Fatimah Sri Ayu Bijak Lestari Assagaf 1

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Psychiatry Research 317 (2022) 114814
Contents lists available at ScienceDirect
Psychiatry Research
journal homepage: www.elsevier.com/locate/psychres
Review article
Global burden of mental health problems among children and adolescents

during COVID-19 pandemic: An umbrella review
M. Mahbub Hossain a, b, *, Fazilatun Nesa c, Jyoti Das c, Roaa Aggad d, Samia Tasnim d,
Mohan Bairwa e, Ping Ma d, Gilbert Ramirez f
a
Department of Decision and Information Sciences, C.T. Bauer College of Business, University of Houston, Houston, TX 77204, USA
b
Department of Health Systems and Population Health Sciences, Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, TX 77204, USA
c
Research Initiative for Health Equity, Khulna, Bangladesh
d
School of Public Health, Texas A&M University, College Station, TX 77840, USA
e
All Indian Institute of Medical Sciences, New Delhi, India
f
Robert Stempel College of Public Health and Social Work, Florida International University, FL 33174, USA
A R T I C L E I N F O A B S T R A C T
Keywords: Mental health problems among children and adolescents are increasingly reported amidst the coronavirus disease
Mental health (COVID-19) pandemic. In this umbrella review, we aimed to synthesize global evidence on the epidemiologic
Psychiatry burden and correlates of child and adolescent mental health (CAMH) problems during this pandemic from
Psychology
existing systematic reviews and meta-analyses. Adopting the Joanna Briggs Institute (JBI) methodology, we
COVID-19
evaluated 422 citations and identified 17 eligible reviews with medium to high methodological quality. Most of
Pandemic
Child health the reviews reported a high prevalence of anxiety, depression, sleep disorders, suicidal behavior, stress-related
Adolescent health disorders, attention-deficit/hyperactivity disorder, and other mental health problems. Also, factors associated
Systematic review with CAMH such as age, gender, place of residence, educational attainment, household income, sedentary life
Meta-analysis style, social media and internet use, comorbidities, family relationships, parents’ psychosocial conditions,
Umbrella review COVID-19 related experiences, closure of schools, online learning, and social support were reported across re
views. As most studies were cross-sectional and used nonrepresentative samples, future research on represen
tative samples adopting longitudinal and intervention designs is needed. Lastly, multipronged psychosocial care
services, policies, and programs are needed to alleviate the burden of CAMH problems during and after this
pandemic.
1. Introduction systematic reviews and meta-analyses found that preventive measures

