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To the Editor Coronavirus disease 2019 (COVID-19) has skyrocketed to be the “eye of storm” of a broad spectrum of issues, thus far affecting not only the safety of human life but also the public mental health in the long term. Xie et al1 have been conscious of such a problem and demonstrated that during the outbreak of COVID-19, the decrease of outdoor activities and social interaction may increase the occurrence of children’s depressive symptoms. The result provided straightforward evidence that COVID-19 to some extent has a negative impact on children’s mental health, which indicates that the corresponding approach is urgent to be explored. Yet, several concerns flooded into my mind.
First, with respect to the risk factors of children’s mental health, researchers enrolled some indicators including household income, parental mental or physical health, and parent emotional support. Thereinto, compared with children without MBDDs (mental, behavioral, and developmental disorders), those with MBDDs more often lived in the lowest income category (prevalence ratio [PR], 1.4) while fewer in the highest category (PR, 0.8), which indicated that household income plays an essential role in children’s mental health.2 Additionally, among children living at less than 100% of the federal poverty level, more than 1 in 5 (22%) had MBDD. Simultaneously, children of parents with mood or substance use disorders may be at increased risk of externalizing and internalizing disorders, and the same is true of those who are affected by violence, abuse, poverty, and maltreatment.3 The influence of these factors provokes our curiosity as well. Second, Ghandour et al4 proposed that diagnoses of depression and anxiety are more common with increased age, and behavior problems are more prevalent among children aged 6 to 11 years than children younger or older. Hence, the study of Xie et al1 with a large sample might lay a foundation for further studies among different age groups. Overall, the possibility of residual confounding and more hierarchical explorations are of great interest.
Corresponding Author: Sixiang Liang, MD, No. 5 An Kang Hu Tong, De Sheng Men Wai Street, Beijing 100088, China (email@example.com).
Published Online: November 16, 2020. doi:10.1001/jamapediatrics.2020.4933
Conflict of Interest Disclosures: None reported.
Liang S, Zeng Q. Factors Affecting Children's Mental Health During the Coronavirus Disease 2019 Pandemic. JAMA Pediatr. 2021;175(3):319–320. doi:10.1001/jamapediatrics.2020.4933
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