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<div class="figure-label">Figure 1. Forest Plots of the Pooled Prevalence of Clinically Significant Depressive Symptoms in Youth During the COVID-19 Pandemic</div><a id="poi210043f1" class="figure-table-anchor"> </a>
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<a href="https://cdn.jamanetwork.com/ama/content_public/journal/peds/938800/poi210043f1_1635371730.45964.png?Expires=1640636926&Signature=3LoqfA5bPBuBoMuGQ9NQOn-BvA~BFcCAdws~38Se9OgI1cd3J3L4lqgXmlWi6YY6VeeuMw2LKy8XQKgBE1JNpnVAMj3JRrVid28lCuqCXxdCJHnwvGEKkEtwLJcjzoUZcPz8qWNJhJ-UY~53vXIgXVB6LZAziR6jrJgnv8W6OjX2VtSBXuVUJnXuopGSbqvpR0jQcyR7TdbzQByxv5WLU8wVv3x~~YFIKBtnt8WPXbUg2DTh5zGtDJabFJicm4vHx2duerGLSI4~wKVq1hpWXYkIVUDqNvDxa~cpqf68RuZz-EY45QLBj0ScRlIzRqqNjEMcHXgTZlMk6ZpNXE5FPw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" target="_blank" path-from-xml="poi210043f1" rel="nofollow"><img data-original="https://cdn.jamanetwork.com/ama/content_public/journal/peds/938800/m_poi210043f1_1635371730.45964.png?Expires=1640636926&Signature=j6JXaXCuHRKkydPxPQx9EOJsWu1dUz13-fbMZU2FiW0nk-PR~WSahowwFcZ7P8Ce0WYhQZ2dcMAtPno2b4OC~AoL5qaTSSIdMkoQV9lOgDlO89eYV8mqRWzBahZf3dxOKKGQINsFxUBW5S~z9GmBDKW7nqf42Au6ylQIgLXooWfhzX5GD9NZDadrr0UtGH~C2zqLfSYIbBAZbRbWrm3OxqaeU~9Yr5jJ4IugLMTccymBVivHgPv3kUQJsqYiOALDPoqzYbaD~oVnm7Gv4EISYI3toemFEp7sahis4HvLFt4TXaBpvr3JZV59PySNS8T6cQZ0wkviHzbpSyVZ7Ar6eQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" alt="Forest Plots of the Pooled Prevalence of Clinically Significant Depressive Symptoms in Youth During the COVID-19 Pandemic" class="content-img lazy" path-from-xml="poi210043f1"></a>
</div>
</div>
<div class="figure-caption clip-last-child">
<p class="para">Contributing studies for clinically elevated depression symptoms are presented in order of largest to smallest prevalence rate. Square data markers represent prevalence rates, with lines around the marker
indicating 95% CIs. The diamond data marker represents the overall effect size based on included studies.</p>
</div>
</div>
<div class="figure-table-wrapper thm-bd-top">
<div class="figure-label">Figure 2. Forest Plots of the Pooled Prevalence of Clinically Significant Anxiety Symptoms in Youth During the COVID-19 Pandemic</div><a id="poi210043f2" class="figure-table-anchor"> </a>
<div class="figure-table-links right">
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</div>
</div>
<div class="figure-caption clip-last-child">
<p class="para">Contributing studies for clinically elevated anxiety symptoms are presented in order of largest to smallest prevalence rate. Square data markers represent prevalence rates, with lines around the marker indicating
95% CIs. The diamond data marker represents the overall effect size based on included studies.</p>
</div>
</div>
</div>
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<div class="table-label">Table 1. Characteristics of Studies Included</div><a class="figure-table-anchor" id="poi210043t1"> </a>
<div class="figure-table-links right">
<a class="view-large figure-table-link is-b desktop-only" path-from-xml="poi210043t1" href="https://cdn.jamanetwork.com/ama/content_public/journal/peds/938800/poi210043t1_1635371730.43466.png?Expires=1640636926&Signature=ghaQtXhjX09NYBheDUaCQOze2FB8Bma5ZOVl6bN8H5E2n3Y9-wR3UxBHqDPNuf017C-EGTIBe~uQPwcgN0dJDZXuUzBAaEYszC3Vf6Adi0za9XKElexyfZFcG8mYvcEwrGzR4C9fYmPQEcThFCx8BT50SwjkTysUz-k~qAYUiVoEbuve4XmHgT2GRN-nc-aUjl2Mks7s6XhGcxKuA6mVIhqRniX0UWPqoyE2tWGGlq3o-4sLDjsaKp55AIfGAJxdxF598rQl7qFbpR998x-LOCUkKhJjJKJbT4BtvwqiAA4TIlQzybGV0rNa6qIo7R89PFBejQzSfSV-6Qcqe0GCTQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" target="_blank" rel="nofollow"><span class="view-large-text">View Large</span></a><a class="download-ppt figure-table-link is-b" path-from-xml="poi210043t1" href="/downloadimage.aspx?image=https://cdn.jamanetwork.com/ama/content_public/journal/peds/938800/poi210043t1_1635371730.43466.png?Expires=1640636926&Signature=ghaQtXhjX09NYBheDUaCQOze2FB8Bma5ZOVl6bN8H5E2n3Y9-wR3UxBHqDPNuf017C-EGTIBe~uQPwcgN0dJDZXuUzBAaEYszC3Vf6Adi0za9XKElexyfZFcG8mYvcEwrGzR4C9fYmPQEcThFCx8BT50SwjkTysUz-k~qAYUiVoEbuve4XmHgT2GRN-nc-aUjl2Mks7s6XhGcxKuA6mVIhqRniX0UWPqoyE2tWGGlq3o-4sLDjsaKp55AIfGAJxdxF598rQl7qFbpR998x-LOCUkKhJjJKJbT4BtvwqiAA4TIlQzybGV0rNa6qIo7R89PFBejQzSfSV-6Qcqe0GCTQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA&sec=248076489&ar=2782796&imagename=&siteId=19" rel="nofollow"><span class="download-ppt-text">Download</span></a><a class="figure-table-twitter figure-table-link figure-table-social addthis_button_twitter is-b at300b" rel="nofollow" title="Twitter" href="#"><span class="share-text"> </span></a><a class="figure-table-facebook figure-table-link figure-table-social addthis_button_facebook is-b at300b" rel="nofollow" title="Facebook" href="#"><span class="share-text"> </span></a>
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</div>
</div>
<div class="table-caption"></div>
</div>
<div class="figure-table-wrapper thm-bd-top">
<div class="table-label">Table 2. Results of Moderator Analyses for the Prevalence of Depressive Symptoms in Children and Adolescence During COVID-19</div><a class="figure-table-anchor" id="poi210043t2"> </a>
<div class="figure-table-links right">
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</div>
</div>
<div class="table-caption"></div>
</div>
<div class="figure-table-wrapper thm-bd-top">
<div class="table-label">Table 3. Results of Moderator Analyses for the Prevalence of Anxiety Symptoms in Children and Adolescence During COVID-19</div><a class="figure-table-anchor" id="poi210043t3"> </a>
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<div class="supplement-title"><span class="title-label">Supplement.</span><p class="para">eTable 1. Example Search Strategy from Medline</p><p class="para">eTable 2. Study Quality Evaluation Criteria</p><p class="para">eTable 3. Quality Assessment of Studies Included</p><p class="para">eTable 4. Sensitivity analysis excluding low quality studies (score=2) for moderators of the prevalence of clinically elevated depressive symptoms in children and adolescence during COVID-19</p><p class="para">eTable 5. Sensitivity analysis excluding low quality studies (score=2) for moderators of the prevalence of clinically elevated anxiety symptoms in children and adolescence during COVID-19</p><p class="para">eFigure 1. PRISMA diagram of review search strategy</p><p class="para">eFigure 2. Funnel plot for studies included in the clinically elevated depressive symptoms</p><p class="para">eFigure 3. Funnel plot for studies included in the clinically elevated anxiety symptoms</p></div>
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<div class="references">
<div class="reference"><a class="reference-number" id="poi210043r1">1.</a>
<div class="reference-content">Tiirikainen K, Haravuori H, Ranta K, Kaltiala-Heino R, Marttunen M. Psychometric properties of the 7-item Generalized Anxiety Disorder Scale (GAD-7) in a
large representative sample of Finnish adolescents. <i xmlns:helper="urn:XsltStringHelper"> Psychiatry Res</i>. 2019;272:30-35.
doi:<a href="http://dx.doi.org/10.1016/j.psychres.2018.12.004">10.1016/j.psychres.2018.12.004</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/30579178" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Psychometric%20properties%20of%20the%207-item%20Generalized%20Anxiety%20Disorder%20Scale%20%28GAD-7%29%20in%20a%20large%20representative%20sample%20of%20Finnish%20adolescents.&author=K%20Tiirikainen&author=H%20Haravuori&author=K%20Ranta&author=R%20Kaltiala-Heino&author=M%20Marttunen&publication_year=2019&journal=Psychiatry%20Res&volume=272&pages=30-35" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.psychres.2018.12.004" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r2">2.</a>
<div class="reference-content">Lu W. Adolescent depression: National trends, risk factors, and healthcare disparities. <i xmlns:helper="urn:XsltStringHelper"> Am J Health Behav</i>. 2019;43(1):181-194.
doi:<a href="http://dx.doi.org/10.5993/AJHB.43.1.15">10.5993/AJHB.43.1.15</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/30522576" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Adolescent%20depression%3A%20National%20trends%2C%20risk%20factors%2C%20and%20healthcare%20disparities.&author=W%20Lu&publication_year=2019&journal=Am%20J%20Health%20Behav&volume=43&pages=181-194" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.5993/AJHB.43.1.15" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r3">3.</a>
<div class="reference-content">Lee J. Mental health effects of school closures during COVID-19. <i xmlns:helper="urn:XsltStringHelper"> Lancet Child Adolesc Health</i>. 2020;4(6):421.
doi:<a href="http://dx.doi.org/10.1016/S2352-4642(20)30109-7">10.1016/S2352-4642(20)30109-7</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32302537" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Mental%20health%20effects%20of%20school%20closures%20during%20COVID-19.&author=J%20Lee&publication_year=2020&journal=Lancet%20Child%20Adolesc%20Health&volume=4&pages=421" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/S2352-4642(20)30109-7" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r4">4.</a>
<div class="reference-content">Sprang G, Silman M. Posttraumatic stress disorder in parents and youth after health-related disasters.
<i xmlns:helper="urn:XsltStringHelper"> Disaster Med Public Health Prep</i>. 2013;7(1):105-110.
doi:<a href="http://dx.doi.org/10.1017/dmp.2013.22">10.1017/dmp.2013.22</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/24618142" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Posttraumatic%20stress%20disorder%20in%20parents%20and%20youth%20after%20health-related%20disasters.&author=G%20Sprang&author=M%20Silman&publication_year=2013&journal=Disaster%20Med%20Public%20Health%20Prep&volume=7&pages=105-110" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1017/dmp.2013.22" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r5">5.</a>
<div class="reference-content">Brooks SK, Webster RK, Smith LE, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence.
<i xmlns:helper="urn:XsltStringHelper"> Lancet</i>. 2020;395(10227):912-920.
doi:<a href="http://dx.doi.org/10.1016/S0140-6736(20)30460-8">10.1016/S0140-6736(20)30460-8</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32112714" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=The%20psychological%20impact%20of%20quarantine%20and%20how%20to%20reduce%20it%3A%20rapid%20review%20of%20the%20evidence.&author=SK%20Brooks&author=RK%20Webster&author=LE%20Smith&publication_year=2020&journal=Lancet&volume=395&pages=912-920" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/S0140-6736(20)30460-8" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r6">6.</a>
<div class="reference-content">Loades ME, Chatburn E, Higson-Sweeney N, et al. Rapid systematic review: the impact of social isolation and loneliness on the mental health of children and
adolescents in the context of COVID-19. <i xmlns:helper="urn:XsltStringHelper"> J Am Acad Child Adolesc Psychiatry</i>. 2020;59(11):1218-1239.e3.
doi:<a href="http://dx.doi.org/10.1016/j.jaac.2020.05.009">10.1016/j.jaac.2020.05.009</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Rapid%20systematic%20review%3A%20the%20impact%20of%20social%20isolation%20and%20loneliness%20on%20the%20mental%20health%20of%20children%20and%20adolescents%20in%20the%20context%20of%20COVID-19.&author=ME%20Loades&author=E%20Chatburn&author=N%20Higson-Sweeney&publication_year=2020&journal=J%20Am%20Acad%20Child%20Adolesc%20Psychiatry&volume=59&pages=1218-1239.e3" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.jaac.2020.05.009" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r7">7.</a>
<div class="reference-content">Golberstein E, Wen H, Miller BF. Coronavirus disease 2019 (COVID-19) and mental health for children and adolescents.
<i xmlns:helper="urn:XsltStringHelper"> JAMA Pediatr</i>. 2020;174(9):819-820.
doi:<a href="http://jamanetwork.com/article.aspx?doi=10.1001/jamapediatrics.2020.1456">10.1001/jamapediatrics.2020.1456</a><br><a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2764730" class="jn-article-link">Article</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32286618" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Coronavirus%20disease%202019%20%28COVID-19%29%20and%20mental%20health%20for%20children%20and%20adolescents.&author=E%20Golberstein&author=H%20Wen&author=BF%20Miller&publication_year=2020&journal=JAMA%20Pediatr&volume=174&pages=819-820" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1001/jamapediatrics.2020.1456" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r8">8.</a>
<div class="reference-content">Racine N, Cooke JE, Eirich R, Korczak DJ, McArthur B, Madigan S. Child and adolescent mental illness during COVID-19: a rapid review.
<i xmlns:helper="urn:XsltStringHelper"> Psychiatry Res</i>. 2020;292:113307.
doi:<a href="http://dx.doi.org/10.1016/j.psychres.2020.113307">10.1016/j.psychres.2020.113307</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32707216" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Child%20and%20adolescent%20mental%20illness%20during%20COVID-19%3A%20a%20rapid%20review.&author=N%20Racine&author=JE%20Cooke&author=R%20Eirich&author=DJ%20Korczak&author=B%20McArthur&author=S%20Madigan&publication_year=2020&journal=Psychiatry%20Res&volume=292&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r9">9.</a>
<div class="reference-content">Singh S, Roy D, Sinha K, Parveen S, Sharma G, Joshi G. Impact of COVID-19 and lockdown on mental health of children and adolescents: a narrative
review with recommendations. <i xmlns:helper="urn:XsltStringHelper"> Psychiatry Res</i>. 2020;293:113429.
doi:<a href="http://dx.doi.org/10.1016/j.psychres.2020.113429">10.1016/j.psychres.2020.113429</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32882598" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Impact%20of%20COVID-19%20and%20lockdown%20on%20mental%20health%20of%20children%20and%20adolescents%3A%20a%20narrative%20review%20with%20recommendations.&author=S%20Singh&author=D%20Roy&author=K%20Sinha&author=S%20Parveen&author=G%20Sharma&author=G%20Joshi&publication_year=2020&journal=Psychiatry%20Res&volume=293&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r10">10.</a>
<div class="reference-content">Zhang L, Zhang D, Fang J, Wan Y, Tao F, Sun Y. Assessment of mental health of Chinese primary school students before and after school closing and
opening during the COVID-19 pandemic. <i xmlns:helper="urn:XsltStringHelper"> JAMA Netw Open</i>. 2020;3(9):e2021482.
doi:<a href="http://jamanetwork.com/article.aspx?doi=10.1001/jamanetworkopen.2020.21482">10.1001/jamanetworkopen.2020.21482</a><br><a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770489" class="jn-article-link">Article</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32915233" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Assessment%20of%20mental%20health%20of%20Chinese%20primary%20school%20students%20before%20and%20after%20school%20closing%20and%20opening%20during%20the%20COVID-19%20pandemic.&author=L%20Zhang&author=D%20Zhang&author=J%20Fang&author=Y%20Wan&author=F%20Tao&author=Y%20Sun&publication_year=2020&journal=JAMA%20Netw%20Open&volume=3&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r11">11.</a>
<div class="reference-content">Hafstad GS, Sætren SS, Wentzel-Larsen T, Augusti E. Adolescents’ symptoms of anxiety and depression before and during the Covid-19 outbreak: a prospective
population-based study of teenagers in Norway. <i xmlns:helper="urn:XsltStringHelper"> Lancet Reg Health Eur</i>. 2021;5:100093.
doi:<a href="http://dx.doi.org/10.1016/j.lanepe.2021.100093">10.1016/j.lanepe.2021.100093</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Adolescents%E2%80%99%20symptoms%20of%20anxiety%20and%20depression%20before%20and%20during%20the%20Covid-19%20outbreak%3A%20a%20prospective%20population-based%20study%20of%20teenagers%20in%20Norway.&author=GS%20Hafstad&author=SS%20Sætren&author=T%20Wentzel-Larsen&author=E%20Augusti&publication_year=2021&journal=Lancet%20Reg%20Health%20Eur&volume=5&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r12">12.</a>
<div class="reference-content">Yue J, Zang X, Le Y, An Y. Anxiety, depression and PTSD among children and their parent during 2019 novel coronavirus disease (COVID-19) outbreak in China.
<i xmlns:helper="urn:XsltStringHelper"> Curr Psychol</i>.
2020;1-8.<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33223783" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Anxiety%2C%20depression%20and%20PTSD%20among%20children%20and%20their%20parent%20during%202019%20novel%20coronavirus%20disease%20%28COVID-19%29%20outbreak%20in%20China.&author=J%20Yue&author=X%20Zang&author=Y%20Le&author=Y%20An&publication_year=2020&journal=Curr%20Psychol&volume=&pages=1-8" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r13">13.</a>
<div class="reference-content">Giannopoulou I, Efstathiou V, Triantafyllou G, Korkoliakou P, Douzenis A. Adding stress to the stressed: senior high school students’ mental health amidst
the COVID-19 nationwide lockdown in Greece. <i xmlns:helper="urn:XsltStringHelper"> Psychiatry Res</i>. 2021;295:113560.
doi:<a href="http://dx.doi.org/10.1016/j.psychres.2020.113560">10.1016/j.psychres.2020.113560</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33187723" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Adding%20stress%20to%20the%20stressed%3A%20senior%20high%20school%20students%E2%80%99%20mental%20health%20amidst%20the%20COVID-19%20nationwide%20lockdown%20in%20Greece.&author=I%20Giannopoulou&author=V%20Efstathiou&author=G%20Triantafyllou&author=P%20Korkoliakou&author=A%20Douzenis&publication_year=2021&journal=Psychiatry%20Res&volume=295&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r14">14.</a>
<div class="reference-content">Merikangas KR, He JP, Burstein M, et al. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey
Replication—Adolescent Supplement (NCS-A). <i xmlns:helper="urn:XsltStringHelper"> J Am Acad Child Adolesc Psychiatry</i>. 2010;49(10):980-989.
doi:<a href="http://dx.doi.org/10.1016/j.jaac.2010.05.017">10.1016/j.jaac.2010.05.017</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/20855043" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Lifetime%20prevalence%20of%20mental%20disorders%20in%20U.S.%20adolescents%3A%20results%20from%20the%20National%20Comorbidity%20Survey%20Replication%E2%80%94Adolescent%20Supplement%20%28NCS-A%29.&author=KR%20Merikangas&author=JP%20He&author=M%20Burstein&publication_year=2010&journal=J%20Am%20Acad%20Child%20Adolesc%20Psychiatry&volume=49&pages=980-989" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.jaac.2010.05.017" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r15">15.</a>
<div class="reference-content">American Psychiatric Association. <i xmlns:helper="urn:XsltStringHelper"> Diagnostic and Statistical Manual of Mental Disorders.</i> 5th ed. American Psychiatric Association; 2013.</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r16">16.</a>
<div class="reference-content">Courtney D, Watson P, Battaglia M, Mulsant BH, Szatmari P. COVID-19 impacts on child and youth anxiety and depression: challenges and opportunities.
<i xmlns:helper="urn:XsltStringHelper"> Can J Psychiatry</i>. 2020;65(10):688-691.
doi:<a href="http://dx.doi.org/10.1177/0706743720935646">10.1177/0706743720935646</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32567353" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=COVID-19%20impacts%20on%20child%20and%20youth%20anxiety%20and%20depression%3A%20challenges%20and%20opportunities.&author=D%20Courtney&author=P%20Watson&author=M%20Battaglia&author=BH%20Mulsant&author=P%20Szatmari&publication_year=2020&journal=Can%20J%20Psychiatry&volume=65&pages=688-691" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1177/0706743720935646" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r17">17.</a>
<div class="reference-content">Zhou SJ, Zhang LG, Wang LL, et al. Prevalence and socio-demographic correlates of psychological health problems in Chinese adolescents during the outbreak of
COVID-19. <i xmlns:helper="urn:XsltStringHelper"> Eur Child Adolesc Psychiatry</i>. 2020;29(6):749-758.
doi:<a href="http://dx.doi.org/10.1007/s00787-020-01541-4">10.1007/s00787-020-01541-4</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32363492" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Prevalence%20and%20socio-demographic%20correlates%20of%20psychological%20health%20problems%20in%20Chinese%20adolescents%20during%20the%20outbreak%20of%20COVID-19.&author=SJ%20Zhou&author=LG%20Zhang&author=LL%20Wang&publication_year=2020&journal=Eur%20Child%20Adolesc%20Psychiatry&volume=29&pages=749-758" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1007/s00787-020-01541-4" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r18">18.</a>
<div class="reference-content">Magson NR, Freeman JYA, Rapee RM, Richardson CE, Oar EL, Fardouly J. Risk and protective factors for prospective changes in adolescent mental health
during the COVID-19 pandemic. <i xmlns:helper="urn:XsltStringHelper"> J Youth Adolesc</i>. 2021;50(1):44-57.
doi:<a href="http://dx.doi.org/10.1007/s10964-020-01332-9">10.1007/s10964-020-01332-9</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33108542" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Risk%20and%20protective%20factors%20for%20prospective%20changes%20in%20adolescent%20mental%20health%20during%20the%20COVID-19%20pandemic.&author=NR%20Magson&author=JYA%20Freeman&author=RM%20Rapee&author=CE%20Richardson&author=EL%20Oar&author=J%20Fardouly&publication_year=2021&journal=J%20Youth%20Adolesc&volume=50&pages=44-57" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1007/s10964-020-01332-9" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r19">19.</a>
<div class="reference-content">Xie X, Xue Q, Zhou Y, et al. Mental health status among children in home confinement during the coronavirus disease 2019 outbreak in Hubei Province, China.
<i xmlns:helper="urn:XsltStringHelper"> JAMA Pediatr</i>. 2020;174(9):898-900.
doi:<a href="http://jamanetwork.com/article.aspx?doi=10.1001/jamapediatrics.2020.1619">10.1001/jamapediatrics.2020.1619</a><br><a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2765196" class="jn-article-link">Article</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32329784" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Mental%20health%20status%20among%20children%20in%20home%20confinement%20during%20the%20coronavirus%20disease%202019%20outbreak%20in%20Hubei%20Province%2C%20China.&author=X%20Xie&author=Q%20Xue&author=Y%20Zhou&publication_year=2020&journal=JAMA%20Pediatr&volume=174&pages=898-900" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1001/jamapediatrics.2020.1619" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r20">20.</a>
<div class="reference-content">Duan L, Shao X, Wang Y, et al. An investigation of mental health status of children and adolescents in China during the outbreak of COVID-19.
<i xmlns:helper="urn:XsltStringHelper"> J Affect Disord</i>. 2020;275:112-118.
doi:<a href="http://dx.doi.org/10.1016/j.jad.2020.06.029">10.1016/j.jad.2020.06.029</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32658812" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=An%20investigation%20of%20mental%20health%20status%20of%20children%20and%20adolescents%20in%20China%20during%20the%20outbreak%20of%20COVID-19.&author=L%20Duan&author=X%20Shao&author=Y%20Wang&publication_year=2020&journal=J%20Affect%20Disord&volume=275&pages=112-118" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.jad.2020.06.029" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r21">21.</a>
<div class="reference-content">Pierce M, McManus S, Jessop C, et al. Says who? the significance of sampling in mental health surveys during COVID-19.
<i xmlns:helper="urn:XsltStringHelper"> Lancet Psychiatry</i>. 2020;7(7):567-568.
doi:<a href="http://dx.doi.org/10.1016/S2215-0366(20)30237-6">10.1016/S2215-0366(20)30237-6</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32502467" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Says%20who%3F%20the%20significance%20of%20sampling%20in%20mental%20health%20surveys%20during%20COVID-19.&author=M%20Pierce&author=S%20McManus&author=C%20Jessop&publication_year=2020&journal=Lancet%20Psychiatry&volume=7&pages=567-568" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/S2215-0366(20)30237-6" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r22">22.</a>
<div class="reference-content">Klein R. Parent-child agreement in clinical assessment of anxiety and other psychopathology: a review. <i xmlns:helper="urn:XsltStringHelper"> J Anxiety Disord.</i>
1991;5(2):187-198.
doi:<a href="http://dx.doi.org/10.1016/0887-6185(91)90028-R">10.1016/0887-6185(91)90028-R</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Parent-child%20agreement%20in%20clinical%20assessment%20of%20anxiety%20and%20other%20psychopathology%3A%20a%20review.&author=R.%20Klein&publication_year=1991&journal=J%20Anxiety%20Disord.&volume=5&pages=187-198" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/0887-6185(91)90028-R" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r23">23.</a>
<div class="reference-content">Edelbrock C, Costello AJ, Dulcan MK, Conover NC, Kala R. Parent-child agreement on child psychiatric symptoms assessed via structured interview.
