What are the associations of COVID-19 policy-related economic and school disruptions with mental health and sleep in US children?

In a recent study published in open JAMA networkresearchers investigated whether economic and school disruptions associated with coronavirus disease 2019 (COVID-19) mitigation policies and unemployment rates were independently associated with perceived stress, sadness, and the positive effect of stress, sleep, and worry associated with COVID-19. 19.

Study: COVID-19 policies, pandemic disruptions, and changes in mental health and infant sleep in the United States. Image credit: fizkes/Shutterstock


Policies to reduce transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), such as school and business closures, social distancing, and personal activity limitations, were critical to controlling the pandemic before the availability of effective antivirals medicines and vaccines. Restrictive and stringent COVID-19 policies have reduced the spread of SARS-CoV-2, but have worsened household economic conditions and altered schooling patterns.

On the contrary, COVID-19 supportive policies have provided financial aid, such as debt relief, to reduce the financial burden of SARS-CoV-2 infections. Assessing the impact of COVID-19 on pediatric stress, sadness, positive affect, sleep and worry can better inform decision-making and policy-making to reduce the burden of SARS-CoV-2 infections.

Previous studies assessing the impact of the SARS-CoV-2 pandemic on mental health were cross-sectional, used convenience sampling, and analyzed mental health outcomes among adults.

about the study

In the present national cohort study, researchers evaluated independent bias-corrected relationships between SARS-CoV-2 containment policies, associated perceived financial and school distress, sleep schedule, and mental well-being in children residing in the United States (US). ).

Data obtained from May to December 2020 from participants in the Adolescent Brain Cognitive Development Study (ABCD) and the first and second data releases of the 2019 coronavirus disease rapid response survey (RRR) were analyzed.

Statewide COVID-19 mitigation policy and countywide unemployment rate indices were utilized to address confounding bias through maximum likelihood instrumental variable (IV) analyzes of limited data from stage 2.0. Geocoded data from 6030 United States (US) children aged 10.0 to 13.0 years old were analyzed between May 2021 and January 2023.

Study exposures were economic disruptions caused by COVID-19 politics (loss of work or wages) and school disruptions (shifting to web-based offline-online hybrid schooling). The main measures and outcomes were levels of perceived stress, measured using the four-item perceived stress scale (PSS-4); positive affect and sadness, measured using the National Institutes of Health (NIH) toolbox battery of emotions (NIH TB-EB); sleep duration, latency and inertia, assessed by the Munich Chronotype Questionnaire (MCTQ); and concern associated with COVID-19.

The team included individuals who completed surveys in 2020 and whose sociodemographic data was available. Missing data were imputed to obtain 25,555 mental health observations from 8,400 children and 25,948 sleep schedule observations from 8,472 children. Data from the ABCD study were linked to three external datasets: (i) US state policy data from the Oxford Government COVID-19 Response Tracker (OxCGRT); (ii) countywide COVID-19 incidence data retrieved from John Hopkins University COVID-19 data; and (iii) US Bureau of Labor Statistics (BLS) county-level monthly unemployment rates.


The median age of the population sample was 13 years, 49% (n=2947) of whom were female, and 273, 461, 1167, 3783, and 347 children were Asian, Black, Hispanic, White, and other ethnicities, respectively. . Economic disruptions were related to 205%, 112%, and 74% increases in levels of stress, sadness, and moderate-to-extreme worry associated with SARS-CoV-2 infection, respectively.

Economic disruption was associated with a 33% reduction in pediatric positive affectivity. However, school disruption was not associated with children’s mental well-being, and neither school nor economic disruptions affected sleep.

Higher levels of psychological distress can have side effects in learning losses, peer and family relationship quality, and poor mental health. Addressing the economic difficulties may lessen the negative effects of the pandemic on pediatric development in the future.

Results indicated that public health policy should assess the financial burden of SARS-CoV-2 containment policies and measures on families to protect children’s mental health status until antiviral drugs and vaccines are available for pediatric use. Optimized COVID-19 mitigation policies during the pandemic can prioritize pediatric mental health while providing financial relief to families.


Overall, study results provided bias-corrected predictions through the association of economic disruptions associated with SARS-CoV-2 containment policy and pediatric mental health status. School interruptions did not significantly affect mental health outcomes. Thus, physicians must assess economic conditions when supporting children’s mental well-being.

Future studies should include assessments for objective measures, sleep quality, incidence and severity of new-onset psychiatric disorders, using specific clinical assessment scales of mental well-being, such as the nine-item Patient Health Questionnaire. In addition, the most recent data from the ABCD study should be analyzed and linked to social determinants of health to assess the long-term effects of COVID-19 policies on children’s mental health.

What are the associations of COVID-19 policy-related economic and school disruptions with mental health and sleep in US children?

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