Consequences of the Coronavirus disease 2019 pandemic on child and adolescent mental,psychosocial,and physical health: A scoping review and interactive evidence map

Abstract

Effects of the Coronavirus disease 2019 (COVID-19) pandemic on children stem beyond immediate infectious and post-infectious risks. Our aim was to conduct a scoping review and produce an online Interactive Evidence Map (IEM) highlighting available literature around unintended effects of the pandemic on children’s and adolescents’ mental, psychosocial, and physical health. A search was run monthly in MEDLINE, PsycINFO, CENTRAL, and Cochrane COVID-19 Study Register from May 1^st 2021 through April 30^th 2022. All articles involving children and adolescents under 18 years of age relating to any unintended mental, psychosocial, and physical health consequences of the pandemic and resultant restrictions were included. Data were extracted and topics categorized, with corresponding data uploaded into EPPI-Reviewer and transferred to EPPI-Mapper for visualization. A total of 14,555 citations were screened and 826 (6%) articles included. Most articles reported on mental health outcomes, particularly anxiety (n = 309, 37%) and depression (n = 294, 36%). Psychosocial outcomes related to lockdowns such as loneliness (n = 120, 15%) and impact on adolescent relationships with others (n = 149, 18%) were also reported. Fewer articles examined physical consequences, but those that did mostly focused on child abuse (n = 73, 9%). Overall, currently mapped literature focuses on consequences related to mental health outcomes such as anxiety and depression.

Introduction

In March 2020, Coronavirus disease 2019 (COVID-19) was declared a pandemic (WHO, 2020a) and measures were initiated worldwide (e.g., lockdowns, social distancing, and school closures) to reduce the disease spreading. These measures caused major disruptions in everyday life for many, which in turn have led to increased mental, emotional, physical, and social challenges (Ontario, 2020). Many studies reported that children and adolescents were adversely impacted by these measures (Cianfarani and Pampanini, 2023), with evidence now available on immediate and long-term psychosocial impacts (Ghosh et al., 2020).

While COVID-19 infection can result in less acute immediate health difficulties for children and adolescents, they remain equally (if not more) vulnerable to negative side effects associated with the pandemic (Saleem et al., 2020). Various public health measures and restrictions taken to slow the spread of COVID-19 may have greatly impacted children and adolescents, given their vulnerability related to different stages of their development (Vallejo-Slocker et al., 2022). There was a drastic shift in everyday life caused by these measures, leading to unforeseen and unintentional mental health and psychosocial consequences (Oostrom et al., 2023). A growing body of research has examined various emotional, social, and physical strains placed on children, adolescents, and their families during the pandemic (Hagmann, 2020; WHO, 2020b). Awareness and understanding of this research are critical for addressing holistic healthcare needs of children and adolescents, both during and beyond this pandemic (Lateef et al., 2021).

This pandemic has had a wide range of impacts on children and adolescents, making it an excellent topic for a scoping review (Panchal et al., 2021). With pre-print and peer-reviewed publications on COVID-19 becoming rapidly available, this living approach was timely to identify emerging literature (Ioannidis et al., 2021). Additionally, an interactive evidence map (IEM) is an intuitive and visual online tool which provides an overview of existing evidence on a specific topic for healthcare professionals, decision makers, funding agencies, and patients (White et al., 2020). Given how vulnerable children and adolescents are (Adegboye et al., 2021), it is important to know the breadth of evidence and gaps in the literature surrounding mental, psychosocial, and physical health consequences related to the pandemic (e.g., social distancing, stay-at-home orders, stigma of having COVID-19 infection, and school closures) (Lateef et al., 2021). Mapping this evidence can support the development of resources and strategies to mitigate any unintended consequences of future pandemics and direct where health services and related supports are needed.

Aim

The aim is to identify and map available evidence around the unintended effects of the COVID-19 pandemic and resultant restrictions on children’s and adolescents’ mental, psychosocial, and physical health.

Methods

Between May 2021 and April 2022, we identified peer-reviewed literature reporting the unintended effects of the COVID-19 pandemic on children’s and adolescents’ mental, psychosocial, and physical health and developed an IEM. A protocol was developed a priori and registered in Open Science Framework on May 25th, 2022 (https://osf.io/7vdcm/?view_only=0794b6608ec54f33855b1928540fab08); any protocol deviations were reported there.

Review methods

This scoping review followed Arksey and O’Malley’s (2005) methodological framework (Arksey and O'Malley, 2005), enhanced by Levac et al. (2010) (Levac et al., 2010). Specifically, we followed six steps: (1) identifying a research question; (2) identifying relevant articles; (3) article selection; (4) charting data; (5) reporting results; (6) consultation. Reporting of this review adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) – 2018 Extension for Scoping Reviews (Tricco et al., 2018). An online IEM was also used to visually map included peer-reviewed literature (White H, 2020).