<i xmlns:helper="urn:XsltStringHelper"> J Child Psychol Psychiatry</i>. 1986;27(2):181-190.
doi:<a href="http://dx.doi.org/10.1111/j.1469-7610.1986.tb02282.x">10.1111/j.1469-7610.1986.tb02282.x</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/3958075" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Parent-child%20agreement%20on%20child%20psychiatric%20symptoms%20assessed%20via%20structured%20interview.&author=C%20Edelbrock&author=AJ%20Costello&author=MK%20Dulcan&author=NC%20Conover&author=R%20Kala&publication_year=1986&journal=J%20Child%20Psychol%20Psychiatry&volume=27&pages=181-190" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1111/jcpp.1986.27.issue-2" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r24">24.</a>
<div class="reference-content">Hawes MT, Szenczy AK, Olino TM, Nelson BD, Klein DN. Trajectories of depression, anxiety and pandemic experiences: a longitudinal study of youth in New York
during the spring-summer of 2020. <i xmlns:helper="urn:XsltStringHelper"> Psychiatry Res</i>. 2021;298:113778.
doi:<a href="http://dx.doi.org/10.1016/j.psychres.2021.113778">10.1016/j.psychres.2021.113778</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33550176" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Trajectories%20of%20depression%2C%20anxiety%20and%20pandemic%20experiences%3A%20a%20longitudinal%20study%20of%20youth%20in%20New%20York%20during%20the%20spring-summer%20of%202020.&author=MT%20Hawes&author=AK%20Szenczy&author=TM%20Olino&author=BD%20Nelson&author=DN%20Klein&publication_year=2021&journal=Psychiatry%20Res&volume=298&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r25">25.</a>
<div class="reference-content">Cost KT, Crosbie J, Anagnostou E, et al. Mostly worse, occasionally better: impact of COVID-19 pandemic on the mental health of Canadian children and
adolescents. <i xmlns:helper="urn:XsltStringHelper"> Eur Child Adolesc Psychiatry</i>. 2021.
doi:<a href="http://dx.doi.org/10.1007/s00787-021-01744-3">10.1007/s00787-021-01744-3</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33638005" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Mostly%20worse%2C%20occasionally%20better%3A%20impact%20of%20COVID-19%20pandemic%20on%20the%20mental%20health%20of%20Canadian%20children%20and%20adolescents.&author=KT%20Cost&author=J%20Crosbie&author=E%20Anagnostou&publication_year=2021&journal=Eur%20Child%20Adolesc%20Psychiatry&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r26">26.</a>
<div class="reference-content">MacTavish A, Mastronardi C, Menna R, et al. The acute impact of the COVID-19 pandemic on children’s mental health in southwestern Ontario. <i>PsyArXiv</i>.
Preprint posted online September 19, 2020. doi:<a href="http://dx.doi.org/10.31234/osf.io/5cwb4">10.31234/osf.io/5cwb4</a></div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r27">27.</a>
<div class="reference-content">Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
<i xmlns:helper="urn:XsltStringHelper"> PLoS Med</i>. 2009;6(7):e1000097.
doi:<a href="http://dx.doi.org/10.1371/journal.pmed.1000097">10.1371/journal.pmed.1000097</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/19621072" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Preferred%20reporting%20items%20for%20systematic%20reviews%20and%20meta-analyses%3A%20the%20PRISMA%20statement.&author=D%20Moher&author=A%20Liberati&author=J%20Tetzlaff&author=DG%20Altman&publication_year=2009&journal=PLoS%20Med&volume=6&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r28">28.</a>
<div class="reference-content">Ebesutani C, Bernstein A, Martinez JI, Chorpita BF, Weisz JR. The youth self report: applicability and validity across younger and older youths.
<i xmlns:helper="urn:XsltStringHelper"> J Clin Child Adolesc Psychol</i>. 2011;40(2):338-346.
doi:<a href="http://dx.doi.org/10.1080/15374416.2011.546041">10.1080/15374416.2011.546041</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/21391029" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=The%20youth%20self%20report%3A%20applicability%20and%20validity%20across%20younger%20and%20older%20youths.&author=C%20Ebesutani&author=A%20Bernstein&author=JI%20Martinez&author=BF%20Chorpita&author=JR%20Weisz&publication_year=2011&journal=J%20Clin%20Child%20Adolesc%20Psychol&volume=40&pages=338-346" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1080/15374416.2011.546041" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r29">29.</a>
<div class="reference-content">National Heart, Lung, and Blood Institute. Study quality assessment tools: quality assessment tool for observational cohort and cross-sectional studies. Accessed July 6, 2021.
https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r30">30.</a>
<div class="reference-content">Borenstein M, Hesdges L, Higgins J, Rothstein H. <i xmlns:helper="urn:XsltStringHelper"> Introduction to Meta-Analysis</i>. Wiley; 2009.</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r31">31.</a>
<div class="reference-content">Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test.
<i xmlns:helper="urn:XsltStringHelper"> BMJ</i>. 1997;315(7109):629-634.
doi:<a href="http://dx.doi.org/10.1136/bmj.315.7109.629">10.1136/bmj.315.7109.629</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/9310563" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Bias%20in%20meta-analysis%20detected%20by%20a%20simple%2C%20graphical%20test.&author=M%20Egger&author=G%20Davey Smith&author=M%20Schneider&author=C%20Minder&publication_year=1997&journal=BMJ&volume=315&pages=629-634" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1136/bmj.315.7109.629" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r32">32.</a>
<div class="reference-content">AlAzzam M, Abuhammad S, Abdalrahim A, Hamdan-Mansour AM. Predictors of depression and anxiety among senior high school students during COVID-19 pandemic: the
context of home quarantine and online education. <i xmlns:helper="urn:XsltStringHelper"> J Sch Nurs</i>.
2021;1059840520988548.<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33563066" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Predictors%20of%20depression%20and%20anxiety%20among%20senior%20high%20school%20students%20during%20COVID-19%20pandemic%3A%20the%20context%20of%20home%20quarantine%20and%20online%20education.&author=M%20AlAzzam&author=S%20Abuhammad&author=A%20Abdalrahim&author=AM%20Hamdan-Mansour&publication_year=2021&journal=J%20Sch%20Nurs&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r33">33.</a>
<div class="reference-content">Asanov I, Flores F, McKenzie D, Mensmann M, Schulte M. Remote-learning, time-use, and mental health of Ecuadorian high-school students during the COVID-19
quarantine. <i xmlns:helper="urn:XsltStringHelper"> World Dev</i>. 2021;138:105225.
doi:<a href="http://dx.doi.org/10.1016/j.worlddev.2020.105225">10.1016/j.worlddev.2020.105225</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33110286" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Remote-learning%2C%20time-use%2C%20and%20mental%20health%20of%20Ecuadorian%20high-school%20students%20during%20the%20COVID-19%20quarantine.&author=I%20Asanov&author=F%20Flores&author=D%20McKenzie&author=M%20Mensmann&author=M%20Schulte&publication_year=2021&journal=World%20Dev&volume=138&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r34">34.</a>
<div class="reference-content">Cao Y, Huang L, Si T, Wang NQ, Qu M, Zhang XY. The role of only-child status in the psychological impact of COVID-19 on mental health of Chinese
adolescents. <i xmlns:helper="urn:XsltStringHelper"> J Affect Disord</i>. 2021;282:316-321.
doi:<a href="http://dx.doi.org/10.1016/j.jad.2020.12.113">10.1016/j.jad.2020.12.113</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33421858" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=The%20role%20of%20only-child%20status%20in%20the%20psychological%20impact%20of%20COVID-19%20on%20mental%20health%20of%20Chinese%20adolescents.&author=Y%20Cao&author=L%20Huang&author=T%20Si&author=NQ%20Wang&author=M%20Qu&author=XY%20Zhang&publication_year=2021&journal=J%20Affect%20Disord&volume=282&pages=316-321" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.jad.2020.12.113" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r35">35.</a>
<div class="reference-content">Cheah CSL, Wang C, Ren H, Zong X, Cho HS, Xue X. COVID-19 racism and mental health in Chinese American families.
<i xmlns:helper="urn:XsltStringHelper"> Pediatrics</i>. 2020;146(5):e2020021816.
doi:<a href="http://dx.doi.org/10.1542/peds.2020-021816">10.1542/peds.2020-021816</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32873719" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=COVID-19%20racism%20and%20mental%20health%20in%20Chinese%20American%20families.&author=CSL%20Cheah&author=C%20Wang&author=H%20Ren&author=X%20Zong&author=HS%20Cho&author=X%20Xue&publication_year=2020&journal=Pediatrics&volume=146&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r36">36.</a>
<div class="reference-content">Chen F, Zheng D, Liu J, Gong Y, Guan Z, Lou D. Depression and anxiety among adolescents during COVID-19: a cross-sectional study.
<i xmlns:helper="urn:XsltStringHelper"> Brain Behav Immun</i>. 2020;88:36-38.
doi:<a href="http://dx.doi.org/10.1016/j.bbi.2020.05.061">10.1016/j.bbi.2020.05.061</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32464156" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Depression%20and%20anxiety%20among%20adolescents%20during%20COVID-19%3A%20a%20cross-sectional%20study.&author=F%20Chen&author=D%20Zheng&author=J%20Liu&author=Y%20Gong&author=Z%20Guan&author=D%20Lou&publication_year=2020&journal=Brain%20Behav%20Immun&volume=88&pages=36-38" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.bbi.2020.05.061" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r37">37.</a>
<div class="reference-content">Chen S, Cheng Z, Wu J. Risk factors for adolescents’ mental health during the COVID-19 pandemic: a comparison between Wuhan and other urban areas in China.
<i xmlns:helper="urn:XsltStringHelper"> Global Health</i>. 2020;16(1):96.
doi:<a href="http://dx.doi.org/10.1186/s12992-020-00627-7">10.1186/s12992-020-00627-7</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33036622" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Risk%20factors%20for%20adolescents%E2%80%99%20mental%20health%20during%20the%20COVID-19%20pandemic%3A%20a%20comparison%20between%20Wuhan%20and%20other%20urban%20areas%20in%20China.&author=S%20Chen&author=Z%20Cheng&author=J%20Wu&publication_year=2020&journal=Global%20Health&volume=16&pages=96" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1186/s12992-020-00627-7" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r38">38.</a>
<div class="reference-content">Chi X, Liang K, Chen ST, et al. Mental health problems among Chinese adolescents during the COVID-19: the importance of nutrition and physical activity.
<i xmlns:helper="urn:XsltStringHelper"> Int J Clin Health Psychol</i>. 2021;21(3):100218.
doi:<a href="http://dx.doi.org/10.1016/j.ijchp.2020.100218">10.1016/j.ijchp.2020.100218</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33391373" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Mental%20health%20problems%20among%20Chinese%20adolescents%20during%20the%20COVID-19%3A%20the%20importance%20of%20nutrition%20and%20physical%20activity.&author=X%20Chi&author=K%20Liang&author=ST%20Chen&publication_year=2021&journal=Int%20J%20Clin%20Health%20Psychol&volume=21&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r39">39.</a>
<div class="reference-content">Crescentini C, Feruglio S, Matiz A, et al. Stuck outside and inside: an exploratory study on the effects of the COVID-19 outbreak on Italian parents and children’s
internalizing symptoms. <i xmlns:helper="urn:XsltStringHelper"> Front Psychol</i>. 2020;11:586074.
doi:<a href="http://dx.doi.org/10.3389/fpsyg.2020.586074">10.3389/fpsyg.2020.586074</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33192917" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Stuck%20outside%20and%20inside%3A%20an%20exploratory%20study%20on%20the%20effects%20of%20the%20COVID-19%20outbreak%20on%20Italian%20parents%20and%20children%E2%80%99s%20internalizing%20symptoms.&author=C%20Crescentini&author=S%20Feruglio&author=A%20Matiz&publication_year=2020&journal=Front%20Psychol&volume=11&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r40">40.</a>
<div class="reference-content">Dong H, Yang F, Lu X, Hao W. Internet addiction and related psychological factors among children and adolescents in China during the coronavirus disease 2019
(COVID-19) epidemic. <i xmlns:helper="urn:XsltStringHelper"> Front Psychiatry</i>. 2020;11:00751.
doi:<a href="http://dx.doi.org/10.3389/fpsyt.2020.00751">10.3389/fpsyt.2020.00751</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32982806" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Internet%20addiction%20and%20related%20psychological%20factors%20among%20children%20and%20adolescents%20in%20China%20during%20the%20coronavirus%20disease%202019%20%28COVID-19%29%20epidemic.&author=H%20Dong&author=F%20Yang&author=X%20Lu&author=W%20Hao&publication_year=2020&journal=Front%20Psychiatry&volume=11&pages=00751" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.3389/fpsyt.2020.00751" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r41">41.</a>
<div class="reference-content">Garcia de Avila MA, Hamamoto Filho PT, Jacob FLDS, et al. Children’s anxiety and factors related to the COVID-19 pandemic: an exploratory study using the Children’s
Anxiety Questionnaire and the Numerical Rating Scale. <i xmlns:helper="urn:XsltStringHelper"> Int J Environ Res Public Health</i>. 2020;17(16):E5757.
doi:<a href="http://dx.doi.org/10.3390/ijerph17165757">10.3390/ijerph17165757</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32784898" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Children%E2%80%99s%20anxiety%20and%20factors%20related%20to%20the%20COVID-19%20pandemic%3A%20an%20exploratory%20study%20using%20the%20Children%E2%80%99s%20Anxiety%20Questionnaire%20and%20the%20Numerical%20Rating%20Scale.&author=MA%20Garcia de Avila&author=PT%20Hamamoto Filho&author=FLDS%20Jacob&publication_year=2020&journal=Int%20J%20Environ%20Res%20Public%20Health&volume=17&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r42">42.</a>
<div class="reference-content">Glynn LM, Davis EP, Luby JL, Baram TZ, Sandman CA. A predictable home environment may protect child mental health during the COVID-19 pandemic.
<i xmlns:helper="urn:XsltStringHelper"> Neurobiol Stress</i>. 2021;14:100291.
doi:<a href="http://dx.doi.org/10.1016/j.ynstr.2020.100291">10.1016/j.ynstr.2020.100291</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33532520" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=A%20predictable%20home%20environment%20may%20protect%20child%20mental%20health%20during%20the%20COVID-19%20pandemic.&author=LM%20Glynn&author=EP%20Davis&author=JL%20Luby&author=TZ%20Baram&author=CA%20Sandman&publication_year=2021&journal=Neurobiol%20Stress&volume=14&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r43">43.</a>
<div class="reference-content">Hou TY, Mao XF, Dong W, Cai WP, Deng GH. Prevalence of and factors associated with mental health problems and suicidality among senior high school students
in rural China during the COVID-19 outbreak. <i xmlns:helper="urn:XsltStringHelper"> Asian J Psychiatr</i>. 2020;54:102305.
doi:<a href="http://dx.doi.org/10.1016/j.ajp.2020.102305">10.1016/j.ajp.2020.102305</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32668388" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Prevalence%20of%20and%20factors%20associated%20with%20mental%20health%20problems%20and%20suicidality%20among%20senior%20high%20school%20students%20in%20rural%20China%20during%20the%20COVID-19%20outbreak.&author=TY%20Hou&author=XF%20Mao&author=W%20Dong&author=WP%20Cai&author=GH%20Deng&publication_year=2020&journal=Asian%20J%20Psychiatr&volume=54&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r44">44.</a>
<div class="reference-content">Li W, Zhang Y, Wang J, et al. Association of home quarantine and mental health among teenagers in Wuhan, China, during the COVID-19 pandemic.
<i xmlns:helper="urn:XsltStringHelper"> JAMA Pediatr</i>. 2021;175(3):313-316.
doi:<a href="http://jamanetwork.com/article.aspx?doi=10.1001/jamapediatrics.2020.5499">10.1001/jamapediatrics.2020.5499</a><br><a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2775249" class="jn-article-link">Article</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33464303" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Association%20of%20home%20quarantine%20and%20mental%20health%20among%20teenagers%20in%20Wuhan%2C%20China%2C%20during%20the%20COVID-19%20pandemic.&author=W%20Li&author=Y%20Zhang&author=J%20Wang&publication_year=2021&journal=JAMA%20Pediatr&volume=175&pages=313-316" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1001/jamapediatrics.2020.5499" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r45">45.</a>
<div class="reference-content">Luthar SS, Ebbert AM, Kumar NL. Risk and resilience during COVID-19: a new study in the Zigler paradigm of developmental science.
<i xmlns:helper="urn:XsltStringHelper"> Dev Psychopathol</i>.
2021;33(2):565-580.<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33032677" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Risk%20and%20resilience%20during%20COVID-19%3A%20a%20new%20study%20in%20the%20Zigler%20paradigm%20of%20developmental%20science.&author=SS%20Luthar&author=AM%20Ebbert&author=NL%20Kumar&publication_year=2021&journal=Dev%20Psychopathol&volume=33&pages=565-580" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1017/S0954579420001388" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r46">46.</a>
<div class="reference-content">McGuine TA, Biese KM, Petrovska L, et al. Mental health, physical activity, and quality of life of us adolescent athletes during COVID-19-related school closures
and sport cancellations: a study of 13 000 athletes. <i xmlns:helper="urn:XsltStringHelper"> J Athl Train</i>. 2020.
doi:<a href="http://dx.doi.org/10.4085/478-20">10.4085/478-20</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33290516" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Mental%20health%2C%20physical%20activity%2C%20and%20quality%20of%20life%20of%20us%20adolescent%20athletes%20during%20COVID-19-related%20school%20closures%20and%20sport%20cancellations%3A%20a%20study%20of%2013%E2%80%8A000%20athletes.&author=TA%20McGuine&author=KM%20Biese&author=L%20Petrovska&publication_year=2020&journal=J%20Athl%20Train&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r47">47.</a>
<div class="reference-content">Murata S, Rezeppa T, Thoma B, et al. The psychiatric sequelae of the COVID-19 pandemic in adolescents, adults, and health care workers.
<i xmlns:helper="urn:XsltStringHelper"> Depress Anxiety</i>. 2021;38(2):233-246.
doi:<a href="http://dx.doi.org/10.1002/da.23120">10.1002/da.23120</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33368805" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=The%20psychiatric%20sequelae%20of%20the%20COVID-19%20pandemic%20in%20adolescents%2C%20adults%2C%20and%20health%20care%20workers.&author=S%20Murata&author=T%20Rezeppa&author=B%20Thoma&publication_year=2021&journal=Depress%20Anxiety&volume=38&pages=233-246" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1002/da.v38.2" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r48">48.</a>
<div class="reference-content">Orgilés M, Espada JP, Delvecchio E, et al. Anxiety and depressive symptoms in children and adolescents during COVID-19 pandemic: a transcultural approach.
<i xmlns:helper="urn:XsltStringHelper"> Psicothema</i>.
2021;33(1):125-130.<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33453745" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Anxiety%20and%20depressive%20symptoms%20in%20children%20and%20adolescents%20during%20COVID-19%20pandemic%3A%20a%20transcultural%20approach.&author=M%20Orgilés&author=JP%20Espada&author=E%20Delvecchio&publication_year=2021&journal=Psicothema&volume=33&pages=125-130" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r49">49.</a>
<div class="reference-content">Ravens-Sieberer U, Kaman A, Erhart M, Devine J, Schlack R, Otto C. Impact of the COVID-19 pandemic on quality of life and mental health in children
and adolescents in Germany. <i xmlns:helper="urn:XsltStringHelper"> Eur Child Adolesc Psychiatry</i>. 2021.
doi:<a href="http://dx.doi.org/10.1007/s00787-021-01726-5">10.1007/s00787-021-01726-5</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33492480" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Impact%20of%20the%20COVID-19%20pandemic%20on%20quality%20of%20life%20and%20mental%20health%20in%20children%20and%20adolescents%20in%20Germany.&author=U%20Ravens-Sieberer&author=A%20Kaman&author=M%20Erhart&author=J%20Devine&author=R%20Schlack&author=C%20Otto&publication_year=2021&journal=Eur%20Child%20Adolesc%20Psychiatry&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r50">50.</a>
<div class="reference-content">Tang S, Xiang M, Cheung T, Xiang YT. Mental health and its correlates among children and adolescents during COVID-19 school closure: the importance of parent-child
discussion. <i xmlns:helper="urn:XsltStringHelper"> J Affect Disord</i>. 2021;279:353-360.
doi:<a href="http://dx.doi.org/10.1016/j.jad.2020.10.016">10.1016/j.jad.2020.10.016</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33099049" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Mental%20health%20and%20its%20correlates%20among%20children%20and%20adolescents%20during%20COVID-19%20school%20closure%3A%20the%20importance%20of%20parent-child%20discussion.&author=S%20Tang&author=M%20Xiang&author=T%20Cheung&author=YT%20Xiang&publication_year=2021&journal=J%20Affect%20Disord&volume=279&pages=353-360" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.jad.2020.10.016" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r51">51.</a>
<div class="reference-content">Zhou J, Yuan X, Qi H, et al. Prevalence of depression and its correlative factors among female adolescents in China during the coronavirus disease 2019
outbreak. <i xmlns:helper="urn:XsltStringHelper"> Global Health</i>. 2020;16(1):69.
doi:<a href="http://dx.doi.org/10.1186/s12992-020-00601-3">10.1186/s12992-020-00601-3</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32723373" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Prevalence%20of%20depression%20and%20its%20correlative%20factors%20among%20female%20adolescents%20in%20China%20during%20the%20coronavirus%20disease%202019%20outbreak.&author=J%20Zhou&author=X%20Yuan&author=H%20Qi&publication_year=2020&journal=Global%20Health&volume=16&pages=69" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1186/s12992-020-00601-3" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r52">52.</a>
<div class="reference-content">Zhang Z, Zhai A, Yang M, et al. Prevalence of depression and anxiety symptoms of high school students in Shandong province during the COVID-19 epidemic.
<i xmlns:helper="urn:XsltStringHelper"> Front Psychiatry</i>. 2020;11:570096.
doi:<a href="http://dx.doi.org/10.3389/fpsyt.2020.570096">10.3389/fpsyt.2020.570096</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33408653" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Prevalence%20of%20depression%20and%20anxiety%20symptoms%20of%20high%20school%20students%20in%20Shandong%20province%20during%20the%20COVID-19%20epidemic.&author=Z%20Zhang&author=A%20Zhai&author=M%20Yang&publication_year=2020&journal=Front%20Psychiatry&volume=11&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r53">53.</a>
<div class="reference-content">Zhang C, Ye M, Fu Y, et al. The psychological impact of the COVID-19 pandemic on teenagers in China.
<i xmlns:helper="urn:XsltStringHelper"> J Adolesc Health</i>. 2020;67(6):747-755.
doi:<a href="http://dx.doi.org/10.1016/j.jadohealth.2020.08.026">10.1016/j.jadohealth.2020.08.026</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33041204" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=The%20psychological%20impact%20of%20the%20COVID-19%20pandemic%20on%20teenagers%20in%20China.&author=C%20Zhang&author=M%20Ye&author=Y%20Fu&publication_year=2020&journal=J%20Adolesc%20Health&volume=67&pages=747-755" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.jadohealth.2020.08.026" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r54">54.</a>
<div class="reference-content">Masonbrink AR, Hurley E. Advocating for children during the COVID-19 school closures. <i xmlns:helper="urn:XsltStringHelper"> Pediatrics</i>. 2020;146(3):e20201440.
doi:<a href="http://dx.doi.org/10.1542/peds.2020-1440">10.1542/peds.2020-1440</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32554517" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Advocating%20for%20children%20during%20the%20COVID-19%20school%20closures.&author=AR%20Masonbrink&author=E%20Hurley&publication_year=2020&journal=Pediatrics&volume=146&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r55">55.</a>
<div class="reference-content">Schaller J, Zerpa M. Short-run effects of parental job loss on child health. <i xmlns:helper="urn:XsltStringHelper"> Am J Health Econ</i>. 2019;5(1):8-41.
doi:<a href="http://dx.doi.org/10.1162/ajhe_a_00106">10.1162/ajhe_a_00106</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Short-run%20effects%20of%20parental%20job%20loss%20on%20child%20health.&author=J%20Schaller&author=M%20Zerpa&publication_year=2019&journal=Am%20J%20Health%20Econ&volume=5&pages=8-41" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1162/ajhe_a_00106" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r56">56.</a>
<div class="reference-content">Marques L, Robinaugh DJ, LeBlanc NJ, Hinton D. Cross-cultural variations in the prevalence and presentation of anxiety disorders.
<i xmlns:helper="urn:XsltStringHelper"> Expert Rev Neurother</i>. 2011;11(2):313-322.
doi:<a href="http://dx.doi.org/10.1586/ern.10.122">10.1586/ern.10.122</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/21306217" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Cross-cultural%20variations%20in%20the%20prevalence%20and%20presentation%20of%20anxiety%20disorders.&author=L%20Marques&author=DJ%20Robinaugh&author=NJ%20LeBlanc&author=D%20Hinton&publication_year=2011&journal=Expert%20Rev%20Neurother&volume=11&pages=313-322" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1586/ern.10.122" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r57">57.</a>
<div class="reference-content">Rzymski P, Nowicki M, Mullin GE, et al. Quantity does not equal quality: scientific principles cannot be sacrificed.
<i xmlns:helper="urn:XsltStringHelper"> Int Immunopharmacol</i>. 2020;86:106711.
doi:<a href="http://dx.doi.org/10.1016/j.intimp.2020.106711">10.1016/j.intimp.2020.106711</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32585609" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Quantity%20does%20not%20equal%20quality%3A%20scientific%20principles%20cannot%20be%20sacrificed.&author=P%20Rzymski&author=M%20Nowicki&author=GE%20Mullin&publication_year=2020&journal=Int%20Immunopharmacol&volume=86&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r58">58.</a>
<div class="reference-content">Essau CA, Lewinsohn PM, Seeley JR, Sasagawa S. Gender differences in the developmental course of depression.
