A systematic review of the impact of the Covid-19 pandemic on children’s and parents’ mental health outcomes, and an empirical study of behavioural inhibition in early childhood and risk and protective factors of anxiety at age seven

The number of children and young people experiencing mental health difficulties is rising exponentially and despite the increases in funding and service developments, it is not enough to meet the needs of this expanding population. Having a greater, more accurate understanding of the impact of the Covid-19 pandemic on children’s and parents’ mental health, in addition to further understanding the risk and protective factors that contribute to childhood anxiety (the most common mental health difficulty experienced by children) is essential to inform government and healthcare strategies, to ensure the mental health needs of children are met. Paper 1: There is increasing awareness that the Covid-19 pandemic has had a negative impact on children’s and parents’ mental health outcomes. However, inconsistent findings have been reported and the evidence base for the impact of the Covid-19 pandemic on children’s and parents’ mental health is predominantly dominated by cross-sectional research. Therefore, this systematic review aimed to explore the impact of the Covid-19 pandemic on children’s and parents’ mental health through a focus on longitudinal research designs. Additionally, it aimed to synthesise the association between children’s and parents’ mental health, and the interaction of parents’ mental health on child mental health outcomes during the pandemic. Sixteen studies met criteria to be included in this review, all of which were assessed as acceptable or high quality. Findings indicate that parental mental health has worsened since the onset of the pandemic, however, the impact of the pandemic on children’s mental health is less clear. Some studies found worsening in child mental health difficulties, whilst others reported no changes. Most studies reported associations between parent and child mental health during the pandemic, and of the only study that explored moderation, maternal mood was found to moderate children’s mental health difficulties. From this, increasing parental resources and supporting parent mental health has been identified as an absolute priority, and further research with multiple time points during and after the pandemic is essential to further understand the impact of the pandemic on children’s mental health outcomes. Paper 2: The empirical paper aimed to examine whether behavioural inhibition (BI), maternal anxiety and other family environmental factors such as sociodemographic adversity and maternal warmth play a role in the development of anxiety symptoms and disorders during middle childhood. A nationally-representative community sample of 332 mothers during pregnancy were recruited and followed up at multiple time points over seven years. Behavioural inhibition was measured via questionnaire report during early infancy and via observation during early childhood. Mothers completed questionnaires and clinical diagnostic interviews about their own mental health as well as that of their child. Findings indicate that BI did not predict the presence of an anxiety disorder or elevated internalising difficulties at seven years. Internalising difficulties at early childhood, and maternal anxiety between late infancy to middle childhood, were significant predictors of both children’s risk of having an anxiety disorder and internalising difficulties at seven years. Maternal warmth was negatively correlated with child internalising difficulties and children’s risk of having an anxiety disorder at seven years. This study highlights the importance of identifying mothers with anxiety disorders during the perinatal period to offer support and treatment, and offers recommendations for necessary improvements to early identification of child anxiety