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Children’s mental health worsened across the board in the UK during the COVID-19 pandemic, but the steepest decline was experienced by those from wealthier families - with employed parents or from higher income households.

The study, led by researchers at the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, and the University of Essex, highlights the urgent need for action to improve child mental health across all groups.

The findings, which are published in the Journal of Epidemiology & Community Health, contradict predictions that disadvantaged children, who had worse mental health before the pandemic, would be hardest hit.

Research has already shown that declines in mental health during the COVID-19 pandemic may have been greatest among younger people, but the impact on inequalities in child mental health were not clear. To find out more, the researchers analysed 16,361 parental observations of 9,272 children in the nationally representative Understanding Society: the UK Household Longitudinal Study.

The research found that children with coupled, highly educated, employed parents and from higher household income experienced steeper declines in their mental health during the pandemic than more disadvantaged children, who tended to have lower mental health to begin with, effectively narrowing child mental health inequalities.

For example, the average difference in child SDQ scores between those whose parents were unemployed compared with those whose parents were employed was 2.35 points before the pandemic but fell to 0.02 points during the pandemic.

This pattern was less pronounced for inequalities by (male) sex and area deprivation, which were maintained during the pandemic. White children, including those from white minority groups, had poorer baseline mental health than children from other ethnic backgrounds and experienced larger declines during the pandemic, leading to a widening of this inequality.

Dr Naomi Miall, lead author of the study, said: “Our study provides evidence that trends in child mental health have continued to worsen during the pandemic. Unexpectedly, in many cases children from traditionally advantaged groups saw larger declines than children from disadvantaged groups - that is, child mental health has become more equal but at a worse overall level.

“The pattern is contrary to predictions from some child health experts that the financial and emotional strain of lockdowns would fall hardest on children with parents in unstable employment, living in overcrowded housing, with less access to outdoor space and educational resources.

“We speculate that social isolation and reduced access to services during the COVID-19 pandemic brought the experiences of traditionally advantaged groups closer to those already faced by children from disadvantaged backgrounds, and/or that emergency income support measures during the pandemic may have eased the economic burden for disadvantaged families.

“Additional pressures faced by some working parents, who had to balance childcare and paid work during the pandemic, may also have contributed to the poorer mental health of children with employed parents during the pandemic.

“Interventions are urgently needed to improve child mental health across all groups, while seeking to maintain the narrower inequalities observed during the first year of the pandemic via upstream policies to reduce socioeconomic disadvantage.”

Child mental health was measured using the Strengths and Difficulties Questionnaire (SDQ) at ages 5 and 8 in annual surveys 2011–19, and at ages 5–11 in July and September 2020 and in March 2021. The potential interactions between the periods before and during the pandemic and sex, ethnicity, family structure, parental education, employment, household income and area deprivation on mental health were also explored.

Some 1,372 (15%) children were observed both before and during the COVID-19 pandemic, 7,226 (78%) were measured beforehand, and 674 (7%) only measured during the pandemic. The final analysis was based on 7,999 (86%) children and 14,018 (86%) observations. This revealed a trend towards poorer mental health between 2011 and 2019 that continued during the pandemic.

The study, ‘Inequalities in children’s mental health before and during the COVID-19 pandemic: findings from the UK Household Longitudinal Study’ is published the Journal of Epidemiology & Community Health. The work was funded by the Medical Research Council and the Scottish Government Chief Scientist Office.

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Enquiries: ali.howard@glasgow.ac.uk or elizabeth.mcmeekin@glasgow.ac.uk / 0141 330 6557 or 0141 330 4831

First published: 21 September 2023