Search strategy

A research librarian developed and refined a comprehensive search strategy in consultation with content experts and methodologists (Supplemental Material A). A second research librarian peer reviewed search strategies using Peer Review of Electronic Search Strategies (PRESS) checklist (McGowan et al., 2016). Searches were carried out monthly starting in May 2021 through April 2022 in three bibliographic databases: Ovid MEDLINE (1946-), Ovid PsycINFO (1987-), and Cochrane (CENTRAL and Cochrane COVID-19 Study Register). Index (subject headings) and text words, and combined concepts for COVID-19, children, and adolescents were used. Our search was limited to English language, peer-reviewed articles published in academic journals, as well as clinical guidelines or position statements. Each month, search results were compared with previous monthly searches to remove duplicates (e.g., preprints) using a standardized method documented by a research librarian.

Eligibility and screening

Articles were included for review if they aligned with pre-established criteria: were specific to the population of interest (children and adolescents under 18 years of age), reported data related to concepts of mental, psychosocial, and physical unintended outcomes, and within the context of the pandemic, were peer-reviewed primary or secondary (knowledge synthesis) research, full text articles, published in academic journals. We excluded any articles that reported on COVID-19 management, prevalence, or prevention strategies, studies where the mean age of participants was over 18 years, animal studies, literature classified as opinion papers, commentaries, or letters. Eligibility criteria and outcomes of interest are described in further detail in Supplemental Material B.

Reviewer one screened titles and abstracts using pre-determined eligibility criteria. Reviewer two verified all studies excluded by reviewer one. Two independent reviewers assessed the full-text of each included article from title and abstract screening. Disagreements were resolved through discussion with a senior investigator until consensus was reached.

Data extraction and analysis

One reviewer extracted relevant data from included articles and entered it into a standardized form in Microsoft Excel (2013). A second reviewer verified all extracted data. All data were extracted in their original form and included (a) study information, (b) participant characteristics, and (c) study category outcomes (mental health [e.g., anxiety, depression, and coping], psychosocial effects [e.g., social isolation, neglect, bullying, and stigma], and physical consequences [e.g., abuse, poisoning, and service utilization]). We performed a narrative synthesis, guided by qualitative content analysis (Erlingsson and Brysiewicz, 2017) to summarize quantity, content, and coverage of included literature. Summary statistics on the number of articles and types of studies examining the different outcomes listed above were also reported.

Mapping and categorization

All included articles were imported into EPPI-Reviewer (web-based software) (Thomas, 2022) and assigned to applicable categories specified during data extraction. During mapping, topics were defined by review authors to use as filters in the IEM (Supplemental Material D). Categorized articles were then imported into EPPI-Mapper (EPPI-Centre, 2022) to create an IEM. This scoping review and IEM were updated on a monthly basis by searching each database, followed by an iterative process of screening, data extraction, categorization, and mapping.

Consultation

Following synthesis, review findings were presented to our parent advisory group. This group meets regularly to provide advice, guidance, and knowledge from a parent perspective on our various research activities (Hartling et al., 2021). A summary presentation was given to the group in October 2022 which provided an overview of the purpose, methods, and scoping review results. A 30-min group discussion was then led by SE and LH to understand what parents perceived as key takeaway messages from this review, as well as how best to disseminate review findings.

Results

Search results

As presented in Figure 1 (PRISMA Flow Chart), our search identified 14,555 unique citations; 1441 full-texts were screened, and 826 (57%) of the full-text articles met inclusion criteria and were mapped and synthesized (Figure 2).

Figure 1.

PRISMA flow diagram.

Figure 2.

Static image of IEM.

Study characteristics

Included articles (i.e., primary research and evidence syntheses) were published between May 1st, 2021 and April 30th, 2022 (Figure 1): on average there were 69 new articles included each month ranging from 43 (5%) (May 2021) to 88 (11%) (March 2022). Seven articles published in 2020 were indexed during our search timeframe, met eligibility criteria, and were included.

Articles represented studies from 60 different countries, and the majority were conducted in high-income countries (The World Bank, 2022) including the United States (25%, n = 207), China (15%, n = 126), and Canada (6%, n = 53). Most primary studies (94%, 779/826) were quantitative in nature (93%, n = 723), with only 3% (n = 24) of these being interventional designs. In comparison, 6% (n = 46) were qualitative studies, with most (67%, n = 31) utilizing interviews for data collection. Less than 1% (n = 11) of primary studies used a mixed-methods design. Additionally, 6% (n = 47) of articles were evidence syntheses, including narrative reviews (2%, n = 18), systematic reviews (2%, n = 17), meta-analyses (<1%, n = 7), scoping reviews (<1%, n = 4), and one rapid review (<1%).

