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To what extent are individual and structural social determinants of health (SDoH) and vaccinations associated with child mental health during the COVID-19 pandemic?
In this cohort study of 8493 US children, pandemic-related food insecurity, parental unemployment, disrupted mental health treatment, living in neighborhoods with higher shares of adults working full-time, and living in states lagging in vaccination rates were associated with increased trajectories of perceived stress, sadness, and COVID-19–related worry. Associations between SDoH and these mental health outcomes were more common among Asian, Black, and Hispanic children more than White children.
Supporting children’s mental health requires multifaceted policies that address SDoH and structural barriers to food, health services, employment protection, and vaccination.
The COVID-19 pandemic disproportionately affected mental health in socioeconomically disadvantaged children in the US. However, little is known about the relationship of preexisting and time-varying social determinants of health (SDoH) at individual and structural levels, vaccination eligibility/rates, and the racial and ethnic differences to trajectories of child mental health during the COVID-19 pandemic.
To estimate the association of trajectories of child mental health to multilevel SDoH and vaccination eligibility/rates.
Design, Setting, and Participants
This prospective longitudinal cohort study, conducted from May 16, 2020, to March 2, 2021, integrated structural-level, pandemic-related data with the Adolescent Brain Cognitive Development (ABCD) cohort data (release 4.0). The ABCD study recruited 11 878 children (baseline) and conducted 6 COVID-19 rapid response surveys across 21 US sites (in 17 states) from May 16, 2020, to March 2, 2021.
Preexisting individual (eg, household income) and structural (area deprivation) SDoH and time-varying individual (eg, food insecurity, unemployment) and structural (eg, social distancing, vaccination eligibility/rates) SDoH.
Main Outcomes and Measures
Perceived Stress Scale, the National Institutes of Health–Toolbox emotion measures, and COVID-19–related worry.
The longitudinal sample included 8493 children (mean [SD] age, 9.93 [0.63] years; 5011 girls [47.89%]; 245 Asian [2.34%], 1213 Black [11.59%], 2029 Hispanic [19.39%], 5851 White [55.93%], and 1124 children of other/multiracial ethnicity [10.74%]). Trajectories of stress, sadness, and COVID-19–related worry decreased after adult vaccination rollout. Compared with younger children, boys, White children, or those living with married parents, those who reported greater perceived stress included older children aged 12 to 15 years (β = 0.26; 95% CI, 0.12-0.41; P < .001); girls (β = 0.75; 95% CI, 0.61-0.89; P < .001); Hispanic children (β = 0.24; 95% CI, 0.01-0.47; P = .04); children living with separated parents (β = 0.50; 95% CI, 0.03-0.96; P = .04); children experiencing disrupted medical health care access (β = 0.19; 95% CI, 0.01-0.36; P = .04); children living in economically deprived neighborhoods (β = 0.28; 95% CI, 0.05-0.51; P = .02); children living in areas with more full-time working-class adults who were unable to social distance (β = 1.35; 95% CI, 0.13-2.67; P = .04); and children living in states with fewer fully vaccinated adults (β = 0.59; 95% CI, 0.16-1.02; P = .007). COVID-19 pandemic–related worry was higher among Asian children (β = 0.22; 95% CI, 0.08-0.37; P = .003), Black children (β = 0.33; 95% CI, 0.22-0.43; P < .001), children of other/multiracial ethnicity (β = 0.17; 95% CI, 0.09-0.25; P < .001), and children with disrupted medical health care (β = 0.15; 95% CI, 0.09-0.21) and disrupted mental health treatment (β = 0.11; 95% CI, 0.06-0.16). Inability to afford food was associated with increased sadness (β = 1.50; 95% CI, 0.06-2.93; P = .04). States with later vaccination eligibility dates for all adults were associated with greater COVID-19–related worry (β = 0.16; 95% CI, 0.01-0.31; P = .03) and decreased positive affect (β = −1.78; 95% CI, −3.39 to −0.18; P = .03) among children.
Conclusions and Relevance
Results of this study suggest a disproportionately adverse association of the COVID-19 pandemic with child mental health among racial and ethnic minority groups, which may be improved by addressing modifiable individual (food insecurity, unemployment, health services, parental supervision) and structural (area deprivation, job protection, vaccination) SDoH.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Accepted for Publication: March 1, 2022.
Published Online: April 27, 2022. doi:10.1001/jamapsychiatry.2022.0818
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Xiao Y et al. JAMA Psychiatry.
Corresponding Author: Yunyu Xiao, PhD, Department of Population Health Sciences, Weill Cornell Medicine, New York–Presbyterian, Division 306, 425 E 61 St, New York, NY 10065 (firstname.lastname@example.org).
Author Contributions: Dr Xiao had full access to all 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: Xiao, Pathak, Mann.
Drafting of the manuscript: Xiao, Pathak.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Xiao, Yip.
Obtained funding: Xiao.
Administrative, technical, or material support: Xiao, Pathak.
Supervision: Pathak, Mann.
Conflict of Interest Disclosures: Dr Xiao reported receiving grants from the Bill & Melinda Gates Foundation during the conduct of the study. Dr Mann reported receiving royalties for commercial use of the Columbia Suicide Severity Rating Scale paid from the Research Foundation for Mental Hygiene. No other disclosures were reported.
Funding/Support: This research is supported by grant CORONAVIRUSHUB-D-21-00125 from the Bill & Melinda Gates Foundation and a Research Grants Council Collaborative Research Fund grant (C7151-20G) from the University Grants Committee of Hong Kong.
Role of the Funder/Sponsor: The funders 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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