Child mental health has worsened during pandemic, but inequalities have narrowed

Reviewed by Danielle Ellis, B.Sc.Sep 25 2023

The findings confound predictions in some quarters that disadvantaged children, who had worse mental health to start with, would be hardest hit. But even if child mental health has become more equal, it worsened, overall, following the pandemic, emphasize the researchers.

There is some evidence that declines in mental health during the COVID-19 pandemic may have been greatest among younger people, say the researchers, but the impact on inequalities in child mental health isn't clear.

To explore this further, they analyzed 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 2011–19, and when they were aged 5–11 in July and September 2020 and in March 2021.

The potential interactions between the periods before and during the pandemic and sex, ethnicity, family structure, parental education, employment, household income and area deprivation on mental health were also explored.

Some 1372 (15%) children were observed both before and during the COVID-19 pandemic; 7226 (78%) were measured beforehand; and 674 (7%) only measured during the pandemic.

The final analysis was based on 7999 (86%) children and 14018 (86%) observations. This revealed a trend towards poorer mental health between 2011 and 2019 that continued during the pandemic.

Children with coupled, highly educated, employed parents and from higher household income experienced steeper declines in their mental health during the pandemic than more disadvantaged children, who tended to have lower mental health to begin with, effectively narrowing child mental health inequalities.

For example, the average difference in child SDQ scores between those whose parents were unemployed compared with those whose parents were employed was 2.35 points before the pandemic but fell to 0.02 points during the pandemic.

This pattern was less pronounced for inequalities by (male) sex and area deprivation, which were maintained during the pandemic. White children, including those from white minority groups, had poorer baseline mental health than children from other ethnic backgrounds and experienced larger declines during the pandemic, leading to a widening of this inequality.

This is an observational study, and as such, can't establish cause, and the researchers acknowledge that child SDQ scores were calculated using symptoms reported only by parents rather than multiple sources.

Small sample sizes necessitated the aggregation of minority ethnicities, which may have masked important differences between groups, they add. And only 15% of the children were observed before and during the pandemic.

But they point out: "Our study provides evidence that trends in child mental health have continued to worsen during the pandemic. Unexpectedly, in many cases children from traditionally advantaged groups saw larger declines than children from disadvantaged groups–that is, child mental health has become more equal but at a worse overall level.

"The pattern is contrary to predictions from some child health experts that the financial and emotional strain of lockdowns would fall hardest on children with parents in unstable employment, living in overcrowded housing, with less access to outdoor space and educational resources.

"We speculate that social isolation and reduced access to services during the COVID-19 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 suggest.

They conclude that the overall decline in child mental health is particularly important because poor mental health in childhood has ramifications across the life course, including effects on children's ability to engage in education.

"Interventions are 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 via upstream policies to reduce socioeconomic disadvantage."