Background: The coronavirus disease 2019 (COVID-19) is profoundly affecting life around the globe. Isolation, contact restrictions and economic shutdown impose a complete change to the psychosocial environment in affected countries. These measures have the potential to threaten the mental health of children and adolescents significantly. Even though the current crisis can bring with it opportunities for personal growth and family cohesion, disadvantages may outweigh these benefits. Anxiety, lack of peer contact and reduced opportunities for stress regulation are main concerns. Another main threat is an increased risk for parental mental illness, domestic violence and child maltreatment. Especially for children and adolescents with special needs or disadvantages, such as disabilities, trauma experiences, already existing mental health problems, migrant background and low socioeconomic status, this may be a particularly challenging time. To maintain regular and emergency child and adolescent psychiatric treatment during the pandemic is a major challenge but is necessary for limiting long-term consequences for the mental health of children and adolescents. Urgent research questions comprise understanding the mental health effects of social distancing and economic pressure, identifying risk and resilience factors, and preventing long-term consequences, including-but not restricted to-child maltreatment. The efficacy of telepsychiatry is another highly relevant issue is to evaluate the efficacy of telehealth and perfect its applications to child and adolescent psychiatry.
Conclusion: There are numerous mental health threats associated with the current pandemic and subsequent restrictions. Child and adolescent psychiatrists must ensure continuity of care during all phases of the pandemic. COVID-19-associated mental health risks will disproportionately hit children and adolescents who are already disadvantaged and marginalized. Research is needed to assess the implications of policies enacted to contain the pandemic on mental health of children and adolescents, and to estimate the risk/benefit ratio of measures such as home schooling, in order to be better prepared for future developments.
Keywords: Adolescents; Adverse childhood experiences; Children; Coronavirus disease 2019 (COVID-19); Domestic violence family; Economic hardship; Mental health; Pandemic; Recession; SARS-CoV-2.
© The Author(s) 2020.
Conflict of interest statement
Competing interestsJMF has received research funding from the EU, DFG (German Research Foundation), BMG (Federal Ministry of Health), BMBF (Federal Ministry of Education and Research), BMFSFJ (Federal Ministry of Family, Senior Citizens, Women and Youth), BfArM (Federal Institute for Drugs and Medical Devices), German armed forces, several state ministries of social affairs, State Foundation Baden-Württemberg, Volkswagen Foundation, Pontifical Gregorian University, CJD, Caritas, Diocese of Rottenburg-Stuttgart. Moreover, he received travel grants, honoraria and sponsoring for conferences and medical educational purposes from DFG, AACAP, NIMH/NIH, EU, Pro Helvetia, Shire, several universities, professional associations, political foundations, and German federal and state ministries during the last 5 years. Every grant and every honorarium have to be declared to the law office of the University Hospital Ulm. Professor Fegert holds no stocks of pharmaceutical companies. BV has been consultant for Medice and Lundeck Pharmaceuticals, and for law firms Goodwin & Procter and Haynes & Boone. He holds no stocks of pharmaceutical companies. PLP has received research funding from the German Federal Institute for Drugs and Medical Devices (BfArM), German Federal Ministry of Education and Research (BMBF), VW-Foundation, Baden-Württemberg Foundation, Lundbeck, Servier. He received a speaker´s honorarium from Shire. Professor Plener holds no stocks of pharmaceutical companies. VC states that she has no conflict of interests.
[Health professionals facing the coronavirus disease 2019 (COVID-19) pandemic: What are the mental health risks?].Encephale. 2020 Apr 22:S0013-7006(20)30076-2. doi: 10.1016/j.encep.2020.04.008. Online ahead of print. Encephale. 2020. PMID: 32370984 Free PMC article. French.
Ensuring mental health care during the SARS-CoV-2 epidemic in France: A narrative review.Encephale. 2020 Apr 22:S0013-7006(20)30073-7. doi: 10.1016/j.encep.2020.04.005. Online ahead of print. Encephale. 2020. PMID: 32370982 Free PMC article.
[Ensuring mental health care during the SARS-CoV-2 epidemic in France: A narrative review].Encephale. 2020 Apr 2:S0013-7006(20)30064-6. doi: 10.1016/j.encep.2020.03.001. Online ahead of print. Encephale. 2020. PMID: 32312567 Free PMC article. French.
Florida Domestic Violence.2019 May 2. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. StatPearls. 2020 Jan–. PMID: 29630246 Free Books & Documents. Review.
[Psychopharmacotherapy during the COVID-19 pandemic].Nervenarzt. 2020 Jun 2. doi: 10.1007/s00115-020-00939-4. Online ahead of print. Nervenarzt. 2020. PMID: 32488413 Review. German.
- Fegert JM, Kehoe LA, Vitiello B, Karwautz A, Eliez S, Raynaud J-P, et al. COVID-19: services must remain active, we must communicate with networking partners and avoid further closure of psychiatric units. https://www.escap.eu/index/coronavirus-and-mental-health/maintain-contact-with-patients-and-their-families-and-prevent-closure-of-services. 2020.
- Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health. 2020;17(5):1729. doi: 10.3390/ijerph17051729. - DOI - PMC - PubMed
- The Alliance for Child Protection in Humanitarian Action. Technical Note: Protection of Children during the Coronavirus Pandemic (v.1); 2020. https://alliancecpha.org/en/COVD19.
- Team ICC-R. Estimating the number of infections and the impact of non-pharmaceutical interventions on COVID-19 in 11 European countries. https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-Europe-estimates-and-NPI-impact-30-03-2020.pdf; 2020.
- Fegert JM, Berthold O, Clemens V, Kölch M. COVID-19-Pandemie: Kinderschutz ist systemrelevant. Dtsch Arztebl Int. 2020;117(14):A-703.