such as quarantine and isolation for infection prevention may have
The world has become acquainted with the coronavirus disease 2019 immediate and prolonged mental health impacts (Hossain et al., 2020a).
(COVID-19) pandemic that has triggered a wide range of biological, This evidence suggests ongoing and future mental health crises associ
psychological, and socioeconomic consequences globally (Bashir et al., ated with this pandemic that should be investigated and addressed
2020; Bialek et al., 2020; Fauci et al., 2020). A growing body of across various population groups globally.
empirical research informs a high burden of mental health problems in Mental health problems in childhood and adolescence are unique as
recent times that is increasingly recognized as a psychiatric epidemic they have versatile correlates and may have long-term health bio
synergistically occurring alongside this pandemic (Hossain et al., 2020; psychosocial consequences (Bassuk et al., 2015; Lund et al., 2018;
Robinson et al., 2022). Several reviews suggested a heavy psychosocial Yoshikawa et al., 2012). The global prevalence of mental health disor
impact of COVID-19 pandemic resulting in mental health problems such ders in children and adolescents has been inconsistent yet high across
as anxiety, depression, posttraumatic stress disorders (PTSD), and sleep previous syntheses of research (Polanczyk et al., 2015; Silva et al.,
disorders (Hessami et al., 2020; Ren et al., 2020; Robinson et al., 2022; 2020). Specifically, several childhood mental health problems,
Şimşir et al., 2021; Wu et al., 2021). An umbrella review of eight including depression and anxiety, have become highly prevalent over
* Corresponding author at: Department of Decision and Information Sciences, C.T. Bauer College of Business, University of Houston, Houston, TX 77204, USA.
E-mail address: mhossa25@central.uh.edu (M.M. Hossain).
https://doi.org/10.1016/j.psychres.2022.114814
Received 22 April 2022; Received in revised form 24 August 2022; Accepted 26 August 2022
Available online 28 August 2022
0165-1781/Published by Elsevier B.V.
M.M. Hossain et al. Psychiatry Research 317 (2022) 114814
the past years (Bassuk et al., 2015; Polanczyk et al., 2015; Silva et al., 2. Methodology
2020; Wu et al., 2021). For example, a recent study found that the
incidence of depression or anxiety in ages 6 to 17 has risen from 5.4% in 2.1. Guidelines, data sources, and search strategy
2003 to 8.4% in 2011–2012 in the US (Bitsko et al., 2018). Another
study that was published in 2010 reported that 1 in 5 US children In this umbrella review, we have followed the Preferred Reporting
experience a serious or debilitating mental health problem in their Items for Systematic Reviews and Meta-analyses (PRISMA) guideline
lifetime (Merikangas et al., 2010). Similar studies from Canada (Page et al., 2021) and the Joanna Briggs Institute (JBI) recommenda
(Gadermann et al., 2022; Spady et al., 2001), Europe (Deighton et al., tions (Aromataris et al., 2020). The conduct of an umbrella review aims
2019; Kovess-Masfety et al., 2016), and Australia (Kamieniecki, 2001; to address the broader scope of a scholarly topic and related issues
Sawyer et al., 2018) suggest comparative high burden of child and presenting a wide picture of existing evidence. Umbrella reviews iden
adolescent mental health (CAMH) problems. Moreover, countries with tify and examine evidence from existing systematically conducted re
limited resources, mostly those in the global south, often lack views through a rigorous process. In this umbrella review, we conducted
high-quality evidence on mental health epidemiology. Yet, emerging an extensive literature search in PubMed/MEDLINE, APA PsycInfo,
literature from many low- and middle-income countries suggests a high Academic Search Ultimate, Cumulative Index to Nursing and Allied
burden of CAMH problems in those contexts that is a global mental Health Literature (CINAHL), Health Source- Nursing/Academic Edition,
health concern (Hossain and Purohit, 2019; Patel, 2007; Patel et al., Health Policy Reference Center, and Web of Science using a set of key
2008). These numbers are expected to increase amidst and after the words as outlined in Table 1.
COVID-19 pandemic.
The impacts of the COVID-19 pandemic on the mental health out 3. Inclusion criteria
comes of children have drawn considerable attention amongst global
researchers. Children and adolescents constitute the most vulnerable 3.1. Participants
population affected by the preventive measures for COVID-19, such as
the closure of schools, leading to reduced interaction with peers, and This review focused on children and adolescents irrespective of the
lessened opportunities for physical activity and exploration (Larsen
et al., 2021; Rajmil et al., 2021). These effects are expected to have Table 1
adverse impacts on the welfare and mental health of children through Keywords and search strategy.
sleeping disorders, depression, stress and anxiety (M. Hossain et al.,
Search Search topic Search keywords (titles, abstracts, general
2020; Larsen et al., 2021). Studies conducted across the globe provide query keywords, and subject headings)
evidence of the detrimental impact of the pandemic on the mental health
1 Condition/ outcome “mental health” OR “mental wellbeing” OR
of adolescents (Jones et al., 2021). During the COVID-19 pandemic
of interest “mental well-being” OR “mental disorder*”
lockdown, the percentage of Bangladeshi children who suffered from OR “mental illness” OR “psychiatr*” OR
mental health disturbances ranged from 43% for subthreshold distur “psychological health” OR “psychological
bances to 7.2% for severe disturbances (Yeasmin et al., 2020). In Turkey, distress” OR “psychological impact” OR
“psychological outcomes” OR “psychological
children of health workers had significantly higher anxiety levels
consequence*” OR “psychological
measured using the State-Trait Anxiety Inventory for Children (STAI-C) comorbid*” OR “psychosocial problem*” OR
than non-health workers’ children (Almis et al., 2022). In Ireland, a “behavioral problem*” OR “behavioral
qualitative study showed that adolescents and children experienced disorder*” OR “cognitive disorder*” OR
increased rates of social isolation, maladaptive behavior, anxiety, and “cognitive impairment*” OR “emotional
distress” OR “depression” OR “depressive
depression during the pandemic (O’Sullivan et al., 2021). Moreover, the
disorder*” OR “anxiety” OR “PTSD” OR
pandemic resulted in a significant psychosocial impact on Chinese ad “PTSS” OR “posttraumatic” OR
olescents and children in terms of emotional distress, with a prevalence “posttraumatic” OR “addiction” OR
of 24.9% for anxiety, 19.7% for depression, and 15.2% for stress (Tang “substance use disorders” OR “mood
disorder*” OR “affective disorder*” OR
et al., 2021). Another systematic review of Chinese studies showed that
“DSM*” OR “psychosis” OR “psychotic” OR
the prevalence of COVID-19 related posttraumatic stress, sleep disor “oppositional defiant disorder” OR
ders, anxiety, and depression were 48%, 44%, 26%, and 29%, respec “hyperactiv*” OR “conduct disorder” OR
tively (Ma et al., 2021). “obsess*” OR “phobi*” OR “schizophren*”
An increasing body of primary studies has facilitated the develop OR “bipolar disorder” OR “anorexia” OR
“bulimi*” OR “challenging behav*”
ment of many such reviews that should be synthesized to provide an
2 Population “child*” OR “adolescen*” OR “young people”
extensive overview of all CAMH problems and their associated factors. OR “school students” OR “youth” OR “teen*”
Such systematic overview of reviews, also known as umbrella reviews, 3 Exposure/ Context “Coronavirus” OR “COVID-19” OR
have become increasingly useful in understanding the evidence land “COVID19” OR “SARS-CoV-2” OR “2019
scape in a given domain (Aromataris et al., 2015). The findings of an novel coronavirus” OR “2019-nCoV”
4 Phenomenon “prevalence” OR “incidence” OR “rate” OR
umbrella review can offer a “bird’s eye” view of a scientific field that “diagno*” OR “disease burden” OR
may help evidence-based decision-making, synthesizing future evi “epidemiolog*” OR “frequen*” OR
dence, and conducting primary research on least-explored areas of “determinant*” OR “predictor*” OR
knowledge and practice (Aromataris et al., 2015; Dang and Hou, 2021; “correlate*” OR “risk factors” OR “protective
factors” OR “associated factors”
M. M. Hossain et al., 2020b). This umbrella review aimed to summarize
5 Study types “systematic review” OR “systematic literature
the global evidence on the epidemiological burden and correlates of review” OR “meta-analy*” OR “metaanaly*”
mental health problems among children and adolescents during the OR “quantitative review” OR “qualitative
COVID-19 pandemic from existing systematic reviews and review” OR “meta-synthesis” OR “pooled
meta-analyses. The results of this review can help understand and prevalence” OR “pooled estimate*” OR
“scoping review” OR “critical review” OR
address mental health problems among children and adolescents in this “integrative review” OR “evidence-based
pandemic and future public health emergencies. review” OR “synthesized evidence”
Final Intersection of four 1 AND 2 AND 3 AND 4 AND 5
search topics
query
2
age range adopted in systematic reviews and the primary studies marked heterogeneity in the methods and outcomes of the included
included in the same. For studies with mixed participants such as ado reviews. For this reason, a narrative synthesis of overall evidence on the
lescents with young adults or children as a part of other population burden of and factors associated with mental health problems in chil
groups, a decision was made prior to conducting the review about dren and adolescents during the COVID-19 pandemic was presented in
including a review if at least 70% of its studies focused on children or this review.
adolescents.
6. Assessment of methodological quality
3.2. Phenomenon of interest
In this umbrella review, we used the JBI checklist for the critical
This review studied a wide range of mental health problems, appraisal of systematic reviews and research syntheses to assess the
including but not limited to psychiatric disorders enlisted in the Diag methodological quality of studies included in this umbrella review
nostic and Statistical Manual of Mental Disorders (DSM–5) and the In (Aromataris et al., 2020, 2015). This checklist has ten items evaluating
ternational Classification of Diseases (ICD-10) Classification of Mental different methodological aspects of a systematically conducted review,
and Behavioral Disorders. To make the evidence inclusive of any prob including the appropriateness of the search strategies, the approach to
lem that affects mental health and wellbeing, this review considered synthesizing evidence, potentials sources of biases, and prospects for
research that emphasized psychosocial problems alongside psychiatric future research and policymaking. We used this ten-items checklist and
conditions. allocated one point for each item. So, the overall score of a study can
range from zero to ten. In this review, studies receiving zero to four, five
3.3. Context to seven, and eight to ten points were categorized as the low, medium,
and high-quality studies, respectively. The epidemiologic burden of
The context of this review was the COVID-19 pandemic. Therefore, CAMH and other key findings of this review were similar across reviews
studies conducted during and in the context of this pandemic were irrespective of their methodological quality.
considered eligible for this review. If a review used data collected
beyond the scope of this pandemic, it was considered ineligible for in 7. Results
clusion. Moreover, studies with mixed data from COVID-19 and previous
infectious outbreaks were reviewed carefully. In such cases, a study was 7.1. Overview of the included studies
considered eligible if at least 70% of the respondents on included studies
informed evidence in the context of COVID-19. We found a total of 422 citations using the search strategy described
earlier (See Fig. 1 for the review process). After eliminating 181 dupli
3.4. Types of studies cate citations, we retained 241 unique citations and reviewed their titles
and abstracts. A total of 24 citations met our preliminary criteria and
Any review article with a systematic approach to retrieve and syn were retained for full-text review. After full-text evaluation, 17 sys
thesize evidence was considered eligible for inclusion in this umbrella tematic reviews (Bussières et al., 2021; Chai et al., 2021; Chawla et al.,
review. This decision was made considering methodological differences 2021; Cunning and Hodes, 2022; Elharake et al., 2022; Jones et al.,
within systematically conducted review articles. Therefore, systematic 2021; Ma et al., 2021; Marchi et al., 2021; Nearchou et al., 2020; Oli
literature reviews, scoping reviews, and meta-analyses were included, veira et al., 2022; Panchal et al., 2021; Panda et al., 2021; Racine et al.,
