| Responses |
No. (%) |
|
Measures taken to reduce anxietya |
|
| Music |
88 (21) |
| Talking to friends |
73 (17.3) |
| Talking to parents |
51 (12) |
| Hobbies |
123 (29) |
| Physical exercise |
35 (8.3) |
|
What are you missing most?b |
|
| Freedom to move out |
140 (33) |
| School |
79 (18.7) |
| Friends |
133 (31.5) |
| Sports |
48 (11.4) |
|
What is the first thing you do once the lockdown is over?c |
|
| Meet friends |
279 (66) |
| Stay at home |
66 (15.6) |
| aReading and
playing games on mobile phone in 4.7% each, and sleeping more in
3%; bshopping (3%) and movies in theater (2.4%);
cGo shopping (6.6%), and organize a party or go to watch
movie in 5.9% each. |
Of these, 130 (30.7%) children had psychosocial
problems, of which 107 (25.2%) had anxiety or depressive symptoms, the
common reasons being fear of acquiring COVID-19 infection (60%), not
able to attend school (56%), and not able to meet friends (80%). Of
others, 23 (5.4%) were feeling hopeless, 107 (25.2%) seemed to be having
less fun, and 99 (23.4%) were feeling sad or unhappy. Around a quarter
(24.3%) were worrying a lot and 12.5% were ‘down on oneself.’
Of the remaining, 246 (58%) children were happy to
spend more time with family, 140 (33%) did not feel any anything
unusual, while 32 children (7.6%) children were annoyed by the constant
presence of parents.
The topic of discussion with friends was COVID-19
pandemic in 43 (10%) children and 103 children (23.2%) kept a daily
count of patients suffering and dying from COVID-19. All children
responded that they had not anticipated this happening, and 267 (63%)
children felt that this lockdown will change their habits, mind set or
outlook towards other people.
Binary regression analysis showed that duration of
lockdown, family size, siblings, working status of parents, healthcare
status of parents, source of information of pandemic etc did not have
any significant effect on mental health (anxiety or depression).
However, increased use of social media was associated with higher risk
of anxiety or depressive symptoms [OR (95% CI) 1.83 (1.21 to 3.96); P=0.001]
We found that anxiety or depressive symptoms were
seen in nearly 25% of all surveyed children as a result of lockdown. We
started the survey after completing 4 weeks of lockdown and finished by
8 weeks after which the lockdown restrictions were relaxed. Completing
the study within lockdown time ensured that children were able to answer
all questions with complete clarity and lack of memory lapses. We did
not find any relation between duration of lockdown and impact on mental
health symptoms. Nearly half of this lockdown period coincided with the
regular summer break for most children. So, it is possible that the
impact is less due to this overlap.
Interestingly, we found that higher usage of social
media platforms was associated with anxiety or depressive symptoms.
However, it can also be argued that children with mental health issues
were more likely to access social media rather than use of social media
being the cause of mental health issues. We restricted to children age
11 years or more of age since the cognitive function and social skills
are better developed in this age group [4], and proxy-reporting is
avoided [3].
The data is self-reported and hence subject to
reporting bias. Also, the children may have been influenced by other
family members though they were requested to not seek help while
answering questions. This is not a truly representative sample since the
children interviewed are from private English-medium schools, which
typically represents upper-middle socioeconomic strata. None of the
interviewed children had COVID-positive patients in the family. We do
not know if this effect on mental health is a temporary phenomenon but
these children will need to be followed up for long term effects.
Majority of the children were optimistic about long term outlook,
leading us to believe that adverse impact on mental health may be
short-lived.
The study results are important to healthcare
providers, parents as well as policy makers. Policy makers should devise
ways to minimize these effects while implementing a lockdown (home
confinement) on children. Parents and health providers should recognize
these problems early and treat if necessary.
Contributors: SS: designed the questionnaire,
data interpretation and analysis. Critical appraisal of the manuscript
was done by him; AK: conceptualized this study, designed the
questionnaire and interviewed the children, assisted in the data
interpretation and analysis, and drafted the manuscript. RS: gave inputs
on the questionnaire, interviewed the children, did the data entry and
drafted the manuscript. SM: helped in interviewing the children, data
entry, and in drafting of the manuscript. All authors approved the final
manuscript.
Ethics clearance: Surya Hospital Scientific
research and ethical review committee on 1 April, 2020.
Funding: None; Competing interests: None
stated.
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2. Murphy JM, Bergmann P, Chiang C, et al. The
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improving data quality. In: Lyberg L, Biemer P, Collins M, et al.
eds. Sur-vey Measurement and Process Quality. Wiley, 1997: 331-50.
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