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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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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 (email@example.com).
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.
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