<i xmlns:helper="urn:XsltStringHelper"> J Affect Disord</i>. 2010;127(1-3):185-190.
doi:<a href="http://dx.doi.org/10.1016/j.jad.2010.05.016">10.1016/j.jad.2010.05.016</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/20573404" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Gender%20differences%20in%20the%20developmental%20course%20of%20depression.&author=CA%20Essau&author=PM%20Lewinsohn&author=JR%20Seeley&author=S%20Sasagawa&publication_year=2010&journal=J%20Affect%20Disord&volume=127&pages=185-190" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.jad.2010.05.016" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r59">59.</a>
<div class="reference-content">Riecher-Rössler A. Sex and gender differences in mental disorders. <i xmlns:helper="urn:XsltStringHelper"> Lancet Psychiatry</i>. 2017;4(1):8-9.
doi:<a href="http://dx.doi.org/10.1016/S2215-0366(16)30348-0">10.1016/S2215-0366(16)30348-0</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/27856397" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Sex%20and%20gender%20differences%20in%20mental%20disorders.&author=A%20Riecher-Rössler&publication_year=2017&journal=Lancet%20Psychiatry&volume=4&pages=8-9" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/S2215-0366(16)30348-0" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r60">60.</a>
<div class="reference-content">Oldehinkel AJ, Verhulst FC, Ormel J. Mental health problems during puberty: Tanner stage-related differences in specific symptoms: the TRAILS study.
<i xmlns:helper="urn:XsltStringHelper"> J Adolesc</i>. 2011;34(1):73-85.
doi:<a href="http://dx.doi.org/10.1016/j.adolescence.2010.01.010">10.1016/j.adolescence.2010.01.010</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/20172603" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Mental%20health%20problems%20during%20puberty%3A%20Tanner%20stage-related%20differences%20in%20specific%20symptoms%3A%20the%20TRAILS%20study.&author=AJ%20Oldehinkel&author=FC%20Verhulst&author=J%20Ormel&publication_year=2011&journal=J%20Adolesc&volume=34&pages=73-85" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.adolescence.2010.01.010" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r61">61.</a>
<div class="reference-content">Hall-Lande JA, Eisenberg ME, Christenson SL, Neumark-Sztainer D. Social isolation, psychological health, and protective factors in adolescence.
<i xmlns:helper="urn:XsltStringHelper"> Adolescence</i>.
2007;42(166):265-286.<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/17849936" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Social%20isolation%2C%20psychological%20health%2C%20and%20protective%20factors%20in%20adolescence.&author=JA%20Hall-Lande&author=ME%20Eisenberg&author=SL%20Christenson&author=D%20Neumark-Sztainer&publication_year=2007&journal=Adolescence&volume=42&pages=265-286" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r62">62.</a>
<div class="reference-content">Christakis DA, Van Cleve W, Zimmerman FJ. Estimation of US children’s educational attainment and years of life lost associated with primary school closures during the
coronavirus disease 2019 pandemic. <i xmlns:helper="urn:XsltStringHelper"> JAMA Netw Open</i>. 2020;3(11):e2028786.
doi:<a href="http://jamanetwork.com/article.aspx?doi=10.1001/jamanetworkopen.2020.28786">10.1001/jamanetworkopen.2020.28786</a><br><a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2772834" class="jn-article-link">Article</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33180132" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Estimation%20of%20US%20children%E2%80%99s%20educational%20attainment%20and%20years%20of%20life%20lost%20associated%20with%20primary%20school%20closures%20during%20the%20coronavirus%20disease%202019%20pandemic.&author=DA%20Christakis&author=W%20Van Cleve&author=FJ%20Zimmerman&publication_year=2020&journal=JAMA%20Netw%20Open&volume=3&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r63">63.</a>
<div class="reference-content">Madigan S, Racine N, Cooke JE, Korczak DJ. COVID-19 and telemental health: benefits, challenges, and future directions.
<i xmlns:helper="urn:XsltStringHelper"> Can Psychol</i>. 2021;62(1):5-11.
doi:<a href="http://dx.doi.org/10.1037/cap0000259">10.1037/cap0000259</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=COVID-19%20and%20telemental%20health%3A%20benefits%2C%20challenges%2C%20and%20future%20directions.&author=S%20Madigan&author=N%20Racine&author=JE%20Cooke&author=DJ%20Korczak&publication_year=2021&journal=Can%20Psychol&volume=62&pages=5-11" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1037/cap0000259" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r64">64.</a>
<div class="reference-content">Webb Hooper M, Nápoles AM, Pérez-Stable EJ. COVID-19 and racial/ethnic disparities. <i xmlns:helper="urn:XsltStringHelper"> JAMA</i>. 2020;323(24):2466-2467.
doi:<a href="http://jamanetwork.com/article.aspx?doi=10.1001/jama.2020.8598">10.1001/jama.2020.8598</a><br><a href="https://jamanetwork.com/journals/jama/fullarticle/2766098" class="jn-article-link">Article</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32391864" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=COVID-19%20and%20racial%2Fethnic%20disparities.&author=M%20Webb Hooper&author=AM%20Nápoles&author=EJ%20Pérez-Stable&publication_year=2020&journal=JAMA&volume=323&pages=2466-2467" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1001/jama.2020.8598" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r65">65.</a>
<div class="reference-content">Hawke LD, Hayes E, Darnay K, Henderson J. Mental health among transgender and gender diverse youth: an exploration of effects during the COVID-19 pandemic.
<i xmlns:helper="urn:XsltStringHelper"> Psychol Sex Orientat Gend Divers</i>. Published online February 4, 2021.
doi:<a href="http://dx.doi.org/10.1037/sgd0000467">10.1037/sgd0000467</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Mental%20health%20among%20transgender%20and%20gender%20diverse%20youth%3A%20an%20exploration%20of%20effects%20during%20the%20COVID-19%20pandemic.&author=LD%20Hawke&author=E%20Hayes&author=K%20Darnay&author=J%20Henderson&publication_year=&journal=Psychol%20Sex%20Orientat%20Gend%20Divers&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r66">66.</a>
<div class="reference-content">Craig S, Ames ME, Bondi BC, Pepler DJ. Canadian Adolescents’ mental health and substance use during the covid-19 pandemic: associations with COVID-19 stressors. <i>PsyArXiv</i>. Preprint posted
online September 9, 2020. doi:<a href="http://dx.doi.org/10.31234/osf.io/kprd9">10.31234/osf.io/kprd9</a></div>
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<p class="get-citation-citation">Racine N, McArthur BA, Cooke JE, Eirich R, Zhu J, Madigan S. Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19<span class="subtitle"><span
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<h1 class="meta-article-title ">Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19<span class="subtitle"><span class="colon-for-citation-subtitle">: </span>A Meta-analysis</span></h1>
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<span class="meta-authors--limited"><span class="wi-fullname brand-fg"><a href="/searchresults?author=Nicole+Racine&q=Nicole+Racine" rel="nofollow" target="_blank">Nicole Racine, PhD, RPsych<sup>1,2</sup></a></span><span
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class="wi-fullname brand-fg"><a href="/searchresults?author=Brae+Anne+McArthur&q=Brae+Anne+McArthur" rel="nofollow" target="_blank">Brae Anne McArthur, PhD, RPsych<sup>1,2</sup></a></span><span
class="al-author-delim">; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Jessica+E.+Cooke&q=Jessica+E.+Cooke" rel="nofollow" target="_blank">Jessica E. Cooke, MSc<sup>1,2</sup></a></span>;
<a class="meta-authors--etal td-u">et al</a></span>
<span class="meta-authors--remaining"><span class="wi-fullname brand-fg"><a href="/searchresults?author=Rachel+Eirich&q=Rachel+Eirich" rel="nofollow" target="_blank">Rachel Eirich, BA<sup>1,2</sup></a></span><span
class="al-author-delim">; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Jenney+Zhu&q=Jenney+Zhu" rel="nofollow" target="_blank">Jenney Zhu, BA<sup>1,2</sup></a></span><span
class="al-author-delim">; </span><span
class="wi-fullname brand-fg"><a href="/searchresults?author=Sheri+Madigan&q=Sheri+Madigan" rel="nofollow" target="_blank">Sheri Madigan, PhD, RPsych<sup>1,2</sup></a></span></span>
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<div class="meta-author-name"><sup>1</sup>Department of Psychology, University of Calgary, Calgary, Alberta, Canada</div>
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<div class="meta-author-name"><sup>2</sup>Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada </div>
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<span class="meta-citation-journal-name">JAMA Pediatr. </span><span class="meta-citation"> 2021;175(11):1142-1150. doi:10.1001/jamapediatrics.2021.2482</span>
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<span class="heading-text thm-col h3 cb section-type-keyPoints decorated-hed sb-sc ">Key Points</span>
<p><strong>Question</strong> <span>What is the global prevalence of clinically elevated child and adolescent anxiety and depression symptoms during COVID-19?</span></p>
<p><strong>Findings</strong> <span>In this meta-analysis of 29 studies including 80 879 youth globally, the pooled prevalence estimates of clinically elevated child and adolescent depression and anxiety were 25.2% and 20.5%,
respectively. The prevalence of depression and anxiety symptoms during COVID-19 have doubled, compared with prepandemic estimates, and moderator analyses revealed that prevalence rates were higher when collected later in the
pandemic, in older adolescents, and in girls.</span></p>
<p><strong>Meaning</strong> <span>The global estimates of child and adolescent mental illness observed in the first year of the COVID-19 pandemic in this study indicate that the prevalence has significantly increased, remains
high, and therefore warrants attention for mental health recovery planning.</span></p> <a class="article-section-id-anchor" id="248076463"></a>
<div class="h3 cb section-type-abstract decorated-hed ">
<div class="heading-text thm-col sb-sc"> Abstract </div>
</div>
<p><strong>Importance</strong> <span>Emerging research suggests that the global prevalence of child and adolescent mental illness has increased considerably during COVID-19. However, substantial variability in prevalence rates
have been reported across the literature.</span></p>
<p><strong>Objective</strong> <span>To ascertain more precise estimates of the global prevalence of child and adolescent clinically elevated depression and anxiety symptoms during COVID-19; to compare these rates with
prepandemic estimates; and to examine whether demographic (eg, age, sex), geographical (ie, global region), or methodological (eg, pandemic data collection time point, informant of mental illness, study quality) factors explained
variation in prevalence rates across studies.</span></p>
<p><strong>Data Sources</strong> <span>Four databases were searched (PsycInfo, Embase, MEDLINE, and Cochrane Central Register of Controlled Trials) from January 1, 2020, to February 16, 2021, and unpublished studies were
searched in <i>PsycArXiv</i> on March 8, 2021, for studies reporting on child/adolescent depression and anxiety symptoms. The search strategy combined search terms from 3 themes: (1) mental illness (including depression and
anxiety), (2) COVID-19, and (3) children and adolescents (age ≤18 years). For <i>PsycArXiv</i>, the key terms <i>COVID-19</i>, <i>mental health</i>, and <i>child/adolescent</i> were used.</span></p>
<p><strong>Study Selection</strong> <span>Studies were included if they were published in English, had quantitative data, and reported prevalence of clinically elevated depression or anxiety in youth (age ≤18 years).</span></p>
<p><strong>Data Extraction and Synthesis</strong> <span>A total of 3094 nonduplicate titles/abstracts were retrieved, and 136 full-text articles were reviewed. Data were analyzed from March 8 to 22, 2021.</span></p>
<p><strong>Main Outcomes and Measures</strong> <span>Prevalence rates of clinically elevated depression and anxiety symptoms in youth.</span></p>
<p><strong>Results</strong> <span>Random-effect meta-analyses were conducted. Twenty-nine studies including 80 879 participants met full inclusion criteria. Pooled prevalence estimates of clinically elevated depression and
anxiety symptoms were 25.2% (95% CI, 21.2%-29.7%) and 20.5% (95% CI, 17.2%-24.4%), respectively. Moderator analyses revealed that the prevalence of clinically elevated depression and anxiety symptoms were higher in studies
collected later in the pandemic and in girls. Depression symptoms were higher in older children.</span></p>
<p><strong>Conclusions and Relevance</strong> <span>Pooled estimates obtained in the first year of the COVID-19 pandemic suggest that 1 in 4 youth globally are experiencing clinically elevated depression symptoms, while 1 in 5
youth are experiencing clinically elevated anxiety symptoms. These pooled estimates, which increased over time, are double of prepandemic estimates. An influx of mental health care utilization is expected, and allocation of
resources to address child and adolescent mental health concerns are essential.</span></p>
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<div class="heading-text thm-col sb-sc"> Introduction </div>
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<p class="para">Prior to the COVID-19 pandemic, rates of clinically significant generalized anxiety and depressive symptoms in large youth cohorts were approximately
11.6%<sup><a href="#poi210043r1" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">1</a></sup> and
12.9%,<sup><a href="#poi210043r2" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">2</a></sup> respectively. Since COVID-19 was declared an international public health emergency, youth around the world have
experienced dramatic disruptions to their everyday lives.<sup><a href="#poi210043r3" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">3</a></sup> Youth are enduring pervasive social isolation and missed
milestones, along with school closures, quarantine orders, increased family stress, and decreased peer interactions, all potential precipitants of psychological distress and mental health difficulties in
youth.<sup><a href="#poi210043r4" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">4</a></sup><sup>-<a href="#poi210043r4" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">7</a></sup>
Indeed, in both
cross-sectional<sup><a href="#poi210043r8" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">8</a></sup><sup>,<a href="#poi210043r9" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">9</a></sup>
and longitudinal
studies<sup><a href="#poi210043r10" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">10</a></sup><sup>,<a href="#poi210043r11" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">11</a></sup>
amassed to date, the prevalence of youth mental illness appears to have increased during the COVID-19 pandemic.<sup><a href="#poi210043r3" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">3</a></sup> However,
data collected vary considerably. Specifically, ranges from 2.2%<sup><a href="#poi210043r12" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">12</a></sup> to
63.8%<sup><a href="#poi210043r13" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">13</a></sup> and
1.8%<sup><a href="#poi210043r12" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">12</a></sup> to
49.5%<sup><a href="#poi210043r13" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">13</a></sup> for clinically elevated depression and anxiety symptoms, respectively. As governments and policy makers deploy
and implement recovery plans, ascertaining precise estimates of the burden of mental illness for youth are urgently needed to inform service deployment and resource allocation.</p>
<a class="article-section-id-anchor" id="248076470"></a>
<p class="para">Depression and generalized anxiety are 2 of the most common mental health concerns in youth.<sup><a href="#poi210043r14" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">14</a></sup> Depressive
symptoms, which include feelings of sadness, loss of interest and pleasure in activities, as well as disruption to regulatory functions such as sleep and
appetite,<sup><a href="#poi210043r15" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">15</a></sup> could be elevated during the pandemic as a result of social isolation due to school closures and physical
distancing requirements.<sup><a href="#poi210043r6" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">6</a></sup> Generalized anxiety symptoms in youth manifest as uncontrollable worry, fear, and
hyperarousal.<sup><a href="#poi210043r15" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">15</a></sup> Uncertainty, disruptions in daily routines, and concerns for the health and well-being of family and
loved ones during the COVID-19 pandemic are likely associated with increases in generalized anxiety in youth.<sup><a href="#poi210043r16" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">16</a></sup></p>
<a class="article-section-id-anchor" id="248076471"></a>
<p class="para">When heterogeneity is observed across studies, as is the case with youth mental illness during COVID-19, it often points to the need to examine demographic, geographical, and methodological moderators. Moderator
analyses can determine for whom and under what circumstances prevalence is higher vs lower. With regard to demographic factors, prevalence rates of mental illness both prior to and during the COVID-19 pandemic are differentially
reported across child age and sex, with
girls<sup><a href="#poi210043r17" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">17</a></sup><sup>,<a href="#poi210043r18" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">18</a></sup>
and older
children<sup><a href="#poi210043r17" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">17</a></sup><sup>,<a href="#poi210043r19" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">19</a></sup>
being at greater risk for internalizing disorders. Studies have also shown that youth living in regions that experienced greater disease
burden<sup><a href="#poi210043r2" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">2</a></sup> and urban
areas<sup><a href="#poi210043r20" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">20</a></sup> had greater mental illness severity. Methodological characteristics of studies also have the potential to
influence the estimated prevalence rates. For example, studies of poorer methodological quality may be more likely to overestimate prevalence
rates.<sup><a href="#poi210043r21" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">21</a></sup> The symptom reporter (ie, child vs parent) may also contribute to variability in the prevalence of mental
illness across studies. Indeed, previous research prior to the pandemic has demonstrated that child and parent reports of internalizing symptoms
vary,<sup><a href="#poi210043r22" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">22</a></sup> with children/adolescents reporting more internalizing symptoms than
parents.<sup><a href="#poi210043r23" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">23</a></sup> Lastly, it is important to consider the role of data collection timing on potential prevalence rates. While
feelings of stress and overwhelm may have been greater in the early months of the pandemic compared with later,<sup><a href="#poi210043r24" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">24</a></sup>
extended social isolation and school closures may have exerted mental health concerns.</p> <a class="article-section-id-anchor" id="248076472"></a>
<p class="para">Although a narrative systematic review of 6 studies early in the pandemic was conducted,<sup><a href="#poi210043r8" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">8</a></sup> to our knowledge,
no meta-analysis of prevalence rates of child and adolescent mental illness during the pandemic has been undertaken. In the current study, we conducted a meta-analysis of the global prevalence of clinically elevated symptoms of
depression and anxiety (ie, exceeding a clinical cutoff score on a validated measure or falling in the moderate to severe symptom range of anxiety and depression) in youth during the first year of the COVID-19 pandemic. While
research has documented a worsening of symptoms for children and youth with a wide range of anxiety disorders,<sup><a href="#poi210043r25" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">25</a></sup>
including social anxiety,<sup><a href="#poi210043r26" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">26</a></sup> clinically elevated symptoms of generalized anxiety are the focus of the current
meta-analysis. In addition to deriving pooled prevalence estimates, we examined demographic, geographical, and methodological factors that may explain between-study differences. Given that there have been several precipitants of
psychological distress for youth during COVID-19, we hypothesized that pooled prevalence rates would be higher compared with prepandemic estimates. We also hypothesized that child mental illness would be higher among studies with
older children, a higher percentage of female individuals, studies conducted later in the pandemic, and that higher-quality studies would have lower prevalence rates.</p> <a class="article-section-id-anchor" id="248076473"></a>
<div class="h3 cb section-type-section ">
<div class="heading-text thm-col sb-sc"> Methods </div>
</div>
<a class="article-section-id-anchor" id="248076474"></a>
<div class="h4 cb section-type-section ">
<div class="heading-text "> Search Strategy and Selection Criteria </div>
</div>
<a class="article-section-id-anchor" id="248076475"></a>
<p class="para">This systematic review was registered as a protocol with PROSPERO (CRD42020184903) and the Preferred Reporting Items for Systematic Reviews and Meta-analyses
(<a href="http://www.equator-network.org/reporting-guidelines/prisma/">PRISMA</a>) reporting guideline was followed.<sup><a href="#poi210043r27" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">27</a></sup>
Ethics review was not required for the study. Electronic searches were conducted in collaboration with a health sciences librarian in PsycInfo, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and MEDLINE from
inception to February 16, 2021. The search strategy (eTable 1 in the <a class="supplement-link section-jump-link" data-tab-toggle=".tab-nav-supplemental" href="#note-POI210043-1">Supplement</a>) combined search terms from 3 themes:
(1) mental illness (including depression and anxiety), (2) COVID-19, and (3) children and adolescents (age ≤18 years). Both database and subject headings were used to search keywords. As a result of the rapidly evolving nature of
research during the COVID-19 pandemic, we also searched a repository of unpublished preprints, <i>PsycArXiv</i>. The key terms <i>COVID-19</i>, <i>mental health</i>, and <i>child/adolescent</i> were used on March 8, 2021, and
yielded 38 studies of which 1 met inclusion criteria.</p> <a class="article-section-id-anchor" id="248076476"></a>
<p class="para">The following inclusion criteria were applied: (1) sample was drawn from a general population; (2) proportion of individuals meeting clinical cutoff scores or falling in the moderate to severe symptom range of anxiety
or depression as predetermined by validated self-report measures were provided; (3) data were collected during COVID-19; (4) participants were 18 years or younger; (5) study was empirical; and (6) studies were written in English.