whereas primary studies or narrative reviews without a clear review 2021; Samji et al., 2021; Sanja et al., 2021; Sharma et al., 2021; Viner
method were excluded. Moreover, articles were included in the full text et al., 2022), including 6 meta-analytic reviews (Bussières et al., 2021;
was available in the English language. Lastly, studies published from Chai et al., 2021; Ma et al., 2021; Racine et al., 2021; Sanja et al., 2021;
January 1, 2020, to December 31, 2021, were primarily included in this Sharma et al., 2021) met all criteria of this umbrella review and were
review, and the search was last updated on March 12, 2022. selected for further analysis (see Table 2).
4. Study selection 7.2. Characteristics of the included studies
We collated and uploaded all identified citations were to the cloud- Seventeen reviews included in this umbrella review used different
based screening tool Rayyan. Two reviewers independently reviewed databases for retrieving primary studies. The number of databases
those citations using the above-mentioned criteria. All conflicts were ranged from 2 to 11 with a median number of 5 databases, whereas
addressed through a discussion, and the opinion of a third reviewer was MEDLINE and WHO COVID-19 databases are the leading sources of in
taken whenever it was necessary. Articles that appeared to be qualified formation across multiple reviews.
at this stage were considered for full-text review, and a final set of ar The number of primary studies included in different reviews ranged
ticles meeting all eligibility criteria was retained for data extraction and from 5 to 102. Moreover, the sample size across studies ranged from 12
synthesis. to 1199,320 in systematic reviews, whereas a meta-analytic review used
a pooled sample of 80,879 participants (Racine et al., 2021). The ma
5. Data extraction and synthesis jority of the primary studies were cross-sectional, and online data
collection measures were widely used across studies. China was the most
We used a standardized data extraction form that included key var common source of primary studies, followed by the North American and
iables of interest such as the bibliographic information of each article, European countries. Limited primary studies were reported from LMICs
the type of the reviews, number of primary studies, databases accessed such as India, Brazil, Bangladesh, and countries from Sub-Saharan Africa
in respective reviews, characteristics of the study samples and pop (Elharake et al., 2022; Panchal et al., 2021; Panda et al., 2021; Racine
ulations, epidemiologic measures used in those studies, and finally, the et al., 2021; Samji et al., 2021; Sanja et al., 2021).
burden of mental health problems and factors associated with the same. The methodological quality of the reviews was assessed using the JBI
Two reviewers (FN and AD) conducted the data extraction indepen critical appraisal checklist (See Supplementary Material). Most of the
dently in the supervision of a third reviewer (ST). The extracted data reviews (n = 13) included in this umbrella review were of high quality
were further reviewed for accuracy and quality by another reviewer (Bussières et al., 2021; Chai et al., 2021; Chawla et al., 2021; Jones et al.,
(MMH). As this review included a wide range of systematically con 2021; Ma et al., 2021; Nearchou et al., 2020; Oliveira et al., 2022;
ducted reviews with and without quantitative synthesis, there was Panchal et al., 2021; Panda et al., 2021; Racine et al., 2021; Samji et al.,
3
Fig. 1. Flow diagram of the umbrella review process.
2021; Sharma et al., 2021; Viner et al., 2022), whereas the remaining (n CI: 17% - 40%) among children and adolescents.
= 4) reviews had medium quality (Cunning and Hodes, 2022; Elharake
et al., 2022; Marchi et al., 2021; Sanja et al., 2021). None of the reviews 8.3. Sleep disorders
were identified to have low methodological quality as per the JBI
checklist. Seven reviews reported varying magnitude of sleep disorders among
children and adolescents during this pandemic (Bussières et al., 2021;
8. Epidemiological burden of CAMH during COVID-19 Chawla et al., 2021; Ma et al., 2021; Panchal et al., 2021; Panda et al.,
2021; Sharma et al., 2021; Viner et al., 2022). For example, Panchal
8.1. Anxiety et al. (2021) reported that the prevalence of sleep disorders was 20%
and 55.9% among children and adolescents, respectively. Another re
Thirteen reviews reported a varying burden of anxiety among chil view by Sharma et al. (2021) reported a pooled prevalence of any sleep
dren and adolescents during this pandemic (Chai et al., 2021; Chawla disorders as 54% (95% CI: 50% - 57%), whereas the pooled prevalence
et al., 2021; Jones et al., 2021; Ma et al., 2021; Marchi et al., 2021; of worsening sleep quality was 27% (95% CI: 12% - 49%) and the pooled
Nearchou et al., 2020; Oliveira et al., 2022; Panchal et al., 2021; Racine estimate of abnormal sleep duration was 16% (95% CI: 5% - 40%).
et al., 2021; Samji et al., 2021; Sanja et al., 2021; Sharma et al., 2021;
Viner et al., 2022). The prevalence of anxiety ranged from 1.85% to 74% 8.4. Trauma and stress-related disorders
across primary studies included in the reviews. For example, studies
reported in the review by Panchal et al. (2021) found the prevalence of Four reviews examined the burden of posttraumatic stress disorders
anxiety ranging from 1.85% to 49.5%. Another review by Samji et al. in different samples of children and adolescents (Elharake et al., 2022;
(2021) reported the prevalence of anxiety between 8% and 74%. A Jones et al., 2021; Ma et al., 2021; Oliveira et al., 2022). For example,
meta-analytic review by Racine et al. (2021) found that 20.5% (95% CI: Ma et al. (2021) found a pooled prevalence of PTSD as 48%, whereas
17% - 24%) participants had anxiety disorders during this pandemic. another review by Jones et al. (Jones et al., 2021) found that adolescents
experienced a high effect size of PTSD (beta = 0.16 to 0.27). Another
8.2. Depression review by Elharake et al. (2022) found that 30.8% to 67.05% of the
study samples had PTSD symptoms among young people amidst the
Among the included studies, thirteen reviews and meta-analyses COVID-19 pandemic. Moreover, three reviews have reported a varying
evaluated a high prevalence of depression among children and adoles burden of psychological distress and stress-related disorders (Elharake
cents ranging from 2% to 71.5% (Chai et al., 2021; Chawla et al., 2021; et al., 2022; Oliveira et al., 2022; Panda et al., 2021). For example,
Elharake et al., 2022; Jones et al., 2021; Ma et al., 2021; Marchi et al., Oliveira et al. (2022) reported that 7% to 25% of children and adoles
2021; Oliveira et al., 2022; Panchal et al., 2021; Panda et al., 2021; cents experienced stress-related disorders amidst this pandemic.
Racine et al., 2021; Samji et al., 2021; Sanja et al., 2021; Viner et al.,
2022). For example, Marchi et al. (2021) found that the prevalence of 8.5. Suicidal thoughts, ideations, and behavior
depression was between 2% and 4% across the reviewed literature.
Another review by Oliveira et al. (2022) reported the prevalence of Four reviews studied the burden of suicidal thoughts, ideations, and
depression between 6.3% and 71.5%. A meta-analytic review by Ma self-harm behavior among children and adolescents during this
et al. (2021) reported the pooled prevalence of depression as 29% (95% pandemic (Oliveira et al., 2022; Panchal et al., 2021; Samji et al., 2021;
4
Table 2
Overview of evidence from existing systematic reviews and meta-analyses on CAMH problems during COVID-19.
Author and Name(s) and Number of Sample sizes in the Methodological Characteristics of the Burden of mental Factors associated
year timeframe of primarystudies; includedprimary quality score study populations health (prevalence, with children and
ofPublication searchingDatabases type of review studies (total or and rating (demographics, rate, correlates or adolescent mental
(meta-analysis rangeas reported in recruitmentstrategy, any quantitative health in respective
orsystematic respectivereviews) and location) measures of studies
review) epidemiologic
burden)
Nearchou APA PsycInfo, 12; Systemic Sample size range 8 (High) The study focused on The prevalence of Factors like fear of
et al. MEDLINE, CINAHL, Review from 17 to 8072. human participant ≤18 depression and affecting with
(2020) Scopus, years old; applied anxiety in young Covid-19, social
PubMed, Embase, quantitative cross- people ranged from distancing, Covid-
ERIC, and the WHO sectional design; data 22.6% to 43.7%. 19 circumstances,
Global Health collected through and 18.9% to 37.4% and emergencies
database till June online and open access respectively. were found to be
2020 forum; conducted in Moreover, among associated with
China, Italy, Poland, children and mental health
Turkey, and United adolescent 22%− outcome. However,
State 62.2% were found some positive
to have Covid-19 domains were
related emotional found such as
reaction as well as belongingness,
2.39%− 22% in relationship with
terms of having peer, hope,
somatic syndrome meaning of life, life
satisfaction.
Panda et al. MEDLINE, Embase, 15; Systemic Sample size range 9 (High) The study included Studies had found Studies found
(2021) Web of Science, Review from 50 to 8079 children up to 18 year 79.4% children multiple associated
CENTRAL, medRxiv and their caregiver; were found to have factors like female,
and bioRxiv till participants are psychological state urban citizen,
August 2020 recruited through due to the pandemic clinical depression
direct and online while 22.5%, level, family
interview; studies were 35.2%, 21.3% member infected
cross-sectional design suffered from fear of with covid-19, non-
from France Italy, covid-19 infection, medical
China, India Hong boredom, and sleep occupation, poor
Kong, Brazil, Turkey, disturbance academic records,
Bangladesh and Korea respectively. addicted to internet
were reported Overall, 34.5%, or smartphone. On
41.7%, 42.3% and the other hand,
30.8% of children higher exercise,
were found to be knowledge on
suffering from covid-19,
anxiety, depression, prevention, and
irritability, and control measures,
inattention. having siblings
Similarly, 52.3% found to be
and 27.4% of protective factors.
caregivers
developed anxiety
and depression,
respectively.
Bussières MEDLINE, ERIC, APA 28; Meta- Sample size ranges 10 (High) Children aged 5–13 Studies found that
et al. PsycInfo, and Google Analysis from 12 to 8124; years old (including children
(2021) Scholar till June 2021 total of 14,209 pre-existing conditions demonstrated
participants. like ASD, epilepsy, longer sleeping
obesity) were recruited; hours (g = 0.324;
The quantitative 95% CI [0.10, 0.55];
synthesis of cross p = 0.004; k = 9)
sectional, longitudinal and higher levels of
and retrospective both internalized (g
studies done; most = 0.215; 95% CI
study were from [0.06, 0.37]; p <
European countries 0.001; k = 19) and
followed by middle east externalized (g =
then America 0.141 (95% CI
[0.08, 0.21]; p <
0.01; k = 15)
symptoms during
lockdown. effect
sizes in studies
where the child was
the informant (g =
0.57; 95% CI
[− 0.36, 1.50]; p =
0.23; k = 3)
(continued on next page)
5
Table 2 (continued )
burden)
Chai et al. PubMed, Web of 12; Meta- Total sample size 9 (High) The studies recruited The pooled The percentage of
(2021) Science, APA Analysis 34,276. Sample size Chinese children and prevalence of boy participants
PsycInfo, Google ranges from 396 to adolescents; all data mental problems was found to be an
Scholar, and the 8079. collected through was 28% (95% associated
China National online measures; confidence interval, moderator factor.
Knowledge Studies were conducted CI: 0.22–0.34) while
Infrastructure (CNKI) in China for depression it was
till March 2021 22% (95% CI:
0.16–0.30) and for
anxiety it was 25%
(95% CI: 0.20–0.32)
Chawla et al. PubMed, Cochrane, 102; Systemic Sample size ranges 9 (High) The children/ Studies found Being women and
(2021) WHO global health review from 61 to 10,000. adolescents with mostly 10%− 30% older aged found to
research till March psychological effects, participants be aggravating
2021 communication issues, suffered from factor for anxiety
stress different level of and depression.
or sleep disturbances depression and Furthermore,
were recruited; Age of anxiety. factors like reduced
participants ranges physical activity,
from pre-schoolers to increased internet
24; Online survey and use, screen time
telephone interview and social media
were conducted; Most use, sedentary
of the studies were lifestyle were
cross sectional or associated with
retrospective design severe anxiety.
and recruited According to most
participants from China of the studies,
reduced sleep
latency, increased
sleep time as well
as reduced sleep
quality was
correlated with the
condition.
Cunning PubMed, MEDLINE, 6; Systemic Sample size ranges 5 (Medium) The children and The prevalence of Being female
et al. APA PsycInfo, AMED, review from 101 to 600 adolescent under age OCD among seemed to be an
