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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.


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.

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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 (

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.

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