Study Design
This descriptive, inductive qualitative study was completed as part of a larger mixed-method, longitudinal research study which was developed to provide actionable intelligence to local decision makers in Bradford during Covid-19. We used community and stakeholder consultation to identify priority topics for research (McEachan et al., 2020). This consultation process revealed concerns about how children would be affected by being unable to attend school and the impact of lockdown and social distancing on their social and mental wellbeing. These concerns seemed to centre on school-aged children and in particular adolescents. Research on this particular participant group was deemed critical in order to respond quickly to their needs and make recommendations for their futures.
Study Setting and Timing
The BiB research programme was in a unique position to be able to study the impact of the Covid-19 response on a key vulnerable population: primary and/or secondary school aged children living in a highly deprived and ethnically diverse city. BiB has been tracking the health and wellbeing of over 13,500 children, and their parents, born in the city between March 2007 and January 2011. Participants in all BiB cohorts have consented to the use of their routine health and education data and to be contacted for future research. Recent recruitment and follow-ups of our cohort participants means that we have a detailed understanding of the physical and mental health, social, and economic circumstances of BiB families since index pregnancies/births, including data collected in the recent ‘pre-pandemic’ and ‘pre-lockdown’ period (2016-March 2020) (McEachan et al., 2020).
The interviews took place in August and September 2020, just before the majority of the children returned to school. Since March 2020, Bradford had experienced a relatively high number of Covid-19 cases compared with the rest of the UK, and since July 2020 had been under stricter local lockdown measures which remained in place until the introduction of the tier system in October 2020 where Bradford was placed under the strictest tier (Gov-UK, 2020). These restrictions included no mixing of households indoors, a ‘rule of six’ outdoors and no travelling in or out of the area. High rates of Covid-19 in areas like Bradford are likely to be due to greater deprivation, high population density and a higher than average number of multi-generational households (Institute for Fiscal Studies, 2020).
Sampling and Data collection
Due to the age of the BiB cohort, we focused on families with children aged 10-13, choosing to interview both parents and children as a way to explore adolescent mental wellbeing from different perspectives (see Lockyer et al., 2020). Our sample started with 100 families (parents and children) who had both participated in the recent BiB Covid-19 adult and child surveys, split into two groups. The first group (randomly selected from a total of 490) was a sample of 50 children (and their corresponding parent) who reported moderate to low mental wellbeing on the Revised Child Anxiety and Depression Scale (RCADS) in their survey and the second group (randomly selected from a total of 306) was a sample of 50 children (and their corresponding parent) who reported medium to high mental wellbeing on this scale. We decided to exclude children who reported low to very low wellbeing on the RCADS because we felt it would not be ethical to contact these families when we could only offer limited support and signposting at the time due to social distancing. In addition, this group was only 22 children out of a total of 818. This group of 100 were then purposefully sampled by ethnicity, age of child, sex and deprivation (using the index of multiple deprivation) to make the small sample as diverse as possible. We also took into account the parent responses and whether they were concerned about their children’s’ mental wellbeing, and ensured we included those who did indicate it was a concern and those who did not (Lockyer et al., 2020). The sample of 100 was reduced to 50 families this way, with the aim to conduct interviews with around 20 families. Recruitment took place via a letter with information about the study and a follow up phone call to ask if they wished to participate. Overall, the first author conducted 41 interviews (with 20 families: 20 parents and 21 children).
The sample of interviewed children consisted of 9 boys and 12 girls aged 10-13, with the majority being 11 or 12 years old. In terms of ethnic group, they were White British (9), Pakistani heritage (7) and other (4) (the label of ‘other’ included children of African and Eastern European heritage) (Lockyer et al., 2020). The index of multiple deprivation associated with where they lived ranged the full spectrum from 1-8, but most families where clustered in the lower numbers (higher deprivation) (see Table 1 for participant demographics).
