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Caregiver-reported emotional-behavioral symptoms in Spanish youth during the COVID-19 pandemic: a longitudinal study

Pediatric Research (2024)Cite this article

Abstract

Background

COVID-19 pandemic stressors affected youth’s mental health. This longitudinal study aims to explore these effects while considering predictive factors such as age and sex.

Methods

An initial sample of 1502 caregivers answered a longitudinal survey evaluating their youths’ (4–17 years of age) emotional/behavioral symptoms using the Pediatric Symptom Checklist (PSC) screening tool. First assessment in May–July 2020 included the prior year’s retrospective (TR) and since-lockdown-start (T0) PSC, followed by monthly evaluations until February 2021.

Results

A positive screening PSC (PSC+) was reported in 13.09% of cases at TR and 35.01% at T0, but the likelihood of PSC+ quickly decreased over time. At T0, a more pronounced impact was found on children (39.7%) compared to adolescents (25.4%); male children exhibited higher risk for a PSC+ at T0 and longitudinally than females. Adolescents presented a weaker effect of time-improvement. PSC+ at TR, experienced stressors, and caregiver’s stress/depressive symptoms positively predicted PSC+ at T0 and longitudinally; adolescents’ unproductive coping style predicted PSC+ at T0.

Conclusion

The study shows a caregiver-reported increase in emotional/behavioral symptoms in youths during the COVID-19 pandemic, affecting predominantly younger children in the early stages and showing gradual improvement over time, albeit possibly slower in adolescents.

Impact

The results show the anticipated surge in emotional and behavioral symptoms during the COVID-19 lockdown in youth reported by caregivers, followed by subsequent amelioration. Of greater significance, the study reveals a heightened impact on young children initially, yet it suggests a slower improvement trajectory in adolescents. The study also identifies risk factors linked to emotional and behavioral symptoms within each age group. Alongside the longitudinal approach, the authors underscore the remarkable inclusion of a significant representation of young children, an unusual feature in such surveys.

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Fig. 1: Timeline diagrams for new COVID-19 cases, lockdown phases, and stringency measures in Spain.
Fig. 2: Percentages of PSC+ at lockdown.
Fig. 3: Longitudinal trajectories of PSC+, PSC+ stratified by sex/age, and LCU.
Fig. 4: Longitudinal trajectories of PSC subscales.

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Data availability

Dataset generated during the study can be accessed, after permission, by contacting the authors.

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Acknowledgements

All the authors of the study thank staff-members of Hospital Sant Joan de Déu, who provided valuable feedback, particularly Laura Duran and Jesús Lull for their initial support of the study. They also thank all the families that voluntarily participated in the study. This study has been indexed within the COVID-MINDS initiative bringing together longitudinal studies on COVID-19 pandemic mental health impact (https://www.covidminds.org/). Part of this work was presented at the 20th International Congress of the European Society for Child and Adolescent Psychiatry, 29th June to July 1st 2023.

Funding

The study is part of the Kids Corona platform of studies at the Hospital Sant Joan de Déu, Barcelona (https://www.sjdhospitalbarcelona.org/en/kidscorona). This research was partially funded by the Project Grant PI22/00655 from Health Institute Carlos III, the Stavros Niarchos Foundation (SNF), Banco Santander, and other private donors of Kids Corona at the Hospital Sant Joan de Déu Barcelona. The authors thank the CERCA Program, Generalitat de Catalunya.

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Authors and Affiliations

  1. Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950, Esplugues de Llobregat, Spain

    Xavier Estrada-Prat, Jordina Tor, Marcela Mezzatesta, Aritz Aranbarri, Alazne Aizpitarte, Anna Butjosa, Natalia Albiac, Marina Fabrega, Immaculada Insa Pineda, Jose A. Alda, Ester Camprodon, Montserrat Dolz & Esther Via

  2. Department of Child and Adolescent Mental Health. Hospital Sant Joan de Déu, Passeig Sant Joan de Déu, 2, 08950, Esplugues de Llobregat, Spain

    Xavier Estrada-Prat, Jordina Tor, Aritz Aranbarri, Alazne Aizpitarte, Anna Butjosa, Jose A. Alda, Ester Camprodon, Montserrat Dolz & Esther Via

  3. Department of Social Psychology and Methodology, Universidad Autónoma de Madrid, Madrid, Spain

    Eduardo Estrada

  4. Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain

    Anna Butjosa, Josep Maria Haro & Montserrat Dolz

  5. Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain

    Josep Maria Haro

  6. Independent researcher in collaboration with the Hospital Sant Joan de Déu of Barcelona, Barcelona, Spain

    Carles Virgili & Charlotte Keating

  7. Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain

    Montserrat Dolz

Authors
  1. Xavier Estrada-Prat
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  2. Eduardo Estrada
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Contributions

Conceptualization, X.E.-P. and E.V.; methodology, X.E.-P., E.E., J.T., C.V., A.B., A.A., A.A., E.V.; formal analysis, E.E., J.T., C.V., E.V.; data curation, X.E-P., J.T., E.V.; original draft preparation, X.E.-P., J.T., E.V.; writing—review and editing, all authors. All authors have read and agreed to the published version of the manuscript.

Corresponding authors

Correspondence to Jordina Tor or Esther Via.

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The authors declare no competing interests.

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The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board and the Ethics Committee of Institut de Recerca Sant Joan de Déu (protocol code PIC-73-20, approved on the 23 of April 2020).

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Informed consent was obtained from all subjects involved in the study.

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Estrada-Prat, X., Estrada, E., Tor, J. et al. Caregiver-reported emotional-behavioral symptoms in Spanish youth during the COVID-19 pandemic: a longitudinal study. Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03364-4

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