We describe data on an extensively characterized group of children and adults (N = 69, 41♀, age range = 7–51 years, including 26 children and their mothers) with a total of ~ 2’500 tests conducted across seven assessment timepoints during the Covid-19 pandemic, also including pre-pandemic baseline data. Our findings indicate significant effects of Covid-19-related restrictions on mental well-being and psychosocial functioning in children and adults as for example reflected by heightened scores in anxiety, depression or caregiver stress and significant variation of anxiety, depression, general health, and burden of care in adults or in mood and overall emotional and behavioral problems in children. Well-being in mothers predicted mood and emotional and behavioral problems in children. In children meeting friends was a significant predictor of mood during restrictions. Additionally, neural correlates of mentalizing in prefrontal, but not temporoparietal regions, preceded the development of fear about contamination and illness across all participants. In mothers, higher neural activation in temporoparietal, but not frontal, regions during mentalizing preceded higher reports of subjective burden of care during restrictions. This may indicate that higher tendency to mentalize, usually considered beneficial for social interactions38 and favorable when present in mother-child dyads39, can be negatively associated with socioemotional functioning during prolonged stress.
Child behavior as measured by the SDQ or CBCL showed no difference when comparing pre-pandemic scores to those during restrictions, which is in line with longitudinal reports7 observing a relatively stable level of problem behaviors with Covid-19-onset. However, there was significant variation in emotional and behavioral problems across restrictions. When looking at distinct subscales, a significant variation over time was observed for all scales, except prosocial behavior, which we hypothesized was restricted due to social distancing measures. Follow-up assessment comparing each timepoint revealed significant differences in hyperactivity marked by a strong decrease in scores from T4 to T5. Notably, the observed drop in hyperactivity coincided with eases of restrictions by the Swiss federal government (i.e., reopening of primary and lower secondary schools). Consequently, higher hyperactivity was observed during the most stringent restriction phase, while decreases in hyperactivity were observed once these were eased and thus are likely explained by the transition towards regular routines. Additionally, children’s time spent outside, and mood varied significantly. Slight variations in scores may be explained by several public holidays (Easter) around mid-restrictions, which is marked by more time spent outside in all participants, higher mood in children and lower caregiver burden in mothers (no home-schooling). Evidence highlights that prolonged school closure or restrictive measures are detrimental to children’s physical and mental health and can have long-lasting consequences14. Our findings further indicate that meeting friends predicted better mood, which is in line with prior evidence emphasizing the importance of friendships and peer relationships in developmental groups11,36.
Quantitative measures obtained were further supported by qualitative reports, which provide a unique insight into children’s values and further highlight sources of resilience. More specifically, children mentioned more time for leisure, sleep, family, and friends or less stress or exams as positive attributes of school closure. Negative mentions centered around restrictions affecting social contacts, prohibiting hobbies or sports, or increased stress and conflict. Interestingly, across two time points, positive mentions about returning to schools across all children solely focused on social domains (e.g., meeting friends, class, teachers again or in-person schooling), whereas negative mentions included less sleep, less free time or increased stress and homework, or restrictions. Themes reported were in line with findings of qualitative reports during Covid-1911,36.
Anxiety, depression and caregiver burden was high amongst adults with varying group scores across the first pandemic months. Anxiety was highest at the beginning and after seven weeks of restrictions reaching clinically significant levels. An increase in anxiety due to restrictions is in line with accumulating Covid-19 reports2,5,8,40. Likewise, findings of possible decreases with time have been reported2,40. A significant variation over time was also observed for scores of depression, though follow-up comparisons did not survive multiple comparison correction. While group average scores of depression were in the normal range, it is notable that 32.56% of all adults reported heightened depressive symptoms and 4.65% qualified for a major depressive episode at least once. These observations mirror reports of heightened depression scores in the general population during Covid-19 (e.g., retrospective reports2 or longitudinal data6). Variations in general health, as measured by the General Health Questionnaire across restrictions, were significant, but no significant main effect of time was observed for perceived distress. Participant reports reflected significant changes in news consumption and time spent outside, with decreases in the amount of news consumed. Adults’ and children’s time spent outside showed similar trajectories, which might be driven by Easter vacation, the inclusion of parents within the adult group or easing of restrictions/return to work towards the end of testing. Sex, media consumption, time spent outside or parenthood did not explain variations in scores of anxiety, depression or distress in adults. This is somewhat surprising given prior evidence of the impact of each of these variables on mental well-being during Covid-19 (gender and parenting35; news consumption2; time spent outside36).
