The Association Between School Closures and Child Mental Health During COVID-19 | Adolescent Medicine | JN Learning | AMA Ed Hub [Skip to Content]
[Skip to Content Landing]

The Association Between School Closures and Child Mental Health During COVID-19

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Is there an association between school closures and child mental health outcomes, and how does it vary by key sociodemographic characteristics?

Findings  In this survey study of 2324 adults with at least 1 school-aged child, a small association between school closures and worse child mental health outcomes was observed, with older children and children from families with lower income experiencing more mental health problems associated with school closures. Children from families with lower income and those belonging to minority racial/ethnic groups were most likely to experience school closures.

Meaning  These findings suggest older and Black and Hispanic children as well as children from families with lower income who attend school remotely may experience disproportionate mental health difficulties.

Abstract

Importance  In-person schooling has been disrupted for most school-aged youth during the COVID-19 pandemic, with low-income, Black, and Hispanic populations most likely to receive fully remote instruction. Disruptions to in-person schooling may have negatively and inequitably affected children’s mental health.

Objective  To estimate the association between school closures and child mental health outcomes and how it varies across sociodemographic factors.

Design, Setting, and Participants  This cross-sectional population-based survey study included a nationally representative sample of US adults aged 18 to 64 years with at least 1 child in the household. The survey was administered between December 2 and December 21, 2020, via web and telephone in English and Spanish. Participants were recruited from the NORC AmeriSpeak panel, an address-based panel with known probability sampling and coverage of 97% of US households.

Exposures  Schooling modality (in person, fully remote, or hybrid), household income, age.

Main Outcomes and Measures  Child mental health difficulties were measured with the parent-report version of the Strengths and Difficulties Questionnaire, with small, medium, and large effect sizes defined as 1.3-, 3.3-, and 5.2-point differences, respectively.

Results  A total of 2324 adults completed the survey. Overall, 1671 respondents (71.9%) were women, 244 (10.5%) were Black, 372 (16.0%) were Hispanic, and 421 (18.1%) had a high school education or less. Children attending school in-person had higher household incomes (mean difference, $9719; 95% CI, $4327 to $15 111; P < .001) and were more likely to be White compared with those attending remotely (366 of 556 [65.8%] vs 597 of 1340 [44.5%]; P < .001). Older children in remote schooling had more mental health difficulties than those attending in-person schooling (standardized effect size, 0.23 [95% CI, 0.07 to 0.39] per year older; P = .006), corresponding to small effect sizes in favor of in-person schooling for older children and very small effect sizes favoring remote schooling for younger children. Children from families with higher income benefitted more from attending schools in-person compared with their peers from families with lower income (B = −0.20 [95% CI, −0.10 to −0.30] per $10 000-increase in annual income; P < .001), although this advantage was not apparent for children attending hybrid school (B = −0.05 [95% CI, −0.16 to 0.06] per $10 000-increase in annual income; P = .34), and directionally lower but not significantly different for children attending remote school (B = −0.12 [95% CI, −0.04 to −0.20] per $10 000-increase in annual income; P < .001). Learning pods fully buffered the associations of hybrid schooling (d = −0.25; 95% CI, −0.47 to −0.04) but not remote schooling (d = 0.04; 95% CI, −0.10 to 0.18) with negative mental health outcomes.

Conclusions and Relevance  The findings of this study suggest that older and Black and Hispanic children as well as those from families with lower income who attend school remotely may experience greater impairment to mental health than their younger, White, and higher-income counterparts. Ensuring that all students have access to additional educational and mental health resources must be an important public health priority, met with appropriate funding and workforce augmentation, during and beyond the COVID-19 pandemic.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

Article Information

Accepted for Publication: July 3, 2021.

Published: September 3, 2021. doi:10.1001/jamanetworkopen.2021.24092

Correction: This article was corrected on September 30, 2021, to fix errors in Table 1 and Figure 2.

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Hawrilenko M et al. JAMA Network Open.

Corresponding Author: Matt Hawrilenko, PhD, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195 (mhavril@uw.edu).

Author Contributions: Dr Hawrilenko 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: All authors.

Acquisition, analysis, or interpretation of data: Hawrilenko, Tandon, Christakis.