(2022) BNI, CINAHL, participants 21 having symptoms of adolescents ranged exaggerating factor
Embase, EMCare and OCD were included in from 44.6% to 73% with slightly higher
HMIL till January this study; recruitment causing prevalence (72.1%)
2021 strategies were not exaggerating than men. Studies
specified, the studies symptoms found some more
were conducted in associated factors
Denmark, Israel, the like family history
USA, Turkey, and Iran of ADHD, financial
strain, or new
unemployment,
increased age,
family
accommodation.
Sanja et al. Ovid MEDLINE, 27; Meta- Total sample size 7 (Medium) The study recruited After pandemic, the Factors to increase
(2021) Embase, Global Analysis 52,797. children and prevalence of anxiety and
Health and APA adolescents from 6 to anxiety is 49.5% depression level are
PsycInfo till 19 years old (54.12% and severe anxiety female gender
November 2020 were female); is 20.5% (p < (32.2%, M = 2.85,
recruitment strategies 0.0001), for SE = 0.06),
were not specified; depression it is 16% smartphone and
conducted in Asia among adolescents internet addiction,
(20%), Europe (50%), low family income,
America (20%0, Africa perceived threats,
(5%), Oceania (5%) higher grades at
school, loneliness,
social distancing,
poor academic
records, social
stigma, friends or
family conflict,
emotion-focused
coping.
8 (High)
6
burden)
Jones et al. EBSCOhost, 16; Systemic Sample sizes varied 13–17 years old The pandemic Factors which
(2021) MEDLINE, APA Review from 102 to 9554. adolescents along with increased the worsened the
PsycInfo, APA Psych mental illness were likelihood of condition by social
articles, Socindex, included in this study; anxiety (OR = 2.29, media (OR = 1.8,
and CINAHL till 75% studies conducted 95% CI: 1.94–2.48 95% CI: 1.29–2.8)
January 2021 through online for low support, OR and internet
measures, and 25% not = 3.18, 95% CI: addiction (OR =
clearly reported; 2.54–3.98 for 3.1 95% CI:
recruited in China, UK, moderate support) 1.2–7.7). Female
the USA, Canada, and 31% of the gender, social
Germany, Japan, adolescents distancing,
Denmark and reported of negative coping
Philippine depression. Also skills, adolescents
16.3% adolescents with diagnosed
suffered from OCD (44.6%) found
psychological to worsen the
impairment and condition.
experienced higher
rates of
posttraumatic stress
disorder (PTSD)
(effect size beta =
0.16~0.27) and
higher rates of
anxiety (effect size
beta = 0.32~0.47)
Ma et al. PubMed, APA 23; Systemic Sample size vary 10 (High) The studies focused on The prevalence of Females gender
(2021) PsycInfo, and Web of review & 20; from 46 to 9554; the children and depression ranged with age between
Science, and two Meta-Analysis. total sample size adolescents age up to from 10 to 71% with 13 and 18 year
Chinese academic 57,927. 18 years, with suicidal a pooled prevalence were found to be
databases: China behavior, suicidal of 29% (95%CI: higher risk factors
National Knowledge ideation and attempt; 17%, 40%). The for both anxiety s
Infrastructure (CNKI) computer-based prevalence of (29.1%, 95%CI:
and Wanfang simulation studies with anxiety ranged from 17.1%, 41.1%, p <
September 2020 no human participants, 7%− 55% with a 0.001) and
most study were from pooled prevalence depression (33.9%,
China 2 study from of 26% (95%CI: 95%CI: 24.6%,
turkey 16%, 35%). 43.1%, p < 0.001).
Prevalence of sleep
disorder was
between 32%−
56%, with a pooled
prevalence of 44%
(95%CI: 21%, 68%).
The pooled
prevalence of PTSD
was 48% (95%CI:
− 0.25, 1.21, p =
0.200)
Marchi et al. PubMed, APA 59; Systematic 7 (Medium) The study focused on The prevalence of The protective
(2021) PsycInfo, Web of scoping review child and adolescent depression and factors found to be
Science, CINHAL, and below 18 years old; anxiety among associated with the
Social Science Study was identified in children and symptoms were
Premium Collection an iterative way; most adolescents ranges strong resilience,
till December 2020 of the study were took from 2%− 44%. And positive emotion
in China and United these symptoms regulation,
states seemed to reach physical activity,
peak around April- parental self-
May with the efficacy, family
decline by May- functioning, social
June 2020 support. On the
other hand,
negative factors to
impact were
emotional
reactivity,
experiential
avoidance,
exposure to
7
burden)
excessive
information,
internet use,
closure of schools,
social isolation,
decline support
from friend,
family’s crisis
related hardships
(such as job loss,
income loss,
caregiving burden,
and illness).
Panchal et al. Embase, Ovid, Global 61; Systemic Sample size ranges 9 (High) The children and The prevalence of Risk factors to
(2021) Health, APA PsycInfo, review from 15 to 7772. adolescent ≤19 years anxiety and increase anxiety
Web of Science, and old (female 49.7%) depression ranges and depression are
pre-print databases exposed to covid 19 from 1.85 to 49.5% lack of routine (p <
till April 1, 2021 lockdown were and 2.2% to63.8% 0.001), female sex
included in this study; respectively, (p < 0.001),
most study involved Irritability ranged adolescence (p =
participant through from 16.7%− 73.2% 0.005), excessive
self-report; studies and anger from COVID-19
were conducted across 30%− 51.1%. information (p <
5 continents, Europe (n Symptoms of ADHD 0.05), media
= 35), Asia (n = 22), ranges from 55.9% exposure (OR =
Australia(n = 1), North to 76.6% (p < 2.4), previous r
America (n = 1), South 0.001); sleeping psychiatric
America (n = 1). disorder observed treatment (OR =
among 55.6% 4.4), increased
adolescents and social media usage
20% children. In s (OR = 1.83, p =
addition, The 0.001), suffering
prevalence of non- from Autism
suicidal self-injury Spectrum Disorder,
(OR = 1.35, (p < high amount of
0.001), suicide COVID-19 cases in
ideation (OR = the area (OR = 2.3,
1.32, p = 0.008), p < 0.001), first-
suicide planning line job
(OR = 1.71, p < responsibilities
0.001), suicide related to COVID-
attempts (OR = 19 (p < 0.05). The
1.74, p < 0.001) protective was
found to be all
types of routine,
family
communication,
social support,
appropriate play,
leisure and
physical activity.
Racine et al. PsycInfo, Cochrane 29; Meta- Total sample size 9 (High) Participants up to 18 The pooled For depression, the
(2021) Central Register of Analysis 80,879; sample size years old (mean age 13 prevalence rate for rate is increased
Controlled Trials ranges from 168 to years) were included in depression and with the increased
(CENTRAL), Embase, 8079. this study; recruitment anxiety are 25.2% months of year (b
and MEDLINE till strategies were not (95% CI, 0.21–0.30) = 0.26; 95%
February 2021. specified; Studies were and 20.5% (95% CI, CI,0.06–0.46),
performed in East Asia 0.17–0.24) increased child age
(n = 16), Europe (n = respectively. The (b = 0.08; 95% CI,
4), North America (n = rate in European 0.01–0.15), for
6), South America (n = countries is higher female (b = 0.03;
2) and middle east (n = (k = 4; rate = 0.34; 95% CI,
1) 95% CI, 0.23–0.46; 0.01–0.05). Again,
P = 0.01) in For anxiety, the
comparison to East rate is increased
Asian countries (k with the increased
= 14; rate = 0.17; months of year (b
95% CI, 0.13–0.21; = 0.27; 95% CI,
P < 0.001) 0.10- 0.44), for
female (b = 0.04;
8
burden)
95% CI,
0.01–0.07).
Samji et al. MEDLINE, PsycInfo, 116; Systemic Total sample size 8 (High) The studies include The prevalence of Older age and
(2021) PubMed, Embase, review 127,923. youth up to 18 years of depression and female gender were
CINAHL, Web of age, one third of the anxiety raged from positively
Science, medRxiv, studied focused on 13%− 64% and associated the
PsyArxiv, and Scopus neurodiverse 8%− 74% symptoms. Studies
till February 2021. conditions such as ASD, respectively. found some more
ADH and OCD; studies Moreover, aggravating factors
were performed in East prevalence of like more screen
Asia, north America, suicidal ideation time, internet use,
south Asia, Australia, ranged from 6%− social media,
West Asia, South 37% and non- physical and social
America, Southeast suicidal self-injury distancing,
Asia, Sub-Saharan increased from 32% pandemic control
Africa and North Africa to 42% measures,
increased time at
home, lack of daily
routine, online
learning of
children, adverse
childhood
experiences (family
abuse, neglect, and
household
dysfunction),
covid-19 news,
suffering from ASD,
ADHD. However,
some protective
factors may
improve the
symptoms like
engaging in
hobbies, listening
to music, praying,
maintaining a
routine, physical
activity, Increasing
knowledge and
awareness of
COVID-19
prevention and
control measures.
Sharma et al. MEDLINE, Embase, 16; Meta- Total sample size 10 (High) Studies includes The pooled The positive factors
(2021) and Web of Science Analysis 21,018; sample children, adolescents prevalence of any to improve sleep
sizes ranges from and youth age ranging sleep disturbance in quality are
37 to 7736. from 6 months to 29 children during the harmonious family
years; all the studies COVID-19 atmosphere,
recruited through pandemic was 54% increased parent-
online surveys; location (95%CI: 50%− children
of the studies were not 57%). The pooled communication,
specified. prevalence of good parenting
children with practice, younger
worsening of sleep parent, parents in
quality and sleep physical activity,
duration were 27% parents
(95% CI: 12%− discouraging
49%) and 16% screen time,
(95%CI: 5%− 40%) parents
respectively. The encouraging
pooled prevalence children to sleep.
of children not The associated
meeting sleep negative factors
duration were poor maternal
recommendation factors (poor sleep
was 49% (95%CI: pattern, poor self-
39%− 58%) control, poor
control of emotion,
Maternal COVID-
9
burden)
19 anxiety),
decreased outdoor
activities, female
gender etc.
Elharake PubMed and 5; Systematic Sample size ranged 7 (Medium) Five studies included The prevalence of Risk factors
et al. Collabovid; January review from 584 to 4342 children and 16 studies depression (11.78% associated with
(2022) 2020- July 2021 included college - 22.6%), anxiety adverse mental
students with varying (18.9% - 24.9%), health outcomes in
ages; studies were from PTST (14%) and children included
China, India, France, stress (15.2%) were lower parents
Jordan, Nigeria, reported among educational
Switzerland, and the US children-based attainment and
samples. Among the having a family
college students, member infected
4.18% - 50.3% had with COVID-19.
depression, 7.7% - Moreover, among
79.66% had college students,
anxiety, 24.7% - several factors such
71% had stress, and as family financial
30.8% - 67.05% had challenges, food
PTSD symptoms. insecurity (less
than three meals
per day), living in
rural areas, closed
on infected with
COVID-19 were
associated with
poor mental health
outcomes.
Oliveira Embase, 19; Systematic More than 35,543 9 (High) 17 cross-sectional and The prevalence of Differences were
et al. Epistemonikos, review children and two cohort studies were fear (61.9%), observed between
(2022) LILACS, APA adolescents were conducted using helplessness age groups (6–18
PsycInfo, PubMed, included internet based (66.1%), worry years versus 2–8
Scopus, Web of approaches; nine (68.5%), emotional years) and
Science, WHO Covid countries were problems (27.4%), responders
database, and Google represented- most anxiety (17.6% - (parents versus
Scholar; up to studies were from 43.7%), depression self-reported)
February 1, 2021 China (6.3% - 71.5%),
stress (7% - 25%),
PTSD (85.5%),
suicidal ideation
(29.7% - 31.3%)
behavioral
problems (5.7%
− 13.9%) were
reported across the
included studies
Viner et al. PubMed, PsycInfo, 36; Systematic Studies included 9 (High) Five cohort studies, 9 No significant School closure
(2022) Web of Science Social review 79,781 children pre-post studies, one increase in UK during lockdown
Citation Index, and 18,028 parents modeling, and 21 cross- suicide rates; was studied in the
Australian Education sectional studies were however, COVID-19 included studies
Index, British included; 13 studies related problems highlighting the
Education Index, were from LMICs (8 were associated psychosocial
Education Resources from China), 11 from with 48% of the impacts of such
Information centre, UK, 4 from the US, 5 reported suicide measures. Most
WHO Global from Italy, and one deaths. The studies found
Research Database on study each from several prevalence of mental and
COVID-19, MedRxiv, countries anxiety (boys: 44%, emotional
PsyArXiv, Research girls: 53.3%, difficulties in this
Square, and COVID- overall: 10%− period, whereas a
19 Living Evidence; 21.8%), depression study with
up to September 1, (boys: 21.9%, girls: preexisting mental
2020 19.4%, overall: 17% health problems in
- 28.6%), emotional children found a
difficulties (37%), significant
suicidal ideation reduction in
(17.5% in 16–18 emotional
years compared to difficulties during
6% of pre-COVID lockdown. Child
estimates), conduct abuse reporting
10
burden)
problems (43%), and referral

