Children from wealthier UK families experienced the greatest decline in mental health during the pandemic, confounding predictions that disadvantaged children would be most affected.
In the UK, children who have grown up in poverty are over three times as likely to experience mental health problems by age 14 years as those who have never experienced poverty. Prior to the COVID-19 pandemic, disadvantaged groups generally had worse mental health than more advantaged groups.
A decline in the mental health of adults and young people during the COVID-19 pandemic response has been seen in most, but not all, studies, and there was some evidence that declines may have been greatest among younger people. "But the impact on inequalities in child mental health isn't clear", said the authors of a new study, published in the Journal of Epidemiology & Community Health.
To investigate this further, researchers analysed 16,361 parental observations of 9272 children in the nationally representative Understanding Society: the UK Household Longitudinal Study .
Child mental health was measured using the Strengths and Difficulties Questionnaire (SDQ) filled in by parents when their children were aged 5 and 8 in annual surveys during 2011 to 2019, and when they were aged 5 to 11 in July and September 2020 and in March 2021.
After weighting, the mean age was 7 years, 49.5% of observations were from female children, 17.4% were from ethnic minority groups (excluding White minority groups), and 17.8% were from children living in poverty.
Child Mental Health Inequalities Narrowed During Pandemic
The researchers found there was a trend towards poorer mental health between 2011 and 2019 that continued during the pandemic, with children's mental health having worsened across the board in the UK during the pandemic.
The mean difference in child SDQ scores was highest for those with unemployed compared with employed parents, at 2.35 pre-pandemic, but attenuated to only 0.02 during the pandemic. The steepest decline in mental health scores appeared to have been experienced by those children with coupled, highly educated, employed parents, and higher household income families, whereas more disadvantaged groups experienced smaller declines in mental health.
This confounded predictions that disadvantaged children would be hardest hit. More disadvantaged children tended to have lower mental health to begin with, explained the authors, so during the pandemic child mental health inequalities effectively narrowed.
"Trends in child mental health have continued to worsen during the pandemic," alerted the authors, who underlined that child mental health had become "more equal but at a worse overall level".
Interventions "Urgently Needed" to Improve Child Mental Health
The authors speculated that social isolation and reduced access to services during the pandemic brought the experiences of traditionally advantaged groups closer to those already faced by children from disadvantaged backgrounds, and/or that emergency income support measures during the pandemic may have eased the economic burden for disadvantaged families.
"Additional pressures faced by some working parents, who had to balance childcare and paid work during the pandemic, may also have contributed to the poorer mental health of children with employed parents during the pandemic," they suggested.
The authors expressed that as an observational study it could not establish cause. In addition, they acknowledged that child SDQ scores were calculated using symptoms reported only by parents rather than multiple sources, that small sample sizes necessitated the aggregation of minority ethnicities, which may have masked important differences between groups, and that only 15% of the children were observed both before and during the pandemic.
"Poor mental health in childhood has ramifications across the life course, including effects on children's ability to engage in education," they pointed out.
Interventions were "urgently needed" to improve child mental health across all groups, while seeking to "maintain the narrower inequalities" observed during the first year of the pandemic, they urged.