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Assessment of Mental Health of Chinese Primary School Students Before and After School Closing and Opening During the COVID-19 Pandemic

Educational Objective
To understand how to assess the mental health of primary school students before and after school closing and opening during COVID-19

1 Credit CME

JAMA Network Open

Published Online: September 11, 2020

Research Letter

Article Information and Disclosures

Lei Zhang, MS^1,2,3;

Dandan Zhang, MS^1,2,3;

Jiao Fang, MS^1,2,3;

Yuhui Wan, MD^1,2,3;

Fangbiao Tao, MD^1,2,3;

Ying Sun, MD^1,2,3

Author Affiliations

¹Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui Province, China
²Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, Hefei, Anhui, China
³Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, Anhui, China

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During the coronavirus disease 2019 (COVID-19) pandemic, most governments across the globe have temporarily closed schools, a decision that has impacted 1.4 billion students worldwide.¹ The outbreak of COVID-19 took place during the winter vacation (originally scheduled during January 21 to February 19, 2020) of Chinese schools while all the students were at home. On January 27, China’s Ministry of Education announced that the 2020 spring semester for schools would be postponed to late April owing to the novel coronavirus outbreak, affecting 278 million students across primary and postsecondary grades in China. Although recent modeling studies predict that school closures alone would prevent only 2% to 4% of deaths,² school closures may be associated with mental health problems among students owing to a prolonged state of physical isolation from peers, teachers, extended family, and community networks.³^,4 Most of the available data are cross-sectional, and not much is known about the long-term mental health outcomes associated with prolonged school closure among children and adolescents.⁵ This longitudinal cohort study investigated psychological symptoms, nonsuicidal self-injury, and suicidal ideation, plans, and attempts among a cohort of children and adolescents before the outbreak started (wave 1, early November 2019) and 2 weeks after school reopening (wave 2, mid-May 2020) in an area of China with low risk of COVID-19.

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Article Information

Accepted for Publication: August 10, 2020.

Published: September 11, 2020. doi:10.1001/jamanetworkopen.2020.21482

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Zhang L et al. JAMA Network Open.

Corresponding Author: Ying Sun, MD, Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, 81st Meishan Rd, Hefei 230032, Anhui Province, China (yingsun@ahmu.edu.cn).

Author Contributions: Dr Sun had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Wan, Tao, Sun.

Acquisition, analysis, or interpretation of data: L. Zhang, D. Zhang, Fang, Sun.

Drafting of the manuscript: L. Zhang, Sun.

Critical revision of the manuscript for important intellectual content: D. Zhang, Fang, Wan, Tao, Sun.

Statistical analysis: L. Zhang, Fang.

Obtained funding: Sun.

Administrative, technical, or material support: D. Zhang, Wan, Tao, Sun.

Supervision: Tao, Sun.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was funded by grants 81673188 and 81872638 (Dr Sun) from the National Natural Science Foundation of China.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: The authors thank all the children and their parents who participated in the study and the members of the survey teams.

References

UNESCO. COVID-19 educational disruption and response. Accessed June 10, 2020. https://en.unesco.org/news/covid-19-educational-disruption-and-response

Viner RM , Russell SJ , Croker H , et al. School closure and management practices during coronavirus outbreaks including COVID-19: a rapid systematic review. Lancet Child Adolesc Health. 2020;4(5):397-404. doi:10.1016/S2352-4642(20)30095-X PubMed Google Scholar Crossref

Loades ME , Chatburn E , Higson-Sweeney N , et al. Rapid systematic review: the impact of social isolation and loneliness on the mental health of children and adolescents in the context of COVID-19. J Am Acad Child Adolesc Psychiatry. 2020;S0890-8567(20)30337-3. doi:10.1016/j.jaac.2020.05.009 Google Scholar

Xie X , Xue Q , Zhou Y , et al. Mental health status among children in home confinement during the coronavirus disease 2019 outbreak in Hubei Province, China. JAMA Pediatr. Published online April 24, 2020. doi:10.1001/jamapediatrics.2020.1619 PubMed Google Scholar

Lee J . Mental health effects of school closures during COVID-19. Lancet Child Adolesc Health. 2020;4(6):421. doi:10.1016/S2352-4642(20)30109-7 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.