hyperactivity/ services declines
inattention (41%), leading to low
insomnia (23.2%), reporting.
low life satisfaction Increased social
(18% of 2001), low media and internet
wellbeing (26.9% of use, lack of healthy
1201), child food consumption,
protection referral and low-level of
fell by 36% (156 per family education
quarter in 2019 to were reported
99 in 2020)56 to across samples.
39% (incidence rate
ratio for 2020
compared with
2018/2019 was
0.61
[95%CI,
0.43–0.86])
Viner et al., 2022). For example, Panchal et al. (2021) reported a high with 2018/2019 was 0.61 [95%CI, 0.43–0.86]), suggesting a potential
prevalence of suicide ideation (OR = 1.32, p = 0.008), suicide planning burden of child abuse and related mental health problems (Viner et al.,
(OR = 1.71, p < 0.001), suicide attempts (OR = 1.74, p < 0.001), and 2022). Overall mental and psychosocial health problems deteriorated
non-suicidal self-harm (OR = 1.35, p < 0.001). Another review by Samji across all reviews that included children, adolescents, and their family
et al. (2021) found that the prevalence of suicidal ideation ranged from caregivers in respective empirical studies.
6% to 37%, and non-suicidal self-increased from 32% to 42% during this
pandemic. Viner et al. (2022) found that the prevalence of suicidal 9. Correlates of mental health problems in children and
ideation increased to 17.5% among adolescents aged 16–18 years adolescents during COVID-19
compared to 6% of pre-COVID estimates.
Multiple factors associated with mental health problems were iden
8.6. Attention-deficit/hyperactivity disorder tified across multiple reviews that affected the mental health of children
and adolescents during this pandemic. The age of the children and ad
Several empirical studies reported the burden of attention-deficit/ olescents was reported to be associated with mental health problems in
hyperactivity disorder in children and adolescents during this different studies. For example, Chawla et al. (2021) found that older
pandemic that was synthesized in three reviews (Panchal et al., 2021; children and adolescents was an aggravating factor for anxiety and
Panda et al., 2021; Viner et al., 2022). Viner et al. (2022) found that 41% depression. Increased age was also reported as a risk factor by Cunning
of the participating children had hyperactivity/inattention, whereas and Hodes (2022), Samji et al. (2021), and Ma et al. (2021). Specifically,
Panchal et al. (2021) reported that the symptoms of ADHD ranged from Racine et al. (2021) found that increased child age was associated with a
55.9% to 76.6% (p < 0.001) among children and adolescents across higher burden of depression (b = 0.08, 95% CI: 0.01 – 0.15). Moreover,
multiple studies. Panda et al. (2021) found that 30.8% of the partici differences in mental health outcomes were observed between partici
pating children had attention-deficit symptoms alongside other mental pants aged 2–8 years and those aged 6–18 years in a review by Oliveira
health problems. et al. (2022).
Gender was associated with mental health outcomes as reported in
8.7. Other mental health problems several reviews. Chai et al. (2021) reported the percentage of boys was a
moderator of mental health outcomes across study samples. In contrast,
Several other mental health problems were reported in multiple re several reviews reported girls had a higher burden of mental health
views. Cunning et al. (Cunning and Hodes, 2022) reported that the problems during this pandemic. For example, female gender was asso
prevalence of OCD among adolescents ranged from 44.6% to 73% ciated with increased anxiety and depression level (32.2%, M = 2.85, SE
causing exaggerating symptoms. Moreover, emotional disorders were = 0.06) as reported by Sanja et al. (2021). Another review by Panchal
reported by three reviews that found 22% to 62.2% of children and et al. (2021) found that the female gender was significantly associated
adolescents experienced emotional difficulties during this pandemic with anxiety and depression (p < 0.001). Racine et al. (2021) reported
(Nearchou et al., 2020; Oliveira et al., 2022; Viner et al., 2022). A review that female participants had higher rates of depression (b = 0.03, 95%
by Nearchou et al. (2020) found that 2.39% to 37% of participants had CI: 0.01 – 0.05).
somatic syndrome. Furthermore, psychological problems such as fear of Urban residence was found to be associated with mental health
COVID-19 (Oliveira et al., 2022; Panda et al., 2021), boredom (Panda outcomes in a review by Panda et al. (2021), whereas Elharake et al.
et al., 2021), irritability (Panchal et al., 2021; Panda et al., 2021), (2022) reported poor mental health outcomes in college students living
internalized and externalized problems (Bussières et al., 2021), help in rural areas. Moreover, the time of the study appeared to affect the
lessness (Oliveira et al., 2022), conduct problems (Viner et al., 2022), study outcomes. For example, Racine et al. (2021) found that later
and low life satisfaction (Viner et al., 2022) were reported across re months of the year was associated with higher burden of anxiety (b =
views. In addition, child protection referral fell by 36% (156 per quarter 0.27, 95% CI: 0.10 – 0.44) and depression (b = 0.26, 95% CI: 0.06 –
in 2019 to 99 in 2020) to 39% (incidence rate ratio for 2020 compared 0.46). Furthermore, poor academic records were associated with
11
adverse mental health outcomes in one review (Panda et al., 2021), 2021; Samji et al., 2021; Sanja et al., 2021). For example, social
whereas another review found that higher academic grades were asso distancing was associated with adverse mental health outcomes in a
ciated with anxiety and depression (Sanja et al., 2021). review by Jones et al. (2021). Moreover, Samji et al. (2021) reported
Several reviews synthesized evidence on behavioral and lifestyle- that social distancing was associated with poor mental health outcomes.
related factors associated with mental health problems. For example, Both social stigma and social distancing were related to a higher burden
Chawla et al. (2021) found that a sedentary lifestyle, increased screen of anxiety in a review by Sanja et al. Furthermore, Panchal et al. (2021)
time, and lack of exercise were associated with depression and anxiety. and Marchi et al. (2021) found social support to have a protective role
Physical activity and regular exercise were associated with improved on mental health outcomes in children and adolescents.
mental health across multiple reviews (Chawla et al., 2021; Marchi
et al., 2021; Panchal et al., 2021; Panda et al., 2021; Samji et al., 2021; 10. Discussion
Sharma et al., 2021). Staying home for increased duration and lack of
daily routine affected mental health in many children and adolescents, This umbrella review provides a systematic overview of global evi
as reported by Panchal et al. (2021) and Samji et al. (2021). A Review by dence on CAMH during the COVID-19 pandemic from existing system
Viner et al. (2022) found that a lack of healthy food consumption was atic reviews and meta-analyses. To the best of our knowledge, this is one
associated with adverse mental health outcomes among children amidst of the few umbrella reviews on mental health in COVID-19 (Fernandez
this pandemic. Moreover, better emotional regulation and psychological et al., 2021; Sahebi et al., 2021) and the first one emphasizing CAMH.
resilience were associated with improved mental health outcomes. The findings of this review may facilitate mental and child health poli
Furthermore, better knowledge about the pandemic was associated with cymaking and practice and inform further research strengthening the
better mental health among children and adolescents (Marchi et al., global knowledge base. In this review, we found a varying burden of
2021), whereas excessive information was negatively associated with several mental health problems such as anxiety, depression, sleep dis
mental health, as reported by Panchal et al. (2021). orders, PTSD, suicidal behavior, psychological distress, and other psy
Individual behaviors such as hobbies, praying, and listening to music chosocial challenges among children and adolescents. Moreover, we
were reported to be associated with positive mental health (Samji et al., identified several critical factors associated with mental health problems
2021). Internet and smartphone addiction appeared to be a common risk in this young population. Individual social demographic factors associ
factor associated with mental health problems reported in several re ated with mental health outcomes included older age of the children and
views (Chawla et al., 2021; Jones et al., 2021; Marchi et al., 2021; adolescents, female gender, location of the residence, educational
Panchal et al., 2021; Panda et al., 2021; Samji et al., 2021; Sanja et al., attainment, sedentary lifestyle, lack of routine activities, spending more
2021; Sharma et al., 2021; Viner et al., 2022). Moreover, the past history time at home, social media addiction, Internet overuse, knowledge
of mental health problems was associated with adverse mental health about pandemic or excessive information, emotional regulation, resil
outcomes, as reported in several reviews (Cunning and Hodes, 2022; ience, self-efficacy, physical activity and exercise behavior, recreational
Jones et al., 2021; Panchal et al., 2021; Samji et al., 2021; Viner et al., activities, spending time on hobbies, and history of mental health
2022). Severe events related to COVID-19 affected mental health among problems. Furthermore, several family-related factors associated with
many children and adolescents. For example, Panda et al. (2021) found mental health were identified, which included belongingness and rela
that having a family member who was infected with COVID-19 was tionship with family members, parents’ education, household income
associated with adverse psychological outcomes. Another review by and economic hardship, adverse childhood and family experience, and
Panchal et al. (2021) reported an increased number of COVID-19 cases challenging family relationships. In addition, community and social
within the same geographic area affected mental health (OR = 2.3, p < factors related to mental health included social distancing practices,
0.001) in children and adolescents. social support, social stigma, closure of the schools, online learning
Several family issues were reported to be associated with mental activities, and COVID-19 related life events and preventive measures.
health outcomes during this pandemic. Nearchou et al. (2020) found These factors influenced mental health outcomes among children and
that belongingness and better relationships with closed ones were adolescents in different contexts as identified in existing reviews and
associated with improved mental health. Parental self-efficacy and respective primary studies included within those reviews.
family functioning were protective factors for mental health, as reported Most studies reported a high prevalence of CAMH problems across
by Marchi et al. (2021). Moreover, adverse childhood and family ex contexts suggesting a heavy psychosocial impact of this pandemic that is
periences such as household dysfunction, family neglect, and child consistent with other reviews conducted in different populations
abuse were associated with poor mental health outcomes (Samji et al., (Bourmistrova et al., 2022; Fernandez et al., 2021; Hossain et al., 2020;
2021). Moreover, the parents education and responsiveness were asso Li et al., 2021; Sahebi et al., 2021). Socioecological perspectives may
ciated with the mental health of children and adolescents (Elharake inform the complex epidemiology of these crises emerging at different