Mothers reported moderately elevated levels of subjective burden of care which is in line with studies investigating parental burden during Covid-1941. A moderate burden of care has been associated with elevated risk for physical, psychosomatic, or mental health problems37,41. In the present study, mother-child variables were strongly associated. Subjective burden of caregiving in mothers predicted emotional and behavioral problems in children, while anxiety and depression did not. This indicates that higher burden in mothers was linked to more problem behaviors in children. Notably, emotional and behavioral problems in the child were reported by the mother, thus reporting bias can’t be excluded. We further investigated the effect of the mothers’ well-being on children’s self-reported mood, demonstrating that elevated depression in mothers affected children’s mood ratings. Dyadic relationships are a primary vehicle for children’s learning9. While commonly a driver of positive effects, it may also lead to negative consequences, as demonstrated in the example of vicarious conditioned fear learning in parent-child dyads42. We thus hypothesize, that negative mental health in adults may have negatively impacted children’s well-being, possibly through learnt maladaptive coping or contagion. Increased parental stress and anxiety may lead to parental burnout13 or increased aggression15. Intergenerational care during early years lays the foundation for healthy social skill development43 and systemic mental health intervention programs commonly draw from this relationship44. Our data support programs investing in increased parental support, which are expected to influence children’s well-being positively.
The neural correlates of mentalizing as measured prior to the pandemic in prefrontal, but not temporoparietal brain regions, preceded the development of fear about contamination and illness and in all participants. In mothers, higher neural activation during mentalizing in temporoparietal, but not frontal regions was associated with higher burden of caregiving during restrictions. Activation increases in the right temporoparietal junction are commonly reported as a response to tasks of mentalizing, as this area selectively responds to observed social interactions45 and is part of the so-called paternal caregiver brain network46. Prefrontal areas are similarly engaged during tasks of mentalizing and are crucial for cognitive control processes10. Our data indicate that neural activation during mentalization in prefrontal cortex prior to Covid-19 precedes the development of fear of contamination and illnesses across all individuals. The assessment of fear about contamination and illness required participants to make statements relating to the likelihood of oneself, a parent, a pet, or someone else in the world becoming sick and/or dying because of a virus or illness. Activation increases in prefrontal cortex have been linked to psychological state attributions, independent of whether they affect oneself, a relative, imagined people or animals47. A higher tendency to think about other people’s well-being, as reflected by higher mentalization-related activation in the prefrontal cortex, may thus be linked to the likelihood of developing fear about contamination and illness affecting ourselves and others.
Overall, better mentalizing has been associated with higher social competence, psychological and physiological functioning22, while impairments have been associated with stress and depression23. Increased mentalizing skills in caregivers are beneficial for child development. For example, parental mentalization has been positively associated with regulatory skills in children48, which may be protective during stressful life events43. However, the opposite effect may occur during stressful situations17. For example, higher levels of mentalizing abilities are associated with higher cortisol and heart rate reactivity in stressful situations49. This may temporarily be beneficial, but may have a long-term negative impact depending on the intensity and duration of negative events. Our data indicate that mentalization can be negatively associated with increased burden and fear development in prolonged stressful situations.
In the present example, extensive phenotyping within individuals (e.g., over 2’500 assessments conducted) allow a comprehensive view and an opportunity to assess effects of time within individuals. Nevertheless, observations such as the existence of potential subgroups will have to be further examined using larger and more diverse populations. An example for possible subgroups reacting differently to stressful life events as associated with pandemics include children that may in fact benefit or even thrive during restrictions7. A more detailed understanding of subgroups of individuals that are differently affected may increase opportunities to select the best fitting individualized treatments or prevention. Assessing direct subjective experience of the severity of impact by Covid-19 and associated restrictions would have been a valuable addition. Moreover, it remains to be investigated how far-reaching the herein observed negative effects on well-being are. Past work has indicated that early adversities can have an impact for life, with effects potentially being most significant in younger age and depending on the intensity of the experience50. An increased understanding of protective and/or risk factors and mechanisms leading to the development of stress-related psychopathologies may ultimately hold the potential to facilitate more personalized prevention and treatment strategies.