Understanding the impact of the Covid-19 pandemic on the mental health of children and young people with pre-existing mental health conditions

Although children and young people (CYP) represent only 1-2% of those with Coronavirus disease (Covid-19) globally, they and their families have been significantly affected by the pandemic. Emerging research suggests that the long-term sequelae of repeated intermittent lockdowns, prolonged social isolation, fear of infection, school closures and increased family pressures have had detrimental effects on the mental health of CYP (e.g. Newlove-Delgado et al., 2021). Moreover, some may also develop long-term illness linked to Covid-19 infection (Long Covid-19), which may further exacerbate poor mental health (Stephenson et al., 2022).

CYP with pre-existing mental health conditions may be particularly vulnerable, but there are limited representative epidemiological data on this population. Our previous survey of 2500 CYP under Child and Adolescent Mental Health Services (CAMHS) showed that those with neurodevelopmental disorders were the most affected, with worse emotional and behavioural change, but also more difficulties with complying with social distancing and engaging with online education (Parlatini et al., in preparation). Thus, pre-existing mental health conditions may negatively affect CYP's resilience and flexibility to adapt to rapid changes. Unfortunately, there is increasing concern, supported by the literature on previous outbreaks (Sprang & Silman, 2013), that the effects on mental health may become more apparent over time due to ongoing uncertainty, rapid changes in education access, family stress and reduced support from services.

Further, having pre-existing mental health conditions has been identified as a risk factor for Long Covid in adults, and it is important to understand whether CYP with pre-existing mental health conditions may also be at higher risk, and how they may be affected by Long Covid. Finally, about one third of the surveyed families reported that CAMHS was not meeting their needs and it is not clear whether this was related to the transition from face-to-face to remote interventions. This also highlighted the necessity to develop an effective system to rapidly communicate individual survey results to clinicians, enabling effective follow-up and service planning.

The importance of the pandemic and its ensuing restrictions on children's mental health is well-recognised; the UK inquiry on the Covid -18 pandemic and its handling has recently been extended specifically to include CYP's mental health. Helping clinicians understand which patients are at greatest risk; how they may be differentially affected by changes in social distancing restrictions and school provision over time; and whether the care provided meets their needs, is therefore pivotal to effectively respond to the current pandemic and to plan for any future scenarios.

To understand how the different aspects of the pandemic, from social distancing to the effects on family economics and education, interplay with pre-Covid child-based factors (e.g. age, sex and diagnosis) and sociodemographic characteristics (e.g. ethnicity and family circumstances) and differentially impact on the mental health of CYP with pre-existing mental health conditions, by building a cross-sectional exploratory model of clinical outcome.

To understand the effect of time-dependent factors, such as changes in social distancing restrictions and education provision as the pandemic evolves, by re-testing the sample at salient time points (e.g. school closure and re-opening) and modelling the trajectory of clinical outcomes over longitudinal data.

To explore the potential mechanisms of change in outcomes during Covid-19 by conducting qualitative semi-structured interviews with CYP with pre-existing mental health conditions and their families.