Prevalence and Risk Factors Associated With Self-reported Psychological Distress Among Children and Adolescents During the COVID-19 Pandemic in China.

Publisher: American Medical Association Country of Publication: United States NLM ID: 101729235 Publication Model: Electronic Cited Medium: Internet ISSN: 2574-3805 (Electronic) Linking ISSN: 25743805 NLM ISO Abbreviation: JAMA Netw Open Subsets: MEDLINE

Original Publication: Chicago, IL : American Medical Association, [2018]-

Mental Health* ; Pandemics* ; Psychological Distress*; Anxiety/*etiology ; COVID-19/*psychology ; Depression/*etiology ; Stress, Psychological/*etiology; Adolescent ; Anxiety/epidemiology ; Child ; China/epidemiology ; Cross-Sectional Studies ; Depression/epidemiology ; Exercise ; Female ; Humans ; Logistic Models ; Male ; Masks ; Odds Ratio ; Prevalence ; Risk Factors ; SARS-CoV-2 ; Schools ; Self Report ; Stress, Psychological/epidemiology ; Students

Importance: Schools have been suspended nationwide in 188 countries, and classes have shifted to home-based distance learning models to control the spread of the coronavirus disease 2019 (COVID-19) pandemic. Additional information is needed to determine mental health status among school-aged children and adolescents during this public health crisis and the risk factors associated with psychological distress during the pandemic.
Objective: To assess self-reported psychological distress among school-aged children and adolescents associated with the COVID-19 pandemic.
Design, Setting, and Participants: This cross-sectional study using data from a survey on the mental health of school-aged children and adolescents in Guangdong province, China, conducted by using a stratified cluster random sampling method between March 8 to 30, 2020. To estimate outcomes associated with location of districts, only data from students with internet protocol addresses and current addresses in Guangdong were included. Data were analyzed from April 5 to July 20, 2020.
Exposure: Home-based distance learning during the COVID-19 pandemic.
Main Outcome and Measures: The main outcome was self-reported psychological distress, measured using the total score on the 12-item General Health Questionnaire of 3 or greater. Multivariate logistic regression was used to analyze risk factors associated with mental health status. Odds ratios (ORs) were used to analyze the associations of factors with psychological distress.
Results: Among 1 310 600 students who completed the survey, 1 199 320 students (mean [SD] age, 12.04 [3.01] years; 619 144 [51.6%] boys) were included in the final analysis. A total of 126 355 students (10.5%) self-reported psychological distress. Compared with students in primary school, high school students had increased risk of psychological distress (OR, 1.19 [95% CI, 1.15-1.23]). Compared with students who wore a face mask frequently, students who never wore a face mask had increased risk of psychological distress (OR, 2.59 [95% CI, 2.41-2.79]). Additionally, students who spent less than 0.5 hours exercising had increased odds of self-reported psychological distress compared with students who spent more than 1 hour exercising (OR, 1.64 [95% CI, 1.61-1.67]).
Conclusions and Relevance: These findings suggest that the prevalence of self-reported psychological distress among students during the COVID-19 pandemic was relatively high. Frequency of wearing a face mask and time spent exercising were factors associated with mental health. Therefore, it may be necessary for governments, schools, and families to pay attention to the mental health of school-aged children and adolescents during the COVID-19 pandemic and take corresponding countermeasures to reduce the impact of the COVID-19 pandemic on students' mental health.

BMJ. 2020 Apr 9;369:m1442. (PMID: 32273278)
Int J Environ Res Public Health. 2019 Apr 04;16(7):. (PMID: 30987309)
Clinics (Sao Paulo). 2005 Feb;60(1):61-70. (PMID: 15838583)
Aust N Z J Psychiatry. 2009 Jul;43(7):674-80; quiz 681. (PMID: 19530025)
J Med Internet Res. 2020 May 6;22(5):e19128. (PMID: 32330115)
Lancet Infect Dis. 2020 May;20(5):e102-e107. (PMID: 32145768)
World J Pediatr. 2011 Feb;7(1):54-9. (PMID: 21191777)
Psychiatry Res. 2020 May;287:112915. (PMID: 32199182)
JAMA. 2003 Oct 15;290(15):2063-4. (PMID: 14559963)
Health Qual Life Outcomes. 2016 Sep 26;14(1):136. (PMID: 27669741)
EClinicalMedicine. 2020 Apr 24;22:100356. (PMID: 32337502)
Int J Environ Res Public Health. 2017 Nov 14;14(11):. (PMID: 29135949)
JAMA Intern Med. 2020 Jun 1;180(6):817-818. (PMID: 32275292)
J Adolesc Health. 2020 Aug;67(2):179-185. (PMID: 32487491)
Gen Psychiatr. 2020 Mar 6;33(2):e100213. (PMID: 32215365)
J Am Acad Child Adolesc Psychiatry. 2020 Oct;59(10):1099-1102.e1. (PMID: 32615153)
Epidemiol Health. 2019;41:e2019035. (PMID: 31319652)
Disaster Med Public Health Prep. 2013 Feb;7(1):105-10. (PMID: 24618142)
Lancet Psychiatry. 2018 Sep;5(9):739-746. (PMID: 30099000)
Asian J Psychiatr. 2020 Aug;52:102066. (PMID: 32302935)
Lancet Public Health. 2020 May;5(5):e243-e244. (PMID: 32275858)
Int J Environ Res Public Health. 2020 Mar 06;17(5):. (PMID: 32155789)
JAMA Pediatr. 2020 Sep 1;174(9):898-900. (PMID: 32329784)
Am J Public Health. 2012 Sep;102(9):1742-50. (PMID: 22873479)
Eur Child Adolesc Psychiatry. 2020 Jun;29(6):749-758. (PMID: 32363492)
J Clin Nurs. 2009 Dec;18(23):3253-61. (PMID: 19732241)
Lancet. 2020 Aug 1;396(10247):298-300. (PMID: 32622373)
Lancet. 2020 Mar 21;395(10228):945-947. (PMID: 32145186)

Date Created: 20210126 Date Completed: 20210203 Latest Revision: 20210206

20231215

PMC7838937

10.1001/jamanetworkopen.2020.35487

33496797