Table 1
Family no. | Sex of BiB Child | Age of BiB child on 31 March 2020 | Ethnicity | IMD | Parent | Non-BiB Child Interviewed |
Medium to high mental wellbeing using RCADS |
Family 1 | Female | 10 | Other | 1 | Mum | |
Family 5 | Male | 11 | Pakistani | 3 | Mum | |
Family 7 | Male | 12 | White British | 2 | Mum | |
Family 8 | Male | 12 | White British | 5 | Mum | Female aged 10 |
Family 9 | Female | 12 | White British | 4 | Mum | |
Family 10 | Female | 11 | Pakistani | 4 | Mum | |
Family 12 | Male | 11 | White British | 4 | Mum | |
Family 13 | Female | 12 | Pakistani | 3 | Dad | |
Family 14 | Male | 11 | Pakistani | 3 | Mum | |
Family 15 | Female | 12 | White British | 8 | Mum | |
Family 19 | Male | 11 | Other | 6 | Mum | |
Moderate to low mental wellbeing using RCADS |
Family 2 | Female | 11 | Pakistani | 1 | Mum | |
Family 3 | Female | 11 | White British | 1 | Mum | |
Family 4 | Female | 11 | White British | 1 | Mum | |
Family 6 | Male | 12 | Other | 1 | Mum | |
Family 11 | Female | 11 | White British | 2 | Mum | |
Family 16 | Female | 11 | White British | 6 | Mum | Female aged 10 |
Family 17 | Male | 11 | Pakistani | 1 | Mum | |
Family 18 | Male | 12 | Pakistani | 2 | Mum | Male aged 10 |
Family 20 | Female | 12 | Other | 5 | Mum | |
Consent was given verbally by both the parent and child prior to each interview. Due to social distancing measures, the interviews were conducted over the phone or via video call, whichever was the family’s preference. For the interview with children, the parent and child were given the option of having the parent present or not, or having a sibling present.
Interview questioning
Through the consultation process we identified important areas to explore such as changes to daily routine, how they felt about school/schoolwork in this period, what activities they were/were not able to do. Topic guides for the child and parent interviews were developed as flexible document to allow participants to voice what they considered to be important. We paid particular attention to making sure questions to children were tangible and focused on the present. For example, instead of asking ‘tell me about your daily routine during lockdown’ we asked ‘can you tell me a bit about what you did today?’, later asking whether that was a typical lockdown day. Interviews were piloted (4 child, 3 parent) and changes made to improve questioning, especially for the child interviews. The pilot interviews were not recorded and the data has not been included in the analysis.
Analysis
For the analysis, we used the principles of reflexive thematic analysis (Braun and Clarke, 2019). Nine interviews from four families were select based on their representativeness of the whole data set and analysed independently by the first and last authors, who came together to identify commonalities in the responses and discuss how these could be ordered into loose themes. These were then used and refined by the first author to analyse the remaining interviews. Although the RCADS scores from the survey were used to create the sample, they were not analysed through this lens as there were no discernible differences between the two groups.
Findings
We found that the transitional age of the children we interviewed had an important influence on their experience Covid-19 and the first UK lockdown. Their age combined with lockdown meant that they missed out on key learning and social opportunities at a crucial time in their lives. Covid-19 and lockdown also disrupted their daily mental wellbeing, during a period of personal change and transition. Based on our analysis of the data and the most prominent themes identified, we are presenting our findings under four headings: Anxiety about Covid-19; Boredom and Lethargy; Disengagement from School and Reduced Social Contact.
Anxiety about Covid-19
Both parents and children indicated that many children were experiencing relatively high levels of worry around the potential health impacts of Covid-19. Some parents described their child as too anxious to leave their homes during the initial lockdown (March-June 2020), even for permitted exercise:
She wouldn’t even take the dog out, it seemed to really affect her, she was quite scared. And obviously she’s at that age now where she’s got a TV upstairs and she can read, so you know, she’s reading about the coronavirus every day and seeing things, so it did scare her at the beginning and she didn’t, I don’t think she left the house for about eight weeks. (Family 11, Parent)
Parents attributed their children’s’ increased anxiety to the constant news cycle about Covid-19 and what their children saw on social media platforms such as YouTube and Instagram:
He’s kind of, you know, nervous because he keeps hearing this many or how many people died, these people, you know, how many people are positive for this virus and this and this. So first, you know, for few weeks he was keeping looking at those news, everybody every day, you know, telling me, telling me. Then I told him “no, stop looking at this news, yeah, because it’s too much for you”. Yeah, because he was taking in that, you know, then he was worried, he was saying “I’m not going outside” first. (Family 14, Parent)
Reassuring their children was challenging, because parents also felt unable to make sense of the news and so much was unknown at the time. Some decided that whilst they could not completely control what their children saw or heard, they would stop watching the news as a family and encourage their children to stay away from Covid-19 related stories.
