parent showed better outcome in terms of intensity of behavioural problems (18). The COVID-19 pandemic has led to worsening of existing mental health problems among children and adolescents. Many adolescents with pre-existing mental conditions received mental health services only from school settings and closure of schools caused loss of access to mental health services and disruption in mental healthcare (6).

In one of the studies carried out in Barcelona, Spain , symptoms such as irritability, attentional problems, oppositional behaviours, sleep problems, sadness, fatigue, anxiety, isolation, body disturbances, dissatisfaction and fear of death increased especially in children and adolescents with ASD and behavioural disorders. Boys showed increased social isolation and inflexibility while girls exhibited lesser self-injurious behaviours and better eating habits, with increased body dissatisfaction. There was an increase in the use of electronic devices among adolescents with boys spending more time than girls. Almost half of the children and adolescents showed difficulties in concentration due to loss of routine and less physical activity (19).

A study on Irish children and adolescents, indicated disruption in routines due to restrictions which provoked anxiety in children with ASD. Adolescents having better understanding of virus provokes fear which leads to maladaptive existential anxiety (9).

RECOMMENDATIONS

In order to ensure mental well-being of children and adolescents, various stakeholders like parents, teachers, healthcare workers, policy makers should come together and collaborate and plan strategies accordingly (6),(8),(10),(12),(14).

1. Parents play a major role in life of their children and can act as support system in these stressful times. They should devote time and engage in various activities with their children and keep them busy especially younger children (8),(12).
2. Parents should address the anxiety of their children regarding the current situation and ensure them that this will not last forever (8).
3. Children should be encouraged to follow a consistent daily routine and extra care should be taken about creating healthy food and sleeping habits (8).
4. Adolescents should be encouraged to be in touch with their friends and communicate with them frequently (9).
5. Due to lockdown and physical distancing online classes are conducted by the school. Teachers through these classes should create awareness about mental health. They should interact with every student in the class and encourage them to express their feelings (15).
6. Teachers should engage students in various creative activities in order to break the monotony of online classes.
7. Policy makers in Government should frame policies keeping in view the long-term effect of pandemic on mental health (6),(7),(8),(9).
8. In order to provide easy access to counselling and treatment of mental health ailments, Government should rope in healthcare workers and psychiatrists in both rural and urban areas.

Conclusion

The majority of children and adolescents after COVID-19 pandemic experienced deterioration in their mental health due to implementation of the emergency measures throughout the world. Various cross- sectional studies showed that children as well as adolescents were burdened significantly by physical distancing measures, homeschooling and frequent lockdowns, as well as increased stress from social isolation. Lethargy, agitation and inattention, impaired social interaction, clinginess, and separation problems, poor sleep including nightmares, reduced appetite are commonly reported manifestations in young children. On younger children, there was more impact by the pandemic as compared to older children and with increasing age, emotional problems among girls tend to increase. Children and adolescents with traits like low socio-economic status, single-parent families, low education status of parents and migrant status were found more vulnerable to mental health problems. Also, children who had pre-existing mental health problems or who were diagnosed with ASD, experienced more negative changes compared with children/adolescents without pre-existing psychiatric diagnosis. There is increased anxiety, depression, irritability, sleep disorders, lethargy, dissatisfaction and fear of death. Although various studies have been performed to assess the short-term impact on mental health of children and adolescents, there should be follow-up studies to evaluate the long- term impact, this pandemic will have on psychological health of children and adolescents.

References

1.
World Health Organization. Coronavirus Disease (COVID-2019) Situation Reports. Accessed: May 23, 2021. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-report.
2.
WHO coronavirus disease (covid-19) dashboard. (2020). Accessed: June 5, 2021. https://covid19.who.int/.
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DOI and Others

DOI: 10.7860/JCDR/2022/52034.16176

Date of Submission: Aug 21, 2021
Date of Peer Review: Nov 18, 2021
Date of Acceptance: Jan 04, 2022
Date of Publishing: Mar 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Aug 23, 2021
• Manual Googling: Jan 03, 2022
• iThenticate Software: Jan 25, 2022 (19%)

ETYMOLOGY: Author Origin

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