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      The impact of school closure on children’s well-being during the COVID-19 pandemic

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          Abstract

          In March 2021, the World Health Organization declared the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as a pandemic. As a result, many governments have imposed virus containment measures to prevent and limit the spread of the infection of COVID-19, such as social distancing, stay-at-home policies, lockdown restrictions, and school closure, causing widespread disruptions in parents and children’s daily routines (Ortega and Martinez, 2021). According to UNESCO, in April 2020 primary and elementary schools were suspended nationwide in more than 188 countries and over 1000 million worldwide students were not attending school, creating an unprecedented crisis in the education sector globally (Lee, 2020), and increasing concern about its negative effects on mental health (Tandon, 2021b). From a mental health perspective, it is well established that social interaction among children at school is a determining factor for their cognitive and emotional development (Shala, 2013), which in turn, influences their academic, social, and family performance (Barrero et al., 2021). Due to the unexpected restrictions, children around the world are attending online distance learning from home, coping with an unprepared and unprecedented scenario of disruptive technological innovation and digital transformation, as well as other issues such as psychological stress from staying isolated at home, and difficulties in completing distance learning task. Recent studies have highlighted that those children exposed to COVID-19 related measures, such as mandatory school closure are more likely to manifest symptoms of anxiety, depression, and post-traumatic stress disorder (PTSD), stress, insomnia, emotional disturbance, irritability, sleep and appetite disturbance, negative eating habits, and impairment in social interactions (Petretto et al., 2020). Children are more susceptible to have long-term negative consequences in mental health later in life because of the pandemic crisis according to recent scientific literature (Marques et al., 2020). As the COVID-19 outbreak has been intensifying across the world, countries such as The United States, Japan, China, Australia, Brazil, The United Kingdom, Spain, and Italy are concerned about the significant increase in emergency calls to report domestic violence, child abuse and neglect after mandatory school closures was imposed as an effort to curb the spread of the outbreak, highlighting the huge impact this strict measure has on children’s integrity (Usher et al., 2020). Although the debate on the effects of school closures to reduce and delay the peak in the infection rate of COVID-19 is still open, there is a consensus on the negative effects of these policies on children's physical and mental health. These negative effects are becoming a major concern to policymakers and international organizations seeking to promote children’s well-being, suggesting that urgent action plans and public health strategies to mitigate physical abuse and severe mental health outcomes of COVID-19 must be applied. In such a scenario, it is important to discuss some aspects related to school closures and social isolation that can lead to limited opportunities for children and adolescents, and widen inequality gaps, which in turn can create restricted access for those with pre-existing disabilities or learning disabilities (Vélez et al., 2020), and can also increase the exposure to cyberbullying or other types of harassment among peers that can leave long-lasting effects on children’s mental health. Furthermore, it has been shown that school closures have negative consequences especially for girls and adolescents due to a higher rate of sexual exploitation, early pregnancy, early and forced marriage, as well as difficult access to education in their own homes as they are forced to perform household chores (UNESCO, 2021). This at-risk group is more likely not to be able to return to school after the COVID-19 pandemic. Moreover, the lack of resources for mental health services, such as multidisciplinary healthcare workers, have raised concerns about the difficulties in handling the consequences of confinement in children and adolescents, particularly in low-income countries. In fact, some child protective services whose immediate action plans were activated from educational institutions have interrupted their programs and the access for vulnerable children and their families to these services has become more restrictive (Fegert et al., 2020). The COVID-19 pandemic exposed weaknesses in public health structures of healthcare systems globally (Tandon, 2021a). Mental health has historically been an unattended public health issue, which the COVID-19 has unexpectedly accelerated. Therefore, it is necessary to improve accessibility rates to mental health care pathways. It is also essential to design and implement mental health promotion and prevention programs for children and adolescents in the context of the pandemic. It is a major challenge for schools to generate a reliable and safe environment ensuring cognitive and emotional devolvement, as well as social skills necessary to enhance well-being and to minimize mental health issues. Nevertheless, it is pertinent to bring into consideration that these new post-pandemic life conditions provide an opportunity to restructure the education system by improving teaching-learning models in schools and including new pedagogical and didactic strategies promoting contextualized and integral learning, implementing hybrid methodologies that include a psychosocial component, and mental health support strategies to ensure a positive and safe transition back to schools. Although the school plays a fundamental role in children’s development, the family and caregivers are also responsible for promoting children’s mental health, even more in the recent context of the ongoing pandemic to meet the coming challenges concerning children’s well-being around the world. Financial disclosure This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Declaration of Competing Interest The authors report no financial or other relationship relevant to the subject of this article.

