Anxiety increased among children and adolescents during pandemic-related school closures in Europe: a systematic review and meta-analysis
Background: Considering the heterogenous evidence, a systematic review of the change in anxiety in European children and adolescents associated with the COVID-19 pandemic is lacking. We therefore assessed the change compared with pre-pandemic baselines stratified by gender and age as well as evaluat...
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| Main Authors: | , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
2023
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| In: |
Child and adolescent psychiatry and mental health
Year: 2023, Volume: 17, Pages: 1-19 |
| ISSN: | 1753-2000 |
| DOI: | 10.1186/s13034-023-00612-z |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.1186/s13034-023-00612-z
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| Author Notes: | Helena Ludwig-Walz, Indra Dannheim, Lisa M. Pfadenhauer, Jörg M. Fegert and Martin Bujard |
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| 245 | 1 | 0 | |a Anxiety increased among children and adolescents during pandemic-related school closures in Europe |b a systematic review and meta-analysis |c Helena Ludwig-Walz, Indra Dannheim, Lisa M. Pfadenhauer, Jörg M. Fegert and Martin Bujard |
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| 520 | |a Background: Considering the heterogenous evidence, a systematic review of the change in anxiety in European children and adolescents associated with the COVID-19 pandemic is lacking. We therefore assessed the change compared with pre-pandemic baselines stratified by gender and age as well as evaluated the impact of country-specific restriction policies. Methods: A registration on the ‘International Prospective Register of Systematic Reviews’ (PROSPERO) occurred and an a priori protocol was published. We searched six databases (PubMed, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, WHO COVID-19) using a peer-reviewed search string with citation tracking and grey literature screening. Primary outcomes were: (1) general anxiety symptoms; and (2) clinically relevant anxiety rates. We used the Oxford COVID-19 Stringency Index as an indicator of pandemic-related restrictions. Screening of title/abstract and full text as well as assessing risk of bias (using the ‘Risk of Bias in Non-randomized Studies of Exposure’ [ROBINS-E]) and certainty of evidence (using the ‘Grading of Recommendations Assessment, Development and Evaluation’ [GRADE]) was done in duplicate. We pooled data using a random effects model. Reporting is in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement. Results: Of 7,422 non-duplicate records, 18 studies with data from 752,532 pre-pandemic and 763,582 pandemic participants met full inclusion criteria. For general anxiety symptoms the total change effect estimate yielded a standardised mean difference (SMD) of 0.34 (95% confidence interval [CI], 0.17–0.51) and for clinically relevant anxiety rates we observed an odds ratio of 1.08 (95%-CI, 0.98–1.19). Increase in general anxiety symptoms was highest in the 11–15 years age group. Effect estimates were higher when pandemic-related restrictions were more stringent (Oxford Stringency Index > 60: SMD, 0.52 [95%-CI, 0.30–0.73]) and when school closures (School Closure Index ≥ 2: SMD, 0.44 [95%-CI, 0.23–0.65]) occurred. Conclusion: General anxiety symptoms among children and adolescents in Europe increased in a pre/during comparison of the COVID-19 pandemic; particularly for males aged 11–15 years. In periods of stringent pandemic-related restrictions and/or school closures a considerable increase in general anxiety symptoms could be documented. PROSPERO registration: CRD42022303714. | ||
| 650 | 4 | |a Adolescent | |
| 650 | 4 | |a Anxiety | |
| 650 | 4 | |a Child | |
| 650 | 4 | |a Communicable disease control | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a Europe | |
| 650 | 4 | |a Evidence-informed decision-making | |
| 650 | 4 | |a Health policy | |
| 650 | 4 | |a Lockdown | |
| 650 | 4 | |a Meta-analysis | |
| 650 | 4 | |a Pandemic preparedness | |
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