Prevalence of clinical‐level emotional/behavioral problems in schoolchildren during the coronavirus disease 2019 pandemic in Japan: A prospective cohort study

Takahashi, Fumito; Honda, Hideo

BACKGROUND: Several empirical studies have investigated negative mental health outcomes related to the spread of infectious diseases, including coronavirus disease 2019 (COVID‐19). However, little is known about children's emotional/behavioral problems, especially externalizing problems, during such situations. This prospective cohort study aimed to investigate pandemic‐related emotional/behavioral problems and their risk factors among schoolchildren in Japan. METHODS: A total of 4800 parents with children in grades 1−12 participated in a two‐wave longitudinal survey. Wave 1 and Wave 2 were conducted on March 4−8 and May 15−18, 2020, respectively. Survey items included demographic information, parental depression, children's diagnoses of neurodevelopmental disorders, the total length of school closure, and emotional/behavioral problems. Children's emotional/behavioral problems were assessed using the Strengths and Difficulties Questionnaire (SDQ), which has cutoff points to differentiate clinical‐level problems, which were the primary focus of this study. RESULTS: The proportions of clinical‐level problems were higher at Wave 2 (emotional symptoms = 24.8%, conduct problems = 22.7%, hyperactivity/inattention = 36.8%, peer relationship problems = 36.2%, and lack of prosocial behavior = 23.5%) compared to Wave 1. Lower grade‐level and lower annual family income predicted the increased proportions of children's clinical‐level emotional symptoms, hyperactivity/inattention, and prosocial behavior at Wave 2. The total length of school closure was not a significant predictor of subsequent emotional/behavioral problems. The highest proportion of clinical‐level problems at Wave 2 for the four SDQ subscales was observed in children with neurodevelopmental disorders. CONCLUSIONS: The number of schoolchildren with severe emotional/behavioral problems increased during the COVID‐19 pandemic. Appropriate prevention and early intervention programs should be provided, especially for children who are in lower grade levels, have low family incomes, or have neurodevelopmental disorders.