Samples of participants who may be affected differently from a mental health perspective during COVID-19 were excluded (eg, children with preexisting psychiatric diagnoses, children with chronic illnesses, children diagnosed or
suspected of having COVID-19). We also excluded case studies and qualitative analyses.</p> <a class="article-section-id-anchor" id="248076477"></a>
<p class="para">Five (N.R., B.A.M., J.E.C., R.E. and J.Z.) authors used Covidence software (Covidence Inc) to review all abstracts and to determine if the study met criteria for inclusion. Twenty percent of abstracts reviewed for
inclusion were double-coded, and the mean random agreement probability was 0.89; disagreements were resolved via consensus with the first author (N.R.). Two authors (N.R. and B.A.M.) reviewed full-text articles to determine if they
met all inclusion criteria and the percent agreement was 0.80; discrepancies were resolved via consensus.</p> <a class="article-section-id-anchor" id="248076478"></a>
<div class="h4 cb section-type-section ">
<div class="heading-text "> Data Extraction </div>
</div>
<a class="article-section-id-anchor" id="248076479"></a>
<p class="para">When studies met inclusion criteria, prevalence rates for anxiety and depression were extracted, as well as potential moderators. When more than 1 wave of data was provided, the wave with the largest sample size was
selected. For 1 study in which both parent and youth reports were provided,<sup><a href="#poi210043r26" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">26</a></sup> the youth report was selected, given
research that they are the reliable informants of their own behavior.<sup><a href="#poi210043r28" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">28</a></sup> The following moderators were extracted: (1)
study quality (see the next subsection); (2) participant age (continuously as a mean); (3) sex (% female in a sample); (4) geographical region (eg, East Asia, Europe, North America), (5) informant (child, parent), (6) month in 2020
when data were collected (range, 1-12). Data from all studies were extracted by 1 coder and the first author (N.R.). Discrepancies were resolved via consensus.</p> <a class="article-section-id-anchor" id="248076480"></a>
<div class="h4 cb section-type-section ">
<div class="heading-text "> Study Quality </div>
</div>
<a class="article-section-id-anchor" id="248076481"></a>
<p class="para">Adapted from the National Institute of Health Quality Assessment Tool for Observation Cohort and Cross-Sectional Studies, a short 5-item questionnaire was used (eTable 2 in the
<a class="supplement-link section-jump-link" data-tab-toggle=".tab-nav-supplemental" href="#note-POI210043-1">Supplement</a>).<sup><a href="#poi210043r29" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">29</a></sup>
Studies were given a score of 0 (no) or 1 (yes) for each of the 5 criteria (validated measure; peer-reviewed, response rate ≥50%, objective assessment, sufficient exposure time) and summed to give a total score of 5. When
information was unclear or not provided by the study authors, it was marked as 0 (no).</p> <a class="article-section-id-anchor" id="248076482"></a>
<div class="h4 cb section-type-section ">
<div class="heading-text "> Data Analysis </div>
</div>
<a class="article-section-id-anchor" id="248076483"></a>
<p class="para">All included studies are from independent samples. Comprehensive Meta-Analysis version 3.0 (Biostat) software was used for data analysis. Pooled prevalence estimates with associated 95% confidence intervals around the
estimate were computed. We weighted pooled prevalence estimates by the weight of the inverse of their variance, which gives greater weight to large sample sizes.</p> <a class="article-section-id-anchor" id="248076484"></a>
<p class="para">We used random-effects models to reflect the variations observed across studies and assessed between-study heterogeneity using the <i>Q</i> and <i>I<sup>2</sup></i> statistics. Pooled prevalence is reported as an event
rate (ie, 0.30) but interpreted as prevalence (ie, 30.0%). Significant <i>Q</i> statistics and <i>I<sup>2</sup></i> values more than 75% suggest moderator analyses should be
explored.<sup><a href="#poi210043r30" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">30</a></sup> As recommended by Bornstein et
al,<sup><a href="#poi210043r30" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">30</a></sup> we examined categorical moderators when <i>k</i> of 10 or higher and a minimum cell size of <i>k</i> more than 3
were available. A <i>P</i> value of .05 was considered statistically significant. For continuous moderators, random-effect meta-regression analyses were conducted. Publication bias was examined using the Egger
test<sup><a href="#poi210043r31" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">31</a></sup> and by inspecting funnel plots for symmetry.</p> <a class="article-section-id-anchor" id="248076485"></a>
<div class="h3 cb section-type-section ">
<div class="heading-text thm-col sb-sc"> Results </div>
</div>
<a class="article-section-id-anchor" id="248076486"></a>
<p class="para">Our electronic search yielded 3094 nonduplicate records (eFigure 1 in the <a class="supplement-link section-jump-link" data-tab-toggle=".tab-nav-supplemental" href="#note-POI210043-1">Supplement</a>). Based on the
abstract review, a total of 136 full-text articles were retrieved to examine against inclusion criteria, and 29 nonoverlapping
studies<sup><a href="#poi210043r10" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">10</a></sup><sup>,<a href="#poi210043r12" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">12</a></sup><sup>,<a href="#poi210043r13" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">13</a>,<a href="#poi210043r17" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">17</a></sup><sup>,<a href="#poi210043r19" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">19</a></sup><sup>,<a href="#poi210043r20" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">20</a>,<a href="#poi210043r26" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">26</a></sup><sup>,<a href="#poi210043r32" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">32</a></sup><sup>-<a href="#poi210043r32" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">53</a></sup>
met full inclusion criteria.</p> <a class="article-section-id-anchor" id="248076487"></a>
<div class="h4 cb section-type-section ">
<div class="heading-text "> Study Characteristics </div>
</div>
<a class="article-section-id-anchor" id="248076488"></a>
<p class="para">A total of 29 studies were included in the meta-analyses, of which 26 had youth symptom reports and 3
studies<sup><a href="#poi210043r39" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">39</a></sup><sup>,<a href="#poi210043r42" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">42</a></sup><sup>,<a href="#poi210043r48" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">48</a></sup>
had parent reports of child symptoms. As outlined in <a href="#poi210043t1" class="table-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Table 1</a>, across all 29 studies, 80 879 participants were included, of which
the mean (SD) perecentage of female individuals was 52.7% (12.3%), and the mean age was 13.0 years (range, 4.1-17.6 years). All studies provided binary reports of sex or gender. Sixteen studies (55.2%) were from East Asia, 4 were
from Europe (13.8%), 6 were from North America (20.7%), 2 were from Central America and South America (6.9%), and 1 study was from the Middle East (3.4%). Eight studies (27.6%) reported having racial or ethnic minority participants
with the mean across studies being 36.9%. Examining study quality, the mean score was 3.10 (range, 2-4; eTable 3 in the
<a class="supplement-link section-jump-link" data-tab-toggle=".tab-nav-supplemental" href="#note-POI210043-1">Supplement</a>).</p> <a class="article-section-id-anchor" id="248076490"></a>
<div class="h4 cb section-type-section ">
<div class="heading-text "> Pooled Prevalence of Clinically Elevated Depressive Symptoms in Youth During COVID-19 </div>
</div>
<a class="article-section-id-anchor" id="248076491"></a>
<p class="para">The pooled prevalence from a random-effects meta-analysis of 26 studies revealed a pooled prevalence rate of 0.25 (95% CI, 0.21-0.30;
<a href="#poi210043f1" class="figure-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Figure 1</a>) or 25.2%. The funnel plot was symmetrical (eFigure 2 in the
<a class="supplement-link section-jump-link" data-tab-toggle=".tab-nav-supplemental" href="#note-POI210043-1">Supplement</a>); however, the Egger test was statistically significant (intercept, −9.5; 95% CI, −18.4 to −0.48;
<i>P</i> = .02). The between-study heterogeneity statistic was significant (<i>Q</i> = 4675.91; <i>P</i> < .001; <i>I</i><sup>2</sup> = 99.47). Significant moderators are reported below, and all moderator analyses are presented
in <a href="#poi210043t2" class="table-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Table 2</a>.</p> <a class="article-section-id-anchor" id="248076494"></a>
<p class="para">As the number of months in the year increased, so too did the prevalence of depressive symptoms (<i>b</i> = 0.26; 95% CI, 0.06-0.46). Prevalence rates were higher as child age increased (<i>b</i> = 0.08; 95% CI,
0.01-0.15), and as the percentage of female individuals (<i>b</i> = 0.03; 95% CI, 0.01-0.05) in samples increased. Sensitivity analyses removing low-quality studies were conducted (ie, scores of
2)<sup><a href="#poi210043r32" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">32</a></sup><sup>,<a href="#poi210043r43" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">43</a></sup>
(eTable 4 in the <a class="supplement-link section-jump-link" data-tab-toggle=".tab-nav-supplemental" href="#note-POI210043-1">Supplement</a>). Moderators remained significant, except for age, which became nonsignificant
(<i>b</i> = 0.06; 95% CI, −0.02 to 0.13; <i>P</i> = .14).</p> <a class="article-section-id-anchor" id="248076495"></a>
<div class="h4 cb section-type-section ">
<div class="heading-text "> Pooled Prevalence of Clinically Elevated Anxiety Symptoms in Youth During COVID-19 </div>
</div>
<a class="article-section-id-anchor" id="248076496"></a>
<p class="para">The overall pooled prevalence rate across 25 studies for elevated anxiety was 0.21 (95% CI, 0.17-0.24; <a href="#poi210043f2" class="figure-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Figure 2</a>)
or 20.5%. The funnel plot was symmetrical (eFigure 3 in the <a class="supplement-link section-jump-link" data-tab-toggle=".tab-nav-supplemental" href="#note-POI210043-1">Supplement</a>) and the Egger test was nonsignificant
(intercept, −6.24; 95% CI, −14.10 to 1.62; <i>P</i> = .06). The heterogeneity statistic was significant (<i>Q</i> = 3300.17; <i>P</i> < .001; <i>I</i><sup>2</sup> = 99.27). Significant moderators are reported below, and all
moderator analyses are presented in <a href="#poi210043t3" class="table-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Table 3</a>.</p> <a class="article-section-id-anchor" id="248076499"></a>
<p class="para">As the number of months in the year increased, so too did the prevalence of anxiety symptoms (<i>b</i> = 0.27; 95% CI, 0.10-0.44). Prevalence rates of clinically elevated anxiety was higher as the percentage of female
individuals in the sample increased (<i>b</i> = 0.04; 95% CI, 0.01-0.07) and also higher in European countries (<i>k</i> = 4; rate = 0.34; 95% CI, 0.23-0.46; <i>P</i> = .01) compared with East Asian countries (<i>k</i> = 14;
rate = 0.17; 95% CI, 0.13-0.21; <i>P</i> < .001). Lastly, the prevalence of clinically elevated anxiety was higher in studies deemed to have poorer quality (<i>k</i> = 21; rate = 0.22; 95% CI, 0.18-0.27; <i>P</i> < .001)
compared with studies with better study quality scores (<i>k</i> = 4; rate = 0.12; 95% CI, 0.07-0.20; <i>P</i> < .001). Sensitivity analyses removing low quality studies (ie, scores of
2)<sup><a href="#poi210043r32" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">32</a></sup><sup>,<a href="#poi210043r43" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">43</a></sup>
yielded the same pattern of results (eTable 5 in the <a class="supplement-link section-jump-link" data-tab-toggle=".tab-nav-supplemental" href="#note-POI210043-1">Supplement</a>).</p>
<a class="article-section-id-anchor" id="248076500"></a>
<div class="h3 cb section-type-section ">
<div class="heading-text thm-col sb-sc"> Discussion </div>
</div>
<a class="article-section-id-anchor" id="248076501"></a>
<p class="para">The current meta-analysis provides a timely estimate of clinically elevated depression and generalized anxiety symptoms globally among youth during the COVID-19 pandemic. Across 29 samples and 80 879 youth, the pooled
prevalence of clinically elevated depression and anxiety symptoms was 25.2% and 20.5%, respectively. Thus, 1 in 4 youth globally are experiencing clinically elevated depression symptoms, while 1 in 5 youth are experiencing
clinically elevated anxiety symptoms. A comparison of these findings to prepandemic estimates (12.9% for depression<sup><a href="#poi210043r2" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">2</a></sup> and
11.6% for anxiety<sup><a href="#poi210043r1" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">1</a></sup>) suggests that youth mental health difficulties during the COVID-19 pandemic has likely doubled.</p>
<a class="article-section-id-anchor" id="248076502"></a>
<p class="para">The COVID-19 pandemic, and its associated restrictions and consequences, appear to have taken a considerable toll on youth and their psychological well-being. Loss of peer interactions, social isolation, and reduced
contact with buffering supports (eg, teachers, coaches) may have precipitated these increases.<sup><a href="#poi210043r3" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">3</a></sup> In addition, schools are
often a primary location for receiving psychological services, with 80% of children relying on school-based services to address their mental health
needs.<sup><a href="#poi210043r54" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">54</a></sup> For many children, these services were rendered unavailable owing to school closures.</p>
<a class="article-section-id-anchor" id="248076503"></a>
<p class="para">As the month of data collection increased, rates of depression and anxiety increased correspondingly. One possibility is that ongoing social
isolation,<sup><a href="#poi210043r6" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">6</a></sup> family financial
difficulties,<sup><a href="#poi210043r55" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">55</a></sup> missed milestones, and school
disruptions<sup><a href="#poi210043r3" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">3</a></sup> are compounding over time for youth and having a cumulative association. However, longitudinal research
supporting this possibility is currently scarce and urgently needed. A second possibility is that studies conducted in the earlier months of the pandemic (February to March
2020)<sup><a href="#poi210043r12" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">12</a></sup><sup>,<a href="#poi210043r51" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">51</a></sup>
were more likely to be conducted in East Asia where self-reported prevalence of mental health symptoms tends to be
lower.<sup><a href="#poi210043r56" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">56</a></sup> Longitudinal trajectory research on youth well-being as the pandemic progresses and in pandemic recovery phases
will be needed to confirm the long-term mental health implications of the COVID-19 pandemic on youth mental illness.</p> <a class="article-section-id-anchor" id="248076504"></a>
<p class="para">Prevalence rates for anxiety varied according to study quality, with lower-quality studies yielding higher prevalence rates. It is important to note that in sensitivity analyses removing lower-quality studies, other
significant moderators (ie, child sex and data collection time point) remained significant. There has been a rapid proliferation of youth mental health research during the COVID-19 pandemic; however, the rapid execution of these
studies has been criticized owing to the potential for some studies to sacrifice methodological quality for methodological
rigor.<sup><a href="#poi210043r21" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">21</a></sup><sup>,<a href="#poi210043r57" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">57</a></sup>
Additionally, several studies estimating prevalence rates of mental illness during the pandemic have used nonprobability or convenience samples, which increases the likelihood of bias in
reporting.<sup><a href="#poi210043r21" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">21</a></sup> Studies with representative samples and/or longitudinal follow-up studies that have the potential to
demonstrate changes in mental health symptoms from before to after the pandemic should be prioritized in future research.</p> <a class="article-section-id-anchor" id="248076505"></a>
<p class="para">In line with previous research on mental illness in childhood and adolescence,<sup><a href="#poi210043r58" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">58</a></sup> female sex was associated
with both increased depressive and anxiety symptoms. Biological susceptibility, lower baseline self-esteem, a higher likelihood of having experienced interpersonal violence, and exposure to stress associated with gender inequity may
all be contributing factors.<sup><a href="#poi210043r59" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">59</a></sup> Higher rates of depression in older children were observed and may be due to puberty and
hormonal changes<sup><a href="#poi210043r60" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">60</a></sup> in addition to the added effects of social isolation and physical distancing on older children who
particularly rely on socialization with
peers.<sup><a href="#poi210043r6" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">6</a></sup><sup>,<a href="#poi210043r61" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">61</a></sup>
However, age was not a significant moderator for prevalence rates of anxiety. Although older children may be more acutely aware of the stress of their parents and the implications of the current global pandemic, younger children may
be able to recognize changes to their routine, both of which may contribute to similar rates of anxiety with different underlying mechanisms.</p> <a class="article-section-id-anchor" id="248076506"></a>
<p class="para">In terms of practice implications, a routine touch point for many youth is the family physician or pediatrician’s office. Within this context, it is critical to inquire about or screen for youth mental health
difficulties. Emerging research<sup><a href="#poi210043r42" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">42</a></sup> suggests that in families using more routines during COVID-19, lower child depression
and conduct problems are observed. Thus, a tangible solution to help mitigate the adverse effects of COVID-19 on youth is working with children and families to implement consistent and predictable routines around schoolwork, sleep,
screen use, and physical activity. Additional resources should be made available, and clinical referrals should be placed when children experience clinically elevated mental distress. At a policy level, research suggests that social
isolation may contribute to and confer risk for mental health
concerns.<sup><a href="#poi210043r4" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">4</a></sup><sup>,<a href="#poi210043r5" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">5</a></sup>
As such, the closure of schools and recreational activities should be considered a last resort.<sup><a href="#poi210043r62" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">62</a></sup> In addition, methods
of delivering mental health resources widely to youth, such as group and individual telemental health services, need to be adapted to increase scalability, while also prioritizing equitable access across diverse
populations.<sup><a href="#poi210043r63" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">63</a></sup></p> <a class="article-section-id-anchor" id="248076507"></a>
<div class="h4 cb section-type-section ">
<div class="heading-text "> Limitations </div>
</div>
<a class="article-section-id-anchor" id="248076508"></a>
<p class="para">There are some limitations to the current study. First, although the current meta-analysis includes global estimates of child and adolescent mental illness, it will be important to reexamine cross-regional differences
once additional data from underrepresented countries are available. Second, most study designs were cross-sectional in nature, which precluded an examination of the long-term association of COVID-19 with child mental health over
time. To determine whether clinically elevated symptoms are sustained, exacerbated, or mitigated, longitudinal studies with baseline estimates of anxiety and depression are needed. Third, few studies included racial or ethnic
minority participants (27.6%), and no studies included gender-minority youth. Given that racial and ethnic minority<sup><a href="#poi210043r64" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">64</a></sup>
and gender-diverse
youth<sup><a href="#poi210043r65" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">65</a></sup><sup>,<a href="#poi210043r66" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">66</a></sup>
may be at increased risk for mental health difficulties during the pandemic, future work should include and focus on these groups. Finally, all studies used self- or parent-reported questionnaires to examine the prevalence of
clinically elevated (ie, moderate to high) symptoms. Thus, studies using criterion standard assessments of child depression and anxiety disorders via diagnostic interviews or multimethod approaches may supplement current findings
and provide further details on changes beyond generalized anxiety symptoms, such symptoms of social anxiety, separation anxiety, and panic.</p> <a class="article-section-id-anchor" id="248076509"></a>
<div class="h3 cb section-type-section ">
<div class="heading-text thm-col sb-sc"> Conclusions </div>
</div>
<a class="article-section-id-anchor" id="248076510"></a>
<p class="para">Overall, this meta-analysis shows increased rates of clinically elevated anxiety and depression symptoms for youth during the COVID-19 pandemic. While this meta-analysis supports an urgent need for intervention and
recovery efforts aimed at improving child and adolescent well-being, it also highlights that individual differences need to be considered when determining targets for intervention (eg, age, sex, exposure to COVID-19 stressors).
Research on the long-term effect of the COVID-19 pandemic on mental health, including studies with pre– to post–COVID-19 measurement, is needed to augment understanding of the implications of this crisis on the mental health
trajectories of today’s children and youth.</p> <a class="article-section-id-anchor" id="248076511"></a>
<div class="h3 cb section-type-acknowledgements has-back-to-top">
<a href="#top" class="section-jump-link back-to-top" data-tab-toggle=".tab-nav-full-text">Back to top</a>
<div class="heading-text thm-col sb-sc"> Article Information </div>
</div>
<p class="authorInfoSection"><strong>Corresponding Author:</strong> Sheri Madigan, PhD, RPsych, Department of Psychology University of Calgary, Calgary, AB T2N 1N4, Canada
(<a href="mailto:sheri.madigan@ucalgary.ca" target="_blank">sheri.madigan@ucalgary.ca</a>).</p>
<p class="para"><strong>Accepted for Publication:</strong> May 19, 2021.</p>
<p class="parapublished-online"><strong>Published Online:</strong> August 9, 2021. doi:<a href="http://jamanetwork.com/article.aspx?doi=10.1001/jamapediatrics.2021.2482" target="_blank">10.1001/jamapediatrics.2021.2482</a></p>
<p class="paraauthor-contributions"><strong>Author Contributions:</strong> Drs Racine and Madigan had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data
analysis.</p>
<p class="para"><i>Concept and design: </i>Racine, Madigan.</p>
<p class="para"><i>Acquisition, analysis, or interpretation of data: </i>All authors.</p>
<p class="para"><i>Drafting of the manuscript: </i>Racine, McArthur, Eirich, Zhu, Madigan.</p>
<p class="para"><i>Critical revision of the manuscript for important intellectual content: </i>Racine, Cooke, Eirich, Madigan.</p>
<p class="para"><i>Statistical analysis: </i>Racine, McArthur.</p>
<p class="para"><i>Administrative, technical, or material support: </i>Madigan.</p>
<p class="para"><i>Supervision: </i>Racine, Madigan.</p>
<p class="parafinancial-disclosure"><strong>Conflict of Interest Disclosures:</strong> Dr Racine reported fellowship support from Alberta Innovates. Dr McArthur reported a postdoctoral fellowship award from the Alberta Children’s
Hospital Research Institute. Ms Cooke reported graduate scholarship support from Vanier Canada and Alberta Innovates Health Solutions outside the submitted work. Ms Eirich reported graduate scholarship support from the Social
Science and Humanities Research Council. No other disclosures were reported.</p>
<p class="para"><strong>Additional Contributions:</strong> We acknowledge Nicole Dunnewold, MLIS (Research and Learning Librarian, Health Sciences Library, University of Calgary), for her assistance with the search strategy, for which
they were not compensated outside of their salary. We also acknowledge the contribution of members of the Determinants of Child Development Laboratory at the University of Calgary, in particular, Julianna Watt, BA, and Katarina
Padilla, BSc, for their contribution to data extraction, for which they were paid as research assistants.</p> <a class="article-section-id-anchor" id="248076512"></a>
<div class="h3 cb section-type-references ">
<div class="heading-text thm-col sb-sc"> References </div>
</div>
<div class="references">
<div class="reference"><a class="reference-number" id="poi210043r1">1.</a>
<div class="reference-content">Tiirikainen K, Haravuori H, Ranta K, Kaltiala-Heino R, Marttunen M. Psychometric properties of the 7-item Generalized Anxiety Disorder Scale (GAD-7) in a
large representative sample of Finnish adolescents. <i xmlns:helper="urn:XsltStringHelper"> Psychiatry Res</i>. 2019;272:30-35.
doi:<a href="http://dx.doi.org/10.1016/j.psychres.2018.12.004">10.1016/j.psychres.2018.12.004</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/30579178" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Psychometric%20properties%20of%20the%207-item%20Generalized%20Anxiety%20Disorder%20Scale%20%28GAD-7%29%20in%20a%20large%20representative%20sample%20of%20Finnish%20adolescents.&author=K%20Tiirikainen&author=H%20Haravuori&author=K%20Ranta&author=R%20Kaltiala-Heino&author=M%20Marttunen&publication_year=2019&journal=Psychiatry%20Res&volume=272&pages=30-35" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.psychres.2018.12.004" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r2">2.</a>
<div class="reference-content">Lu W. Adolescent depression: National trends, risk factors, and healthcare disparities. <i xmlns:helper="urn:XsltStringHelper"> Am J Health Behav</i>. 2019;43(1):181-194.
doi:<a href="http://dx.doi.org/10.5993/AJHB.43.1.15">10.5993/AJHB.43.1.15</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/30522576" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Adolescent%20depression%3A%20National%20trends%2C%20risk%20factors%2C%20and%20healthcare%20disparities.&author=W%20Lu&publication_year=2019&journal=Am%20J%20Health%20Behav&volume=43&pages=181-194" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.5993/AJHB.43.1.15" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r3">3.</a>
<div class="reference-content">Lee J. Mental health effects of school closures during COVID-19. <i xmlns:helper="urn:XsltStringHelper"> Lancet Child Adolesc Health</i>. 2020;4(6):421.
doi:<a href="http://dx.doi.org/10.1016/S2352-4642(20)30109-7">10.1016/S2352-4642(20)30109-7</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32302537" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Mental%20health%20effects%20of%20school%20closures%20during%20COVID-19.&author=J%20Lee&publication_year=2020&journal=Lancet%20Child%20Adolesc%20Health&volume=4&pages=421" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/S2352-4642(20)30109-7" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r4">4.</a>
<div class="reference-content">Sprang G, Silman M. Posttraumatic stress disorder in parents and youth after health-related disasters.
<i xmlns:helper="urn:XsltStringHelper"> Disaster Med Public Health Prep</i>. 2013;7(1):105-110.
doi:<a href="http://dx.doi.org/10.1017/dmp.2013.22">10.1017/dmp.2013.22</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/24618142" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Posttraumatic%20stress%20disorder%20in%20parents%20and%20youth%20after%20health-related%20disasters.&author=G%20Sprang&author=M%20Silman&publication_year=2013&journal=Disaster%20Med%20Public%20Health%20Prep&volume=7&pages=105-110" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1017/dmp.2013.22" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r5">5.</a>
<div class="reference-content">Brooks SK, Webster RK, Smith LE, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence.
<i xmlns:helper="urn:XsltStringHelper"> Lancet</i>. 2020;395(10227):912-920.
doi:<a href="http://dx.doi.org/10.1016/S0140-6736(20)30460-8">10.1016/S0140-6736(20)30460-8</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32112714" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=The%20psychological%20impact%20of%20quarantine%20and%20how%20to%20reduce%20it%3A%20rapid%20review%20of%20the%20evidence.&author=SK%20Brooks&author=RK%20Webster&author=LE%20Smith&publication_year=2020&journal=Lancet&volume=395&pages=912-920" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/S0140-6736(20)30460-8" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r6">6.</a>
<div class="reference-content">Loades ME, Chatburn E, Higson-Sweeney N, et al. Rapid systematic review: the impact of social isolation and loneliness on the mental health of children and
adolescents in the context of COVID-19. <i xmlns:helper="urn:XsltStringHelper"> J Am Acad Child Adolesc Psychiatry</i>. 2020;59(11):1218-1239.e3.
doi:<a href="http://dx.doi.org/10.1016/j.jaac.2020.05.009">10.1016/j.jaac.2020.05.009</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Rapid%20systematic%20review%3A%20the%20impact%20of%20social%20isolation%20and%20loneliness%20on%20the%20mental%20health%20of%20children%20and%20adolescents%20in%20the%20context%20of%20COVID-19.&author=ME%20Loades&author=E%20Chatburn&author=N%20Higson-Sweeney&publication_year=2020&journal=J%20Am%20Acad%20Child%20Adolesc%20Psychiatry&volume=59&pages=1218-1239.e3" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.jaac.2020.05.009" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r7">7.</a>
<div class="reference-content">Golberstein E, Wen H, Miller BF. Coronavirus disease 2019 (COVID-19) and mental health for children and adolescents.
<i xmlns:helper="urn:XsltStringHelper"> JAMA Pediatr</i>. 2020;174(9):819-820.
doi:<a href="http://jamanetwork.com/article.aspx?doi=10.1001/jamapediatrics.2020.1456">10.1001/jamapediatrics.2020.1456</a><br><a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2764730" class="jn-article-link">Article</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32286618" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Coronavirus%20disease%202019%20%28COVID-19%29%20and%20mental%20health%20for%20children%20and%20adolescents.&author=E%20Golberstein&author=H%20Wen&author=BF%20Miller&publication_year=2020&journal=JAMA%20Pediatr&volume=174&pages=819-820" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1001/jamapediatrics.2020.1456" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r8">8.</a>
<div class="reference-content">Racine N, Cooke JE, Eirich R, Korczak DJ, McArthur B, Madigan S. Child and adolescent mental illness during COVID-19: a rapid review.
<i xmlns:helper="urn:XsltStringHelper"> Psychiatry Res</i>. 2020;292:113307.
doi:<a href="http://dx.doi.org/10.1016/j.psychres.2020.113307">10.1016/j.psychres.2020.113307</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32707216" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Child%20and%20adolescent%20mental%20illness%20during%20COVID-19%3A%20a%20rapid%20review.&author=N%20Racine&author=JE%20Cooke&author=R%20Eirich&author=DJ%20Korczak&author=B%20McArthur&author=S%20Madigan&publication_year=2020&journal=Psychiatry%20Res&volume=292&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r9">9.</a>
<div class="reference-content">Singh S, Roy D, Sinha K, Parveen S, Sharma G, Joshi G. Impact of COVID-19 and lockdown on mental health of children and adolescents: a narrative review
with recommendations. <i xmlns:helper="urn:XsltStringHelper"> Psychiatry Res</i>. 2020;293:113429.
doi:<a href="http://dx.doi.org/10.1016/j.psychres.2020.113429">10.1016/j.psychres.2020.113429</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32882598" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Impact%20of%20COVID-19%20and%20lockdown%20on%20mental%20health%20of%20children%20and%20adolescents%3A%20a%20narrative%20review%20with%20recommendations.&author=S%20Singh&author=D%20Roy&author=K%20Sinha&author=S%20Parveen&author=G%20Sharma&author=G%20Joshi&publication_year=2020&journal=Psychiatry%20Res&volume=293&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r10">10.</a>
<div class="reference-content">Zhang L, Zhang D, Fang J, Wan Y, Tao F, Sun Y. Assessment of mental health of Chinese primary school students before and after school closing and
opening during the COVID-19 pandemic. <i xmlns:helper="urn:XsltStringHelper"> JAMA Netw Open</i>. 2020;3(9):e2021482.
doi:<a href="http://jamanetwork.com/article.aspx?doi=10.1001/jamanetworkopen.2020.21482">10.1001/jamanetworkopen.2020.21482</a><br><a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770489" class="jn-article-link">Article</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32915233" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Assessment%20of%20mental%20health%20of%20Chinese%20primary%20school%20students%20before%20and%20after%20school%20closing%20and%20opening%20during%20the%20COVID-19%20pandemic.&author=L%20Zhang&author=D%20Zhang&author=J%20Fang&author=Y%20Wan&author=F%20Tao&author=Y%20Sun&publication_year=2020&journal=JAMA%20Netw%20Open&volume=3&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r11">11.</a>
<div class="reference-content">Hafstad GS, Sætren SS, Wentzel-Larsen T, Augusti E. Adolescents’ symptoms of anxiety and depression before and during the Covid-19 outbreak: a prospective
population-based study of teenagers in Norway. <i xmlns:helper="urn:XsltStringHelper"> Lancet Reg Health Eur</i>. 2021;5:100093.
doi:<a href="http://dx.doi.org/10.1016/j.lanepe.2021.100093">10.1016/j.lanepe.2021.100093</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Adolescents%E2%80%99%20symptoms%20of%20anxiety%20and%20depression%20before%20and%20during%20the%20Covid-19%20outbreak%3A%20a%20prospective%20population-based%20study%20of%20teenagers%20in%20Norway.&author=GS%20Hafstad&author=SS%20Sætren&author=T%20Wentzel-Larsen&author=E%20Augusti&publication_year=2021&journal=Lancet%20Reg%20Health%20Eur&volume=5&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r12">12.</a>
<div class="reference-content">Yue J, Zang X, Le Y, An Y. Anxiety, depression and PTSD among children and their parent during 2019 novel coronavirus disease (COVID-19) outbreak in China.
