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Citation
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Viner R, Russell S, Saulle R, Croker H, Stansfield C, Packer J, Nicholls D, Goddings AL, Bonell C, Hudson L, Hope S, Ward J, Schwalbe N, Morgan A, Minozzi S. JAMA Pediatr. 2021; ePub(ePub): ePub. |
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Abstract
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Importance: School closures during COVID-19 are likely to be associated with significant health harms to children and young people. A systematic review of the evidence is needed to inform policy decisions around school closures and reopenings.
OBJECTIVE: To assess the associations of school closures on health and well-being outcomes in children and young people aged 0 to 19 years, excluding associations with transmission of infection. Evidence Review: Eleven databases were searched from inception to September 2020, and machine learning was applied for screening articles. A total of 16817 records were screened, 151 were reviewed in full text, and 43 studies were included. Quality assessment was tailored to study type. A narrative synthesis of results was undertaken because data did not allow meta-analysis.
FINDINGS: A total of 43 studies from 12 countries with 104630 study individuals were included in analysis. Of those, 9 (21%) were longitudinal pre-post studies, 5 (12%) were cohort, 28 (65%) were cross-sectional, and 1 (1%) was a modeling study; all assessed change by comparison with population reference data. Eighteen studies (42%) were high quality, 19 (45%) were medium quality, and 6 (14%) were low quality. Cause of closure in all studies was the first COVID-19 wave with the exception of 5 influenza studies (11.6%). Twenty-seven studies (62.8%) concerning mental health identified considerable associations across emotional, behavioral, and restlessness/inattention problems; 18% to 60% of children and young people scored above risk thresholds for distress, particularly anxiety and depressive symptoms. Two studies reported nonsignificant rises in suicide. Child protection referrals fell 27% to 39% to half the expected number of referrals originating in schools. Data suggested marked rises in screen time and social media use and reductions in physical activity; however, data on sleep and diet were inconclusive. Available data suggested likely higher harms in children and young people from more low-resource populations.
CONCLUSIONS and Relevance: School closures as part of social distancing measures are associated with considerable harms to children and young people's health and well-being. Associations of school closure were not able to be separated from broader lockdown. Available data are short term; longer-term harms are likely to be magnified. Data on longer-term associations using strong research designs are needed, particularly among vulnerable groups. These findings are important for policy makers seeking to balance the risks of transmission through school-aged children with the harms of closing schools.. © 2021 American Medical Association. All rights reserved.
Language: en |