Children reported feeling worried about the personal health impacts of getting Covid-19 but often they were more concerned about their families, particularly if they felt their parents and grandparents were medically vulnerable:
I was a bit worried about my mum because they had cancer, I think, three years ago, or something. And I was worried that it was easier for them to get coronavirus, so I was really worried for my mum. (Family 17, Child)
I just didn’t really know what would happen, because when you just started hearing about Covid-19, I was always worried, will it come to Bradford, will I get it and pass it to my dad, because I’d heard that kids don’t get it as bad as older people. Because I was like, oh, can I pass it to my parents or my nana and will they, summat happen? So I was always scared of that. And then when it did come to Bradford I got really worried. But my parents helped me get through that. (Family 20, Child)
Both parents and children discussed how they talked through these anxieties, and parents played an important role in comforting and reassuring their children. They became less worried as lockdown measures lifted and the numbers of cases and deaths started to decrease, although at first children were nervous about being in public places. Parents described their children’s vigilance about mask-wearing, social distancing and hand-washing, although this was sometimes taken to the extreme:
I think that were the major thing, the hygiene thing, they got to the point where they were making, they were washing their hands raw. And I think they were frightened, I know they were frightened for their dad because he’s a bus driver and obviously he’s in his late 50s now and he, I think they were frightened for their dad. (Family 20, Parent)
Boredom and Lethargy
As well as experiencing anxiety, children were also facing boredom. Many of the children described lockdown as boring, especially as time had gone on. Some of them had very active lives before lockdown, attending multiple extra-curricular activities such as sports clubs, youth clubs and activities related to their church or mosque. The majority of these had stopped completely, with some carrying on virtually. Whilst most had appreciated a bit of a rest at first they started to feel ‘cooped up inside’ (Family 10, Child) and that their days were repetitive:
He was saying “it’s boring, boring”, every day he used to wake up, “oh it’s boring, we can’t go anywhere, so we can’t do anything”. (Family 14, Parent)
Having no ‘reason to get up in the morning’ was causing some of the children to sleep in and/or get up quite late. Their bedtimes had become more relaxed since not going to school and so they were often getting up a lot later than they usually would, sometimes after midday and in the most extreme example, 2pm. One child explained why he was getting up a lot later:
[On] a day like this, a lockdown day, I don’t need to get up so like I just kind of lie asleep through the entire thing. (Family 18, Child)
As discussed by many of the parents, the majority of the children interviewed were reaching adolescence and were perhaps starting to need or want more sleep and the relative freedom of lockdown had given them more opportunity for this. However, some parents were troubled by their children’s lack of routine and structure in their day which meant they were spending a lot of time alone watching videos or playing computer games on a TV or tablet. Even when they were able to go out and do a few more things, some children had fallen into lethargy:
No he hasn’t been [out in public] but when I’ve asked him to go with me somewhere you know, just to get him out the house, ‘no, I’ll stay here’, I don’t think that’s because he’s worried about the virus, actually I think that’s because he just wants to stay indoors, you know, so…. it’s just the iPad the whole day. (Family 5, Parent)
During lockdown, children often had to entertain themselves, because parents were very busy working from home or working as key workers outside of the home. Some parents were worried about how they could get their children back into a routine when school started and whether they would struggle with concentration. This boredom combined with anxiety often meant children were more irritable than usual, less tolerant of their siblings, experiencing mood swings or low moods. Parents reported that they were unsure whether this could be attributed to their age or to the impact of lockdown.
