Assessment of Mental Health of High School Students During Social Distancing and Remote Schooling During the COVID-19 Pandemic in Austria | Adolescent Medicine | JAMA Network Open | JAMA Network
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Table 1.  Measures of Psychological Health by Gender
Measures of Psychological Health by Gender
Table 2.  Measures of Psychological Health by Smartphone Use
Measures of Psychological Health by Smartphone Use
1.
World Medical Association.  World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects.   JAMA. 2013;310(20):2191-2194. doi:10.1001/jama.2013.281053.Google ScholarCrossref
2.
Brähler  E, Mühlan  H, Albani  C, Schmidt  S.  Teststatistische Prüfung und Normierung der Deutschen Versionen des EUROHIS-QOL Lebensqualität-index und des WHO-5 Wohlbefindens-index.   Diagnostica. 2007;53(2):83-96. doi:10.1026/0012-1924.53.2.83Google ScholarCrossref
3.
Spitzer  RL, Kroenke  K, Williams  JBW.  Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study.   JAMA. 1999;282(18):1737-1744. doi:10.1001/jama.282.18.1737PubMedGoogle ScholarCrossref
4.
Löwe  B, Decker  O, Müller  S,  et al.  Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population.   Med Care. 2008;46(3):266-274. doi:10.1097/MLR.0b013e318160d093PubMedGoogle ScholarCrossref
5.
Morin  CM, Belleville  G, Bélanger  L, Ivers  H.  The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response.   Sleep. 2011;34(5):601-608. doi:10.1093/sleep/34.5.601PubMedGoogle ScholarCrossref
6.
Richter  F, Strauss  B, Braehler  E, Altmann  U, Berger  U.  Psychometric properties of a short version of the Eating Attitudes Test (EAT-8) in a German representative sample.   Eat Behav. 2016;21:198-204. doi:10.1016/j.eatbeh.2016.03.006PubMedGoogle ScholarCrossref
7.
Teutsch  F, Ramelow  D, Maier  G, Felder-Puig  R.  Lineartabellen zu den Ergebnissen der HBSC-Studie 2018: Gesundheit und Gesundheitsverhalten von Schülerinnen und Schülern in Österreich. Bundesministerium; 2018.
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    Research Letter
    Pediatrics
    June 28, 2021

    Assessment of Mental Health of High School Students During Social Distancing and Remote Schooling During the COVID-19 Pandemic in Austria

    Author Affiliations
    • 1Department for Psychotherapy and Biopsychosocial Health, Danube University, Krems, Austria
    • 2Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
    • 3Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
    JAMA Netw Open. 2021;4(6):e2114866. doi:10.1001/jamanetworkopen.2021.14866
    Introduction

    To get the COVID-19 pandemic under control, many countries have imposed lockdown measures or remote schooling. This study assessed mental health in high school students aged 14 to 20 years after 1 semester of attending school remotely and almost a year of social distancing in Austria.

    Methods

    This cross-sectional study was approved by the local Ethics Committee and was conducted according to the guidelines of the Declaration of Helsinki.1 This study follows the American Association for Public Opinion Research (AAPOR) reporting guideline.

    This cross-sectional study was supported by the Austrian Federal Ministry of Education, Science and Research, which informed and invited all schools to participate. Adolescents were recruited to be representative by region. Participants had to agree to the data protection declaration to start the survey, which served as electronic informed consent. Well-being (assessed with the World Health Organization–5 Well-being Index [WHO-5]2), depressive symptoms (assessed with the Patient Health Questionnaire-9 [PHQ-9]3), anxiety symptoms (assessed with the General Anxiety Disorder-7 [GAD-7]4), sleep quality (assessed with the Insomnia Severity Index [ISI]5), and disordered eating (assessed with the Eating Attitudes Test [EAT-8]6) were assessed via an online survey open from February 3 to February 28, 2021 (eMethods in the Supplement). Smartphone use and its association with mental health were analyzed using SPSS statistical software version 26 (IBM).

    Descriptive statistics, t tests, χ2 tests, and univariate analysis of variance were computed. Effect sizes are shown as Hedge g or η2. P values were 2-tailed, and statistical significance was set at P = .05. Data were analyzed from March 1 to March 11, 2021.

    Results

    A total of 3052 adolescents (mean [SD] 16.5 [1.4] years; 2139 [70.1%] girls; 508 students [16.6%] with migration background) participated in the study. A total of 1514 students (55.0%) exceeded the cutoff for clinically relevant depressive symptoms (ie, PHQ-9 score, ≥11), 1326 students (47.0%) had clinically relevant anxiety symptoms (ie, GAD-7 score, ≥11), 680 students (22.8%) had clinically relevant moderate insomnia (ie, ISI score, ≥15), and 1702 students (59.5%) had clinically relevant disordered eating behavior (ie, EAT-8 score, ≥2/3). Measures of psychological health by self-reported gender are summarized in Table 1. The prevalence of suicidal ideation (item 9 of the PHQ-9) within the last 2 weeks was 1016 students (36.9%), including 246 students (8.9%) with suicidal ideation nearly every day and 203 students (7.4%) with suicidal ideation more than half the days. Increased mobile phone use was associated with worse mental health (Table 2).