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          Challenges and burden of the Coronavirus 2019 (COVID-19) pandemic for child and adolescent mental health: a narrative review to highlight clinical and research needs in the acute phase and the long return to normality

          Background The coronavirus disease 2019 (COVID-19) is profoundly affecting life around the globe. Isolation, contact restrictions and economic shutdown impose a complete change to the psychosocial environment in affected countries. These measures have the potential to threaten the mental health of children and adolescents significantly. Even though the current crisis can bring with it opportunities for personal growth and family cohesion, disadvantages may outweigh these benefits. Anxiety, lack of peer contact and reduced opportunities for stress regulation are main concerns. Another main threat is an increased risk for parental mental illness, domestic violence and child maltreatment. Especially for children and adolescents with special needs or disadvantages, such as disabilities, trauma experiences, already existing mental health problems, migrant background and low socioeconomic status, this may be a particularly challenging time. To maintain regular and emergency child and adolescent psychiatric treatment during the pandemic is a major challenge but is necessary for limiting long-term consequences for the mental health of children and adolescents. Urgent research questions comprise understanding the mental health effects of social distancing and economic pressure, identifying risk and resilience factors, and preventing long-term consequences, including—but not restricted to—child maltreatment. The efficacy of telepsychiatry is another highly relevant issue is to evaluate the efficacy of telehealth and perfect its applications to child and adolescent psychiatry. Conclusion There are numerous mental health threats associated with the current pandemic and subsequent restrictions. Child and adolescent psychiatrists must ensure continuity of care during all phases of the pandemic. COVID-19-associated mental health risks will disproportionately hit children and adolescents who are already disadvantaged and marginalized. Research is needed to assess the implications of policies enacted to contain the pandemic on mental health of children and adolescents, and to estimate the risk/benefit ratio of measures such as home schooling, in order to be better prepared for future developments.
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            Family violence and COVID‐19: Increased vulnerability and reduced options for support

