Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19: A Meta-analysis | Adolescent Medicine | JAMA Pediatrics | JAMA Network
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    2 Comments for this article
    Pandemic-Related Increase of Anxiety and Depression in Gender Minority Children and Adolescents
    Steve Gawrys, BS | Rocky Vista University College of Osteopathic Medicine
    To the Editor

    In, “Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19A Meta-analysis,” Nicole Racine et al. give an incredibly insightful analysis of the global increase in anxiety and depression in children and adolescents since the start of the COVID-19 pandemic[1]. This rise in anxiety and depression is incredibly important to properly investigate and address, especially in our young population. We recognize that Dr. Racine’s inclusion criteria created limitations, namely the lack of studies examining the rates of anxiety and depression in gender minority youth. Given the pandemic is ongoing, there is a
    lack of quantitative data received from standardized mental health surveys (PHQ-9, GAD7, etc.). To supplement these findings reported in the article, we located recent data that indicate an increase in anxiety and depression among LGBTQ+ youth[2][3].

    Mitchell KJ. et al. presents a study focusing on sexual and gender minority youth and emerging adults and the increased mental health impact on these populations from the pandemic[2]. A subgroup within their study includes adolescents ages 13 to 17-year-old[2]. In their study, they found that gender minority youth were more likely than cisgender youth to report that the pandemic had an impact on their mental health[2].

    Perl et al. conducted surveys and distributed questionnaires that compared the effects of the pandemic on the mental health of transgender and gender non-conforming youth to cisgender youth[3]. They found an increase in negative emotions for both groups, while transgender and gender non-conforming youth experienced an increased prevalence of symptoms related to the stress of the pandemic [3].

    To address the lack of current data available and given that gender minority youth are at higher risk for anxiety and depression due to the pandemic[4], we call for researchers to conduct more quantitative analysis specifically geared towards gender-minority youth.

    Sincerely Submitted,
    Steven P. Gawrys OMS-II, Westin J. Wong OMS-II, Justin T. Bradshaw OMS-II

    [1] Racine N, McArthur BA, Cooke JE, Eirich R, Zhu J, Madigan S. Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19: A Meta-analysis. JAMA Pediatrics. 2021;175(11):1142-1150. doi:10.1001/jamapediatrics.2021.2482

    [2] Mitchell KJ, Ybarra ML, Banyard V, Goodman KL, Jones LM. Impact of the COVID-19 Pandemic on Perceptions of Health and Well-Being Among Sexual and Gender Minority Adolescents and Emerging Adults. LGBT Health. Published online November 5, 2021:lgbt.2021.0238. doi:10.1089/lgbt.2021.0238

    [3] Perl L, Oren A, Klein Z, Shechner T. Effects of the COVID19 Pandemic on Transgender and Gender Non-Conforming Adolescents’ Mental Health. Psychiatry Res. 2021;302:114042. doi:10.1016/j.psychres.2021.114042

    [4] Salerno, J. P., Williams, N. D., & Gattamorta, K. A. (2020). LGBTQ populations: Psychologically vulnerable communities in the COVID-19 pandemic. Psychological Trauma: Theory, Research, Practice, and Policy, 12(S1), S239–S242.
    RE: Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19
    Tomoyuki Kawada, MD | Nippon Medical School
    Racine et al. conducted a meta-analysis to evaluate the prevalence of depressive and anxiety symptoms in children and adolescents during the first year of COVID-19 pandemic, compared with prevalence in pre-pandemic periods (1). The pooled prevalence of depression and anxiety symptoms were 25.2% and 20.5%, which was double of pre-pandemic estimates. In addition, depressive and anxiety symptoms were predominant in girls and in the late periods of pandemic. Furthermore, prevalence of depression symptoms was relatively higher in older children. Mental health care is important to prevent adverse events, and I want to discuss the risk of depression and suicide during the COVID-19 pandemic.

    Kim et al. reported the association of the COVID-19 pandemic with self-reported mental problems in youths (2). The adjusted odds ratios (95% confidence interval) of subjects during the early period of the COVID-19 pandemic compared with pre-pandemic for severe stress, very severe stress, sadness or despair, suicidal thoughts, suicide planning, and suicide attempts were 0.90 (0.83-0.97), 0.65 (0.60-0.72), 0.81 (0.78-0.84), 0.77 (0.73-0.80), 0.88 (0.81-0.96), 0.64 (0.58-0.70), respectively. These data present that the level of stress and suicide-related behaviors decreased among youths in the early period of the pandemic.

    Kemper et al. also reported a decrease in the prevalence of depression and suicide risk during the initial period of the COVID-19 pandemic in adolescents, aged ≥12 years (3). They handled adolescents with relatively higher rates of depression and suicide risk before the pandemic, and speculated that the target adolescents, who had faced significant stressors, experienced the improvement of social environment such as remote schooling and stay-at-home orders. I think that mental health by social distancing might contribute to lowering the depression and suicide risk during the early period of the COVID-19 pandemic.