<i xmlns:helper="urn:XsltStringHelper"> Curr Psychol</i>.
2020;1-8.<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33223783" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Anxiety%2C%20depression%20and%20PTSD%20among%20children%20and%20their%20parent%20during%202019%20novel%20coronavirus%20disease%20%28COVID-19%29%20outbreak%20in%20China.&author=J%20Yue&author=X%20Zang&author=Y%20Le&author=Y%20An&publication_year=2020&journal=Curr%20Psychol&volume=&pages=1-8" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r13">13.</a>
<div class="reference-content">Giannopoulou I, Efstathiou V, Triantafyllou G, Korkoliakou P, Douzenis A. Adding stress to the stressed: senior high school students’ mental health amidst the
COVID-19 nationwide lockdown in Greece. <i xmlns:helper="urn:XsltStringHelper"> Psychiatry Res</i>. 2021;295:113560.
doi:<a href="http://dx.doi.org/10.1016/j.psychres.2020.113560">10.1016/j.psychres.2020.113560</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33187723" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Adding%20stress%20to%20the%20stressed%3A%20senior%20high%20school%20students%E2%80%99%20mental%20health%20amidst%20the%20COVID-19%20nationwide%20lockdown%20in%20Greece.&author=I%20Giannopoulou&author=V%20Efstathiou&author=G%20Triantafyllou&author=P%20Korkoliakou&author=A%20Douzenis&publication_year=2021&journal=Psychiatry%20Res&volume=295&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r14">14.</a>
<div class="reference-content">Merikangas KR, He JP, Burstein M, et al. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey
Replication—Adolescent Supplement (NCS-A). <i xmlns:helper="urn:XsltStringHelper"> J Am Acad Child Adolesc Psychiatry</i>. 2010;49(10):980-989.
doi:<a href="http://dx.doi.org/10.1016/j.jaac.2010.05.017">10.1016/j.jaac.2010.05.017</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/20855043" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Lifetime%20prevalence%20of%20mental%20disorders%20in%20U.S.%20adolescents%3A%20results%20from%20the%20National%20Comorbidity%20Survey%20Replication%E2%80%94Adolescent%20Supplement%20%28NCS-A%29.&author=KR%20Merikangas&author=JP%20He&author=M%20Burstein&publication_year=2010&journal=J%20Am%20Acad%20Child%20Adolesc%20Psychiatry&volume=49&pages=980-989" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.jaac.2010.05.017" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r15">15.</a>
<div class="reference-content">American Psychiatric Association. <i xmlns:helper="urn:XsltStringHelper"> Diagnostic and Statistical Manual of Mental Disorders.</i> 5th ed. American Psychiatric Association; 2013.</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r16">16.</a>
<div class="reference-content">Courtney D, Watson P, Battaglia M, Mulsant BH, Szatmari P. COVID-19 impacts on child and youth anxiety and depression: challenges and opportunities.
<i xmlns:helper="urn:XsltStringHelper"> Can J Psychiatry</i>. 2020;65(10):688-691.
doi:<a href="http://dx.doi.org/10.1177/0706743720935646">10.1177/0706743720935646</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32567353" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=COVID-19%20impacts%20on%20child%20and%20youth%20anxiety%20and%20depression%3A%20challenges%20and%20opportunities.&author=D%20Courtney&author=P%20Watson&author=M%20Battaglia&author=BH%20Mulsant&author=P%20Szatmari&publication_year=2020&journal=Can%20J%20Psychiatry&volume=65&pages=688-691" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1177/0706743720935646" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r17">17.</a>
<div class="reference-content">Zhou SJ, Zhang LG, Wang LL, et al. Prevalence and socio-demographic correlates of psychological health problems in Chinese adolescents during the outbreak of
COVID-19. <i xmlns:helper="urn:XsltStringHelper"> Eur Child Adolesc Psychiatry</i>. 2020;29(6):749-758.
doi:<a href="http://dx.doi.org/10.1007/s00787-020-01541-4">10.1007/s00787-020-01541-4</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32363492" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Prevalence%20and%20socio-demographic%20correlates%20of%20psychological%20health%20problems%20in%20Chinese%20adolescents%20during%20the%20outbreak%20of%20COVID-19.&author=SJ%20Zhou&author=LG%20Zhang&author=LL%20Wang&publication_year=2020&journal=Eur%20Child%20Adolesc%20Psychiatry&volume=29&pages=749-758" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1007/s00787-020-01541-4" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r18">18.</a>
<div class="reference-content">Magson NR, Freeman JYA, Rapee RM, Richardson CE, Oar EL, Fardouly J. Risk and protective factors for prospective changes in adolescent mental health
during the COVID-19 pandemic. <i xmlns:helper="urn:XsltStringHelper"> J Youth Adolesc</i>. 2021;50(1):44-57.
doi:<a href="http://dx.doi.org/10.1007/s10964-020-01332-9">10.1007/s10964-020-01332-9</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33108542" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Risk%20and%20protective%20factors%20for%20prospective%20changes%20in%20adolescent%20mental%20health%20during%20the%20COVID-19%20pandemic.&author=NR%20Magson&author=JYA%20Freeman&author=RM%20Rapee&author=CE%20Richardson&author=EL%20Oar&author=J%20Fardouly&publication_year=2021&journal=J%20Youth%20Adolesc&volume=50&pages=44-57" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1007/s10964-020-01332-9" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r19">19.</a>
<div class="reference-content">Xie X, Xue Q, Zhou Y, et al. Mental health status among children in home confinement during the coronavirus disease 2019 outbreak in Hubei Province, China.
<i xmlns:helper="urn:XsltStringHelper"> JAMA Pediatr</i>. 2020;174(9):898-900.
doi:<a href="http://jamanetwork.com/article.aspx?doi=10.1001/jamapediatrics.2020.1619">10.1001/jamapediatrics.2020.1619</a><br><a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2765196" class="jn-article-link">Article</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32329784" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Mental%20health%20status%20among%20children%20in%20home%20confinement%20during%20the%20coronavirus%20disease%202019%20outbreak%20in%20Hubei%20Province%2C%20China.&author=X%20Xie&author=Q%20Xue&author=Y%20Zhou&publication_year=2020&journal=JAMA%20Pediatr&volume=174&pages=898-900" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1001/jamapediatrics.2020.1619" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r20">20.</a>
<div class="reference-content">Duan L, Shao X, Wang Y, et al. An investigation of mental health status of children and adolescents in China during the outbreak of COVID-19.
<i xmlns:helper="urn:XsltStringHelper"> J Affect Disord</i>. 2020;275:112-118.
doi:<a href="http://dx.doi.org/10.1016/j.jad.2020.06.029">10.1016/j.jad.2020.06.029</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32658812" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=An%20investigation%20of%20mental%20health%20status%20of%20children%20and%20adolescents%20in%20China%20during%20the%20outbreak%20of%20COVID-19.&author=L%20Duan&author=X%20Shao&author=Y%20Wang&publication_year=2020&journal=J%20Affect%20Disord&volume=275&pages=112-118" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.jad.2020.06.029" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r21">21.</a>
<div class="reference-content">Pierce M, McManus S, Jessop C, et al. Says who? the significance of sampling in mental health surveys during COVID-19.
<i xmlns:helper="urn:XsltStringHelper"> Lancet Psychiatry</i>. 2020;7(7):567-568.
doi:<a href="http://dx.doi.org/10.1016/S2215-0366(20)30237-6">10.1016/S2215-0366(20)30237-6</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32502467" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Says%20who%3F%20the%20significance%20of%20sampling%20in%20mental%20health%20surveys%20during%20COVID-19.&author=M%20Pierce&author=S%20McManus&author=C%20Jessop&publication_year=2020&journal=Lancet%20Psychiatry&volume=7&pages=567-568" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/S2215-0366(20)30237-6" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r22">22.</a>
<div class="reference-content">Klein R. Parent-child agreement in clinical assessment of anxiety and other psychopathology: a review. <i xmlns:helper="urn:XsltStringHelper"> J Anxiety Disord.</i>
1991;5(2):187-198.
doi:<a href="http://dx.doi.org/10.1016/0887-6185(91)90028-R">10.1016/0887-6185(91)90028-R</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Parent-child%20agreement%20in%20clinical%20assessment%20of%20anxiety%20and%20other%20psychopathology%3A%20a%20review.&author=R.%20Klein&publication_year=1991&journal=J%20Anxiety%20Disord.&volume=5&pages=187-198" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/0887-6185(91)90028-R" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r23">23.</a>
<div class="reference-content">Edelbrock C, Costello AJ, Dulcan MK, Conover NC, Kala R. Parent-child agreement on child psychiatric symptoms assessed via structured interview.
<i xmlns:helper="urn:XsltStringHelper"> J Child Psychol Psychiatry</i>. 1986;27(2):181-190.
doi:<a href="http://dx.doi.org/10.1111/j.1469-7610.1986.tb02282.x">10.1111/j.1469-7610.1986.tb02282.x</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/3958075" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Parent-child%20agreement%20on%20child%20psychiatric%20symptoms%20assessed%20via%20structured%20interview.&author=C%20Edelbrock&author=AJ%20Costello&author=MK%20Dulcan&author=NC%20Conover&author=R%20Kala&publication_year=1986&journal=J%20Child%20Psychol%20Psychiatry&volume=27&pages=181-190" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1111/jcpp.1986.27.issue-2" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r24">24.</a>
<div class="reference-content">Hawes MT, Szenczy AK, Olino TM, Nelson BD, Klein DN. Trajectories of depression, anxiety and pandemic experiences: a longitudinal study of youth in New York
during the spring-summer of 2020. <i xmlns:helper="urn:XsltStringHelper"> Psychiatry Res</i>. 2021;298:113778.
doi:<a href="http://dx.doi.org/10.1016/j.psychres.2021.113778">10.1016/j.psychres.2021.113778</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33550176" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Trajectories%20of%20depression%2C%20anxiety%20and%20pandemic%20experiences%3A%20a%20longitudinal%20study%20of%20youth%20in%20New%20York%20during%20the%20spring-summer%20of%202020.&author=MT%20Hawes&author=AK%20Szenczy&author=TM%20Olino&author=BD%20Nelson&author=DN%20Klein&publication_year=2021&journal=Psychiatry%20Res&volume=298&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r25">25.</a>
<div class="reference-content">Cost KT, Crosbie J, Anagnostou E, et al. Mostly worse, occasionally better: impact of COVID-19 pandemic on the mental health of Canadian children and
adolescents. <i xmlns:helper="urn:XsltStringHelper"> Eur Child Adolesc Psychiatry</i>. 2021.
doi:<a href="http://dx.doi.org/10.1007/s00787-021-01744-3">10.1007/s00787-021-01744-3</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33638005" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Mostly%20worse%2C%20occasionally%20better%3A%20impact%20of%20COVID-19%20pandemic%20on%20the%20mental%20health%20of%20Canadian%20children%20and%20adolescents.&author=KT%20Cost&author=J%20Crosbie&author=E%20Anagnostou&publication_year=2021&journal=Eur%20Child%20Adolesc%20Psychiatry&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r26">26.</a>
<div class="reference-content">MacTavish A, Mastronardi C, Menna R, et al. The acute impact of the COVID-19 pandemic on children’s mental health in southwestern Ontario. <i>PsyArXiv</i>.
Preprint posted online September 19, 2020. doi:<a href="http://dx.doi.org/10.31234/osf.io/5cwb4">10.31234/osf.io/5cwb4</a></div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r27">27.</a>
<div class="reference-content">Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
<i xmlns:helper="urn:XsltStringHelper"> PLoS Med</i>. 2009;6(7):e1000097.
doi:<a href="http://dx.doi.org/10.1371/journal.pmed.1000097">10.1371/journal.pmed.1000097</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/19621072" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Preferred%20reporting%20items%20for%20systematic%20reviews%20and%20meta-analyses%3A%20the%20PRISMA%20statement.&author=D%20Moher&author=A%20Liberati&author=J%20Tetzlaff&author=DG%20Altman&publication_year=2009&journal=PLoS%20Med&volume=6&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r28">28.</a>
<div class="reference-content">Ebesutani C, Bernstein A, Martinez JI, Chorpita BF, Weisz JR. The youth self report: applicability and validity across younger and older youths.
<i xmlns:helper="urn:XsltStringHelper"> J Clin Child Adolesc Psychol</i>. 2011;40(2):338-346.
doi:<a href="http://dx.doi.org/10.1080/15374416.2011.546041">10.1080/15374416.2011.546041</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/21391029" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=The%20youth%20self%20report%3A%20applicability%20and%20validity%20across%20younger%20and%20older%20youths.&author=C%20Ebesutani&author=A%20Bernstein&author=JI%20Martinez&author=BF%20Chorpita&author=JR%20Weisz&publication_year=2011&journal=J%20Clin%20Child%20Adolesc%20Psychol&volume=40&pages=338-346" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1080/15374416.2011.546041" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r29">29.</a>
<div class="reference-content">National Heart, Lung, and Blood Institute. Study quality assessment tools: quality assessment tool for observational cohort and cross-sectional studies. Accessed July 6, 2021.
https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r30">30.</a>
<div class="reference-content">Borenstein M, Hesdges L, Higgins J, Rothstein H. <i xmlns:helper="urn:XsltStringHelper"> Introduction to Meta-Analysis</i>. Wiley; 2009.</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r31">31.</a>
<div class="reference-content">Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test.
<i xmlns:helper="urn:XsltStringHelper"> BMJ</i>. 1997;315(7109):629-634.
doi:<a href="http://dx.doi.org/10.1136/bmj.315.7109.629">10.1136/bmj.315.7109.629</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/9310563" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Bias%20in%20meta-analysis%20detected%20by%20a%20simple%2C%20graphical%20test.&author=M%20Egger&author=G%20Davey Smith&author=M%20Schneider&author=C%20Minder&publication_year=1997&journal=BMJ&volume=315&pages=629-634" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1136/bmj.315.7109.629" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r32">32.</a>
<div class="reference-content">AlAzzam M, Abuhammad S, Abdalrahim A, Hamdan-Mansour AM. Predictors of depression and anxiety among senior high school students during COVID-19 pandemic: the context
of home quarantine and online education. <i xmlns:helper="urn:XsltStringHelper"> J Sch Nurs</i>.
2021;1059840520988548.<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33563066" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Predictors%20of%20depression%20and%20anxiety%20among%20senior%20high%20school%20students%20during%20COVID-19%20pandemic%3A%20the%20context%20of%20home%20quarantine%20and%20online%20education.&author=M%20AlAzzam&author=S%20Abuhammad&author=A%20Abdalrahim&author=AM%20Hamdan-Mansour&publication_year=2021&journal=J%20Sch%20Nurs&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r33">33.</a>
<div class="reference-content">Asanov I, Flores F, McKenzie D, Mensmann M, Schulte M. Remote-learning, time-use, and mental health of Ecuadorian high-school students during the COVID-19
quarantine. <i xmlns:helper="urn:XsltStringHelper"> World Dev</i>. 2021;138:105225.
doi:<a href="http://dx.doi.org/10.1016/j.worlddev.2020.105225">10.1016/j.worlddev.2020.105225</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33110286" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Remote-learning%2C%20time-use%2C%20and%20mental%20health%20of%20Ecuadorian%20high-school%20students%20during%20the%20COVID-19%20quarantine.&author=I%20Asanov&author=F%20Flores&author=D%20McKenzie&author=M%20Mensmann&author=M%20Schulte&publication_year=2021&journal=World%20Dev&volume=138&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r34">34.</a>
<div class="reference-content">Cao Y, Huang L, Si T, Wang NQ, Qu M, Zhang XY. The role of only-child status in the psychological impact of COVID-19 on mental health of Chinese
adolescents. <i xmlns:helper="urn:XsltStringHelper"> J Affect Disord</i>. 2021;282:316-321.
doi:<a href="http://dx.doi.org/10.1016/j.jad.2020.12.113">10.1016/j.jad.2020.12.113</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33421858" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=The%20role%20of%20only-child%20status%20in%20the%20psychological%20impact%20of%20COVID-19%20on%20mental%20health%20of%20Chinese%20adolescents.&author=Y%20Cao&author=L%20Huang&author=T%20Si&author=NQ%20Wang&author=M%20Qu&author=XY%20Zhang&publication_year=2021&journal=J%20Affect%20Disord&volume=282&pages=316-321" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.jad.2020.12.113" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r35">35.</a>
<div class="reference-content">Cheah CSL, Wang C, Ren H, Zong X, Cho HS, Xue X. COVID-19 racism and mental health in Chinese American families.
<i xmlns:helper="urn:XsltStringHelper"> Pediatrics</i>. 2020;146(5):e2020021816.
doi:<a href="http://dx.doi.org/10.1542/peds.2020-021816">10.1542/peds.2020-021816</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32873719" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=COVID-19%20racism%20and%20mental%20health%20in%20Chinese%20American%20families.&author=CSL%20Cheah&author=C%20Wang&author=H%20Ren&author=X%20Zong&author=HS%20Cho&author=X%20Xue&publication_year=2020&journal=Pediatrics&volume=146&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r36">36.</a>
<div class="reference-content">Chen F, Zheng D, Liu J, Gong Y, Guan Z, Lou D. Depression and anxiety among adolescents during COVID-19: a cross-sectional study.
<i xmlns:helper="urn:XsltStringHelper"> Brain Behav Immun</i>. 2020;88:36-38.
doi:<a href="http://dx.doi.org/10.1016/j.bbi.2020.05.061">10.1016/j.bbi.2020.05.061</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32464156" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Depression%20and%20anxiety%20among%20adolescents%20during%20COVID-19%3A%20a%20cross-sectional%20study.&author=F%20Chen&author=D%20Zheng&author=J%20Liu&author=Y%20Gong&author=Z%20Guan&author=D%20Lou&publication_year=2020&journal=Brain%20Behav%20Immun&volume=88&pages=36-38" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.bbi.2020.05.061" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r37">37.</a>
<div class="reference-content">Chen S, Cheng Z, Wu J. Risk factors for adolescents’ mental health during the COVID-19 pandemic: a comparison between Wuhan and other urban areas in China.
<i xmlns:helper="urn:XsltStringHelper"> Global Health</i>. 2020;16(1):96.
doi:<a href="http://dx.doi.org/10.1186/s12992-020-00627-7">10.1186/s12992-020-00627-7</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33036622" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Risk%20factors%20for%20adolescents%E2%80%99%20mental%20health%20during%20the%20COVID-19%20pandemic%3A%20a%20comparison%20between%20Wuhan%20and%20other%20urban%20areas%20in%20China.&author=S%20Chen&author=Z%20Cheng&author=J%20Wu&publication_year=2020&journal=Global%20Health&volume=16&pages=96" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1186/s12992-020-00627-7" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r38">38.</a>
<div class="reference-content">Chi X, Liang K, Chen ST, et al. Mental health problems among Chinese adolescents during the COVID-19: the importance of nutrition and physical activity.
<i xmlns:helper="urn:XsltStringHelper"> Int J Clin Health Psychol</i>. 2021;21(3):100218.
doi:<a href="http://dx.doi.org/10.1016/j.ijchp.2020.100218">10.1016/j.ijchp.2020.100218</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33391373" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Mental%20health%20problems%20among%20Chinese%20adolescents%20during%20the%20COVID-19%3A%20the%20importance%20of%20nutrition%20and%20physical%20activity.&author=X%20Chi&author=K%20Liang&author=ST%20Chen&publication_year=2021&journal=Int%20J%20Clin%20Health%20Psychol&volume=21&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r39">39.</a>
<div class="reference-content">Crescentini C, Feruglio S, Matiz A, et al. Stuck outside and inside: an exploratory study on the effects of the COVID-19 outbreak on Italian parents and children’s
internalizing symptoms. <i xmlns:helper="urn:XsltStringHelper"> Front Psychol</i>. 2020;11:586074.
doi:<a href="http://dx.doi.org/10.3389/fpsyg.2020.586074">10.3389/fpsyg.2020.586074</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33192917" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Stuck%20outside%20and%20inside%3A%20an%20exploratory%20study%20on%20the%20effects%20of%20the%20COVID-19%20outbreak%20on%20Italian%20parents%20and%20children%E2%80%99s%20internalizing%20symptoms.&author=C%20Crescentini&author=S%20Feruglio&author=A%20Matiz&publication_year=2020&journal=Front%20Psychol&volume=11&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r40">40.</a>
<div class="reference-content">Dong H, Yang F, Lu X, Hao W. Internet addiction and related psychological factors among children and adolescents in China during the coronavirus disease 2019
(COVID-19) epidemic. <i xmlns:helper="urn:XsltStringHelper"> Front Psychiatry</i>. 2020;11:00751.
doi:<a href="http://dx.doi.org/10.3389/fpsyt.2020.00751">10.3389/fpsyt.2020.00751</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32982806" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Internet%20addiction%20and%20related%20psychological%20factors%20among%20children%20and%20adolescents%20in%20China%20during%20the%20coronavirus%20disease%202019%20%28COVID-19%29%20epidemic.&author=H%20Dong&author=F%20Yang&author=X%20Lu&author=W%20Hao&publication_year=2020&journal=Front%20Psychiatry&volume=11&pages=00751" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.3389/fpsyt.2020.00751" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r41">41.</a>
<div class="reference-content">Garcia de Avila MA, Hamamoto Filho PT, Jacob FLDS, et al. Children’s anxiety and factors related to the COVID-19 pandemic: an exploratory study using the Children’s
Anxiety Questionnaire and the Numerical Rating Scale. <i xmlns:helper="urn:XsltStringHelper"> Int J Environ Res Public Health</i>. 2020;17(16):E5757.
doi:<a href="http://dx.doi.org/10.3390/ijerph17165757">10.3390/ijerph17165757</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32784898" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Children%E2%80%99s%20anxiety%20and%20factors%20related%20to%20the%20COVID-19%20pandemic%3A%20an%20exploratory%20study%20using%20the%20Children%E2%80%99s%20Anxiety%20Questionnaire%20and%20the%20Numerical%20Rating%20Scale.&author=MA%20Garcia de Avila&author=PT%20Hamamoto Filho&author=FLDS%20Jacob&publication_year=2020&journal=Int%20J%20Environ%20Res%20Public%20Health&volume=17&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r42">42.</a>
<div class="reference-content">Glynn LM, Davis EP, Luby JL, Baram TZ, Sandman CA. A predictable home environment may protect child mental health during the COVID-19 pandemic.
<i xmlns:helper="urn:XsltStringHelper"> Neurobiol Stress</i>. 2021;14:100291.
doi:<a href="http://dx.doi.org/10.1016/j.ynstr.2020.100291">10.1016/j.ynstr.2020.100291</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33532520" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=A%20predictable%20home%20environment%20may%20protect%20child%20mental%20health%20during%20the%20COVID-19%20pandemic.&author=LM%20Glynn&author=EP%20Davis&author=JL%20Luby&author=TZ%20Baram&author=CA%20Sandman&publication_year=2021&journal=Neurobiol%20Stress&volume=14&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r43">43.</a>
<div class="reference-content">Hou TY, Mao XF, Dong W, Cai WP, Deng GH. Prevalence of and factors associated with mental health problems and suicidality among senior high school students in
rural China during the COVID-19 outbreak. <i xmlns:helper="urn:XsltStringHelper"> Asian J Psychiatr</i>. 2020;54:102305.
doi:<a href="http://dx.doi.org/10.1016/j.ajp.2020.102305">10.1016/j.ajp.2020.102305</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32668388" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Prevalence%20of%20and%20factors%20associated%20with%20mental%20health%20problems%20and%20suicidality%20among%20senior%20high%20school%20students%20in%20rural%20China%20during%20the%20COVID-19%20outbreak.&author=TY%20Hou&author=XF%20Mao&author=W%20Dong&author=WP%20Cai&author=GH%20Deng&publication_year=2020&journal=Asian%20J%20Psychiatr&volume=54&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r44">44.</a>
<div class="reference-content">Li W, Zhang Y, Wang J, et al. Association of home quarantine and mental health among teenagers in Wuhan, China, during the COVID-19 pandemic.
<i xmlns:helper="urn:XsltStringHelper"> JAMA Pediatr</i>. 2021;175(3):313-316.
doi:<a href="http://jamanetwork.com/article.aspx?doi=10.1001/jamapediatrics.2020.5499">10.1001/jamapediatrics.2020.5499</a><br><a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2775249" class="jn-article-link">Article</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33464303" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Association%20of%20home%20quarantine%20and%20mental%20health%20among%20teenagers%20in%20Wuhan%2C%20China%2C%20during%20the%20COVID-19%20pandemic.&author=W%20Li&author=Y%20Zhang&author=J%20Wang&publication_year=2021&journal=JAMA%20Pediatr&volume=175&pages=313-316" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1001/jamapediatrics.2020.5499" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r45">45.</a>
<div class="reference-content">Luthar SS, Ebbert AM, Kumar NL. Risk and resilience during COVID-19: a new study in the Zigler paradigm of developmental science.
<i xmlns:helper="urn:XsltStringHelper"> Dev Psychopathol</i>.
2021;33(2):565-580.<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33032677" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Risk%20and%20resilience%20during%20COVID-19%3A%20a%20new%20study%20in%20the%20Zigler%20paradigm%20of%20developmental%20science.&author=SS%20Luthar&author=AM%20Ebbert&author=NL%20Kumar&publication_year=2021&journal=Dev%20Psychopathol&volume=33&pages=565-580" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1017/S0954579420001388" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r46">46.</a>
<div class="reference-content">McGuine TA, Biese KM, Petrovska L, et al. Mental health, physical activity, and quality of life of us adolescent athletes during COVID-19-related school closures and
sport cancellations: a study of 13 000 athletes. <i xmlns:helper="urn:XsltStringHelper"> J Athl Train</i>. 2020.
doi:<a href="http://dx.doi.org/10.4085/478-20">10.4085/478-20</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33290516" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Mental%20health%2C%20physical%20activity%2C%20and%20quality%20of%20life%20of%20us%20adolescent%20athletes%20during%20COVID-19-related%20school%20closures%20and%20sport%20cancellations%3A%20a%20study%20of%2013%E2%80%8A000%20athletes.&author=TA%20McGuine&author=KM%20Biese&author=L%20Petrovska&publication_year=2020&journal=J%20Athl%20Train&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r47">47.</a>
<div class="reference-content">Murata S, Rezeppa T, Thoma B, et al. The psychiatric sequelae of the COVID-19 pandemic in adolescents, adults, and health care workers.