            Introduction Family violence refers to threatening or other violent behaviours within families that may be physical, sexual, psychological, or economic, and can include child abuse and intimate partner violence (Peterman et al. 2020, van Gelder et al. 2020). Family violence during pandemics is associated with a range of factors including economic stress, disaster‐related instability, increased exposure to exploitative relationships, and reduced options for support (Peterman et al. 2020). Due to the social isolation measures implemented across the globe to help reduce the spread of COVID‐19, people living in volatile situations of family violence are restricted to their homes. Social isolation exacerbates personal and collective vulnerabilities while limiting accessible and familiar support options (van Gelder et al. 2020). In many countries, including Australia, we have already seen an increase in demand for domestic violence services and reports of increased risk for children not attending schools (Duncan, 2020), a pattern similar to previous episodes of social isolation associated with epidemics and pandemics (Boddy, Young & O’Leary 2020). In Australia, as stay‐at‐home orders came into force, the police in some parts of the country reported a 40% drop in crime overall, but a 5% increase in domestic abuse call‐outs (Kagi 2020). At the same time in Australia, Google reported a 75% increase in Internet searches relating to support for domestic abuse (Poate 2020). This pattern is repeated internationally. Reports of domestic abuse and family violence have increased around the world since social isolation and quarantine measures came into force. Recently, anecdotal evidence from the United States, China, Brazil, and Australia indicates increases in intimate partner, women, and children violence due to isolation and quarantine (Campbell 2020; Peterman et al. 2020; van Gelder et al. 2020). China, the first country to impose mass quarantine in the Wuhan province, saw reported domestic abuse incidents rise threefold in February 2020 compared to the previous year (Allen‐Ebrahimian 2020). As Europe imposed quarantine measures in an effort to slow the tide of infection, the Italian government began commissioning hotels to provide shelter to the increasing number of people fleeing abusive situations (Davies & Batha 2020). Similarly, France reported a 32% ‐ 36% increase in domestic abuse complaints following the implementation of self‐isolation and quarantine measures (Reuters News Agency 2020). France also began commissioning hotels as shelters for those fleeing abuse. As quarantine measures extended to the United States, individual states reported similar increases in domestic abuse incidents ranging from 21% to 35% (Wagers 2020). Back in Europe, the UK has also seen concerns about increase in family violence (Bradbury‐Jones & Isham 2020). There have been reports of homicide associated with family violence in several countries (Bradbury‐Jones & Isham 2020; Reuters News Agency 2020). The National Domestic Abuse Hotline in the UK saw a 25% increase in calls since stay‐at‐home measures were implemented (Kelly & Morgan 2020), recording at least eight family violence‐related deaths (Knowles 2020). Isolation and family violence As the novel coronavirus outbreak has intensified globally, countries are adopting dedicated measures to slow the spread of the virus through mitigation and containment (van Gelder et al. 2020; Campbell 2020). Social distancing and isolation are central to the public health strategy adopted by many countries, and in many settings, penalties are in place for any person who breaches these imposed restrictions. Social isolation requires families to remain in their homes resulting in intense and unrelieved contact as well as the depletion of existing support networks, such as through extended family as well as through social or community‐based support networks for families at risk. Additionally, isolation places children at greater risk of neglect as well as physical, emotional, sexual, and domestic abuse (National Society for the Prevention of Cruelty to Children [NSPCC] 2020). Due to (necessary) imposed social distancing and isolation strategies, and the resulting shortages of essential resources and economic consequences of these measures, people globally are living under stressful conditions. While social isolation is an effective measure of infection control, it can lead to significant social, economic, and psychological consequences, which can be the catalyst for stress that can lead to violence. A perfect storm Isolation paired with psychological and economic stressors accompanying the pandemic as well as potential increases in negative coping mechanisms (e.g. excessive alcohol consumption) can come together in a perfect storm to trigger an unprecedented wave of family violence (van Gelder et al. 2020). In Australia, as social distancing measures came into place, alcohol good sales rose more than 36% (Commonwealth Bank Group 2020), and as restaurants, bars, and pubs closed, people are now drinking more within the confines of their homes. Unemployment figures around the world have rapidly risen into the double digits, with millions signing up for welfare payments and a worldwide recession predicted in the near future (Kennedy 2020). Substance misuse, financial strain, and isolation are all well‐known domestic abuse risk factors (Richards 2009). During isolation, there are also fewer opportunities for people living with family violence to call for help. Isolation also helps to keep the abuse hidden with physical or emotional signs of family violence and abuse less visible to others (Stark 2009). COVID‐19 and coercive control Reports show that COVID‐19 is used as a coercive control mechanism whereby perpetrators exert further control in an abusive relationship, specifically in the use of containment, fear, and threat of contagion as a mechanism of abuse. In Australia, charities providing support to people experiencing domestic abuse have highlighted concerns specifically related to reports from people whose intimate partners are using COVID‐19 as a form of abuse. There have been reports of misinformation used by intimate partners related to the extent of quarantine measures (Gearin & Knight 2020) and other forms of COVID‐19‐related abuse (Fielding 2020). Further, there are reports that those experiencing domestic abuse may be afraid to go to hospital for fear of contracting COVID‐19 (Fielding 2020). Reimagining support networks for people living with family violence during these challenging times We recognize that these are challenging times for all of us, but especially for the most vulnerable families and children. The United Nations Secretary‐General Antonio Guterres recently called for countries to prioritize support and set up emergency warning systems for people living with family violence (News Wires 2020). Pharmacies and grocery stores in France are now providing emergency warning systems to help enable people to indicate that they are in danger and need support (Guenfound 2020), through the introduction of code words to alert staff they need help (Davies & Batha 2020). Domestic abuse support agencies in some areas have published specific guidance on domestic abuse in COVID‐19 focussing on what friends and family can do to support people who are isolated (Domestic Violence Resource Centre Australia [DVRCA] 2020). Charities are also recognizing the role that neighbours can play in supporting people living with family violence, providing advice on what to listen for and look for while they themselves are home, and encouraging conversation with neighbours (Gerster 2020). Conclusion The fear and uncertainty associated with pandemics provide an enabling environment that may exacerbate or spark diverse forms of violence. Actions such as social distancing, sheltering in place, restricted travel, and closures of key community resources are likely to dramatically increase the risk of family violence (Campbell, 2020). Governments and policymakers must create awareness about an increased risk of violence during pandemics and highlight the need for people to keep in touch with each other (while observing precautionary measures) and the great importance of reporting any concerns of abuse. It is important to remember that maintaining social connectedness is an important strategy during times of isolation (Usher et al. 2020), even more so with family or friends you suspect may be at risk of family violence. In addition, information about services available locally (e.g. hotlines, tele‐health, respite services, shelters, rape crisis centres, and counselling) must be made known to the general public through a range of sources, including social media, the mainstream media, and health facilities. Mental health professionals can support people by providing first‐line psychological support, including listening empathetically and without judgment, enquiring about needs and concerns, validating peoples’ experiences and feelings, enhancing safety, and connecting people to relevant support services (WHO 2020).
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              Mental health effects of school closures during COVID-19