    In Austria mental health is regularly assessed via the Health Behaviour in School-Aged Children study.7 Since the latest Health Behaviour in School-Aged Children study in 2018,7 mental well-being, as assessed using scores on the WHO-5, decreased from a mean (SD) score of 43.7 (19.8) to 35.8 (19.7) in girls (t2136 = −18.58; P < .001; d = −0.40) and from 53.1 (19.5) to 43.9 (22.4) in boys (t855 = −12.00; P < .001; d = −0.43). Life-satisfaction, measured with an 11-point Cantril ladder from 0, indicating the worst possible life, to 10, the best possible life, decreased from a mean (SD) of 7.1 (1.8) to 5.9 (2.0) in girls (t2138 = −27.91; P < .001; g = −0.62) and from 7.6 (1.6) to 6.3 (2.1) in boys (t856 = −17.83; P < .001; d = −0.66). Mobile phone use has increased 2-fold overall since 2018, with high users (ie, >8 h/d) increasing more than 4-fold (boys: χ25 = 104.45; P < .001; girls: = χ25 = 278.53; P < .001).

    Discussion

    The findings of this cross-sectional study suggest that the COVID-19 pandemic was associated with impaired mental health. The mental well-being and life satisfaction in adolescents in Austria were significantly lower in 2021 compared with in 2018.7 Depressive symptoms, anxiety symptoms, insomnia, and disordered eating were significantly higher than prior to and in the beginning of the COVID-19 pandemic. Suicidal ideation among our study sample was significantly higher than in comparative studies, with approximately one-third of adolescents reporting suicidal thoughts. Smartphone use increased compared with 2018 rates and was significantly associated with mental health.

    This study has some limitations. The cross-sectional design allows no causal conclusions. Additionally, owing to the online nature of the study, a self-selection bias toward higher participation of adolescents with a higher mental health burden is possible.

    Our results suggest a high prevalence of mental disorders 1 year after the COVID-19 pandemic began in Austria. These findings highlight the need to implement health promotion and prevention strategies among adolescents.

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    Article Information

    Accepted for Publication: April 23, 2021.

    Published: June 28, 2021. doi:10.1001/jamanetworkopen.2021.14866

    Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Pieh C et al. JAMA Network Open.

    Corresponding Author: Christoph Pieh, MD, Department for Psychotherapy and Biopsychosocial Health, Danube University, Dr.-Karl-Dorrek-Straße 30, 3500 Krems, Austria (christoph.pieh@donau-uni.ac.at).

    Author Contributions: Prof Dr Pieh had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: Pieh, Plener, Probst, Humer.

    Acquisition, analysis, or interpretation of data: All authors.

    Drafting of the manuscript: Pieh, Probst, Humer.

    Critical revision of the manuscript for important intellectual content: Pieh, Plener, Probst, Dale.

    Statistical analysis: Pieh, Probst, Dale, Humer.

    Obtained funding: Probst.

    Administrative, technical, or material support: Pieh, Plener, Probst, Humer.

    Supervision: Pieh, Plener.

    Conflict of Interest Disclosures: Prof Dr Plener reported receiving grants from Boehringer Ingelheim and Infectopharm outside the submitted work. No other disclosures were reported.

    Funding/Support: This study was supported by the Austrian Federal Ministry of Education, Science and Research.

    Role of the Funder/Sponsor: The sponsor had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

    References
    1.
    World Medical Association.  World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects.   JAMA. 2013;310(20):2191-2194. doi:10.1001/jama.2013.281053.Google ScholarCrossref
    2.
    Brähler  E, Mühlan  H, Albani  C, Schmidt  S.  Teststatistische Prüfung und Normierung der Deutschen Versionen des EUROHIS-QOL Lebensqualität-index und des WHO-5 Wohlbefindens-index.   Diagnostica. 2007;53(2):83-96. doi:10.1026/0012-1924.53.2.83Google ScholarCrossref
    3.
    Spitzer  RL, Kroenke  K, Williams  JBW.  Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study.   JAMA. 1999;282(18):1737-1744. doi:10.1001/jama.282.18.1737PubMedGoogle ScholarCrossref
    4.
    Löwe  B, Decker  O, Müller  S,  et al.  Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population.   Med Care. 2008;46(3):266-274. doi:10.1097/MLR.0b013e318160d093PubMedGoogle ScholarCrossref
    5.
    Morin  CM, Belleville  G, Bélanger  L, Ivers  H.  The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response.   Sleep. 2011;34(5):601-608. doi:10.1093/sleep/34.5.601PubMedGoogle ScholarCrossref
    6.
    Richter  F, Strauss  B, Braehler  E, Altmann  U, Berger  U.  Psychometric properties of a short version of the Eating Attitudes Test (EAT-8) in a German representative sample.   Eat Behav. 2016;21:198-204. doi:10.1016/j.eatbeh.2016.03.006PubMedGoogle ScholarCrossref
    7.
    Teutsch  F, Ramelow  D, Maier  G, Felder-Puig  R.  Lineartabellen zu den Ergebnissen der HBSC-Studie 2018: Gesundheit und Gesundheitsverhalten von Schülerinnen und Schülern in Österreich. Bundesministerium; 2018.
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