<i xmlns:helper="urn:XsltStringHelper"> Depress Anxiety</i>. 2021;38(2):233-246.
doi:<a href="http://dx.doi.org/10.1002/da.23120">10.1002/da.23120</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33368805" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=The%20psychiatric%20sequelae%20of%20the%20COVID-19%20pandemic%20in%20adolescents%2C%20adults%2C%20and%20health%20care%20workers.&author=S%20Murata&author=T%20Rezeppa&author=B%20Thoma&publication_year=2021&journal=Depress%20Anxiety&volume=38&pages=233-246" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1002/da.v38.2" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r48">48.</a>
<div class="reference-content">Orgilés M, Espada JP, Delvecchio E, et al. Anxiety and depressive symptoms in children and adolescents during COVID-19 pandemic: a transcultural approach.
<i xmlns:helper="urn:XsltStringHelper"> Psicothema</i>.
2021;33(1):125-130.<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33453745" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Anxiety%20and%20depressive%20symptoms%20in%20children%20and%20adolescents%20during%20COVID-19%20pandemic%3A%20a%20transcultural%20approach.&author=M%20Orgilés&author=JP%20Espada&author=E%20Delvecchio&publication_year=2021&journal=Psicothema&volume=33&pages=125-130" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r49">49.</a>
<div class="reference-content">Ravens-Sieberer U, Kaman A, Erhart M, Devine J, Schlack R, Otto C. Impact of the COVID-19 pandemic on quality of life and mental health in children and
adolescents in Germany. <i xmlns:helper="urn:XsltStringHelper"> Eur Child Adolesc Psychiatry</i>. 2021.
doi:<a href="http://dx.doi.org/10.1007/s00787-021-01726-5">10.1007/s00787-021-01726-5</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33492480" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Impact%20of%20the%20COVID-19%20pandemic%20on%20quality%20of%20life%20and%20mental%20health%20in%20children%20and%20adolescents%20in%20Germany.&author=U%20Ravens-Sieberer&author=A%20Kaman&author=M%20Erhart&author=J%20Devine&author=R%20Schlack&author=C%20Otto&publication_year=2021&journal=Eur%20Child%20Adolesc%20Psychiatry&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r50">50.</a>
<div class="reference-content">Tang S, Xiang M, Cheung T, Xiang YT. Mental health and its correlates among children and adolescents during COVID-19 school closure: the importance of parent-child
discussion. <i xmlns:helper="urn:XsltStringHelper"> J Affect Disord</i>. 2021;279:353-360.
doi:<a href="http://dx.doi.org/10.1016/j.jad.2020.10.016">10.1016/j.jad.2020.10.016</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33099049" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Mental%20health%20and%20its%20correlates%20among%20children%20and%20adolescents%20during%20COVID-19%20school%20closure%3A%20the%20importance%20of%20parent-child%20discussion.&author=S%20Tang&author=M%20Xiang&author=T%20Cheung&author=YT%20Xiang&publication_year=2021&journal=J%20Affect%20Disord&volume=279&pages=353-360" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.jad.2020.10.016" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r51">51.</a>
<div class="reference-content">Zhou J, Yuan X, Qi H, et al. Prevalence of depression and its correlative factors among female adolescents in China during the coronavirus disease 2019
outbreak. <i xmlns:helper="urn:XsltStringHelper"> Global Health</i>. 2020;16(1):69.
doi:<a href="http://dx.doi.org/10.1186/s12992-020-00601-3">10.1186/s12992-020-00601-3</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32723373" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Prevalence%20of%20depression%20and%20its%20correlative%20factors%20among%20female%20adolescents%20in%20China%20during%20the%20coronavirus%20disease%202019%20outbreak.&author=J%20Zhou&author=X%20Yuan&author=H%20Qi&publication_year=2020&journal=Global%20Health&volume=16&pages=69" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1186/s12992-020-00601-3" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r52">52.</a>
<div class="reference-content">Zhang Z, Zhai A, Yang M, et al. Prevalence of depression and anxiety symptoms of high school students in Shandong province during the COVID-19 epidemic.
<i xmlns:helper="urn:XsltStringHelper"> Front Psychiatry</i>. 2020;11:570096.
doi:<a href="http://dx.doi.org/10.3389/fpsyt.2020.570096">10.3389/fpsyt.2020.570096</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33408653" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Prevalence%20of%20depression%20and%20anxiety%20symptoms%20of%20high%20school%20students%20in%20Shandong%20province%20during%20the%20COVID-19%20epidemic.&author=Z%20Zhang&author=A%20Zhai&author=M%20Yang&publication_year=2020&journal=Front%20Psychiatry&volume=11&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r53">53.</a>
<div class="reference-content">Zhang C, Ye M, Fu Y, et al. The psychological impact of the COVID-19 pandemic on teenagers in China.
<i xmlns:helper="urn:XsltStringHelper"> J Adolesc Health</i>. 2020;67(6):747-755.
doi:<a href="http://dx.doi.org/10.1016/j.jadohealth.2020.08.026">10.1016/j.jadohealth.2020.08.026</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33041204" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=The%20psychological%20impact%20of%20the%20COVID-19%20pandemic%20on%20teenagers%20in%20China.&author=C%20Zhang&author=M%20Ye&author=Y%20Fu&publication_year=2020&journal=J%20Adolesc%20Health&volume=67&pages=747-755" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.jadohealth.2020.08.026" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r54">54.</a>
<div class="reference-content">Masonbrink AR, Hurley E. Advocating for children during the COVID-19 school closures. <i xmlns:helper="urn:XsltStringHelper"> Pediatrics</i>. 2020;146(3):e20201440.
doi:<a href="http://dx.doi.org/10.1542/peds.2020-1440">10.1542/peds.2020-1440</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32554517" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Advocating%20for%20children%20during%20the%20COVID-19%20school%20closures.&author=AR%20Masonbrink&author=E%20Hurley&publication_year=2020&journal=Pediatrics&volume=146&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r55">55.</a>
<div class="reference-content">Schaller J, Zerpa M. Short-run effects of parental job loss on child health. <i xmlns:helper="urn:XsltStringHelper"> Am J Health Econ</i>. 2019;5(1):8-41.
doi:<a href="http://dx.doi.org/10.1162/ajhe_a_00106">10.1162/ajhe_a_00106</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Short-run%20effects%20of%20parental%20job%20loss%20on%20child%20health.&author=J%20Schaller&author=M%20Zerpa&publication_year=2019&journal=Am%20J%20Health%20Econ&volume=5&pages=8-41" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1162/ajhe_a_00106" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r56">56.</a>
<div class="reference-content">Marques L, Robinaugh DJ, LeBlanc NJ, Hinton D. Cross-cultural variations in the prevalence and presentation of anxiety disorders.
<i xmlns:helper="urn:XsltStringHelper"> Expert Rev Neurother</i>. 2011;11(2):313-322.
doi:<a href="http://dx.doi.org/10.1586/ern.10.122">10.1586/ern.10.122</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/21306217" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Cross-cultural%20variations%20in%20the%20prevalence%20and%20presentation%20of%20anxiety%20disorders.&author=L%20Marques&author=DJ%20Robinaugh&author=NJ%20LeBlanc&author=D%20Hinton&publication_year=2011&journal=Expert%20Rev%20Neurother&volume=11&pages=313-322" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1586/ern.10.122" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r57">57.</a>
<div class="reference-content">Rzymski P, Nowicki M, Mullin GE, et al. Quantity does not equal quality: scientific principles cannot be sacrificed.
<i xmlns:helper="urn:XsltStringHelper"> Int Immunopharmacol</i>. 2020;86:106711.
doi:<a href="http://dx.doi.org/10.1016/j.intimp.2020.106711">10.1016/j.intimp.2020.106711</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32585609" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Quantity%20does%20not%20equal%20quality%3A%20scientific%20principles%20cannot%20be%20sacrificed.&author=P%20Rzymski&author=M%20Nowicki&author=GE%20Mullin&publication_year=2020&journal=Int%20Immunopharmacol&volume=86&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r58">58.</a>
<div class="reference-content">Essau CA, Lewinsohn PM, Seeley JR, Sasagawa S. Gender differences in the developmental course of depression.
<i xmlns:helper="urn:XsltStringHelper"> J Affect Disord</i>. 2010;127(1-3):185-190.
doi:<a href="http://dx.doi.org/10.1016/j.jad.2010.05.016">10.1016/j.jad.2010.05.016</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/20573404" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Gender%20differences%20in%20the%20developmental%20course%20of%20depression.&author=CA%20Essau&author=PM%20Lewinsohn&author=JR%20Seeley&author=S%20Sasagawa&publication_year=2010&journal=J%20Affect%20Disord&volume=127&pages=185-190" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.jad.2010.05.016" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r59">59.</a>
<div class="reference-content">Riecher-Rössler A. Sex and gender differences in mental disorders. <i xmlns:helper="urn:XsltStringHelper"> Lancet Psychiatry</i>. 2017;4(1):8-9.
doi:<a href="http://dx.doi.org/10.1016/S2215-0366(16)30348-0">10.1016/S2215-0366(16)30348-0</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/27856397" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Sex%20and%20gender%20differences%20in%20mental%20disorders.&author=A%20Riecher-Rössler&publication_year=2017&journal=Lancet%20Psychiatry&volume=4&pages=8-9" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/S2215-0366(16)30348-0" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r60">60.</a>
<div class="reference-content">Oldehinkel AJ, Verhulst FC, Ormel J. Mental health problems during puberty: Tanner stage-related differences in specific symptoms: the TRAILS study.
<i xmlns:helper="urn:XsltStringHelper"> J Adolesc</i>. 2011;34(1):73-85.
doi:<a href="http://dx.doi.org/10.1016/j.adolescence.2010.01.010">10.1016/j.adolescence.2010.01.010</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/20172603" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Mental%20health%20problems%20during%20puberty%3A%20Tanner%20stage-related%20differences%20in%20specific%20symptoms%3A%20the%20TRAILS%20study.&author=AJ%20Oldehinkel&author=FC%20Verhulst&author=J%20Ormel&publication_year=2011&journal=J%20Adolesc&volume=34&pages=73-85" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.adolescence.2010.01.010" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r61">61.</a>
<div class="reference-content">Hall-Lande JA, Eisenberg ME, Christenson SL, Neumark-Sztainer D. Social isolation, psychological health, and protective factors in adolescence.
<i xmlns:helper="urn:XsltStringHelper"> Adolescence</i>.
2007;42(166):265-286.<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/17849936" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Social%20isolation%2C%20psychological%20health%2C%20and%20protective%20factors%20in%20adolescence.&author=JA%20Hall-Lande&author=ME%20Eisenberg&author=SL%20Christenson&author=D%20Neumark-Sztainer&publication_year=2007&journal=Adolescence&volume=42&pages=265-286" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r62">62.</a>
<div class="reference-content">Christakis DA, Van Cleve W, Zimmerman FJ. Estimation of US children’s educational attainment and years of life lost associated with primary school closures during the
coronavirus disease 2019 pandemic. <i xmlns:helper="urn:XsltStringHelper"> JAMA Netw Open</i>. 2020;3(11):e2028786.
doi:<a href="http://jamanetwork.com/article.aspx?doi=10.1001/jamanetworkopen.2020.28786">10.1001/jamanetworkopen.2020.28786</a><br><a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2772834" class="jn-article-link">Article</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/33180132" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Estimation%20of%20US%20children%E2%80%99s%20educational%20attainment%20and%20years%20of%20life%20lost%20associated%20with%20primary%20school%20closures%20during%20the%20coronavirus%20disease%202019%20pandemic.&author=DA%20Christakis&author=W%20Van Cleve&author=FJ%20Zimmerman&publication_year=2020&journal=JAMA%20Netw%20Open&volume=3&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r63">63.</a>
<div class="reference-content">Madigan S, Racine N, Cooke JE, Korczak DJ. COVID-19 and telemental health: benefits, challenges, and future directions.
<i xmlns:helper="urn:XsltStringHelper"> Can Psychol</i>. 2021;62(1):5-11.
doi:<a href="http://dx.doi.org/10.1037/cap0000259">10.1037/cap0000259</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=COVID-19%20and%20telemental%20health%3A%20benefits%2C%20challenges%2C%20and%20future%20directions.&author=S%20Madigan&author=N%20Racine&author=JE%20Cooke&author=DJ%20Korczak&publication_year=2021&journal=Can%20Psychol&volume=62&pages=5-11" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1037/cap0000259" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r64">64.</a>
<div class="reference-content">Webb Hooper M, Nápoles AM, Pérez-Stable EJ. COVID-19 and racial/ethnic disparities. <i xmlns:helper="urn:XsltStringHelper"> JAMA</i>. 2020;323(24):2466-2467.
doi:<a href="http://jamanetwork.com/article.aspx?doi=10.1001/jama.2020.8598">10.1001/jama.2020.8598</a><br><a href="https://jamanetwork.com/journals/jama/fullarticle/2766098" class="jn-article-link">Article</a><a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/32391864" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=COVID-19%20and%20racial%2Fethnic%20disparities.&author=M%20Webb Hooper&author=AM%20Nápoles&author=EJ%20Pérez-Stable&publication_year=2020&journal=JAMA&volume=323&pages=2466-2467" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1001/jama.2020.8598" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r65">65.</a>
<div class="reference-content">Hawke LD, Hayes E, Darnay K, Henderson J. Mental health among transgender and gender diverse youth: an exploration of effects during the COVID-19 pandemic.
<i xmlns:helper="urn:XsltStringHelper"> Psychol Sex Orientat Gend Divers</i>. Published online February 4, 2021.
doi:<a href="http://dx.doi.org/10.1037/sgd0000467">10.1037/sgd0000467</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Mental%20health%20among%20transgender%20and%20gender%20diverse%20youth%3A%20an%20exploration%20of%20effects%20during%20the%20COVID-19%20pandemic.&author=LD%20Hawke&author=E%20Hayes&author=K%20Darnay&author=J%20Henderson&publication_year=&journal=Psychol%20Sex%20Orientat%20Gend%20Divers&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a>
</div>
</div>
<div class="reference"><a class="reference-number" id="poi210043r66">66.</a>
<div class="reference-content">Craig S, Ames ME, Bondi BC, Pepler DJ. Canadian Adolescents’ mental health and substance use during the covid-19 pandemic: associations with COVID-19 stressors. <i>PsyArXiv</i>. Preprint posted
online September 9, 2020. doi:<a href="http://dx.doi.org/10.31234/osf.io/kprd9">10.31234/osf.io/kprd9</a></div>
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Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents
During COVID-19: A Meta-analysis | Adolescent Medicine | JAMA Pediatrics | JAMA
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Figure 1. Forest Plots of the Pooled Prevalence of Clinically Significant
Depressive Symptoms in Youth During the COVID-19 Pandemic
View LargeDownload
Contributing studies for clinically elevated depression symptoms are presented
in order of largest to smallest prevalence rate. Square data markers represent
prevalence rates, with lines around the marker indicating 95% CIs. The diamond
data marker represents the overall effect size based on included studies.
Figure 2. Forest Plots of the Pooled Prevalence of Clinically Significant
Anxiety Symptoms in Youth During the COVID-19 Pandemic
View LargeDownload
Contributing studies for clinically elevated anxiety symptoms are presented in
order of largest to smallest prevalence rate. Square data markers represent
prevalence rates, with lines around the marker indicating 95% CIs. The diamond
data marker represents the overall effect size based on included studies.
Table 1. Characteristics of Studies Included
View LargeDownload
Table 2. Results of Moderator Analyses for the Prevalence of Depressive
Symptoms in Children and Adolescence During COVID-19
View LargeDownload
Table 3. Results of Moderator Analyses for the Prevalence of Anxiety Symptoms
in Children and Adolescence During COVID-19
View LargeDownload
Supplement.
eTable 1. Example Search Strategy from Medline
eTable 2. Study Quality Evaluation Criteria
eTable 3. Quality Assessment of Studies Included
eTable 4. Sensitivity analysis excluding low quality studies (score=2) for
moderators of the prevalence of clinically elevated depressive symptoms in
children and adolescence during COVID-19
eTable 5. Sensitivity analysis excluding low quality studies (score=2) for
moderators of the prevalence of clinically elevated anxiety symptoms in children
and adolescence during COVID-19
eFigure 1. PRISMA diagram of review search strategy
eFigure 2. Funnel plot for studies included in the clinically elevated
depressive symptoms
eFigure 3. Funnel plot for studies included in the clinically elevated anxiety
symptoms
1.
Tiirikainen K, Haravuori H, Ranta K, Kaltiala-Heino R, Marttunen M.
Psychometric properties of the 7-item Generalized Anxiety Disorder Scale
(GAD-7) in a large representative sample of Finnish adolescents. Psychiatry
Res. 2019;272:30-35. doi:10.1016/j.psychres.2018.12.004PubMedGoogle
ScholarCrossref
2.
Lu W. Adolescent depression: National trends, risk factors, and healthcare
disparities. Am J Health Behav. 2019;43(1):181-194.
doi:10.5993/AJHB.43.1.15PubMedGoogle ScholarCrossref
3.
Lee J. Mental health effects of school closures during COVID-19. Lancet
Child Adolesc Health. 2020;4(6):421.
doi:10.1016/S2352-4642(20)30109-7PubMedGoogle ScholarCrossref
4.
Sprang G, Silman M. Posttraumatic stress disorder in parents and youth
after health-related disasters. Disaster Med Public Health Prep.
2013;7(1):105-110. doi:10.1017/dmp.2013.22PubMedGoogle ScholarCrossref
5.
Brooks SK, Webster RK, Smith LE, et al. The psychological impact of
quarantine and how to reduce it: rapid review of the evidence. Lancet.
2020;395(10227):912-920. doi:10.1016/S0140-6736(20)30460-8PubMedGoogle
ScholarCrossref
6.
Loades ME, Chatburn E, Higson-Sweeney N, et al. Rapid systematic review:
the impact of social isolation and loneliness on the mental health of children
and adolescents in the context of COVID-19. J Am Acad Child Adolesc
Psychiatry. 2020;59(11):1218-1239.e3. doi:10.1016/j.jaac.2020.05.009Google
ScholarCrossref
7.
Golberstein E, Wen H, Miller BF. Coronavirus disease 2019 (COVID-19) and
mental health for children and adolescents. JAMA Pediatr.
2020;174(9):819-820. doi:10.1001/jamapediatrics.2020.1456
ArticlePubMedGoogle ScholarCrossref
8.
Racine N, Cooke JE, Eirich R, Korczak DJ, McArthur B, Madigan S.
Child and adolescent mental illness during COVID-19: a rapid review.
Psychiatry Res. 2020;292:113307. doi:10.1016/j.psychres.2020.113307PubMedGoogle
Scholar
9.
Singh S, Roy D, Sinha K, Parveen S, Sharma G, Joshi G. Impact of
COVID-19 and lockdown on mental health of children and adolescents: a narrative
review with recommendations. Psychiatry Res. 2020;293:113429.
doi:10.1016/j.psychres.2020.113429PubMedGoogle Scholar
10.
Zhang L, Zhang D, Fang J, Wan Y, Tao F, Sun Y. Assessment of mental
health of Chinese primary school students before and after school closing and
opening during the COVID-19 pandemic. JAMA Netw Open. 2020;3(9):e2021482.
doi:10.1001/jamanetworkopen.2020.21482
ArticlePubMedGoogle Scholar
11.
Hafstad GS, Sætren SS, Wentzel-Larsen T, Augusti E. Adolescents’
symptoms of anxiety and depression before and during the Covid-19 outbreak: a
prospective population-based study of teenagers in Norway. Lancet Reg Health
Eur. 2021;5:100093. doi:10.1016/j.lanepe.2021.100093Google Scholar
12.
Yue J, Zang X, Le Y, An Y. Anxiety, depression and PTSD among children
and their parent during 2019 novel coronavirus disease (COVID-19) outbreak in
China. Curr Psychol. 2020;1-8.PubMedGoogle Scholar
13.
Giannopoulou I, Efstathiou V, Triantafyllou G, Korkoliakou P, Douzenis
A. Adding stress to the stressed: senior high school students’ mental health
amidst the COVID-19 nationwide lockdown in Greece. Psychiatry Res.
2021;295:113560. doi:10.1016/j.psychres.2020.113560PubMedGoogle Scholar
14.
Merikangas KR, He JP, Burstein M, et al. Lifetime prevalence of mental
disorders in U.S. adolescents: results from the National Comorbidity Survey
Replication—Adolescent Supplement (NCS-A). J Am Acad Child Adolesc
Psychiatry. 2010;49(10):980-989. doi:10.1016/j.jaac.2010.05.017PubMedGoogle
ScholarCrossref
15.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental
Disorders. 5th ed. American Psychiatric Association; 2013.
16.
Courtney D, Watson P, Battaglia M, Mulsant BH, Szatmari P. COVID-19
impacts on child and youth anxiety and depression: challenges and
opportunities. Can J Psychiatry. 2020;65(10):688-691.
doi:10.1177/0706743720935646PubMedGoogle ScholarCrossref
17.
Zhou SJ, Zhang LG, Wang LL, et al. Prevalence and socio-demographic
correlates of psychological health problems in Chinese adolescents during the
outbreak of COVID-19. Eur Child Adolesc Psychiatry. 2020;29(6):749-758.
doi:10.1007/s00787-020-01541-4PubMedGoogle ScholarCrossref
18.
Magson NR, Freeman JYA, Rapee RM, Richardson CE, Oar EL, Fardouly J.
Risk and protective factors for prospective changes in adolescent mental health
during the COVID-19 pandemic. J Youth Adolesc. 2021;50(1):44-57.
doi:10.1007/s10964-020-01332-9PubMedGoogle ScholarCrossref
19.
Xie X, Xue Q, Zhou Y, et al. Mental health status among children in home
confinement during the coronavirus disease 2019 outbreak in Hubei Province,
China. JAMA Pediatr. 2020;174(9):898-900.
doi:10.1001/jamapediatrics.2020.1619
ArticlePubMedGoogle ScholarCrossref
20.
Duan L, Shao X, Wang Y, et al. An investigation of mental health status
of children and adolescents in China during the outbreak of COVID-19. J
Affect Disord. 2020;275:112-118. doi:10.1016/j.jad.2020.06.029PubMedGoogle
ScholarCrossref
21.
Pierce M, McManus S, Jessop C, et al. Says who? the significance of
sampling in mental health surveys during COVID-19. Lancet Psychiatry.
2020;7(7):567-568. doi:10.1016/S2215-0366(20)30237-6PubMedGoogle ScholarCrossref
22.
Klein R. Parent-child agreement in clinical assessment of anxiety and other
psychopathology: a review. J Anxiety Disord. 1991;5(2):187-198.
doi:10.1016/0887-6185(91)90028-RGoogle ScholarCrossref
23.
Edelbrock C, Costello AJ, Dulcan MK, Conover NC, Kala R. Parent-child
agreement on child psychiatric symptoms assessed via structured interview. J
Child Psychol Psychiatry. 1986;27(2):181-190.
doi:10.1111/j.1469-7610.1986.tb02282.xPubMedGoogle ScholarCrossref
24.
Hawes MT, Szenczy AK, Olino TM, Nelson BD, Klein DN. Trajectories of
depression, anxiety and pandemic experiences: a longitudinal study of youth in
New York during the spring-summer of 2020. Psychiatry Res. 2021;298:113778.
doi:10.1016/j.psychres.2021.113778PubMedGoogle Scholar
25.
Cost KT, Crosbie J, Anagnostou E, et al. Mostly worse, occasionally
better: impact of COVID-19 pandemic on the mental health of Canadian children
and adolescents. Eur Child Adolesc Psychiatry. 2021.
doi:10.1007/s00787-021-01744-3PubMedGoogle Scholar
26.
MacTavish A, Mastronardi C, Menna R, et al. The acute impact of the
COVID-19 pandemic on children’s mental health in southwestern Ontario.
PsyArXiv. Preprint posted online September 19, 2020. doi:10.31234/osf.io/5cwb4
27.
Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred
reporting items for systematic reviews and meta-analyses: the PRISMA
statement. PLoS Med. 2009;6(7):e1000097.
doi:10.1371/journal.pmed.1000097PubMedGoogle Scholar
28.
Ebesutani C, Bernstein A, Martinez JI, Chorpita BF, Weisz JR. The
youth self report: applicability and validity across younger and older youths.
J Clin Child Adolesc Psychol. 2011;40(2):338-346.
doi:10.1080/15374416.2011.546041PubMedGoogle ScholarCrossref
29.
National Heart, Lung, and Blood Institute. Study quality assessment tools:
quality assessment tool for observational cohort and cross-sectional studies.
Accessed July 6, 2021.
https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools
30.
Borenstein M, Hesdges L, Higgins J, Rothstein H. Introduction to
Meta-Analysis. Wiley; 2009.
31.
Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis
detected by a simple, graphical test. BMJ. 1997;315(7109):629-634.
doi:10.1136/bmj.315.7109.629PubMedGoogle ScholarCrossref
32.
AlAzzam M, Abuhammad S, Abdalrahim A, Hamdan-Mansour AM. Predictors of
depression and anxiety among senior high school students during COVID-19
pandemic: the context of home quarantine and online education. J Sch Nurs.