Drafting of the manuscript: Hawrilenko, Kroshus.

Critical revision of the manuscript for important intellectual content: Hawrilenko, Tandon, Christakis.

Statistical analysis: Hawrilenko.

Obtained funding: Hawrilenko, Kroshus, Christakis.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was funded by grant 2027570 from the National Science Foundation.

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.

References
1.
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-XPubMedGoogle ScholarCrossref
2.
Henderson  MB , Peterson  PE , West  MR . Pandemic parent survey finds perverse pattern: students are more likely to be attending school in person where COVID is spreading more rapidly. Education Next. January 19, 2021. Accessed February 3, 2021. https://www.educationnext.org/pandemic-parent-survey-finds-perverse-pattern-students-more-likely-to-be-attending-school-in-person-where-covid-is-spreading-more-rapidly/
3.
Lee  SJ , Ward  KP , Chang  OD , Downing  KM .  Parenting activities and the transition to home-based education during the COVID-19 pandemic.   Child Youth Serv Rev. 2021;122:105585. doi:10.1016/j.childyouth.2020.105585PubMedGoogle Scholar
4.
Zhang  L , Zhang  D , Fang  J , Wan  Y , Tao  F , Sun  Y .  Assessment of mental health of Chinese primary school students before and after school closing and opening during the COVID-19 pandemic.   JAMA Netw Open. 2020;3(9):e2021482. doi:10.1001/jamanetworkopen.2020.21482PubMedGoogle Scholar
5.
Golberstein  E , Wen  H , Miller  BF .  Coronavirus disease 2019 (COVID-19) and mental health for children and adolescents.   JAMA Pediatr. 2020;174(9):819-820. doi:10.1001/jamapediatrics.2020.1456PubMedGoogle ScholarCrossref
6.
Lipari  RN , Hedden  S , Blau  G , Rubenstein  L .  Adolescent Mental Health Service Use and Reasons for Using Services in Specialty, Educational, and General Medical Settings: The CBHSQ Report. Substance Abuse and Mental Health Services Administration; 2016.
7.
Sidpra  J , Abomeli  D , Hameed  B , Baker  J , Mankad  K .  Rise in the incidence of abusive head trauma during the COVID-19 pandemic.   Arch Dis Child. 2021;106(3):e14. doi:10.1136/archdischild-2020-319872PubMedGoogle Scholar
8.
Baron  EJ , Goldstein  EG , Wallace  CT .  Suffering in silence: how COVID-19 school closures inhibit the reporting of child maltreatment.   J Public Econ. 2020;190:104258. doi:10.1016/j.jpubeco.2020.104258PubMedGoogle Scholar
9.
Dunn  CG , Kenney  E , Fleischhacker  SE , Bleich  SN .  Feeding low-income children during the COVID-19 pandemic.   N Engl J Med. 2020;382(18):e40. doi:10.1056/NEJMp2005638PubMedGoogle Scholar
10.
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)30109-7PubMedGoogle ScholarCrossref
11.
Masonbrink  AR , Hurley  E .  Advocating for children during the COVID-19 school closures.   Pediatrics. 2020;146(3):e20201440. doi:10.1542/peds.2020-1440PubMedGoogle Scholar
12.
Ali  MM , West  K , Teich  JL , Lynch  S , Mutter  R , Dubenitz  J .  Utilization of mental health services in educational setting by adolescents in the United States.   J Sch Health. 2019;89(5):393-401. doi:10.1111/josh.12753PubMedGoogle ScholarCrossref
13.
Armitage  R , Nellums  LB .  Considering inequalities in the school closure response to COVID-19.   Lancet Glob Health. 2020;8(5):e644. doi:10.1016/S2214-109X(20)30116-9PubMedGoogle Scholar
14.
Child Trends. Home computer access and internet use. Accessed February 1, 2021. https://www.childtrends.org/indicators/home-computer-access
15.
Garbe  A , Ogurlu  U , Logan  N , Cook  P .  COVID-19 and remote learning: experiences of parents with children during the pandemic.   Am J Qual Res. 2020;4(3):45-65. doi:10.29333/ajqr/8471Google Scholar
16.
