Worldwide prevalence of anxiety and depressive disorders among children according to the Diagnostic and Statistical Manual (DSM) and International Statistical Classification of Diseases and Related Health Problems (ICD) was estimated to be 6.5 and 2.6%, respectively(19). In this study, only 5.81% of the youth was found to have anxiety after school resumption, while 48.84% of them had depression. Our findings differ from those of a previous Chinese study conducted among school students one month immediately after the lockdown, which reported a higher rate of anxiety (18.9%) but a lower rate of depression (22.6%)(20). In a study on adults six weeks after lockdown in India, 52.7% of the subjects had depression and 14% of them had anxiety(21). A study on adults in Malaysia found that 21.8% had depression and 31.6% had anxiety three weeks after the lifting of lockdown measures(22). In addition, a recent systematic review identified three studies that reported prevalence rates of depression during the Coronavirus Disease among Chinese children and adolescents ranging from 22.6 to 43.7%(23). Such discrepancies might have arisen from the use of disparate assessment tools. Moreover, criteria for DSM and ICD were not used in the current study; the young participants instead reported their symptoms with an emphasis on their perspectives about how they felt before outbreaks of the coronavirus epidemic.
All subjects reported some degree of sleep disturbances. In this aspect, adolescents were more severely affected than younger children. Locally, social media and instant messages have become popular tools for social support. Adolescents may be keen on online interactions for virtual support from peers while under isolation during the epidemic. In comparison, children may have less access to such tools and rely more on direct contact with families for social support. Recent evidence has suggested a consistent association between sedentary screen time and poor sleep(24).
Prevalence of PTSS in children and adolescents was 6.25%, which was much lower than that of PTSD (12.8%) one month after Covid-19 outbreaks in China(25), and lower than that of PTSD (41%) reported by Covid-19 disease patients three months after discharge(26). Prevalence of PTSD in the sampled youth population was 14.4% two weeks after Covid-19 outbreaks surged in China in 2020(27). Anxiety was found to be a high-risk factor for PTSS [OR: 12.97, p < 0.001, 95%CI (5.41–31.11)]. From a theoretical perspective of anxiety sensitivity, a child can avoid anxiety-related cues from expected catastrophic consequences(28). Empirical evidence has shown that anxiety sensitivity is linked to PTSD symptoms in youth(29).
Previous studies on the effects of SARS-related quarantine suggest that isolated adults experienced a high level of psychological distress such as depression, irritability, and post-traumatic stress symptoms associated with lockdowns,(30, 31) with long-lasting psycho-behavioural implications for life in years after(32). Quite surprisingly, the present study found that neither children nor adolescents experienced any marked changes in their self-reported PTSS and anxiety three months after school resumption (i.e., lifting of home isolation). During the peak coronavirus disease epidemic periods in China, 2020, the youth’s overarching concerns were disruption to their social interactions and schooling activities, whereas concerns for contracting coronavirus infection or getting ill from it were very low(33). Unlike conventional home-schooling styles applied in other countries, where parents, relatives, or other knowledgeable persons act as instructors for conducting primary education at home(34), the Chinese home-schooling style remained primarily organized by school teachers and combined the use of live/recorded broadcasts, WeChat/DingTalk (social network application) based group communication, and software-based homework submission and assessment. All school subjects were taught online, including the major subjects of Chinese language, sciences and mathematics, and the minor subjects of morality, music, art and gymnastics(35). The daily practice of learning routines was altered for most children and adolescents, as their socialisation with peers transitioned to electronics-based platforms(36). Although children and adolescents experienced a drastic routine disruption due to lockdowns, they may not be completely isolated within a household or in an internet-accessible virtual community. Furthermore, an apparent reduction in academic pressure and increased time spent with family may help dissipate overall stress(37).
In this study, youth response to the coronavirus epidemic appeared qualitatively different from that of the adults. During prolonged periods of urban lockdowns, the impact of negative information in multimedia, excessive fears of being infected, and even the shame or guilt for coronavirus infection converged to shape the psychological well-being of many individuals across China. In particular, residents at the putative epicentre of initial epidemic in Wuhan city, China, subjective experiences of fear, loneliness, panic, anxiety and depression were widely reported amid the coronavirus outbreaks in early 2020(1, 38). However, this work shows that about three months after the recovery of social function in the local populace in central China, the youth in Wuhan city had similar psychological reactions with those in non-Wuhan areas. Prevalence of anxiety and PTSS in children and adolescents was also lower than expected. It is important to note that factors influencing PTSS outcomes are complex, often involving interaction with socioeconomic determinants. For example, primary caregivers in our samples were fairly well educated, with 54.65% of them having a bachelor’s or higher degree. The majority of them were employed. As socioeconomic details such as household income levels and number of rooms in the house were not collected, our analysis could not be extended to include potential intervening factors. More a comprehensive design covering such socioeconomic details may be helpful in future investigation.
Overall, we did not find any significant differences in psychological health status between children and adolescents. Periods of lockdown generally serve as a serendipitous occasion for parents to mingle with their children in physical proximity. According to previous findings, traditional Chinese parents, as compared with American parents, tend to use supportive behaviours rather than verbal expressions to deliver care and love to their children(39). It is possible that home isolation measures during lockdowns ironically incentivized parents to discuss life events more frequently with children and adolescents, which represents a good opportunity of solidifying or improving parent-child interactions, through mutual engagement in family activities conducive to building children’s self-esteem and confidence. For the youth, the process of staying closely with their families suffering and struggling together to recover from traumatic experiences can remarkably afford transformative and positive effects on growth(40). In this case, the youth may not necessarily experience an overt feeling of loneliness(41). They might even perceive lockdowns as some positive, rather than negative, challenges, which helped yield less psychological distress.