Effects of the Pandemic on Children and Young People's Wellbeing in German Cohort

Dr. Tanya Poulaine and Dr. Mandy Vogel of Leipzig University Hospital for Children & Adolescents wrote a JCPP paper titled ‘Well‐being and COVID‐19‐related worries of German children and adolescents: A longitudinal study from pre‐COVID to the end of lockdown in Spring 2020’ (ACAMH)

In April 2021, Jo Carlowe a freelance journalist (who specialises in psychology) conducted a podcast interview with ACAMH discussing the findings of the doctors and looking into their study of the pandemic’s broader effects on young people's mental health and well-being.

The Study

The Life Child study conducted at Leipzig University’s children’s hospital began in 2011, recruiting children by collecting their bio samples and following them from pregnancy until young adulthood. Using sources such as questionnaires and computer-assisted interviews, the two doctors gathered a wide range of information from the children, from physical activity to family background and leisure activities.

They also carried out developmental tests, using computer games and tested motor function and media use. They were also interested in looking at the wider implications that the pandemic has had on the mental health and wellbeing of young people.

Dr. Vogel explained that the studies also included the ‘measurement of the environment’ of the children, seeking to define healthy development in children’s lives and the risk factors involved. This led them to do many different collaborations with different departments across German hospitals and institutes and corporations in the Netherlands, Sweden, and EU.

The study also included annual follow up visits on participants, until they were 20 years of age. The doctors set out with the aim of integrating their research results into practice, such as by developing intervention and prevention programmes for children at the University hospital.

Method

In the first lockdown in March 2020 and the last week of April 2020 participants of the Life Child study were sent online questionnaires. Parents and children that were aged around 11 and 12 were asked to answer a question relating to their wellbeing, media use in the lockdown, and other COVID-19 various.

Using pre covid data from 2019 as baseline data, statistical comparisons were made between those and March 2020 and April 2020 data.

The paper looked at the children and adolescent’s individual and personal worries, but also the worries of people close to them such as friends and family. It also investigated the worries concerning their local town or city, Germany as a country, and the whole world.

Effects on Wellbeing from the Pandemic

Dr Poulain explained that the differences found in the physical and psychological wellbeing of young people pre covid and during Covid showed that wellbeing was lower on both aspects during the spring lockdown in 2020 than a year before the pandemic.

Relationships were also vastly affected, with the percentage of children having no contact with friends (in person or online) rising to 14% in the lockdown period from just 3% the previous year. A staggering 80% of children also stated that they missed their friends during the lockdown.

Social Isolation and Loneliness

When asked about social isolation and its relation to being found children compared to the usual experience in older people, Dr Vogel explained the importance of the topic of loneliness. She stated that loneliness was highly prevalent in children and how the lockdown has stopped them from having any from contact with friends.

She describes the significance of loneliness in children during puberty and understands from research that ‘as children get older the more, they suffer from loneliness’.

Vogel also explains that their results were supported by a US research study that showed loneliness as ‘highly prevalent’ in COVID months of May and June 2020. The US study also showed loneliness being associated with COVID related worries as well as depression and anxiety in children aged six to 18. A Norwegian study had similar findings, which led Vogel to conclude that in general, ‘loneliness during childhood has severe consequences”, since it is associated with higher levels of anxiety and depression later on.

Focusing on media use and mental health, when asked about the ‘changes wellbeing and media use in nine- to 18-year-olds, caused by the lockdown and social distancing’, the study results found that children use media a lot more now in their downtime. Data results (excluding school time) showed that pre COVID media use time differed between weekdays and weekends. However, during the lockdown, the study showed that this difference had ‘vanished’.

Vogel explained that this could possibly be down to a lack of structure in the children’s days. The Life Child Study did not ask participants to specify exact times they were on the screen but have seen in other studies carried out which did, that Spanish children and obese Italian children’s screen time had a daily increase of two hours, which had an impact on mental health.

Findings

From their findings on screen time, Dr Poulain suggests that ‘long screen times on the one hand, and wellbeing, social interaction, or for example, school achievement, on the other, may negatively affect each other in the long run.

Poulain also indicated that children want to sometimes ‘seek escape’ to a virtual world if they are not achieving as well and that excessive screen time can lead to children developing behavioural difficulties.

In a previous study carried out by the two doctors, it was found that ‘adolescents reporting to use computers and the internet for more than two hours per day report more behavioural difficulties and a lower psychological wellbeing one year later’. She linked this to the current data, understanding the relation to media use and wellbeing in the long run, suggesting that this risk could now be higher during a pandemic or experiencing social isolation.

She also states that these patterns of behaviour (high media use and working alone), ‘might not immediately return to normal after a lockdown or a pandemic… and that’s relevant for their mental health in general.’

Factors that have negatively affected wellbeing due to COVID-19:

-Socioeconomic Status

The paper also interestingly discussed the impact of socioeconomic status on well-being of children during the pandemic. Dr. Poulain explains the differences in reaction amongst different children to situations like school closures or social isolation. She found that some children manage to ‘develop new coping strategies’ and can adapt to them, whereas others need to feel more supported in their home environment, receiving comfort from their family (which is supported by other studies).

