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Mental health in clinically referred children and young people before and during the Covid-19 pandemic

Sayal, Kapil; Partlett, Christopher; Bhardwaj, Anupam; Dubicka, Bernadka; Marshall, Tamsin; Gledhill, Julia; Ewart, Colleen; James, Marilyn; Lang, Alexandra; Sprange, Kirsty; Montgomery, Alan

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Professor of Child and Adolescent Psychiatry

Assistant Professor of Medical Statistics and Clinical Trials

Anupam Bhardwaj

Bernadka Dubicka

Tamsin Marshall

Julia Gledhill

Colleen Ewart

Professor of Health Economics

Director Nottingham Clinical Trials Unit


The Covid-19 pandemic and mitigation approaches, including lockdowns and school closures, are thought to have negatively impacted children and young people’s (CYP) mental health. However, the impact for clinically referred CYP is less clear. We investigated differences in the mental health of CYP referred to specialist Child and Adolescent Mental Health Services (CAMHS) before and since the onset of the pandemic. Using baseline data (self- and parent- completed Mood and Feelings Questionnaire and Strengths and Difficulties Questionnaire) from an ongoing RCT (STADIA; ISRCTN: 15748675) in England involving 5–17-year-olds with emotional difficulties recently referred to CAMHS (non-urgent referrals), with repeated cross-sectional comparisons of CYP (n = 1028) recruited during 5 different time periods: (1) Before schools were closed (Group 1 (pre-pandemic); n = 308; 27.08.2019–20.03.2020). (2) Early pandemic period until schools fully re-opened, which included the first national lockdown, its easing and the summer holidays (Group 2 (in-pandemic); n = 183; 21.03.2020–31.08.2020). (3) The following school-term—schools fully re-opened and remained open, including during the second national lockdown (Group 3 (in-pandemic); n = 204; 01.09.2020–18.12.2020). (4) Schools closed as part of the third national lockdown (Group 4 (in-pandemic); n = 101; 05.01.2021–07.03.2021). (5) Schools re-opened and remained open, until the school summer holidays (Group 5 (in-pandemic); n = 232; 08.03.2021–16.07.2021). Most CYP scored above cutoff for emotional problems and depression, with three-quarters meeting criteria for a probable disorder (‘caseness’). The groups did not differ on parent-rated mental health measures. However, self-rated emotional problems, depression, functional impairment and caseness appeared to be higher amongst participants recruited in the two periods following school re-openings. In particular, functional impairment and caseness were greater in Group 5 compared with Group 2. Although symptom severity or impairment did not change in the initial pandemic period, self-reported difficulties were greater during the periods after schools re-opened. This suggests possible greater stresses in the adjustment to re-starting school following recurrent lockdowns and school closures.


Sayal, K., Partlett, C., Bhardwaj, A., Dubicka, B., Marshall, T., Gledhill, J., …Montgomery, A. (2023). Mental health in clinically referred children and young people before and during the Covid-19 pandemic. European Child and Adolescent Psychiatry, 32(12), 2657–2666.

Journal Article Type Article
Acceptance Date Nov 17, 2022
Online Publication Date Dec 17, 2022
Publication Date 2023-12
Deposit Date Nov 21, 2022
Publicly Available Date Dec 18, 2023
Journal European Child and Adolescent Psychiatry
Electronic ISSN 1435-165X
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 32
Issue 12
Pages 2657–2666
Keywords Covid-19; children and young people; mental health; lockdown; school closures; school re-openings; STADIA
Public URL
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