              Joyce Lee (2020)
              The coronavirus disease 2019 (COVID-19) pandemic—and the social distancing measures that many countries have implemented—have caused disruptions to daily routines. As of April 8, 2020, schools have been suspended nationwide in 188 countries, according to UNESCO. Over 90% of enrolled learners (1·5 million young people) worldwide are now out of education. The UNESCO Director-General Audrey Azoulay warned that “the global scale and speed of the current educational disruption is unparalleled”. For children and adolescents with mental health needs, such closures mean a lack of access to the resources they usually have through schools. In a survey by the mental health charity YoungMinds, which included 2111 participants up to age 25 years with a mental illness history in the UK, 83% said the pandemic had made their conditions worse. 26% said they were unable to access mental health support; peer support groups and face-to-face services have been cancelled, and support by phone or online can be challenging for some young people. School routines are important coping mechanisms for young people with mental health issues. When schools are closed, they lose an anchor in life and their symptoms could relapse. “Going to school had been a struggle for [some children with depression] prior to the pandemic, but at least they had school routines to stick with”, said Zanonia Chiu, a registered clinical psychologist working with children and adolescents in Hong Kong, where schools have been closed since Feb 3. “Now that schools are closed, some lock themselves up inside their rooms for weeks, refusing to take showers, eat, or leave their beds.” For some children with depression, there will be considerable difficulties adjusting back to normal life when school resumes. Children with special education needs, such as those with autism spectrum disorder, are also at risk. They can become frustrated and short-tempered when their daily routines are disrupted, said psychiatrist Chi-Hung Au (University of Hong Kong, Hong Kong, China). He advised parents to create a schedule for their children to reduce anxiety induced by uncertainty. With speech therapy sessions and social skills groups suspended, he cautions that stopping therapy can stall progress, and children with special needs might miss their chance to develop essential skills. He points out that creative ways, such as online speech and social skills training, are needed to make up for the loss. Many countries are postponing or cancelling university entrance exams. In Hong Kong, the authorities made a last-minute decision on March 21 to push back the Diploma of Secondary Education (DSE) exams, which were scheduled to start on March 27, by a month to April 24. According to a poll by the student counselling group Hok Yau Club in March, 2020, over 20% of the 757 candidates surveyed said their stress levels were at a maximum 10 out of 10, even before the postponement was announced. 17-year-old DSE candidate Yoyo Fung has been experiencing loss of appetite and sleep problems, and said she found the uncertainties of whether the exams could be delayed further stressful. “I have a huge wave of fear that I might contract the virus and thus cannot make it to the exams. Staying healthy has become another stressor”, she said. Meanwhile, college and university students are stressed about dormitory evacuation and cancellation of anticipated events such as exchange studies and graduation ceremonies. Some lost their part-time jobs as local businesses closed. Students in their final years are anxious about the job market they are going to enter soon. “College students […] are more vulnerable than we think, especially with the current academic and financial burden”, said Chiu. Social distancing measures can result in social isolation in an abusive home, with abuse likely exacerbated during this time of economic uncertainty and stress. Jianli County in Hubei province, China, has seen reports of domestic violence to the police more than triple during the lockdown in February, from 47 last year to 162 this year. Increased rates of child abuse, neglect, and exploitation have also been reported during previous public health emergencies, such as the Ebola outbreak in west Africa from 2014 to 2016. However, not much is known about the long-term mental health effects of large-scale disease outbreaks on children and adolescents. While there is some research on the psychological impact of severe acute respiratory syndrome (SARS) on patients and health-care workers, not much is known about the effects on ordinary citizens. Evidence is especially scarce in children and adolescents. “This is an important gap for research”, Au said. COVID-19 is much more widespread than SARS and other epidemics on a global scale. As the pandemic continues, it is important to support children and adolescents facing bereavement and issues related to parental unemployment or loss of household income. There is also a need to monitor young people's mental health status over the long term, and to study how prolonged school closures, strict social distancing measures, and the pandemic itself affect the wellbeing of children and adolescents. © 2020 kiankhoon/iStock 2020 Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
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                Author and article information

                Journal
                Asian J Psychiatr
                Asian J Psychiatr
                Asian Journal of Psychiatry
                Elsevier B.V.
                1876-2018
                1876-2026
                30 November 2021
                January 2022
                30 November 2021
                : 67
                : 102957
                Affiliations
                [0005]Social Psychology of Health, Aix-Marseille University, Marseille, France
                [0010]Education and Social Development, University of Manizales, Manizales, Colombia
                Author notes
                [* ]Correspondence to: Aix-Marseille University, 29 avenue Robert Schuman 13621, Aix-en-Provence CEDEX 01, France.
                Article
                S1876-2018(21)00413-5 102957
                10.1016/j.ajp.2021.102957
                8641925
                34871968
                ba29c22f-74c9-45ce-8737-c0e5a6fdde7a
                © 2021 Elsevier B.V. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 4 November 2021
                : 23 November 2021
                : 28 November 2021
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                covid-19,pandemic,children,school closure,well-being,mental health

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