Most articles (80%, n = 664) collected information on adolescents aged 13 to 18 years. Outcomes for children ranging in age from 6 to 12 years were reported in 71% (n = 586) of articles. Outcomes for children from birth to 5 years old were much less common, being reported in only 26% (n = 216) of articles. Nineteen percent (n = 156) of articles reported data for children and adolescents across all of these age ranges.

Race and ethnicity data were extracted when available; race was categorized if 20% or more of the population was recorded as a particular race, resulting in 47% (n = 388) of articles reporting information on race and/or ethnicity. White (52%, n = 203), East Asian (33%, n = 129), and Latinx (8%, n = 62) populations were most frequently reported. Other race categories (15%, n = 69) included Black, Middle Eastern/North African, Southeast Asian, South Asian, or Indigenous populations.

Research setting was reported in 99% (n = 819), with most taking place at home (n = 637, 78%) followed by in hospitals/clinics (n = 53, 7%), online (n = 45, 6%), schools (n = 34, 4%), and in pediatric emergency departments (n = 13, 2%).

As identified in our research question, we categorized outcomes for unintended mental health, psychosocial, and physical health consequences (Supplemental Material C). Most articles reported on at least one mental health outcome (88%, n = 725), followed by psychosocial (44%, n = 365) and less frequently on physical health (16%, n = 133). These outcomes make up columns in the IEM and study design defines rows. As studies were included, topics were defined and used as filters to search the IEM (Supplemental Material D). Most prominent topics were COVID-19 lockdowns (66%, n = 547) and parental perceptions/experiences (14%, n = 112), followed by risk/protective factors (11%, n = 94).

Reported outcomes

Included articles (i.e., primary research and evidence syntheses) were organized into three categories: mental health, psychosocial (including negative experiences), and physical health (consequences). Each article could report on multiple outcomes from each category and be selected for multiple categories. Outcomes (Supplemental Material C) for each category are summarized below along with defined topics (Supplemental Material D) for each outcome.

Mental health

Most (88%, n = 685) primary studies reported on at least one mental health outcome, including anxiety (40%, n = 309), followed by depression (38%, n = 294), and stress/distress (23%, n = 182). Across all outcomes and articles the most frequently reported COVID-19 pandemic topic was regarding lockdowns on children’s and adolescents’ mental health (66%, n = 547). Mental health outcomes were most commonly reported in articles involving older age groups, being present in 90% (n = 597) of articles reporting on adolescents aged 13–18 years, 88% (n = 515) aged 6–12 years, and 74% (n = 159) with children from birth to 5 years. Mental health outcomes were reported in most articles with race data (89%, n = 345); those reporting on Black populations had proportionally fewer mental health outcomes (77%, n = 33) than other frequently reported race populations including East Asian (91%, n = 117), Latinx (87%, n = 54), and White (86%, n = 175).

Anxiety

In total, 309 (37%) articles reported anxiety as an outcome. Most primary studies reporting an anxiety outcome were quantitative (83%, n = 255), encompassing over half of the interventional studies (55%, n = 12). Seven percent (n = 21) were qualitative studies, with interviews (4%, n = 13) being most common, and 9% (n = 28) were reviews, including 4% (n = 11) narrative/literature reviews and 3% (n = 9) systematic reviews. Anxiety outcomes were most frequently reported in articles focusing on risk and protective factors (13%, n = 41), with the exception of COVID-19 lockdown as a general topic (65%, n = 202).

Depression

There were 251 (85%) quantitative and 10 (3%) qualitative primary studies, as well as 32 (11%) review articles that reported on depression. Over half of all intervention studies reported depression as an outcome (58%, n = 14/24). Outcomes on depression were a frequent focus of studies reporting on children’s and adolescents’ technology use during the pandemic. Nineteen (49%) articles about technology use reported a depression outcome. Depression was also the most commonly reported mental health outcome for Latinx (32%, n = 20), East Asian (45%, n = 58), and White (36%, n = 73) populations and tied with anxiety for Black populations (26%, n = 11).

Stress and distress

Articles discussing stress and distress remained stable, but there were changes in study type over time. Overall, 82% (n = 150) of these articles were quantitative, 7% (n = 12) were qualitative, and 7% (n = 12) were reviews. Interestingly, 64% (n = 7) of all mixed-methods studies reported an outcome related to stress and distress. Only six studies (3%) reporting stress and distress as an outcome were intervention studies. Stress and distress outcomes were reported proportionally across topics (Supplemental Material D) including COVID-19 lockdown (21%, n = 114), parental perceptions and experiences of their children (21%, n = 23), school closures (22%, n = 12), and technology use (23%, n = 9). The exception was articles assessing risk and protective factor topics at 33% (n = 31).

