gms | German Medical Science

Background/research question: Depression and anxiety represented the leading causes for disease burden among children and adolescents, that potentially have been impacted by the COVID-19 pandemic. We aimed to determine the share change of children and adolescents with depression and anxiety symptoms in the WHO European Region during the COVID-19 pandemic compared to pre-pandemic baselines and evaluate country-related policy impacts.

Methods: We searched six databases and included studies for children and adolescents (≤19 years) of the WHO European Region that compared depression or anxiety symptoms during the COVID-19 pandemic with a pre-pandemic baseline using validated measurement instruments. We used the Oxford Stringency Index as indicator of restriction stringency. Screening for eligibility, data extraction, assessment of the study risk of bias (using ROBINS-E instrument) and certainty grading of evidence (using the GRADE approach), were all done in duplicate. Data were pooled in random effects models. An a priori protocol was published, reporting was carried out in accordance with the PRISMA statement.

Trial registration: PROSPERO: CRD42022303714.

Results: Of 7,422 nonduplicate records, 22 studies for depression symptoms and 18 for anxiety symptoms (including n=1,621,166 pre-pandemic, n=1,571,062 during pandemic) met inclusion criteria. For general depression symptoms (standardized mean difference [SMD], 0.21; 95% confidence interval [CI], 0.12–0.30]), clinically relevant depression rates (odds ratio, 1.36; 95%CI, 1.05–1.76]) and general anxiety symptoms (SMD, 0.34; 95%CI, 0.17–0.51]) a significant increase was determined during the COVID-19 pandemic. Effect estimates were considerable higher, when pandemic-related restrictions were more stringent or school closure occurred.

Conclusion: Depression and anxiety symptoms increased in a pre-during-comparison in the COVID-19 pandemic in the WHO European Region, whereby pandemic-related restrictions (such as school closures) resulted in an immense effect rise. Ensuring adequate supply of mental health recovery services and long-term monitoring is crucial for further healthcare of children and adolescents.

The results were incorporated at several political levels, including in the German government's crisis management board on the COVID-19 pandemic and in the recommendations of the German government's interministerial working group on health effects among children and adolescents due to the COVID-19 pandemic.

Competing interests: Prof Dr Martin Bujard (last five years): Research funding from the European Union and BMBF (German Federal Ministry of Education and Research). Travel grants and honoraria from universities, federal and state parliaments, federal and state ministries, Evangelical-Lutheran Church, Federal Agency for Civic Education. Consultant for BMFSFJ (German Federal Ministry for Family Affairs, Senior Citizens, Women and Youth). All grants and honoraria were declared to the law office of the German Federal Institute for Population Research (BiB).

Prof Dr Jörg M. Fegert (last five years): Research funding from European Union, BMG (Federal Ministry of Health), BMBF (Federal Ministry of Education and Research), BMFSFJ (Federal Ministry of Family, Senior Citizens, Women and Youth), DFG (German Research Foundation), G-BA Innovation Fund, State Ministries of Baden-Württemberg and Saarland, State Foundation Baden-Württemberg, Porticus Foundation, Evangelical-Lutheran Church in Württemberg. Travel grants, honoraria, sponsorship for conferences and medical educational purposes from APK, Adenauer- and Ebertstiftung, Deutschlandfunk, DFG, DJI, DKSB, Infectopharm, med update, UNICEF, professional associations, universities and federal and state ministries. Consultant for APK, federal and state ministries. No industry-sponsored lecture series, no shareholdings, no participation in pharmaceutical companies. Every grant and every honorarium were declared to the law office of the University Hospital Ulm.

No competing interests are declared by any of the other authors.