2021;1059840520988548.PubMedGoogle Scholar
33.
Asanov I, Flores F, McKenzie D, Mensmann M, Schulte M.
Remote-learning, time-use, and mental health of Ecuadorian high-school students
during the COVID-19 quarantine. World Dev. 2021;138:105225.
doi:10.1016/j.worlddev.2020.105225PubMedGoogle Scholar
34.
Cao Y, Huang L, Si T, Wang NQ, Qu M, Zhang XY. The role of
only-child status in the psychological impact of COVID-19 on mental health of
Chinese adolescents. J Affect Disord. 2021;282:316-321.
doi:10.1016/j.jad.2020.12.113PubMedGoogle ScholarCrossref
35.
Cheah CSL, Wang C, Ren H, Zong X, Cho HS, Xue X. COVID-19 racism
and mental health in Chinese American families. Pediatrics.
2020;146(5):e2020021816. doi:10.1542/peds.2020-021816PubMedGoogle Scholar
36.
Chen F, Zheng D, Liu J, Gong Y, Guan Z, Lou D. Depression and
anxiety among adolescents during COVID-19: a cross-sectional study. Brain
Behav Immun. 2020;88:36-38. doi:10.1016/j.bbi.2020.05.061PubMedGoogle
ScholarCrossref
37.
Chen S, Cheng Z, Wu J. Risk factors for adolescents’ mental health during
the COVID-19 pandemic: a comparison between Wuhan and other urban areas in
China. Global Health. 2020;16(1):96.
doi:10.1186/s12992-020-00627-7PubMedGoogle ScholarCrossref
38.
Chi X, Liang K, Chen ST, et al. Mental health problems among Chinese
adolescents during the COVID-19: the importance of nutrition and physical
activity. Int J Clin Health Psychol. 2021;21(3):100218.
doi:10.1016/j.ijchp.2020.100218PubMedGoogle Scholar
39.
Crescentini C, Feruglio S, Matiz A, et al. Stuck outside and inside: an
exploratory study on the effects of the COVID-19 outbreak on Italian parents and
children’s internalizing symptoms. Front Psychol. 2020;11:586074.
doi:10.3389/fpsyg.2020.586074PubMedGoogle Scholar
40.
Dong H, Yang F, Lu X, Hao W. Internet addiction and related
psychological factors among children and adolescents in China during the
coronavirus disease 2019 (COVID-19) epidemic. Front Psychiatry.
2020;11:00751. doi:10.3389/fpsyt.2020.00751PubMedGoogle ScholarCrossref
41.
Garcia de Avila MA, Hamamoto Filho PT, Jacob FLDS, et al. Children’s
anxiety and factors related to the COVID-19 pandemic: an exploratory study using
the Children’s Anxiety Questionnaire and the Numerical Rating Scale. Int J
Environ Res Public Health. 2020;17(16):E5757.
doi:10.3390/ijerph17165757PubMedGoogle Scholar
42.
Glynn LM, Davis EP, Luby JL, Baram TZ, Sandman CA. A predictable home
environment may protect child mental health during the COVID-19 pandemic.
Neurobiol Stress. 2021;14:100291. doi:10.1016/j.ynstr.2020.100291PubMedGoogle
Scholar
43.
Hou TY, Mao XF, Dong W, Cai WP, Deng GH. Prevalence of and factors
associated with mental health problems and suicidality among senior high school
students in rural China during the COVID-19 outbreak. Asian J Psychiatr.
2020;54:102305. doi:10.1016/j.ajp.2020.102305PubMedGoogle Scholar
44.
Li W, Zhang Y, Wang J, et al. Association of home quarantine and mental
health among teenagers in Wuhan, China, during the COVID-19 pandemic. JAMA
Pediatr. 2021;175(3):313-316. doi:10.1001/jamapediatrics.2020.5499
ArticlePubMedGoogle ScholarCrossref
45.
Luthar SS, Ebbert AM, Kumar NL. Risk and resilience during COVID-19: a
new study in the Zigler paradigm of developmental science. Dev Psychopathol.
2021;33(2):565-580.PubMedGoogle ScholarCrossref
46.
McGuine TA, Biese KM, Petrovska L, et al. Mental health, physical
activity, and quality of life of us adolescent athletes during COVID-19-related
school closures and sport cancellations: a study of 13 000 athletes. J Athl
Train. 2020. doi:10.4085/478-20PubMedGoogle Scholar
47.
Murata S, Rezeppa T, Thoma B, et al. The psychiatric sequelae of the
COVID-19 pandemic in adolescents, adults, and health care workers. Depress
Anxiety. 2021;38(2):233-246. doi:10.1002/da.23120PubMedGoogle ScholarCrossref
48.
Orgilés M, Espada JP, Delvecchio E, et al. Anxiety and depressive
symptoms in children and adolescents during COVID-19 pandemic: a transcultural
approach. Psicothema. 2021;33(1):125-130.PubMedGoogle Scholar
49.
Ravens-Sieberer U, Kaman A, Erhart M, Devine J, Schlack R, Otto C.
Impact of the COVID-19 pandemic on quality of life and mental health in
children and adolescents in Germany. Eur Child Adolesc Psychiatry. 2021.
doi:10.1007/s00787-021-01726-5PubMedGoogle Scholar
50.
Tang S, Xiang M, Cheung T, Xiang YT. Mental health and its correlates
among children and adolescents during COVID-19 school closure: the importance of
parent-child discussion. J Affect Disord. 2021;279:353-360.
doi:10.1016/j.jad.2020.10.016PubMedGoogle ScholarCrossref
51.
Zhou J, Yuan X, Qi H, et al. Prevalence of depression and its
correlative factors among female adolescents in China during the coronavirus
disease 2019 outbreak. Global Health. 2020;16(1):69.
doi:10.1186/s12992-020-00601-3PubMedGoogle ScholarCrossref
52.
Zhang Z, Zhai A, Yang M, et al. Prevalence of depression and anxiety
symptoms of high school students in Shandong province during the COVID-19
epidemic. Front Psychiatry. 2020;11:570096.
doi:10.3389/fpsyt.2020.570096PubMedGoogle Scholar
53.
Zhang C, Ye M, Fu Y, et al. The psychological impact of the COVID-19
pandemic on teenagers in China. J Adolesc Health. 2020;67(6):747-755.
doi:10.1016/j.jadohealth.2020.08.026PubMedGoogle ScholarCrossref
54.
Masonbrink AR, Hurley E. Advocating for children during the COVID-19 school
closures. Pediatrics. 2020;146(3):e20201440.
doi:10.1542/peds.2020-1440PubMedGoogle Scholar
55.
Schaller J, Zerpa M. Short-run effects of parental job loss on child
health. Am J Health Econ. 2019;5(1):8-41. doi:10.1162/ajhe_a_00106Google
ScholarCrossref
56.
Marques L, Robinaugh DJ, LeBlanc NJ, Hinton D. Cross-cultural
variations in the prevalence and presentation of anxiety disorders. Expert
Rev Neurother. 2011;11(2):313-322. doi:10.1586/ern.10.122PubMedGoogle
ScholarCrossref
57.
Rzymski P, Nowicki M, Mullin GE, et al. Quantity does not equal quality:
scientific principles cannot be sacrificed. Int Immunopharmacol.
2020;86:106711. doi:10.1016/j.intimp.2020.106711PubMedGoogle Scholar
58.
Essau CA, Lewinsohn PM, Seeley JR, Sasagawa S. Gender differences in
the developmental course of depression. J Affect Disord.
2010;127(1-3):185-190. doi:10.1016/j.jad.2010.05.016PubMedGoogle ScholarCrossref
59.
Riecher-Rössler A. Sex and gender differences in mental disorders. Lancet
Psychiatry. 2017;4(1):8-9. doi:10.1016/S2215-0366(16)30348-0PubMedGoogle
ScholarCrossref
60.
Oldehinkel AJ, Verhulst FC, Ormel J. Mental health problems during
puberty: Tanner stage-related differences in specific symptoms: the TRAILS
study. J Adolesc. 2011;34(1):73-85.
doi:10.1016/j.adolescence.2010.01.010PubMedGoogle ScholarCrossref
61.
Hall-Lande JA, Eisenberg ME, Christenson SL, Neumark-Sztainer D. Social
isolation, psychological health, and protective factors in adolescence.
Adolescence. 2007;42(166):265-286.PubMedGoogle Scholar
62.
Christakis DA, Van Cleve W, Zimmerman FJ. Estimation of US children’s
educational attainment and years of life lost associated with primary school
closures during the coronavirus disease 2019 pandemic. JAMA Netw Open.
2020;3(11):e2028786. doi:10.1001/jamanetworkopen.2020.28786
ArticlePubMedGoogle Scholar
63.
Madigan S, Racine N, Cooke JE, Korczak DJ. COVID-19 and telemental
health: benefits, challenges, and future directions. Can Psychol.
2021;62(1):5-11. doi:10.1037/cap0000259Google ScholarCrossref
64.
Webb Hooper M, Nápoles AM, Pérez-Stable EJ. COVID-19 and racial/ethnic
disparities. JAMA. 2020;323(24):2466-2467. doi:10.1001/jama.2020.8598
ArticlePubMedGoogle ScholarCrossref
65.
Hawke LD, Hayes E, Darnay K, Henderson J. Mental health among
transgender and gender diverse youth: an exploration of effects during the
COVID-19 pandemic. Psychol Sex Orientat Gend Divers. Published online
February 4, 2021. doi:10.1037/sgd0000467Google Scholar
66.
Craig S, Ames ME, Bondi BC, Pepler DJ. Canadian Adolescents’ mental health and
substance use during the covid-19 pandemic: associations with COVID-19
stressors. PsyArXiv. Preprint posted online September 9, 2020.
doi:10.31234/osf.io/kprd9
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Racine N, McArthur BA, Cooke JE, Eirich R, Zhu J, Madigan S. Global
Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents
During COVID-19: A Meta-analysis. JAMA Pediatr. 2021;175(11):1142–1150.
doi:10.1001/jamapediatrics.2021.2482
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Original Investigation
August 9, 2021
GLOBAL PREVALENCE OF DEPRESSIVE AND ANXIETY SYMPTOMS IN CHILDREN AND ADOLESCENTS
DURING COVID-19: A META-ANALYSIS
Nicole Racine, PhD, RPsych1,2; Brae Anne McArthur, PhD, RPsych1,2; Jessica
E. Cooke, MSc1,2; et al Rachel Eirich, BA1,2; Jenney Zhu, BA1,2;
Sheri Madigan, PhD, RPsych1,2
Author Affiliations Article Information
* 1Department of Psychology, University of Calgary, Calgary, Alberta, Canada
* 2Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
JAMA Pediatr. 2021;175(11):1142-1150. doi:10.1001/jamapediatrics.2021.2482
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Thonmoy Dey, BSc; Zachariah John Mansell, BSc; Jasmin Ranu, BSc
Key Points
Question What is the global prevalence of clinically elevated child and
adolescent anxiety and depression symptoms during COVID-19?
Findings In this meta-analysis of 29 studies including 80 879 youth globally,
the pooled prevalence estimates of clinically elevated child and adolescent
depression and anxiety were 25.2% and 20.5%, respectively. The prevalence of
depression and anxiety symptoms during COVID-19 have doubled, compared with
prepandemic estimates, and moderator analyses revealed that prevalence rates
were higher when collected later in the pandemic, in older adolescents, and in
girls.
Meaning The global estimates of child and adolescent mental illness observed in
the first year of the COVID-19 pandemic in this study indicate that the
prevalence has significantly increased, remains high, and therefore warrants
attention for mental health recovery planning.
Abstract
Importance Emerging research suggests that the global prevalence of child and
adolescent mental illness has increased considerably during COVID-19. However,
substantial variability in prevalence rates have been reported across the
literature.
Objective To ascertain more precise estimates of the global prevalence of child
and adolescent clinically elevated depression and anxiety symptoms during
COVID-19; to compare these rates with prepandemic estimates; and to examine
whether demographic (eg, age, sex), geographical (ie, global region), or
methodological (eg, pandemic data collection time point, informant of mental
illness, study quality) factors explained variation in prevalence rates across
studies.
Data Sources Four databases were searched (PsycInfo, Embase, MEDLINE, and
Cochrane Central Register of Controlled Trials) from January 1, 2020, to
February 16, 2021, and unpublished studies were searched in PsycArXiv on March
8, 2021, for studies reporting on child/adolescent depression and anxiety
symptoms. The search strategy combined search terms from 3 themes: (1) mental
illness (including depression and anxiety), (2) COVID-19, and (3) children and
adolescents (age ≤18 years). For PsycArXiv, the key terms COVID-19, mental
health, and child/adolescent were used.
Study Selection Studies were included if they were published in English, had
quantitative data, and reported prevalence of clinically elevated depression or
anxiety in youth (age ≤18 years).
Data Extraction and Synthesis A total of 3094 nonduplicate titles/abstracts
were retrieved, and 136 full-text articles were reviewed. Data were analyzed
from March 8 to 22, 2021.
Main Outcomes and Measures Prevalence rates of clinically elevated depression
and anxiety symptoms in youth.
Results Random-effect meta-analyses were conducted. Twenty-nine studies
including 80 879 participants met full inclusion criteria. Pooled prevalence
estimates of clinically elevated depression and anxiety symptoms were 25.2% (95%
CI, 21.2%-29.7%) and 20.5% (95% CI, 17.2%-24.4%), respectively. Moderator
analyses revealed that the prevalence of clinically elevated depression and
anxiety symptoms were higher in studies collected later in the pandemic and in
girls. Depression symptoms were higher in older children.
Conclusions and Relevance Pooled estimates obtained in the first year of the
COVID-19 pandemic suggest that 1 in 4 youth globally are experiencing clinically
elevated depression symptoms, while 1 in 5 youth are experiencing clinically
elevated anxiety symptoms. These pooled estimates, which increased over time,
are double of prepandemic estimates. An influx of mental health care utilization
is expected, and allocation of resources to address child and adolescent mental
health concerns are essential.
Introduction
Prior to the COVID-19 pandemic, rates of clinically significant generalized
anxiety and depressive symptoms in large youth cohorts were approximately 11.6%1
and 12.9%,2 respectively. Since COVID-19 was declared an international public
health emergency, youth around the world have experienced dramatic disruptions
to their everyday lives.3 Youth are enduring pervasive social isolation and
missed milestones, along with school closures, quarantine orders, increased
family stress, and decreased peer interactions, all potential precipitants of
psychological distress and mental health difficulties in youth.4-7 Indeed, in
both cross-sectional8,9 and longitudinal studies10,11 amassed to date, the
prevalence of youth mental illness appears to have increased during the COVID-19
pandemic.3 However, data collected vary considerably. Specifically, ranges from
2.2%12 to 63.8%13 and 1.8%12 to 49.5%13 for clinically elevated depression and
anxiety symptoms, respectively. As governments and policy makers deploy and
implement recovery plans, ascertaining precise estimates of the burden of mental
illness for youth are urgently needed to inform service deployment and resource
allocation.
Depression and generalized anxiety are 2 of the most common mental health
concerns in youth.14 Depressive symptoms, which include feelings of sadness,
loss of interest and pleasure in activities, as well as disruption to regulatory
functions such as sleep and appetite,15 could be elevated during the pandemic as
a result of social isolation due to school closures and physical distancing
requirements.6 Generalized anxiety symptoms in youth manifest as uncontrollable
worry, fear, and hyperarousal.15 Uncertainty, disruptions in daily routines, and
concerns for the health and well-being of family and loved ones during the
COVID-19 pandemic are likely associated with increases in generalized anxiety in
youth.16
When heterogeneity is observed across studies, as is the case with youth mental
illness during COVID-19, it often points to the need to examine demographic,
geographical, and methodological moderators. Moderator analyses can determine
for whom and under what circumstances prevalence is higher vs lower. With regard
to demographic factors, prevalence rates of mental illness both prior to and
during the COVID-19 pandemic are differentially reported across child age and
sex, with girls17,18 and older children17,19 being at greater risk for
internalizing disorders. Studies have also shown that youth living in regions
that experienced greater disease burden2 and urban areas20 had greater mental
illness severity. Methodological characteristics of studies also have the
potential to influence the estimated prevalence rates. For example, studies of
poorer methodological quality may be more likely to overestimate prevalence
rates.21 The symptom reporter (ie, child vs parent) may also contribute to
variability in the prevalence of mental illness across studies. Indeed, previous
research prior to the pandemic has demonstrated that child and parent reports of
internalizing symptoms vary,22 with children/adolescents reporting more
internalizing symptoms than parents.23 Lastly, it is important to consider the
role of data collection timing on potential prevalence rates. While feelings of
stress and overwhelm may have been greater in the early months of the pandemic
compared with later,24 extended social isolation and school closures may have
exerted mental health concerns.
Although a narrative systematic review of 6 studies early in the pandemic was
conducted,8 to our knowledge, no meta-analysis of prevalence rates of child and
adolescent mental illness during the pandemic has been undertaken. In the
current study, we conducted a meta-analysis of the global prevalence of
clinically elevated symptoms of depression and anxiety (ie, exceeding a clinical
cutoff score on a validated measure or falling in the moderate to severe symptom
range of anxiety and depression) in youth during the first year of the COVID-19
pandemic. While research has documented a worsening of symptoms for children and
youth with a wide range of anxiety disorders,25 including social anxiety,26
clinically elevated symptoms of generalized anxiety are the focus of the current
meta-analysis. In addition to deriving pooled prevalence estimates, we examined
demographic, geographical, and methodological factors that may explain
between-study differences. Given that there have been several precipitants of
psychological distress for youth during COVID-19, we hypothesized that pooled
prevalence rates would be higher compared with prepandemic estimates. We also
hypothesized that child mental illness would be higher among studies with older
children, a higher percentage of female individuals, studies conducted later in
the pandemic, and that higher-quality studies would have lower prevalence rates.
Methods
Search Strategy and Selection Criteria
This systematic review was registered as a protocol with PROSPERO
(CRD42020184903) and the Preferred Reporting Items for Systematic Reviews and
Meta-analyses (PRISMA) reporting guideline was followed.27 Ethics review was not
required for the study. Electronic searches were conducted in collaboration with
a health sciences librarian in PsycInfo, Cochrane Central Register of Controlled
Trials (CENTRAL), Embase, and MEDLINE from inception to February 16, 2021. The
search strategy (eTable 1 in the Supplement) combined search terms from 3
themes: (1) mental illness (including depression and anxiety), (2) COVID-19, and
(3) children and adolescents (age ≤18 years). Both database and subject headings
were used to search keywords. As a result of the rapidly evolving nature of
research during the COVID-19 pandemic, we also searched a repository of
unpublished preprints, PsycArXiv. The key terms COVID-19, mental health, and
child/adolescent were used on March 8, 2021, and yielded 38 studies of which 1
met inclusion criteria.
The following inclusion criteria were applied: (1) sample was drawn from a
general population; (2) proportion of individuals meeting clinical cutoff scores
or falling in the moderate to severe symptom range of anxiety or depression as
predetermined by validated self-report measures were provided; (3) data were
collected during COVID-19; (4) participants were 18 years or younger; (5) study
was empirical; and (6) studies were written in English. Samples of participants
who may be affected differently from a mental health perspective during COVID-19
were excluded (eg, children with preexisting psychiatric diagnoses, children
with chronic illnesses, children diagnosed or suspected of having COVID-19). We
also excluded case studies and qualitative analyses.
Five (N.R., B.A.M., J.E.C., R.E. and J.Z.) authors used Covidence software
(Covidence Inc) to review all abstracts and to determine if the study met
criteria for inclusion. Twenty percent of abstracts reviewed for inclusion were
double-coded, and the mean random agreement probability was 0.89; disagreements
were resolved via consensus with the first author (N.R.). Two authors (N.R. and
B.A.M.) reviewed full-text articles to determine if they met all inclusion
criteria and the percent agreement was 0.80; discrepancies were resolved via
consensus.
Data Extraction
When studies met inclusion criteria, prevalence rates for anxiety and depression
were extracted, as well as potential moderators. When more than 1 wave of data
was provided, the wave with the largest sample size was selected. For 1 study in
which both parent and youth reports were provided,26 the youth report was
selected, given research that they are the reliable informants of their own
behavior.28 The following moderators were extracted: (1) study quality (see the
next subsection); (2) participant age (continuously as a mean); (3) sex (%
female in a sample); (4) geographical region (eg, East Asia, Europe, North
America), (5) informant (child, parent), (6) month in 2020 when data were
collected (range, 1-12). Data from all studies were extracted by 1 coder and the
first author (N.R.). Discrepancies were resolved via consensus.
Study Quality
Adapted from the National Institute of Health Quality Assessment Tool for
Observation Cohort and Cross-Sectional Studies, a short 5-item questionnaire was
used (eTable 2 in the Supplement).29 Studies were given a score of 0 (no) or 1
(yes) for each of the 5 criteria (validated measure; peer-reviewed, response
rate ≥50%, objective assessment, sufficient exposure time) and summed to give a
total score of 5. When information was unclear or not provided by the study
authors, it was marked as 0 (no).
Data Analysis
All included studies are from independent samples. Comprehensive Meta-Analysis
version 3.0 (Biostat) software was used for data analysis. Pooled prevalence
estimates with associated 95% confidence intervals around the estimate were
computed. We weighted pooled prevalence estimates by the weight of the inverse
of their variance, which gives greater weight to large sample sizes.
We used random-effects models to reflect the variations observed across studies
and assessed between-study heterogeneity using the Q and I2 statistics. Pooled
prevalence is reported as an event rate (ie, 0.30) but interpreted as prevalence
(ie, 30.0%). Significant Q statistics and I2 values more than 75% suggest
moderator analyses should be explored.30 As recommended by Bornstein et al,30 we
examined categorical moderators when k of 10 or higher and a minimum cell size
of k more than 3 were available. A P value of .05 was considered statistically
significant. For continuous moderators, random-effect meta-regression analyses
were conducted. Publication bias was examined using the Egger test31 and by
inspecting funnel plots for symmetry.
Results
Our electronic search yielded 3094 nonduplicate records (eFigure 1 in the
Supplement). Based on the abstract review, a total of 136 full-text articles
were retrieved to examine against inclusion criteria, and 29 nonoverlapping
studies10,12,13,17,19,20,26,32-53 met full inclusion criteria.
Study Characteristics
A total of 29 studies were included in the meta-analyses, of which 26 had youth
symptom reports and 3 studies39,42,48 had parent reports of child symptoms. As
outlined in Table 1, across all 29 studies, 80 879 participants were included,
of which the mean (SD) perecentage of female individuals was 52.7% (12.3%), and
the mean age was 13.0 years (range, 4.1-17.6 years). All studies provided binary
reports of sex or gender. Sixteen studies (55.2%) were from East Asia, 4 were
from Europe (13.8%), 6 were from North America (20.7%), 2 were from Central
America and South America (6.9%), and 1 study was from the Middle East (3.4%).
Eight studies (27.6%) reported having racial or ethnic minority participants
with the mean across studies being 36.9%. Examining study quality, the mean
score was 3.10 (range, 2-4; eTable 3 in the Supplement).
Pooled Prevalence of Clinically Elevated Depressive Symptoms in Youth During
COVID-19
The pooled prevalence from a random-effects meta-analysis of 26 studies revealed
a pooled prevalence rate of 0.25 (95% CI, 0.21-0.30; Figure 1) or 25.2%. The
funnel plot was symmetrical (eFigure 2 in the Supplement); however, the Egger
test was statistically significant (intercept, −9.5; 95% CI, −18.4 to −0.48;
P = .02). The between-study heterogeneity statistic was significant
(Q = 4675.91; P < .001; I2 = 99.47). Significant moderators are reported below,
and all moderator analyses are presented in Table 2.
As the number of months in the year increased, so too did the prevalence of
depressive symptoms (b = 0.26; 95% CI, 0.06-0.46). Prevalence rates were higher
as child age increased (b = 0.08; 95% CI, 0.01-0.15), and as the percentage of
female individuals (b = 0.03; 95% CI, 0.01-0.05) in samples increased.
Sensitivity analyses removing low-quality studies were conducted (ie, scores of
2)32,43 (eTable 4 in the Supplement). Moderators remained significant, except
for age, which became nonsignificant (b = 0.06; 95% CI, −0.02 to 0.13; P = .14).
Pooled Prevalence of Clinically Elevated Anxiety Symptoms in Youth During
COVID-19
The overall pooled prevalence rate across 25 studies for elevated anxiety was
0.21 (95% CI, 0.17-0.24; Figure 2) or 20.5%. The funnel plot was symmetrical
(eFigure 3 in the Supplement) and the Egger test was nonsignificant (intercept,
−6.24; 95% CI, −14.10 to 1.62; P = .06). The heterogeneity statistic was
significant (Q = 3300.17; P < .001; I2 = 99.27). Significant moderators are
reported below, and all moderator analyses are presented in Table 3.
As the number of months in the year increased, so too did the prevalence of
anxiety symptoms (b = 0.27; 95% CI, 0.10-0.44). Prevalence rates of clinically
elevated anxiety was higher as the percentage of female individuals in the
sample increased (b = 0.04; 95% CI, 0.01-0.07) and also higher in European
countries (k = 4; rate = 0.34; 95% CI, 0.23-0.46; P = .01) compared with East
Asian countries (k = 14; rate = 0.17; 95% CI, 0.13-0.21; P < .001). Lastly, the
prevalence of clinically elevated anxiety was higher in studies deemed to have
poorer quality (k = 21; rate = 0.22; 95% CI, 0.18-0.27; P < .001) compared with
studies with better study quality scores (k = 4; rate = 0.12; 95% CI, 0.07-0.20;
P < .001). Sensitivity analyses removing low quality studies (ie, scores of
2)32,43 yielded the same pattern of results (eTable 5 in the Supplement).
