By now it is widely acknowledged that the COVID-19 lockdowns and school closures have affected youth mental health. It should also be clear by now that, although lockdowns affect us all, the negative effects are unequally distributed.
School closures disrupted learning, daily routine and social contacts, and increased stresses in the home. Furthermore, they are likely to have exacerbated existing mental health conditions and health inequalities. The YoungMinds survey (2020) estimated that 80% of adolescents with pre-existing mental health conditions believe that their mental health worsened during lockdown.
For some people, for whom school attendance is problematic, there may even have been short term mental health improvements (CoSpace study, 2020). So these impacts are multi-faceted, and there are both short term and long term effects.
To better understand this complex picture and identify those most at risk, we need to understand more about how all the different factors interact. A recent study by Karen Mansfield and colleagues from Oxford University asked young people about their mental health and social circumstances during lockdown to identify who was most at risk (Mansfield et al, 2021).
Lockdowns affect us all, but the negative effects are unequally distributed.
Methods
An annual cross-sectional survey (the OxWell study) of secondary school pupils.
Population
School pupils in the south of England, mixed settings, aged 12-21 (school years 8 to 13).
Outcomes
Depression and anxiety were assessed using the Revised Child Anxiety and Depression Scale (RCADS). They also used a single-item question asking pupils to estimate the impact of school closures on their mental wellbeing.
Exposures
The following exposures, or “predictors”, were assessed:
- Socioeconomic: access to free school meals and experience of food poverty
- Increased vulnerability: female gender, previous access to mental health services, living circumstances
- Situational risk factors: parents going out to work, being in years 10 or 12 (with important examinations to complete).
Results
11,765 participants provided data for the survey. The overall prevalence of depression was 14%, anxiety was 10%, with 38% reporting their wellbeing to be worse during lockdown.
Analysing the associations between predictors and outcomes, the odds ratios (OR) of young people reaching clinical thresholds for depression and anxiety were associated with the following conditions:
| Predictor | Depression (OR) | Anxiety (OR) |
| Previously used MH support | 3.91 | 3.83 |
| Female gender | 3.62 | 2.55 |
| Experienced food poverty | 3.36 | 3.03 |
| Approaching national exams | 1.46 | 1.49 |
| Parents are essential workers | 1.34 | 1.25 |
This study found that females, pupils who had experienced food poverty and those who had previously accessed mental health support were at greatest risk of depression, anxiety and a deterioration in wellbeing during lockdown.
Strengths and limitations
- This was a well-conducted survey with a large sample and a clear protocol
- Participants were excluded if they completed the questionnaire too quickly or in an unrealistic way
- Participants with missing data were not included. The researchers did a sensitivity analysis on the impact of non-responders and concluded that they did not affect the results significantly
- Those who did not participate tended to be less engaged with remote learning
- The process for allocation of in-school places differed from school to school
- Although a higher percentage of the in-school group had depression (17% vs 13%), these differences disappeared in the adjusted analysis suggesting that it was not a robust finding
- The study did not look at ethnicity or special educational needs
- The findings are consistent with other evidence (YoungMinds 2020, NHS 2020).
Although a higher percentage of the in-school group had depression (17% vs 13%), these differences disappeared in the adjusted analysis suggesting that it was not a robust finding.
Conclusions
The strongest predictive factors were those we already know to be risk factors for mental ill health. The impact was greatest on those who had previously used mental health support services.
Female gender and experience of food poverty were substantial predictors of higher risk. Pupils who were preparing for important examinations were also impacted more severely than others.
None of these findings are particularly surprising. Young people are well aware of the negative impact of school closures on their social life and educational prospects.
Just because a finding is not surprising doesn’t mean it isn’t important. Schools, families and mental health services need to be aware of these results. Of course, the survey does not tell us anything about the effects of interventions undertaken to ameliorate these effects, or about how services should care for those who have already been impacted. What it does tell us is that impacts are likely to be greatest amongst those already at risk, especially in young women, and in those who experience food poverty.
Female gender and experience of food poverty were substantial predictors of higher risk. Pupils who were preparing for important examinations were also impacted more severely than others.
#CAMHScampfire
Join us around the campfire to discuss this paper
The elves are organising an online journal club to discuss this paper with the lead author, a young person and other professionals working in the field, plus our good friends at ACAMH (the Association of Child and Adolescent Mental Health). We will discuss the research and its implications. The webinar will be facilitated by André Tomlin (@Mental_Elf).
The focus will be on critical appraisal of the research and implications for practice. Primarily targeted at CAMHS practitioners, and researchers, ‘CAMHS around the Campfire’ will be publicly accessible, free to attend, and relevant to a wider audience.
It’s taking place at 5-6pm GMT on Monday 13th December and you can sign up for free on the ACAMH website or follow the conversation at #CAMHScampfire. See you there!
Links
Primary paper
Mansfield KL, Newby D et al. COVID-19 partial school closures and mental health problems: A cross-sectional survey of 11,000 adolescents to determine those most at risk. JCPP Advances 20 July 2021. https://doi.org/10.1002/jcv2.12021
Other references
NHS Digital. (2020). Mental health of children and young people in England, 2020: Wave 1 follow up to the 2017 survey. https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and-young-people-in-england/2020-wave-1-follow-up
YoungMinds. (2020). Coronavirus: Impact on young people with mental health needs.
CoSpace study (2020). Emotional & behavioural difficulties (June 2020)