et al., 2022; Oliveira et al., 2022; Sharma et al., 2021; Viner et al., 2022). levels. Children and adolescents experienced an unusual interruption in
In addition, family financial crises affected the mental health of children their everyday lives that included prolonged stay within home, altered
and adolescents in many reviews. For example, unemployment and relationship dynamics with their caregivers and family members,
financial constraints affected families and the mental health of young less-frequent interactions with peers and relatives, lack of access to
people (Cunning and Hodes, 2022). Elharake et al. (2022) found that outdoor activities, changed nutritional and lifestyle behaviors and other
family financial challenges and food insecurity (less than three meals per changes at the household level (de Figueiredo et al., 2021; Settersten
day) affected mental health in children and college students. et al., 2020). These problems compounded the effects of community and
School closure was associated with a wide range of mental health social changes associated with this pandemic, which included social
outcomes, as studied in a review by Viner et al. (2022) and Marchi et al. distancing, closure of schools and institutions, and interruption of health
(2021). Specifically, Viner et al. (2022) found that child abuse referral and social services (Barach et al., 2020; Nguyen et al., 2021; Viner et al.,
reports declined during this pandemic due to school closure suggesting 2022). Lastly, universal challenges such as socioeconomic problems and
interrupted services in those contexts. As many institutions transitioned health hazards of COVID-19 impacted children, adolescents, and their
to online learning systems, Samji et al. (2021) found such online families that also affected mental health and wellbeing (Hossain et al.,
learning to be associated with adverse mental health outcomes in chil 2020; Marchi et al., 2021; Preston and Rew, 2022). Taken together, a
dren and adolescents. variety of psychosocial stressors emerged during this pandemic, whereas
Social factors such as social isolation and distancing, social stigma, mental health promotion and protective services were mostly disrupted
and social support were associated with overall mental health outcomes or unavailable. These factors affected biopsychosocial health and well
in many reviews (Jones et al., 2021; Marchi et al., 2021; Panchal et al., being across populations resulting in a high burden of CAMH problems
12
that require clinical, public health, social, and policy considerations. Table 3
The overall evidence on the epidemiologic burden of CAMH and Evidence-based recommendations for future research, policymaking, and
associated factors reflected high heterogeneity that can be attributed to practice.
several factors. First, earlier studies on psychosocial impacts were con Recommendations for future research, policymaking, and practice
ducted in China (Cunning and Hodes, 2022; Ma et al., 2021), whereas a • Conducting research using longitudinal/cohort designs to understand
majority of overall studies were from the US, UK, Canada, and several temporal changes and long-term effects on CAMH (Chawla et al., 2021;
high-income countries (Bussières et al., 2021; Elharake et al., 2022; Cunning and Hodes, 2022; Elharake et al., 2022; Hossain et al., 2020; Ma et al.,
Racine et al., 2021; Viner et al., 2022). Although the synthesized evi 2021; Oliveira et al., 2022; Panchal et al., 2021; Sanja et al., 2021)
• Using representative samples of children and adolescent populations rather
dence inform a global phenomenon of elevated psychosocial burden of
than using small, non-representative samples, or sub-groups (Elharake et al.,
CAMH problems, the current evidence gap reflects a lack of research 2022; Nearchou et al., 2020)
equity that must be addressed. Most reviews informed a scarcity of ev • Examining the biopsychosocial determinants of CAMH during and after
idence from the global south reflecting a critical knowledge gap in those COVID-19 pandemic to explore specific risk and protective factors (Elharake
contexts, which requires scholarly efforts to improve research quantity et al., 2022; Nearchou et al., 2020; Samji et al., 2021)
• Applying appropriate psychometric tools for CAMH problems with
and quality in those regions. Another key challenge in the presented standardized cut-off values (Chai et al., 2021; Ma et al., 2021; Nearchou et al.,
evidence is a critical lack of comparative statistics that could inform 2020; Oliveira et al., 2022)
psychiatric epidemiologic changes in study populations. The availability • Exploring the impacts of COVID-19 on education, work, and living conditions
of baseline and comparative data could have provided a better under and their associations with CAMH (Bussières et al., 2021)
• Investigating the impacts of parents’ psychosocial health and family
standing of the mental health impacts amidst this pandemic. Moreover,
relationships on CAMH during COVID-19 (Bussières et al., 2021)
online measures of collecting data and non-standardized scales were • Studying the psychosocial correlates of pandemic-related events and their
widely used in cross-sectional studies reported across reviews (Chawla impacts on CAMH (Chawla et al., 2021; Cunning and Hodes, 2022)
et al., 2021; Cunning and Hodes, 2022; Elharake et al., 2022; Marchi • Investigating the persistence of psychosocial symptomology or development of
et al., 2021; Nearchou et al., 2020), which may not provide represen mental disorders in the future (Panchal et al., 2021; Samji et al., 2021; Sanja
et al., 2021)
tative estimates on CAMH impacts of COVID-19. Furthermore,
• Strengthening research capacities of the researchers and institutions on CAMH
cross-sectional studies may not inform temporal changes in mental research in the context of COVID-19 (Sanja et al., 2021)
health outcomes or how much psychosocial burden can be attributable • Emphasizing younger children’s mental health research- an area with little
to the pandemic or associated factors. Therefore, standardized mea evidence but high significance for long-term impacts (Ma et al., 2021)
• Examining psychiatric comorbidities alongside identified physical and mental
surements approaches should be used in representative samples and
health problems (Ma et al., 2021)
preferably in longitudinal and interventions studies that more accu • Examining the role of timing and context of studies (e.g., studied undertaken
rately reflect the psychosocial impacts locally and globally. A brief during lockdown vs. after returning to school) on CAMH (Samji et al., 2021)
overview of the recommendations for future research on CAMH is pro • Exploring pre-pandemic and existing mental health gaps to develop stronger
vided in Table 3-A. mental health systems in the future (Elharake et al., 2022; Samji et al., 2021)
• Conducting implementation research on mental health services for children
The current evidence on CAMH problems amidst COVID-19 neces
and adolescents emphasizing trends, barriers, and facilitators of mental health
sitates multipronged efforts to alleviate the immediate and future health utilization in different contexts (Elharake et al., 2022; Hossain et al., 2020;
and social consequences of this burden. The policymakers and practi Mohd et al., 2022)
tioners need to evaluate the evidence-based guidelines and recommen • Improving social determinants of CAMH as a local and global health priority
(Abrams and Szefler, 2020; Ashcroft et al., 2021; Elharake et al., 2022;
dations that may fit the mental health needs of children and adolescents
Hossain et al., 2020; Racine et al., 2021; Smitherman et al., 2021)
in different contexts, as listed in Table 3-B. At the individual level, • Integrating clinical and psychosocial interventions in public health and child
awareness of mental health and pandemic safety should be strength health policies and programs with special focus on targeted mental health
ened, addressing the fear of infection and health hazards (Chai et al., components whenever possible (Boldt et al., 2021; Hossain et al., 2020; Mohd
2021; Cunning and Hodes, 2022; Panda et al., 2021; Sanja et al., 2021). et al., 2022; Nearchou et al., 2020)
• Establishing and strengthening mental health safety nets for children and
Moreover, positive psychology-based targeted interventions should be
adolescents (Elharake et al., 2022)
promoted alongside public mental health interventions (Elharake et al., • Psychoeducational interventions on pandemic preparedness and mental health
2022; Mohd et al., 2022; Nearchou et al., 2020). Furthermore, parents, promotion for children and adolescents engaging parents, family members,
teachers, and other caregivers should be engaged in mental health teachers, and other stakeholders (Chai et al., 2021; Cunning and Hodes, 2022;
Panchal et al., 2021; Panda et al., 2021; Sanja et al., 2021)
promotion (Chai et al., 2021; Chawla et al., 2021; Marchi et al., 2021;
• Designing and implementing physical activity-based interventions that may
Panda et al., 2021). As many scholars suggest, those formal and informal improve psychosocial outcomes alongside overall health and wellbeing
caregivers may require psychoeducational and behavioral support to (Chawla et al., 2021; Jones et al., 2021; Marchi et al., 2021; Oliveira et al.,
stay healthy and contribute to interpersonal and community health ef 2022; Panchal et al., 2021; Panda et al., 2021)
forts (Chawla et al., 2021; Marchi et al., 2021; Panchal et al., 2021). • Addressing food insecurity and nutritional problems that may influence
mental health outcomes (Elharake et al., 2022; Panda et al., 2021; Zemrani
Also, healthcare professionals and social workers should be empowered
et al., 2021)
to offer psychosocial care services to the affected children and adoles • Providing extensive and integrative care for children with special needs
cents in diverse settings (Panchal et al., 2021; Sanja et al., 2021). ensuring mental wellbeing (Asbury et al., 2021; Panchal et al., 2021)
Institutional care services should be made available and accessible to • Providing social support, social connectedness, peer-networking, and social
address the growing burden of mental health epidemics accompanying interventions for improving prosocial coping mechanisms among children and
adolescents with poor mental health (Panchal et al., 2021; Panda et al., 2021;
COVID-19 pandemic (Mohd et al., 2022; Nearchou et al., 2020). Health Preston and Rew, 2022; Samji et al., 2021)
systems and services must the strengthened to actualize these efforts at • Educating and engaging parents on positive parenting and mental health
the societal level (Cunning and Hodes, 2022; Mohd et al., 2022; Sanja promotion (Chai et al., 2021; Marchi et al., 2021; Panda et al., 2021)
et al., 2021). Lastly, a stronger policy commitment is needed to improve • Providing family-based interventions for holistic mental health development
of children, adolescents, and their family caregivers (Chai et al., 2021; Chawla
social determinants of mental health in children and adolescents that
et al., 2021; Marchi et al., 2021; Panchal et al., 2021; Panda et al., 2021)
may enable them to overcome the current mental health problems and • Engaging academic institutions and providers for delivering
develop resilience to better psychosocial outcomes in the future nonpharmacological mental health education and services (Panda et al., 2021)
(Elharake et al., 2022; Panchal et al., 2021; Racine et al., 2021). • Developing public health messages and programs emphasizing positive
psychology and better mental health (Cunning and Hodes, 2022; Panchal
et al., 2021; Racine et al., 2021; Samji et al., 2021)
11. Limitations
This umbrella review has several limitations that must be addressed
13
Table 3 (continued ) Funding information