Discussion
The current meta-analysis provides a timely estimate of clinically elevated
depression and generalized anxiety symptoms globally among youth during the
COVID-19 pandemic. Across 29 samples and 80 879 youth, the pooled prevalence of
clinically elevated depression and anxiety symptoms was 25.2% and 20.5%,
respectively. Thus, 1 in 4 youth globally are experiencing clinically elevated
depression symptoms, while 1 in 5 youth are experiencing clinically elevated
anxiety symptoms. A comparison of these findings to prepandemic estimates (12.9%
for depression2 and 11.6% for anxiety1) suggests that youth mental health
difficulties during the COVID-19 pandemic has likely doubled.
The COVID-19 pandemic, and its associated restrictions and consequences, appear
to have taken a considerable toll on youth and their psychological well-being.
Loss of peer interactions, social isolation, and reduced contact with buffering
supports (eg, teachers, coaches) may have precipitated these increases.3 In
addition, schools are often a primary location for receiving psychological
services, with 80% of children relying on school-based services to address their
mental health needs.54 For many children, these services were rendered
unavailable owing to school closures.
As the month of data collection increased, rates of depression and anxiety
increased correspondingly. One possibility is that ongoing social isolation,6
family financial difficulties,55 missed milestones, and school disruptions3 are
compounding over time for youth and having a cumulative association. However,
longitudinal research supporting this possibility is currently scarce and
urgently needed. A second possibility is that studies conducted in the earlier
months of the pandemic (February to March 2020)12,51 were more likely to be
conducted in East Asia where self-reported prevalence of mental health symptoms
tends to be lower.56 Longitudinal trajectory research on youth well-being as the
pandemic progresses and in pandemic recovery phases will be needed to confirm
the long-term mental health implications of the COVID-19 pandemic on youth
mental illness.
Prevalence rates for anxiety varied according to study quality, with
lower-quality studies yielding higher prevalence rates. It is important to note
that in sensitivity analyses removing lower-quality studies, other significant
moderators (ie, child sex and data collection time point) remained significant.
There has been a rapid proliferation of youth mental health research during the
COVID-19 pandemic; however, the rapid execution of these studies has been
criticized owing to the potential for some studies to sacrifice methodological
quality for methodological rigor.21,57 Additionally, several studies estimating
prevalence rates of mental illness during the pandemic have used nonprobability
or convenience samples, which increases the likelihood of bias in reporting.21
Studies with representative samples and/or longitudinal follow-up studies that
have the potential to demonstrate changes in mental health symptoms from before
to after the pandemic should be prioritized in future research.
In line with previous research on mental illness in childhood and adolescence,58
female sex was associated with both increased depressive and anxiety symptoms.
Biological susceptibility, lower baseline self-esteem, a higher likelihood of
having experienced interpersonal violence, and exposure to stress associated
with gender inequity may all be contributing factors.59 Higher rates of
depression in older children were observed and may be due to puberty and
hormonal changes60 in addition to the added effects of social isolation and
physical distancing on older children who particularly rely on socialization
with peers.6,61 However, age was not a significant moderator for prevalence
rates of anxiety. Although older children may be more acutely aware of the
stress of their parents and the implications of the current global pandemic,
younger children may be able to recognize changes to their routine, both of
which may contribute to similar rates of anxiety with different underlying
mechanisms.
In terms of practice implications, a routine touch point for many youth is the
family physician or pediatrician’s office. Within this context, it is critical
to inquire about or screen for youth mental health difficulties. Emerging
research42 suggests that in families using more routines during COVID-19, lower
child depression and conduct problems are observed. Thus, a tangible solution to
help mitigate the adverse effects of COVID-19 on youth is working with children
and families to implement consistent and predictable routines around schoolwork,
sleep, screen use, and physical activity. Additional resources should be made
available, and clinical referrals should be placed when children experience
clinically elevated mental distress. At a policy level, research suggests that
social isolation may contribute to and confer risk for mental health
concerns.4,5 As such, the closure of schools and recreational activities should
be considered a last resort.62 In addition, methods of delivering mental health
resources widely to youth, such as group and individual telemental health
services, need to be adapted to increase scalability, while also prioritizing
equitable access across diverse populations.63
Limitations
There are some limitations to the current study. First, although the current
meta-analysis includes global estimates of child and adolescent mental illness,
it will be important to reexamine cross-regional differences once additional
data from underrepresented countries are available. Second, most study designs
were cross-sectional in nature, which precluded an examination of the long-term
association of COVID-19 with child mental health over time. To determine whether
clinically elevated symptoms are sustained, exacerbated, or mitigated,
longitudinal studies with baseline estimates of anxiety and depression are
needed. Third, few studies included racial or ethnic minority participants
(27.6%), and no studies included gender-minority youth. Given that racial and
ethnic minority64 and gender-diverse youth65,66 may be at increased risk for
mental health difficulties during the pandemic, future work should include and
focus on these groups. Finally, all studies used self- or parent-reported
questionnaires to examine the prevalence of clinically elevated (ie, moderate to
high) symptoms. Thus, studies using criterion standard assessments of child
depression and anxiety disorders via diagnostic interviews or multimethod
approaches may supplement current findings and provide further details on
changes beyond generalized anxiety symptoms, such symptoms of social anxiety,
separation anxiety, and panic.
Conclusions
Overall, this meta-analysis shows increased rates of clinically elevated anxiety
and depression symptoms for youth during the COVID-19 pandemic. While this
meta-analysis supports an urgent need for intervention and recovery efforts
aimed at improving child and adolescent well-being, it also highlights that
individual differences need to be considered when determining targets for
intervention (eg, age, sex, exposure to COVID-19 stressors). Research on the
long-term effect of the COVID-19 pandemic on mental health, including studies
with pre– to post–COVID-19 measurement, is needed to augment understanding of
the implications of this crisis on the mental health trajectories of today’s
children and youth.
Back to top
Article Information
Corresponding Author: Sheri Madigan, PhD, RPsych, Department of Psychology
University of Calgary, Calgary, AB T2N 1N4, Canada (sheri.madigan@ucalgary.ca).
Accepted for Publication: May 19, 2021.
Published Online: August 9, 2021. doi:10.1001/jamapediatrics.2021.2482
Author Contributions: Drs Racine and Madigan had full access to all of the data
in the study and take responsibility for the integrity of the data and the
accuracy of the data analysis.
Concept and design: Racine, Madigan.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Racine, McArthur, Eirich, Zhu, Madigan.
Critical revision of the manuscript for important intellectual content: Racine,
Cooke, Eirich, Madigan.
Statistical analysis: Racine, McArthur.
Administrative, technical, or material support: Madigan.
Supervision: Racine, Madigan.
Conflict of Interest Disclosures: Dr Racine reported fellowship support from
Alberta Innovates. Dr McArthur reported a postdoctoral fellowship award from the
Alberta Children’s Hospital Research Institute. Ms Cooke reported graduate
scholarship support from Vanier Canada and Alberta Innovates Health Solutions
outside the submitted work. Ms Eirich reported graduate scholarship support from
the Social Science and Humanities Research Council. No other disclosures were
reported.
Additional Contributions: We acknowledge Nicole Dunnewold, MLIS (Research and
Learning Librarian, Health Sciences Library, University of Calgary), for her
assistance with the search strategy, for which they were not compensated outside
of their salary. We also acknowledge the contribution of members of the
Determinants of Child Development Laboratory at the University of Calgary, in
particular, Julianna Watt, BA, and Katarina Padilla, BSc, for their contribution
to data extraction, for which they were paid as research assistants.
References
1.
Tiirikainen K, Haravuori H, Ranta K, Kaltiala-Heino R, Marttunen M.
Psychometric properties of the 7-item Generalized Anxiety Disorder Scale
(GAD-7) in a large representative sample of Finnish adolescents. Psychiatry
Res. 2019;272:30-35. doi:10.1016/j.psychres.2018.12.004PubMedGoogle
ScholarCrossref
2.
Lu W. Adolescent depression: National trends, risk factors, and healthcare
disparities. Am J Health Behav. 2019;43(1):181-194.
doi:10.5993/AJHB.43.1.15PubMedGoogle ScholarCrossref
3.
Lee J. Mental health effects of school closures during COVID-19. Lancet
Child Adolesc Health. 2020;4(6):421.
doi:10.1016/S2352-4642(20)30109-7PubMedGoogle ScholarCrossref
4.
Sprang G, Silman M. Posttraumatic stress disorder in parents and youth
after health-related disasters. Disaster Med Public Health Prep.
2013;7(1):105-110. doi:10.1017/dmp.2013.22PubMedGoogle ScholarCrossref
5.
Brooks SK, Webster RK, Smith LE, et al. The psychological impact of
quarantine and how to reduce it: rapid review of the evidence. Lancet.
2020;395(10227):912-920. doi:10.1016/S0140-6736(20)30460-8PubMedGoogle
ScholarCrossref
6.
Loades ME, Chatburn E, Higson-Sweeney N, et al. Rapid systematic review:
the impact of social isolation and loneliness on the mental health of children
and adolescents in the context of COVID-19. J Am Acad Child Adolesc
Psychiatry. 2020;59(11):1218-1239.e3. doi:10.1016/j.jaac.2020.05.009Google
ScholarCrossref
7.
Golberstein E, Wen H, Miller BF. Coronavirus disease 2019 (COVID-19) and
mental health for children and adolescents. JAMA Pediatr.
2020;174(9):819-820. doi:10.1001/jamapediatrics.2020.1456
ArticlePubMedGoogle ScholarCrossref
8.
Racine N, Cooke JE, Eirich R, Korczak DJ, McArthur B, Madigan S.
Child and adolescent mental illness during COVID-19: a rapid review.
Psychiatry Res. 2020;292:113307. doi:10.1016/j.psychres.2020.113307PubMedGoogle
Scholar
9.
Singh S, Roy D, Sinha K, Parveen S, Sharma G, Joshi G. Impact of
COVID-19 and lockdown on mental health of children and adolescents: a narrative
review with recommendations. Psychiatry Res. 2020;293:113429.
doi:10.1016/j.psychres.2020.113429PubMedGoogle Scholar
10.
Zhang L, Zhang D, Fang J, Wan Y, Tao F, Sun Y. Assessment of mental
health of Chinese primary school students before and after school closing and
opening during the COVID-19 pandemic. JAMA Netw Open. 2020;3(9):e2021482.
doi:10.1001/jamanetworkopen.2020.21482
ArticlePubMedGoogle Scholar
11.
Hafstad GS, Sætren SS, Wentzel-Larsen T, Augusti E. Adolescents’
symptoms of anxiety and depression before and during the Covid-19 outbreak: a
prospective population-based study of teenagers in Norway. Lancet Reg Health
Eur. 2021;5:100093. doi:10.1016/j.lanepe.2021.100093Google Scholar
12.
Yue J, Zang X, Le Y, An Y. Anxiety, depression and PTSD among children
and their parent during 2019 novel coronavirus disease (COVID-19) outbreak in
China. Curr Psychol. 2020;1-8.PubMedGoogle Scholar
13.
Giannopoulou I, Efstathiou V, Triantafyllou G, Korkoliakou P, Douzenis
A. Adding stress to the stressed: senior high school students’ mental health
amidst the COVID-19 nationwide lockdown in Greece. Psychiatry Res.
2021;295:113560. doi:10.1016/j.psychres.2020.113560PubMedGoogle Scholar
14.
Merikangas KR, He JP, Burstein M, et al. Lifetime prevalence of mental
disorders in U.S. adolescents: results from the National Comorbidity Survey
Replication—Adolescent Supplement (NCS-A). J Am Acad Child Adolesc
Psychiatry. 2010;49(10):980-989. doi:10.1016/j.jaac.2010.05.017PubMedGoogle
ScholarCrossref
15.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental
Disorders. 5th ed. American Psychiatric Association; 2013.
16.
Courtney D, Watson P, Battaglia M, Mulsant BH, Szatmari P. COVID-19
impacts on child and youth anxiety and depression: challenges and
opportunities. Can J Psychiatry. 2020;65(10):688-691.
doi:10.1177/0706743720935646PubMedGoogle ScholarCrossref
17.
Zhou SJ, Zhang LG, Wang LL, et al. Prevalence and socio-demographic
correlates of psychological health problems in Chinese adolescents during the
outbreak of COVID-19. Eur Child Adolesc Psychiatry. 2020;29(6):749-758.
doi:10.1007/s00787-020-01541-4PubMedGoogle ScholarCrossref
18.
Magson NR, Freeman JYA, Rapee RM, Richardson CE, Oar EL, Fardouly J.
Risk and protective factors for prospective changes in adolescent mental health
during the COVID-19 pandemic. J Youth Adolesc. 2021;50(1):44-57.
doi:10.1007/s10964-020-01332-9PubMedGoogle ScholarCrossref
19.
Xie X, Xue Q, Zhou Y, et al. Mental health status among children in home
confinement during the coronavirus disease 2019 outbreak in Hubei Province,
China. JAMA Pediatr. 2020;174(9):898-900.
doi:10.1001/jamapediatrics.2020.1619
ArticlePubMedGoogle ScholarCrossref
20.
Duan L, Shao X, Wang Y, et al. An investigation of mental health status
of children and adolescents in China during the outbreak of COVID-19. J
Affect Disord. 2020;275:112-118. doi:10.1016/j.jad.2020.06.029PubMedGoogle
ScholarCrossref
21.
Pierce M, McManus S, Jessop C, et al. Says who? the significance of
sampling in mental health surveys during COVID-19. Lancet Psychiatry.
2020;7(7):567-568. doi:10.1016/S2215-0366(20)30237-6PubMedGoogle ScholarCrossref
22.
Klein R. Parent-child agreement in clinical assessment of anxiety and other
psychopathology: a review. J Anxiety Disord. 1991;5(2):187-198.
doi:10.1016/0887-6185(91)90028-RGoogle ScholarCrossref
23.
Edelbrock C, Costello AJ, Dulcan MK, Conover NC, Kala R. Parent-child
agreement on child psychiatric symptoms assessed via structured interview. J
Child Psychol Psychiatry. 1986;27(2):181-190.
doi:10.1111/j.1469-7610.1986.tb02282.xPubMedGoogle ScholarCrossref
24.
Hawes MT, Szenczy AK, Olino TM, Nelson BD, Klein DN. Trajectories of
depression, anxiety and pandemic experiences: a longitudinal study of youth in
New York during the spring-summer of 2020. Psychiatry Res. 2021;298:113778.
doi:10.1016/j.psychres.2021.113778PubMedGoogle Scholar
25.
Cost KT, Crosbie J, Anagnostou E, et al. Mostly worse, occasionally
better: impact of COVID-19 pandemic on the mental health of Canadian children
and adolescents. Eur Child Adolesc Psychiatry. 2021.
doi:10.1007/s00787-021-01744-3PubMedGoogle Scholar
26.
MacTavish A, Mastronardi C, Menna R, et al. The acute impact of the
COVID-19 pandemic on children’s mental health in southwestern Ontario.
PsyArXiv. Preprint posted online September 19, 2020. doi:10.31234/osf.io/5cwb4
27.
Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred
reporting items for systematic reviews and meta-analyses: the PRISMA
statement. PLoS Med. 2009;6(7):e1000097.
doi:10.1371/journal.pmed.1000097PubMedGoogle Scholar
28.
Ebesutani C, Bernstein A, Martinez JI, Chorpita BF, Weisz JR. The
youth self report: applicability and validity across younger and older youths.
J Clin Child Adolesc Psychol. 2011;40(2):338-346.
doi:10.1080/15374416.2011.546041PubMedGoogle ScholarCrossref
29.
National Heart, Lung, and Blood Institute. Study quality assessment tools:
quality assessment tool for observational cohort and cross-sectional studies.
Accessed July 6, 2021.
https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools
30.
Borenstein M, Hesdges L, Higgins J, Rothstein H. Introduction to
Meta-Analysis. Wiley; 2009.
31.
Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis
detected by a simple, graphical test. BMJ. 1997;315(7109):629-634.
doi:10.1136/bmj.315.7109.629PubMedGoogle ScholarCrossref
32.
AlAzzam M, Abuhammad S, Abdalrahim A, Hamdan-Mansour AM. Predictors of
depression and anxiety among senior high school students during COVID-19
pandemic: the context of home quarantine and online education. J Sch Nurs.
2021;1059840520988548.PubMedGoogle Scholar
33.
Asanov I, Flores F, McKenzie D, Mensmann M, Schulte M.
Remote-learning, time-use, and mental health of Ecuadorian high-school students
during the COVID-19 quarantine. World Dev. 2021;138:105225.
doi:10.1016/j.worlddev.2020.105225PubMedGoogle Scholar
34.
Cao Y, Huang L, Si T, Wang NQ, Qu M, Zhang XY. The role of
only-child status in the psychological impact of COVID-19 on mental health of
Chinese adolescents. J Affect Disord. 2021;282:316-321.
doi:10.1016/j.jad.2020.12.113PubMedGoogle ScholarCrossref
35.
Cheah CSL, Wang C, Ren H, Zong X, Cho HS, Xue X. COVID-19 racism
and mental health in Chinese American families. Pediatrics.
2020;146(5):e2020021816. doi:10.1542/peds.2020-021816PubMedGoogle Scholar
36.
Chen F, Zheng D, Liu J, Gong Y, Guan Z, Lou D. Depression and
anxiety among adolescents during COVID-19: a cross-sectional study. Brain
Behav Immun. 2020;88:36-38. doi:10.1016/j.bbi.2020.05.061PubMedGoogle
ScholarCrossref
37.
Chen S, Cheng Z, Wu J. Risk factors for adolescents’ mental health during
the COVID-19 pandemic: a comparison between Wuhan and other urban areas in
China. Global Health. 2020;16(1):96.
doi:10.1186/s12992-020-00627-7PubMedGoogle ScholarCrossref
38.
Chi X, Liang K, Chen ST, et al. Mental health problems among Chinese
adolescents during the COVID-19: the importance of nutrition and physical
activity. Int J Clin Health Psychol. 2021;21(3):100218.
doi:10.1016/j.ijchp.2020.100218PubMedGoogle Scholar
39.
Crescentini C, Feruglio S, Matiz A, et al. Stuck outside and inside: an
exploratory study on the effects of the COVID-19 outbreak on Italian parents and
children’s internalizing symptoms. Front Psychol. 2020;11:586074.
doi:10.3389/fpsyg.2020.586074PubMedGoogle Scholar
40.
Dong H, Yang F, Lu X, Hao W. Internet addiction and related
psychological factors among children and adolescents in China during the
coronavirus disease 2019 (COVID-19) epidemic. Front Psychiatry.
2020;11:00751. doi:10.3389/fpsyt.2020.00751PubMedGoogle ScholarCrossref
41.
Garcia de Avila MA, Hamamoto Filho PT, Jacob FLDS, et al. Children’s
anxiety and factors related to the COVID-19 pandemic: an exploratory study using
the Children’s Anxiety Questionnaire and the Numerical Rating Scale. Int J
Environ Res Public Health. 2020;17(16):E5757.
doi:10.3390/ijerph17165757PubMedGoogle Scholar
42.
Glynn LM, Davis EP, Luby JL, Baram TZ, Sandman CA. A predictable home
environment may protect child mental health during the COVID-19 pandemic.
Neurobiol Stress. 2021;14:100291. doi:10.1016/j.ynstr.2020.100291PubMedGoogle
Scholar
43.
Hou TY, Mao XF, Dong W, Cai WP, Deng GH. Prevalence of and factors
associated with mental health problems and suicidality among senior high school
students in rural China during the COVID-19 outbreak. Asian J Psychiatr.
2020;54:102305. doi:10.1016/j.ajp.2020.102305PubMedGoogle Scholar
44.
Li W, Zhang Y, Wang J, et al. Association of home quarantine and mental
health among teenagers in Wuhan, China, during the COVID-19 pandemic. JAMA
Pediatr. 2021;175(3):313-316. doi:10.1001/jamapediatrics.2020.5499
ArticlePubMedGoogle ScholarCrossref
45.
Luthar SS, Ebbert AM, Kumar NL. Risk and resilience during COVID-19: a
new study in the Zigler paradigm of developmental science. Dev Psychopathol.
2021;33(2):565-580.PubMedGoogle ScholarCrossref
46.
McGuine TA, Biese KM, Petrovska L, et al. Mental health, physical
activity, and quality of life of us adolescent athletes during COVID-19-related
school closures and sport cancellations: a study of 13 000 athletes. J Athl
Train. 2020. doi:10.4085/478-20PubMedGoogle Scholar
47.
Murata S, Rezeppa T, Thoma B, et al. The psychiatric sequelae of the
COVID-19 pandemic in adolescents, adults, and health care workers. Depress
Anxiety. 2021;38(2):233-246. doi:10.1002/da.23120PubMedGoogle ScholarCrossref
48.
Orgilés M, Espada JP, Delvecchio E, et al. Anxiety and depressive
symptoms in children and adolescents during COVID-19 pandemic: a transcultural
approach. Psicothema. 2021;33(1):125-130.PubMedGoogle Scholar
49.
Ravens-Sieberer U, Kaman A, Erhart M, Devine J, Schlack R, Otto C.
Impact of the COVID-19 pandemic on quality of life and mental health in
children and adolescents in Germany. Eur Child Adolesc Psychiatry. 2021.
doi:10.1007/s00787-021-01726-5PubMedGoogle Scholar
50.
Tang S, Xiang M, Cheung T, Xiang YT. Mental health and its correlates
among children and adolescents during COVID-19 school closure: the importance of
parent-child discussion. J Affect Disord. 2021;279:353-360.
doi:10.1016/j.jad.2020.10.016PubMedGoogle ScholarCrossref
51.
Zhou J, Yuan X, Qi H, et al. Prevalence of depression and its
correlative factors among female adolescents in China during the coronavirus
disease 2019 outbreak. Global Health. 2020;16(1):69.
doi:10.1186/s12992-020-00601-3PubMedGoogle ScholarCrossref
52.
Zhang Z, Zhai A, Yang M, et al. Prevalence of depression and anxiety
symptoms of high school students in Shandong province during the COVID-19
epidemic. Front Psychiatry. 2020;11:570096.
doi:10.3389/fpsyt.2020.570096PubMedGoogle Scholar
53.
Zhang C, Ye M, Fu Y, et al. The psychological impact of the COVID-19
pandemic on teenagers in China. J Adolesc Health. 2020;67(6):747-755.
doi:10.1016/j.jadohealth.2020.08.026PubMedGoogle ScholarCrossref
54.
Masonbrink AR, Hurley E. Advocating for children during the COVID-19 school
closures. Pediatrics. 2020;146(3):e20201440.
doi:10.1542/peds.2020-1440PubMedGoogle Scholar
55.
Schaller J, Zerpa M. Short-run effects of parental job loss on child
health. Am J Health Econ. 2019;5(1):8-41. doi:10.1162/ajhe_a_00106Google
ScholarCrossref
56.
Marques L, Robinaugh DJ, LeBlanc NJ, Hinton D. Cross-cultural
variations in the prevalence and presentation of anxiety disorders. Expert
Rev Neurother. 2011;11(2):313-322. doi:10.1586/ern.10.122PubMedGoogle
ScholarCrossref
57.
Rzymski P, Nowicki M, Mullin GE, et al. Quantity does not equal quality:
scientific principles cannot be sacrificed. Int Immunopharmacol.
2020;86:106711. doi:10.1016/j.intimp.2020.106711PubMedGoogle Scholar
58.
Essau CA, Lewinsohn PM, Seeley JR, Sasagawa S. Gender differences in
the developmental course of depression. J Affect Disord.
2010;127(1-3):185-190. doi:10.1016/j.jad.2010.05.016PubMedGoogle ScholarCrossref
59.
Riecher-Rössler A. Sex and gender differences in mental disorders. Lancet
Psychiatry. 2017;4(1):8-9. doi:10.1016/S2215-0366(16)30348-0PubMedGoogle
ScholarCrossref
60.
Oldehinkel AJ, Verhulst FC, Ormel J. Mental health problems during
puberty: Tanner stage-related differences in specific symptoms: the TRAILS
study. J Adolesc. 2011;34(1):73-85.
doi:10.1016/j.adolescence.2010.01.010PubMedGoogle ScholarCrossref
61.
Hall-Lande JA, Eisenberg ME, Christenson SL, Neumark-Sztainer D. Social
isolation, psychological health, and protective factors in adolescence.
Adolescence. 2007;42(166):265-286.PubMedGoogle Scholar
62.
Christakis DA, Van Cleve W, Zimmerman FJ. Estimation of US children’s
educational attainment and years of life lost associated with primary school
closures during the coronavirus disease 2019 pandemic. JAMA Netw Open.
2020;3(11):e2028786. doi:10.1001/jamanetworkopen.2020.28786
ArticlePubMedGoogle Scholar
63.
Madigan S, Racine N, Cooke JE, Korczak DJ. COVID-19 and telemental
health: benefits, challenges, and future directions. Can Psychol.
2021;62(1):5-11. doi:10.1037/cap0000259Google ScholarCrossref
64.
Webb Hooper M, Nápoles AM, Pérez-Stable EJ. COVID-19 and racial/ethnic
disparities. JAMA. 2020;323(24):2466-2467. doi:10.1001/jama.2020.8598
ArticlePubMedGoogle ScholarCrossref
65.
Hawke LD, Hayes E, Darnay K, Henderson J. Mental health among
transgender and gender diverse youth: an exploration of effects during the
COVID-19 pandemic. Psychol Sex Orientat Gend Divers. Published online
February 4, 2021. doi:10.1037/sgd0000467Google Scholar
66.
Craig S, Ames ME, Bondi BC, Pepler DJ. Canadian Adolescents’ mental health and
substance use during the covid-19 pandemic: associations with COVID-19
stressors. PsyArXiv. Preprint posted online September 9, 2020.
doi:10.31234/osf.io/kprd9
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