    Regarding mental risks during the period of COVID-19 pandemic, Mayne et al. described the changes of depressive symptoms and suicide risk among adolescents, aged 12 to 21, during the COVID-19 pandemic between June and December 2019 (pre-pandemic) and June and December 2020 (pandemic) (4). The percentage of adolescents screening positive for depressive symptoms increased from 5.0% to 6.2%. In addition, the percentage of adolescent screening positive for suicide risk increased from 6.1% to 7.1%. I think that the prevalence of depressive symptoms and suicide risk may increase as the COVID-19 pandemic continued. On this point, Crandal et al. observed that the number of screening for depressive symptoms and suicide risk decreased during the initial pandemic period, and then recovered in relation to the lowering of COVID-19 pandemic (5). This means that numerator and denominator should be checked for calculating prevalence of depressive symptoms and suicide risk in combination with the level of COVID-19 pandemic.

    Anyway, continuous surveys are needed for monitoring the prevalence of depression and suicide risk in children and adolescents in the era of COVID-19 pandemic.

    1. JAMA Pediatr 2021;175(11):1142-1150.
    2. JAMA Netw Open 2021;4(12):e2136137.
    3. Pediatrics 2021;148(1):e2021049999.
    4. Pediatrics. 2021;148(3):e2021051507.
    5. J Pediatr 2021 Oct 22. doi: 10.1016/j.jpeds.2021.10.031
    Original Investigation
    August 9, 2021

    Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19: A Meta-analysis

    Author Affiliations
    • 1Department of Psychology, University of Calgary, Calgary, Alberta, Canada
    • 2Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
    JAMA Pediatr. 2021;175(11):1142-1150. doi:10.1001/jamapediatrics.2021.2482
    Key Points

    Question  What is the global prevalence of clinically elevated child and adolescent anxiety and depression symptoms during COVID-19?

    Findings  In this meta-analysis of 29 studies including 80 879 youth globally, the pooled prevalence estimates of clinically elevated child and adolescent depression and anxiety were 25.2% and 20.5%, respectively. The prevalence of depression and anxiety symptoms during COVID-19 have doubled, compared with prepandemic estimates, and moderator analyses revealed that prevalence rates were higher when collected later in the pandemic, in older adolescents, and in girls.

    Meaning  The global estimates of child and adolescent mental illness observed in the first year of the COVID-19 pandemic in this study indicate that the prevalence has significantly increased, remains high, and therefore warrants attention for mental health recovery planning.


    Importance  Emerging research suggests that the global prevalence of child and adolescent mental illness has increased considerably during COVID-19. However, substantial variability in prevalence rates have been reported across the literature.

    Objective  To ascertain more precise estimates of the global prevalence of child and adolescent clinically elevated depression and anxiety symptoms during COVID-19; to compare these rates with prepandemic estimates; and to examine whether demographic (eg, age, sex), geographical (ie, global region), or methodological (eg, pandemic data collection time point, informant of mental illness, study quality) factors explained variation in prevalence rates across studies.

    Data Sources  Four databases were searched (PsycInfo, Embase, MEDLINE, and Cochrane Central Register of Controlled Trials) from January 1, 2020, to February 16, 2021, and unpublished studies were searched in PsycArXiv on March 8, 2021, for studies reporting on child/adolescent depression and anxiety symptoms. The search strategy combined search terms from 3 themes: (1) mental illness (including depression and anxiety), (2) COVID-19, and (3) children and adolescents (age ≤18 years). For PsycArXiv, the key terms COVID-19, mental health, and child/adolescent were used.

    Study Selection  Studies were included if they were published in English, had quantitative data, and reported prevalence of clinically elevated depression or anxiety in youth (age ≤18 years).

    Data Extraction and Synthesis  A total of 3094 nonduplicate titles/abstracts were retrieved, and 136 full-text articles were reviewed. Data were analyzed from March 8 to 22, 2021.

    Main Outcomes and Measures  Prevalence rates of clinically elevated depression and anxiety symptoms in youth.

    Results  Random-effect meta-analyses were conducted. Twenty-nine studies including 80 879 participants met full inclusion criteria. Pooled prevalence estimates of clinically elevated depression and anxiety symptoms were 25.2% (95% CI, 21.2%-29.7%) and 20.5% (95% CI, 17.2%-24.4%), respectively. Moderator analyses revealed that the prevalence of clinically elevated depression and anxiety symptoms were higher in studies collected later in the pandemic and in girls. Depression symptoms were higher in older children.

    Conclusions and Relevance  Pooled estimates obtained in the first year of the COVID-19 pandemic suggest that 1 in 4 youth globally are experiencing clinically elevated depression symptoms, while 1 in 5 youth are experiencing clinically elevated anxiety symptoms. These pooled estimates, which increased over time, are double of prepandemic estimates. An influx of mental health care utilization is expected, and allocation of resources to address child and adolescent mental health concerns are essential.