Recommendations for future research, policymaking, and practice
No funding was received at any stage of conceptualizing or con
• Leveraging evidence-based digital approaches for delivering online education
ensuring optimal mental health of the young learners (Panda et al., 2021)
ducting this umbrella review.
• Organizing safe and planned school opening and resuming in-person/routine
activities ensuring public health compliance for better psychosocial outcomes Declaration of the Competing Interest
(Panda et al., 2021; Racine et al., 2021)
• Funding mental health services for children and adolescents ensuring wider
The authors of this manuscript declared no conflicts of interest.
access and sustainability (Panchal et al., 2021)
• Promoting problem solving skills and empowerment programs among children
and adolescents (Oliveira et al., 2022; Panda et al., 2021) Supplementary materials
• Facilitating recreational activities such as reading books, story reading/telling,
listening to music, spending time on hobbies (Marchi et al., 2021; Panda et al., Supplementary material associated with this article can be found, in
2021)
• Restoring mental health services and increasing access to mental health care
the online version, at doi:10.1016/j.psychres.2022.114814.
(Cunning and Hodes, 2022; Mohd et al., 2022; Sanja et al., 2021)
• Adopting digital mental health resources and services for improving mental References
health access and utilization in children and adolescents (Jones et al., 2021;
Oliveira et al., 2022; Panchal et al., 2021; Panda et al., 2021; Racine et al., Abrams, E.M., Szefler, S.J., 2020. COVID-19 and the impact of social determinants of
2021; Samji et al., 2021) health. Lancet. Respir. Med. 8, 659. https://doi.org/10.1016/S2213-2600(20)
• Providing special attention to early childhood mental health development 30234-4.
interventions (Elharake et al., 2022) Almis, H., Han Almis, B., Bucak, I.H., 2022. Mental health of children of health workers
• Restoring and improving child protection and referral services (Katz and during the COVID-19 pandemic: a cross-sectional study. Clin. Child Psychol.
Fallon, 2021; Renov et al., 2021; Viner et al., 2022) Psychiatry 27, 104–111. https://doi.org/10.1177/13591045211016527.
• Empowering health and other care providers for addressing CAMH problems Aromataris, E., Fernandez, R., Godfrey, C., Holly, C., Khalil, H., Tungpunkom, P., 2020.
through capacity building exercises, developing evidence-based practice JBI Manual for Evidence Synthesis - JBI Global Wiki [WWW Document]. JBI. URL
https://jbi-global-wiki.refined.site/space/MANUAL/3283910768/Chapter+10%3A
guidelines, and mobilizing care resources (M. Hossain et al., 2020; Panchal
+Umbrella+reviews (accessed 3.19.22).
et al., 2021; Sanja et al., 2021)
Aromataris, E., Fernandez, R., Godfrey, C.M., Holly, C., Khalil, H., Tungpunkom, P.,
• Examining and implementing evidence-based guidance on screen time, social 2015. Summarizing systematic reviews: methodological development, conduct and
media and internet use that may protect mental health and wellbeing (Chai reporting of an umbrella review approach. Int. J. Evid. Based Healthc. 13, 132–140.
et al., 2021; Chawla et al., 2021; Marchi et al., 2021) https://doi.org/10.1097/XEB.0000000000000055.
• Strengthening public mental health services for rural and other marginalized Asbury, K., Fox, L., Deniz, E., Code, A., Toseeb, U., 2021. How is COVID-19 affecting the
population groups (Elharake et al., 2022; Hossain et al., 2020) mental health of children with special educational needs and disabilities and their
families? J. Autism Dev. Disord. 51, 1772–1780. https://doi.org/10.1007/S10803-
020-04577-2.
in future evidence syntheses. First, we included major databases but did Ashcroft, R., Lam, S., Kourgiantakis, T., Begun, S., Nelson, M.L.A., Adamson, K.,
Cadell, S., Walsh, B., Greenblatt, A., Hussain, A., Sur, D., Sirotich, F., Craig, S.L.,
not include preprint servers and other potential sources that may 2021. Protocol: preparing social workers to address health inequities emerging
contain eligible reviews. Second, we identified multiple reviews with during the COVID-19 pandemic by building capacity for health policy: a scoping
different methods and synthesized them narratively. A patient-level data review protocol. BMJ Open 11, 53959. https://doi.org/10.1136/BMJOPEN-2021-
053959.
synthesis from individual studies could have provided a more accurate Barach, P., Fisher, S.D., Adams, M.J., Burstein, G.R., Brophy, P.D., Kuo, D.Z., Lipshultz, S.
and less overlapping view of the evidence landscape. Third, as system E., 2020. Disruption of healthcare: will the COVID pandemic worsen non-COVID
atic reviews and meta-analyses included primary studies published outcomes and disease outbreaks? Prog. Pediatr. Cardiol. 59, 101254 https://doi.org/
10.1016/J.PPEDCARD.2020.101254.
before conducting those reviews, a synthesis of the reviews is likely to
Bashir, M.F., Ma, B., Shahzad, L., 2020. A brief review of socio-economic and
miss insights from the most recent primary studies. Fourth, most pri environmental impact of Covid-19. Air Qual. Atmos. Heal. 13, 1403–1409. https://
mary studies included in this review were cross-sectional in nature, doi.org/10.1007/S11869-020-00894-8/FIGURES/5.
Bassuk, E.L., Richard, M.K., Tsertsvadze, A., 2015. The prevalence of mental illness in
which is a limitation of the synthesized evidence as well. We call for
homeless children: a systematic review and meta-analysis. J. Am. Acad. Child
longitudinal research that may strengthen the evidence base in primary Adolesc. Psychiatry 54, 86–96. https://doi.org/10.1016/J.JAAC.2014.11.008 e2.
research and future evidence synthesis. Lastly, heterogeneity and pub Bialek, S., Bowen, V., Chow, N., Curns, A., Gierke, R., Hall, A., Hughes, M., Pilishvili, T.,
lication biases were not assessed in this narrative umbrella study. Un Ritchey, M., Roguski, K., Silk, B., Skoff, T., Sundararaman, P., Ussery, E., Vasser, M.,
Whitham, H., Wen, J., 2020. Geographic differences in COVID-19 cases, deaths, and
derstanding those and addressing the same should be prioritized in incidence — United States. February 12–April 7, 2020 MMWR. Morb. Mortal. Wkly.
future meta-research. Rep. 69, 465–471. https://doi.org/10.15585/mmwr.mm6915e4.
Bitsko, R.H., Holbrook, J.R., Ghandour, R.M., Blumberg, S.J., Visser, S.N., Perou, R.,
Walkup, J.T., 2018. Epidemiology and impact of health care provider-diagnosed
12. Conclusions anxiety and depression among US children. J. Dev. Behav. Pediatr. 39, 395–403.
https://doi.org/10.1097/DBP.0000000000000571.
Psychosocial stressors associated with the COVID-19 pandemic have Boldt, K., Coenen, M., Movsisyan, A., Voss, S., Rehfuess, E., Kunzler, A.M., Lieb, K., Jung-
Sievers, C., 2021. Interventions to ameliorate the psychosocial effects of the COVID-
resulted in a wide range of mental health problems in children and ad 19 pandemic on children-A systematic Review. Int. J. Environ. Res. Public Health 18,
olescents. The current evidence suggests a high burden of anxiety, 1–31. https://doi.org/10.3390/IJERPH18052361.
depression, psychological distress, PTSD, sleep disorders, suicidal Bourmistrova, N.W., Solomon, T., Braude, P., Strawbridge, R., Carter, B., 2022. Long-
term effects of COVID-19 on mental health: a systematic review. J. Affect. Disord.
behavior, addiction disorders, and other psychosocial problems that
299, 118–125. https://doi.org/10.1016/J.JAD.2021.11.031.
require evidence-based measures to address the same. Also, many of Bussières, E.L., Malboeuf-Hurtubise, C., Meilleur, A., Mastine, T., Hérault, E., Chadi, N.,
these problems may persist and develop further mental health crises that Montreuil, M., Généreux, M., Camden, C., Roberge, P., Lane, J., Jasmin, E., Kalubi, J.
C., Bussiéres, E.L., Hurtubise, K., Bach, G., Chrysagis, M., Turner, M.P., Gauvin, C.,
should be addressed by adopting multifaceted psychiatric, psychologi
Hérault, E., 2021. Consequences of the COVID-19 pandemic on children’s mental
cal, and public health efforts. In this regard, context-specific risk health: a meta-analysis. Front. Psychiatry 12. https://doi.org/10.3389/
assessment and management approaches should prioritize population fpsyt.2021.691659.
mental health needs and address current gaps in mental health services. Chai, J., Xu, H., An, N., Zhang, P., Liu, F., He, S., Hu, N., Xiao, X., Cui, Y., Li, Y., 2021.
The prevalence of mental problems for chinese children and adolescents during
Transdisciplinary mental health research, policymaking, and practice COVID-19 in China: a systematic review and meta-analysis. Front. Pediatr. 9 https://
should be emphasized to mitigate the mental health impacts of this doi.org/10.3389/fped.2021.661796.
pandemic and ensure optimal mental, physical, and social health of Chawla, N., Tom, A., Sen, M.S., Sagar, R., 2021. Psychological impact of COVID-19 on
children and adolescents: a systematic review. Indian J. Psychol. Med. 43, 294–299.
children and adolescents locally and globally. https://doi.org/10.1177/02537176211021789.
14
Cunning, C., Hodes, M., 2022. The COVID-19 pandemic and obsessive–compulsive supplement (NCS-A). J. Am. Acad. Child Adolesc. Psychiatry 49, 980–989. https://
disorder in young people: systematic review. Clin. Child Psychol. Psychiatry 27, doi.org/10.1016/J.JAAC.2010.05.017.
18–34. https://doi.org/10.1177/13591045211028169. Mohd, W., Mohd, W., Wan, A., Yunus, M., Kauhanen, L., Sourander, A., Brown, J.S.L.,
Dang, Y., Hou, Y., 2021. The prognostic value of late gadolinium enhancement in heart Peltonen, K., Mishina, K., Lempinen, L., Bastola, K., Gilbert, S., 2022. Registered
diseases: an umbrella review of meta-analyses of observational studies. Eur. Radiol. psychiatric service use, self ‑ harm and suicides of children and young people aged
31, 4528–4537. https://doi.org/10.1007/S00330-020-07437-W/TABLES/2. 0 –24 before and during the COVID ‑ 19 pandemic : a systematic review 3, 1–14.
de Figueiredo, C.S., Sandre, P.C., Portugal, L.C.L., Mázala-de-Oliveira, T., da Silva Nearchou, F., Hennessy, E., Flinn, C., Niland, R., Subramaniam, S.S., 2020. Exploring the
Chagas, L., Raony, Í., Ferreira, E.S., Giestal-de-Araujo, E., dos Santos, A.A., impact of covid-19 on mental health outcomes in children and adolescents: a
Bomfim, P.O.S., 2021. COVID-19 pandemic impact on children and adolescents’ systematic review. Int. J. Environ. Res. Public Health 17, 1–19. https://doi.org/
mental health: biological, environmental, and social factors. Prog. 10.3390/ijerph17228479.
Neuropsychopharmacol. Biol. Psychiatry 106, 110171. https://doi.org/10.1016/J. Nguyen, P.H., Kachwaha, S., Pant, A., Tran, L.M., Walia, M., Ghosh, S., Sharma, P.K.,
PNPBP.2020.110171. Escobar-Alegria, J., Frongillo, E.A., Menon, P., Avula, R., 2021. COVID-19 disrupted
Deighton, J., Lereya, S.T., Casey, P., Patalay, P., Humphrey, N., Wolpert, M., 2019. provision and utilization of health and nutrition services in uttar pradesh, india:
Prevalence of mental health problems in schools: poverty and other risk factors insights from service providers, household phone surveys, and administrative data.
among 28 000 adolescents in England. Br. J. Psychiatry 215, 565–567. https://doi. J. Nutr. 151, 2305. https://doi.org/10.1093/JN/NXAB135.
org/10.1192/BJP.2019.19. O’Sullivan, K., Clark, S., McGrane, A., Rock, N., Burke, L., Boyle, N., Joksimovic, N.,
Elharake, J.A., Akbar, F., Malik, A.A., Gilliam, W., Omer, S.B., 2022. Mental health Marshall, K., 2021. A qualitative study of child and adolescent mental health during
impact of COVID-19 among children and college students: a systematic review. Child the COVID-19 pandemic in Ireland. Int. J. Environ. Res. Public Health 18, 1062.
Psychiatry Hum. Dev. https://doi.org/10.1007/s10578-021-01297-1. https://doi.org/10.3390/IJERPH18031062, 2021, Vol.Page 1062 18,.
Fauci, A.S., Lane, H.C., Redfield, R.R., 2020. Covid-19 — navigating the uncharted. Oliveira, J.M.D., Butini, L., Pauletto, P., Lehmkuhl, K.M., Stefani, C.M., Bolan, M.,
N. Engl. J. Med. 382, 1268–1269. https://doi.org/10.1056/NEJME2002387/SUPPL_ Guerra, E., Dick, B., De Luca Canto, G., Massignan, C., 2022. Mental health effects
FILE/NEJME2002387_DISCLOSURES.PDF. prevalence in children and adolescents during the COVID-19 pandemic: a systematic
Fernandez, R., Sikhosana, N., Green, H., Halcomb, E.J., Middleton, R., Alananzeh, I., review. Worldviews Evid. Based Nurs. 1–8. https://doi.org/10.1111/wvn.12566.
Trakis, S., Moxham, L., 2021. Anxiety and depression among healthcare workers Page, M.J., McKenzie, J.E., Bossuyt, P.M., Boutron, I., Hoffmann, T.C., Mulrow, C.D.,
during the COVID-19 pandemic: a systematic umbrella review of the global Shamseer, L., Tetzlaff, J.M., Akl, E.A., Brennan, S.E., Chou, R., Glanville, J.,