Their results presented those children and adolescents from families with a lower social status showed a much stronger drop in life satisfaction from before the pandemic started until the middle of lockdown compared to those with a higher status. They summarised this evidence as ‘…in socially weaker families, the family support may sometimes not be as helpful as it should be’.

-Housing

Housing conditions also was a highlighted factor that affected these differences too. This theory of housing suggests that children who are less likely have their own room, due to being a part of a socially weakened family, usually also live in smaller housing situations. This could mean these children are then less likely to have a suitable learning environment, lacking resources such as a computer or desk which could explain the reason behind it.

Financial worries and health complications were also reasons why socially weakened families may be less able to cope with challenging situations during a pandemic.

Although the Life Child Study was conducted on German children, the results seemed to prove similar internationally. A study in the UK showed a low level of wellbeing amongst children during the COVID-19 pandemic.

Other studies on children in the US and Italy also found higher media use, and countries like Africa and other regions of the world saw much worse consequences due to school closures, such as an increase in child marriages.

-Covid Measures

According to UNICEF, there are said to be around ten million child marriages that were caused by the COVID-19 pandemic. Dr Vogel points out that children who live in western countries do have significant problems related to COVID-19, however, there are ‘children in other regions of the world who suffer much more’.

When asked about whether the pandemic measures should be ‘balanced against adverse public health effects’ and how these rules should be created, Vogel states that ‘the closing of schools can be necessary’ however there are other practical and ‘feasible’ measures to be used.

She demonstrates the importance of approaching measures as scientists, choosing to learn more about how infections work, (understanding the prevention and effect of them) whilst distinguishing the most vulnerable groups. She also suggests that even if we chose to close schools and nurseries that we have to learn to adapt to the consequences by ‘developing strategies to mitigate them, to help families, especially single parent families in the process.

In her opinion, it is not a case of making a single decision about measures and the public effects but the ‘a continuous process’ of balancing both. Dr. Vogel wants both child psychologists and scientists to understand that they must ‘take a stand for children because they do not have their own ‘lobby’ and ‘everyone deserves a voice at times like these.

Impact of these Factors on Mental Health

This paper also demonstrates findings that strongly show that ‘isolation can have a negative impact on the wellbeing of children and adolescents.

Although the Life Child Study was mainly carried out on healthy children and those from higher social classes, the results still showed a significant drop of wellbeing from before the pandemic to during. Therefore, the doctors believe children who were already struggling before the pandemic were likely to experience a stronger drop in wellbeing.

Dr. Vogel also suggests that some children may develop ‘serious abnormalities' such as anxiety, depression or social withdrawal. She explains this is supported by are studies that show an increase in the number of children who are in need for treatment during the pandemic. This will mean needing more therapists to work alongside those children and their families to help develop new coping strategies.

Impact on Resources

These findings show that there will be an impact on resources and policies made. Dr. Poulain wants us to recognise the importance of social interaction and school for the wellbeing of children and young people and that this is prioritised. From their results, it can be seen that school closures should only occur when other measures are not effective and that when they are closed, schools should put in place effective measures (like mask-wearing, smaller classes and teacher vaccinations) so that students can return much quicker and stay in school for longer.

This would help those responsible consider children during the pandemic and prevent the negative impact that arises from covid measures, which Vogel describes as ‘a burden for children’. She pushes for there to be a ‘constant dialogue between stakeholders of children’s institutions and the scientific community to effectively help children stay safe and well.

Other Factors Affected: Social bias

Social bias in society was also found to be reinforced by the pandemic, lockdown, and social isolation. Poulian explains this as a ‘big danger’. It can be seen in other studies too, which support the idea that the gap between different social groups in society is already huge and ‘should not become bigger’. She states that those who suffer the most in the pandemic will not only be elderly adults or vulnerable people but in fact children, who will ‘lose educational opportunities and important interactions.

This effect on society is found to be more dramatic in other countries too. The doctors are looking to ‘reverse this trend and have already published another paper on media use in children in Asia, as well as weight development in children during the lockdown.

Overall Take Away

Dr. Poulain concludes the interview by stating that lockdown, school closures, and social isolation can all have a negative influence on children's (and adolescents') well-being, especially the ‘lack of contact with friends’. Their takeaway message is that children in socially weakened families have experienced a bigger impact on their wellbeing than those from a higher social class.

Dr Vogel finally adds that children are not the only vulnerable group in society, as many other groups suffer too. She argues that we should ‘not only balance the need for school closures, but also the needs of all of these other vulnerable groups so we can go through this pandemic as a whole society’. She believes the groups should not be competing but figure out a new way to live through this together.

Listen to the Podcast- 'Wellbeing, COVID-19 & Worries of German CYP' - In Conversation Dr. Tanya Poulain & Dr. Mandy Vogel - ACAMH

We invite you to join with like-minded clinicians and experts at our private clinic, Surrey Therapy Practice. Our high-quality therapy rooms are available to rent, and we have a supportive environment for new and experienced therapists.

If you would like to see our rooms or learn more about becoming an associate, please email us at enquiries@surreytherapypractice.com. Visit our website here and connect with us on Facebook or LinkedIn.