Fuchs-Schündeln  N , Krueger  D , Ludwig  A , Popova  I . The long-term distributional and welfare effects of COVID-19 School Closures. National Bureau of Economic Research; 2020:w27773. doi:10.3386/w27773
17.
Christakis  DA , Van Cleve  W , Zimmerman  FJ .  Estimation of US children’s educational attainment and years of life lost associated with primary school closures during the coronavirus disease 2019 pandemic.   JAMA Netw Open. 2020;3(11):e2028786. doi:10.1001/jamanetworkopen.2020.28786PubMedGoogle Scholar
18.
Lange  KW .  Mental health problems in COVID-19 and the need for reliable data.   Mov Nutr Health Dis. Published online June 30, 2020. doi:10.5283/MNHD.28Google Scholar
19.
Goodman  R .  The strengths and difficulties questionnaire: a research note.   J Child Psychol Psychiatry. 1997;38(5):581-586. doi:10.1111/j.1469-7610.1997.tb01545.xPubMedGoogle ScholarCrossref
20.
Cohen  J .  Statistical Power Analysis for the Behavioral Sciences. Academic Press; 2013. doi:10.4324/9780203771587
21.
Lumley  T .  Analysis of complex survey samples.   J Stat Softw. 2004;9(8):1-19. doi:10.18637/jss.v009.i08Google ScholarCrossref
22.
Viner  RM , Bonell  C , Drake  L ,  et al.  Reopening schools during the COVID-19 pandemic: governments must balance the uncertainty and risks of reopening schools against the clear harms associated with prolonged closure.   Arch Dis Child. 2021;106(2):111-113. doi:10.1136/archdischild-2020-319963PubMedGoogle ScholarCrossref
23.
Larosa  E , Djuric  O , Cassinadri  M ,  et al; Reggio Emilia Covid-19 Working Group.  Secondary transmission of COVID-19 in preschool and school settings in northern Italy after their reopening in September 2020: a population-based study.   Euro Surveill. 2020;25(49). doi:10.2807/1560-7917.ES.2020.25.49.2001911PubMedGoogle Scholar
24.
Kroshus  E , Hawrilenko  M , Tandon  PS , Christakis  DA .  Plans of US parents regarding school attendance for their children in the fall of 2020: a national survey.   JAMA Pediatr. 2020;174(11):1093. doi:10.1001/jamapediatrics.2020.3864PubMedGoogle ScholarCrossref
25.
Gilbert  LK , Strine  TW , Szucs  LE ,  et al.  Racial and ethnic differences in parental attitudes and concerns about school reopening during the COVID-19 pandemic—United States, July 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(49):1848-1852. doi:10.15585/mmwr.mm6949a2PubMedGoogle ScholarCrossref
26.
Skalická  V , Belsky  J , Stenseng  F , Wichstrøm  L .  Reciprocal relations between student-teacher relationship and children’s behavioral problems: moderation by child-care group size.   Child Dev. 2015;86(5):1557-1570. doi:10.1111/cdev.12400PubMedGoogle ScholarCrossref
27.
Savitz-Romer  M , Rowan-Kenyon  HT , Nicola  TP , Carroll  S , Hecht  L . Expanding support beyond the virtual classroom: lessons and recommendations from school counselors during the COVID-19 crisis. August 2020. Accessed August 4, 2021. https://www.gse.harvard.edu/sites/default/files/documents/School-Counseling-Covid-19-Report.pdf
28.
Brener  N , Demissie  Z .  Counseling, psychological, and social services staffing: policies in US school districts.   Am J Prev Med. 2018;54(6)(suppl 3):S215-S219. doi:10.1016/j.amepre.2018.01.031PubMedGoogle ScholarCrossref
29.
Schleider  JL , Dobias  M , Sung  J , Mumper  E , Mullarkey  MC .  Acceptability and utility of an open-access, online single-session intervention platform for adolescent mental health.   JMIR Ment Health. 2020;7(6):e20513. doi:10.2196/20513PubMedGoogle Scholar
30.
Wang  K , Rathburn  A , Musu  L . School choice in the United States: 2019. US Department of Education. September 2019. Accessed August 4, 2021. https://nces.ed.gov/pubs2019/2019106.pdf
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
Close
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close