evidence. BMJ Open 11, e054528. https://doi.org/10.1136/BMJOPEN-2021- Grimshaw, J.M., Hróbjartsson, A., Lalu, M.M., Li, T., Loder, E.W., Mayo-Wilson, E.,
054528. McDonald, S., McGuinness, L.A., Stewart, L.A., Thomas, J., Tricco, A.C., Welch, V.A.,
Gadermann, A.M., Gagné Petteni, M., Janus, M., Puyat, J.H., Guhn, M., Georgiades, K., Whiting, P., Moher, D., 2021. The PRISMA 2020 statement: an updated guideline for
2022. Prevalence of mental health disorders among immigrant, refugee, and reporting systematic reviews. BMJ 372. https://doi.org/10.1136/BMJ.N71.
nonimmigrant children and youth in British Columbia, Canada. JAMA Netw. Open 5. Panchal, U., Salazar de Pablo, G., Franco, M., Moreno, C., Parellada, M., Arango, C.,
https://doi.org/10.1001/JAMANETWORKOPEN.2021.44934 e2144934–e2144934. Fusar-Poli, P., 2021. The impact of COVID-19 lockdown on child and adolescent
Hessami, K., Romanelli, C., Chiurazzi, M., Cozzolino, M., 2020. COVID-19 pandemic and mental health: systematic review. Eur. Child Adolesc. Psychiatry. https://doi.org/
maternal mental health: a systematic review and meta-analysis. 10.1080/ 10.1007/s00787-021-01856-w.
14767058.2020.1843155. Panda, P.K., Gupta, J., Chowdhury, S.R., Kumar, R., Meena, A.K., Madaan, P.,
Hossain, M., Purohit, N., 2019. Improving child and adolescent mental health in India: Sharawat, I.K., Gulati, S., 2021. Psychological and behavioral impact of lockdown
status, services, policies, and way forward. Indian J. Psychiatry 61, 415. https://doi. and quarantine measures for COVID-19 pandemic on children, adolescents and
org/10.4103/PSYCHIATRY.INDIANJPSYCHIATRY_217_18. caregivers: a systematic review and meta-analysis. J. Trop. Pediatr. 67 https://doi.
Hossain, M., Tasnim, S., Sultana, A., Faizah, F., Mazumder, H., Zou, L., Lisako, E., org/10.1093/tropej/fmaa122.
Mckyer, J., Ahmed, H.U., Ma, P., Alonzi, S., Silverstein, M.W., 2020. Epidemiology Patel, V., 2007. Mental health in low- and middle-income countries. Br. Med. Bull.
of mental health problems in COVID-19: a review [version 1; peer review: 2 81–82. https://doi.org/10.1093/BMB/LDM010, 81–96.
approved] report report. 10.12688/f1000research.24457.1. Patel, V., Flisher, A.J., Nikapota, A., Malhotra, S., 2008. Promoting child and adolescent
Hossain, M.M., Sultana, A., Purohit, N., 2020a. Mental health outcomes of quarantine mental health in low and middle income countries. J. Child Psychol. Psychiatry 49,
and isolation for infection prevention: a systematic umbrella review of the global 313–334. https://doi.org/10.1111/J.1469-7610.2007.01824.X.
evidence. Epidemiol. Health 42. https://doi.org/10.4178/EPIH.E2020038. Polanczyk, G.V., Salum, G.A., Sugaya, L.S., Caye, A., Rohde, L.A., 2015. Annual research
Hossain, M.M., Sultana, A., Tasnim, S., Fan, Q., Ma, P., McKyer, E.L.J., Purohit, N., review: a meta-analysis of the worldwide prevalence of mental disorders in children
2020b. Prevalence of mental disorders among people who are homeless: an umbrella and adolescents. J. Child Psychol. Psychiatry 56, 345–365. https://doi.org/10.1111/
review. Int. J. Soc. Psychiatry 66, 528–541. https://doi.org/10.1177/ JCPP.12381.
0020764020924689. Preston, A.J., Rew, L., 2022. Connectedness, self-esteem, and prosocial behaviors protect
Jones, E.A.K., Mitra, A.K., Bhuiyan, A.R., 2021. Impact of COVID-19 on mental health in adolescent mental health following social isolation: a systematic review. Issues Ment.
adolescents: a systematic review. Int. J. Environ. Res. Public Heal. 18, 2470. https:// Health Nurs. 43, 32–41. https://doi.org/10.1080/01612840.2021.1948642.
doi.org/10.3390/IJERPH18052470, 2021, Vol.Page18, 2470. Racine, N., McArthur, B.A., Cooke, J.E., Eirich, R., Zhu, J., Madigan, S., 2021. Global
Kamieniecki, G.W., 2001. Prevalence of psychological distress and psychiatric disorders prevalence of depressive and anxiety symptoms in children and adolescents during
among homeless youth in Australia: a comparative review. Aust. N. Z. J. Psychiatry COVID-19: a meta-analysis. JAMA Pediatr. 175, 1142–1150. https://doi.org/
35, 352–358. https://doi.org/10.1046/j.1440-1614.2001.00910.x. 10.1001/jamapediatrics.2021.2482.
Katz, C., Fallon, B., 2021. Protecting children from maltreatment during COVID-19: Rajmil, L., Hjern, A., Boran, P., Gunnlaugsson, G., Camargo, O.K.de, Raman, S., 2021.
struggling to see children and their families through the lockdowns. Child Abuse Original research: impact of lockdown and school closure on children’s health and
Negl. 116, 105084 https://doi.org/10.1016/J.CHIABU.2021.105084. well-being during the first wave of COVID-19: a narrative review. BMJ Paediatr.
Kovess-Masfety, V., Husky, M.M., Keyes, K., Hamilton, A., Pez, O., Bitfoi, A., Carta, M.G., Open 5. https://doi.org/10.1136/BMJPO-2021-001043.
Goelitz, D., Kuijpers, R., Otten, R., Koç, C., Lesinskiene, S., Mihova, Z., 2016. Ren, X., Huang, W., Pan, H., Huang, T., Wang, X., Ma, Y., 2020. Mental health during the
Comparing the prevalence of mental health problems in children 6–11 across Covid-19 outbreak in China: a meta-analysis. Psychiatr. Q. 91, 1033–1045. https://
Europe. Soc. Psychiatry Psychiatr. Epidemiol. 51, 1093–1103. https://doi.org/ doi.org/10.1007/S11126-020-09796-5/FIGURES/5.
10.1007/S00127-016-1253-0/TABLES/4. Renov, V., Risser, L., Berger, R., Hurley, T., Villaveces, A., DeGue, S., Katz, A.,
Larsen, L., Helland, M.S., Holt, T., 2021. The impact of school closure and social isolation Henderson, C., Premo, K., Talis, J., Chang, J.C., Ragavan, M., 2021. The impact of
on children in vulnerable families during COVID-19: a focus on children’s reactions. the COVID-19 pandemic on child protective services caseworkers and
Eur. Child Adolesc. Psychiatry 1, 1–11. https://doi.org/10.1007/S00787-021- administrators. Child Abuse Negl. https://doi.org/10.1016/J.CHIABU.2021.105431.
01758-X/TABLES/5. Robinson, E., Sutin, A.R., Daly, M., Jones, A., 2022. A systematic review and meta-
Li, K., Tang, F., Hanna, S., Bass, D., Shair, S., Dicerbo, L., Giordani, B., Kavcic, V., analysis of longitudinal cohort studies comparing mental health before versus during
Perez, S., Nuccio, A., Stripling, A., 2021. The impact of COVID-19 concerns on the the COVID-19 pandemic in 2020. J. Affect. Disord. 296, 567–576. https://doi.org/
mental health of older adults: a rapid review. Innov. Aging 5, 727–728. https://doi. 10.1016/J.JAD.2021.09.098.
org/10.1093/GERONI/IGAB046.2691. Sahebi, A., Nejati-Zarnaqi, B., Moayedi, S., Yousefi, K., Torres, M., Golitaleb, M., 2021.
Lund, C., Brooke-Sumner, C., Baingana, F., Baron, E.C., Breuer, E., Chandra, P., The prevalence of anxiety and depression among healthcare workers during the
Haushofer, J., Herrman, H., Jordans, M., Kieling, C., Medina-Mora, M.E., Morgan, E., COVID-19 pandemic: an umbrella review of meta-analyses. Prog. Neuro-
Omigbodun, O., Tol, W., Patel, V., Saxena, S., 2018. Social determinants of mental Psychopharmacol. Biol. Psychiatry 107, 110247. https://doi.org/10.1016/J.
disorders and the sustainable development goals: a systematic review of reviews. PNPBP.2021.110247.
Lancet Psychiatry 5, 357–369. https://doi.org/10.1016/S2215-0366(18)30060-9. Samji, H., Wu, J., Ladak, A., Vossen, C., Stewart, E., Dove, N., Long, D., Snell, G., 2021.
Ma, L., Mazidi, M., Li, K., Li, Y., Chen, S., Kirwan, R., Zhou, H., Yan, N., Rahman, A., Review: mental health impacts of the COVID-19 pandemic on children and youth – a
Wang, W., Wang, Y., 2021. Prevalence of mental health problems among children systematic review. Child Adolesc. Ment. Health. https://doi.org/10.1111/
and adolescents during the COVID-19 pandemic: a systematic review and meta- camh.12501.
analysis. J. Affect. Disord. 293, 78–89. https://doi.org/10.1016/j.jad.2021.06.021. Sanja, Đ., Ileana, C.G., Vesna, D., Ana, Đ., 2021. Anxiety and depressive symptomatology
Marchi, J., Johansson, N., Sarkadi, A., Warner, G., 2021. The impact of the COVID-19 among children and adolescents exposed to the COVID-19 pandemic - meta-analysis.
pandemic and societal infection control measures on children and adolescents’ Vojnosanit. Pregl. 1–21. https://doi.org/10.2298/VSP210521092D.
mental health: a scoping review. Front. Psychiatry 12. https://doi.org/10.3389/ Sawyer, M.G., Reece, C.E., Sawyer, A.C.P., Johnson, S.E., Lawrence, D., 2018. Has the
fpsyt.2021.711791. prevalence of child and adolescent mental disorders in Australia changed between
Merikangas, K.R., He, J.P., Burstein, M., Swanson, S.A., Avenevoli, S., Cui, L., Benjet, C., 1998 and 2013 to 2014? J. Am. Acad. Child Adolesc. Psychiatry 57, 343–350.
Georgiades, K., Swendsen, J., 2010. Lifetime Prevalence of Mental Disorders in U.S. https://doi.org/10.1016/J.JAAC.2018.02.012 e5.
adolescents: results from the National comorbidity survey replication–adolescent
15
Settersten, R.A., Bernardi, L., Härkönen, J., Antonucci, T.C., Dykstra, P.A., Tang, S., Xiang, M., Cheung, T., Xiang, Y.T., 2021. Mental health and its correlates
Heckhausen, J., Kuh, D., Mayer, K.U., Moen, P., Mortimer, J.T., Mulder, C.H., among children and adolescents during COVID-19 school closure: the importance of
Smeeding, T.M., van der Lippe, T., Hagestad, G.O., Kohli, M., Levy, R., Schoon, I., parent-child discussion. J. Affect. Disord. 279, 353–360. https://doi.org/10.1016/J.
Thomson, E., 2020. Understanding the effects of Covid-19 through a life course lens. JAD.2020.10.016.
Curr. Perspect. Aging Life Cycle 45, 100360. https://doi.org/10.1016/J. Viner, R., Russell, S., Saulle, R., Croker, H., Stansfield, C., Packer, J., Nicholls, D.,
ALCR.2020.100360. Goddings, A.L., Bonell, C., Hudson, L., Hope, S., Ward, J., Schwalbe, N., Morgan, A.,
Sharma, M., Aggarwal, S., Madaan, P., Saini, L., Bhutani, M., 2021. Impact of COVID-19 Minozzi, S., 2022. School closures during social lockdown and mental health, health
pandemic on sleep in children and adolescents: a systematic review and meta- behaviors, and well-being among children and adolescents during the first COVID-19
analysis. Sleep Med. 84, 259–267. https://doi.org/10.1016/j.sleep.2021.06.002. wave: a systematic review. JAMA Pediatr. 1–10. https://doi.org/10.1001/
Silva, S.A., Silva, S.U., Ronca, D.B., Gonçalves, V.S.S., Dutra, E.S., Carvalho, K.M.B., jamapediatrics.2021.5840.
2020. Common mental disorders prevalence in adolescents: a systematic review and Wu, T., Jia, X., Shi, H., Niu, J., Yin, X., Xie, J., Wang, X., 2021. Prevalence of mental
meta-analyses. PLoS ONE 15, e0232007. https://doi.org/10.1371/JOURNAL. health problems during the COVID-19 pandemic: a systematic review and meta-
PONE.0232007. analysis. J. Affect. Disord. 281, 91–98. https://doi.org/10.1016/J.JAD.2020.11.117.
Şimşir, Z., Koç, H., Seki, T., Griffiths, M.D., 2021. The relationship between fear of Yeasmin, S., Banik, R., Hossain, S., Hossain, M.N., Mahumud, R., Salma, N., Hossain, M.
COVID-19 and mental health problems: a meta-analysis 46, 515–523. https://doi. M., 2020. Impact of COVID-19 pandemic on the mental health of children in
org/10.1080/07481187.2021.1889097. Bangladesh: a cross-sectional study. Child. Youth Serv. Rev. 117, 105277 https://
Smitherman, L.C., Golden, W.C., Walton, J.R., 2021. Health disparities and their effects doi.org/10.1016/J.CHILDYOUTH.2020.105277.
on children and their caregivers during the coronavirus disease 2019 pandemic. Yoshikawa, H., Aber, J.L., Beardslee, W.R., 2012. The effects of poverty on the mental,
Pediatr. Clin. North Am. 68, 1133. https://doi.org/10.1016/J.PCL.2021.05.013. emotional, and behavioral health of children and youth. Am. Psychol. 67, 272–284.
Spady, D.W., Schopflocher, D.P., Svenson, L.W., Thompson, A.H., 2001. Prevalence of https://doi.org/10.1037/A0028015.
mental disorders in children living in Alberta, Canada, as determined from physician Zemrani, B., Gehri, M., Masserey, E., Knob, C., Pellaton, R., 2021. A hidden side of the
billing data. Arch. Pediatr. Adolesc. Med. 155, 1153–1159. https://doi.org/ COVID-19 pandemic in children: the double burden of undernutrition and
10.1001/ARCHPEDI.155.10.1153. overnutrition. Int. J. Equity Health 20. https://doi.org/10.1186/S12939-021-01390-
W.
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Since January 2020 Elsevier has created a COVID-19 resource centre with

free information in English and Mandarin on the novel coronavirus COVID-

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Contents lists available at ScienceDirect

Global burden of mental health problems among children and adolescents

1. Introduction systematic reviews and meta-analyses found that preventive measures

4. Study selection 7.2. Characteristics of the included studies

Fig. 1. Flow diagram of the umbrella review process.

problems (43%), and referral

This umbrella review has several limitations that must be addressed

Table 3 (continued ) Funding information

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