She did cheerleading like four times a week so for that to stop suddenly as well has had a major…as well because everything we’ve known has just stopped, do you know, everything from like going to school and going straight out after school, to being at home, it has, it stopped for her, her whole little life has changed dramatically. So the mood being down from being sociable to being at home all the time. (Family 4, Parent)
Disengagement from school
Whilst a lot of children were unhappy that they were not able to go out and enjoy their hobbies and activities or go on day trips and holidays, a major cause of their boredom was not being able to attend school. They often described school as quite stressful, particularly if they had recently made the transition to secondary school and time off from getting up early, stern teachers, difficult social situations and doing homework was welcome at first. After a while however they became fed up with the monotony and most were quite eager to return to school.
Some parents had adopted a strict home-school regime and others were more relaxed. This was often dependent on whether their schools were offering contact hours, guidance and feedback, whether the parents were working or not and whether there were younger children in the house who needed more help. Parents would describe how arguments and tension were often triggered by home-schooling, as both parents and children had to adapt into different roles, of teacher and student, within a home environment:
They lose their routine like you know, [at] the school [they] sit down with other friends having a proper teacher with them and I think for them it was just you know, staying at home, ‘what’s the point of education?’ at the time. (Family 19, Parent)
Children would often become frustrated when they felt unable to do the work that had been set:
He has been quite anxious and stressed, I’d say we did have a lot of tears, a lot of kind of storming off saying he couldn’t do his work and that kind of thing. (Family 15, Parent)
Parents were concerned their children would fall behind and struggle to get back to their previous level of ability and concentration:
She’d lost her focus, her enthusiasm and she didn’t then want to do even a simple book review, so doing a project on a country was quite good but again, once it was done, that was it, interest was lost once again. So she’s definitely suffered. (Family 16, Parent)
A few of the children were also concerned about the impact of lockdown on their intellectual abilities:
It feels weird because it’s been such a long time that I haven’t been to school, is that sometimes I can’t even like speak properly without messing up or, you know, doing something. I realise that I’ve thought a bit slower and I’m not as like, you know, sharp as I was, as I was in school... I was a really good student before. I feel like quarantine made me a little less smart, in a sense that I’ve not been as sharp as I used to be, used to. And I’ve just kind of been lacking in just intelligence, really. (Family 18, Child)
Many of the children interviewed had just started secondary school or were just about to, so were in a time of transition. For those who had just started, they were still getting used to a larger school and some had experienced issues adapting to this new environment. These children were usually happy to not be attending school but their parents were worried that the lockdown would have a further destabilising effect. Those who were just about to start secondary school were sad they did not get the expected end of primary school experience or get to say goodbye properly to their teachers and friends going to other schools. They had also not been able to visit their new school and have any transition sessions and this was causing anxiety for some children and their parents.
Reduced social contact
For this group of children, school was usually at the centre of their social life and face to face interaction with their friends was their main mode of social contact. Due to their age, some were unable to maintain friendships without in-person contact and many of the younger children did not yet have their own phones and/or social media accounts which vastly reduced their means of independently contacting their friends during lockdown:
Because normally, even before the lockdown, he’ll only meet his friends in school, their relationship was in school than outside the school so since the lockdown there hasn’t been any contact with friends because he doesn’t contact them, (Family 6, Parent)
I just missed hugging [my friends], even when I got to school I couldn’t hug them. I was only able to keep in touch with my best friend because I don’t think Mummy had any other, like any other of my friends emails or anybody, so… (Family 16, Child)
She didn’t really, she didn’t speak to anybody on, you know, on her phone, she didn’t talk. So it sort of got cut off, really, pandemic, and then, you know, when we were allowed to meet up, me and her dad were, sort of pushed for her to meet her friend again. But it were sort of only, they only met up twice. (Family 20, Parent)
For those that were in contact via phone or video calling, social media or texting, often described it as strange compared seeing them in person and that communications could often be misinterpreted or misread. They also discussed finding it awkward and difficult to meet up with friends after so long out of contact:
‘I couldn’t even figure out what to talk about, how to string a sentence together, we was just both sat there, drinking, not knowing what to say’ (Family 9, Child).
Some children did have contact with their friends via gaming but this was reliant on having access to a games console and good Wi-Fi which was a barrier for some households. Children would often describe trying and failing to video call their friends because their friends had poor Wi-Fi reception.