Psychosocial

Forty-three percent (n = 353) of articles (292 [83%] quantitative, 33 [9%] qualitative, 5 [1%] mixed methods, and 23 [7%] reviews) reported at least one psychosocial outcome (e.g., relationships, social isolation, and bullying). Psychosocial outcomes most frequently reported (n = 149, 18%) related to relationships that children and adolescents had with their peers and family members and feelings of social isolation/loneliness (n = 122, 15%). Unlike mental health, psychosocial outcomes were reported similarly for each age group with 42% (n = 90) of articles on children from birth to 5 years, and 44% of articles for both 6–12 (n = 259) and 13–18 (n = 293) age ranges reporting at least one psychosocial outcome.

Relationships

Outcomes relating to relationships were commonly reported in articles which focused on topics of risk and protective factors that children and adolescents faced (n = 71, 28%). Articles which captured the perceptions and experiences of parents regarding their children reported relationship outcomes (25%). Additionally, 28% (n = 36) of articles with East Asian populations reported outcomes on relationships which was more frequent than articles including other race populations (White [19%, n = 39], Latinx [16%, n = 10], and Black [16%, n = 7]).

Social isolation

Social isolation/loneliness was infrequently reported within most race populations with the exception of articles about White populations, of which 15% (n = 18) reported this as an outcome. Topics about school closures and technology use both had a high proportion of studies about social isolation and loneliness (22% [n = 26] and 28% [n = 33], respectively).

Negative experiences

We also identified articles reporting negative experiences related to the COVID-19 pandemic, including bullying (n = 29, 3%) and stigma (n = 3, <1%). These outcomes were not commonly reported, only appearing in 4% (n = 31) of mapped articles.

Articles on bullying primarily focused on cyberbullying. Most (69%, n = 20) were from 2021 and commonly focused on an increase of cyberbullying as lockdown measures shifted school and other activities online. Other articles reported bullying and cyberbullying as a risk factor for mental health outcomes such as anxiety, depression, and stress. With regards to stigma, all articles were published in 2021 and related to weight gain, ethnic minorities, and perceptions of those infected with COVID-19.

Physical consequences

Few articles (11%, n = 87) reported on physical consequences of the pandemic. Quantitative primary studies appeared most frequently (n = 69, 79%) followed by reviews (n = 11, 13%). Most articles reporting on physical health outcomes (84%, n = 73) examined abuse/violent discipline that children and adolescents faced, particularly in response to increased stress resulting from lockdown measures. Accidental poisonings of children during COVID-19 were reported in eight (9%) articles and often resulted from pharmaceutical drugs/medicine and hand sanitizer. Six articles (7%) reported on foreign object removal in children, which included four retrospective cohort studies and two case studies, all involving children from birth to 5 years. Studies reporting physical outcomes most often involved children from birth to 5 years (25%, n = 56) compared to 10% (n = 59) for children aged 6–12 years and 9% (n = 60) for adolescents aged 13–18 years. Results on physical health outcomes, especially abuse, were seldom included in studies reporting on East Asian populations at 3% (n = 4) yet frequently in Black populations at 28% (n = 12) compared to other population groups such as Latino (16%, n = 10) and White (14%, n = 28).

Medical service use by children and adolescents during the pandemic related to mental health, psychosocial, and physical health needs was reported in 52 (6%) articles. Most of those articles focused on services related to psychiatric illness and mental health support within the context of pandemic responses. Articles which reported service utilization, most frequently included children from birth to 5 years (12%, n = 25), compared to 6% for both age groups 6–12 (n = 38) and 13–18 (n = 39) years of age. Service utilization and suicide were most commonly reported in articles where research was conducted in hospital/clinic and pediatric emergency department settings (56%, n = 37).

Consultation

Five parents attended an advisory group meeting where results of this scoping review were presented and discussed. Parents were not surprised by how many articles were retrieved on this topic nor how many reported on impacts of the pandemic on children’s and adolescents’ mental health. Through their lived experience and speaking within their social circles, parents were well aware that children’s and adolescents’ mental health was impacted by COVID-19 pandemic restrictions.

Advisory group participants were interested in understanding what “next steps” were planned and how this information could be used by parents to support children’s and adolescents’ mental health. Some parents identified with several topics closely and felt validated that they weren’t the only ones experiencing challenges related to unintended effects of the pandemic on their children’s health.

Some parents wanted to be able to access the IEM, so they could review studies of interest to them and spoke to how visually pleasing and easy this map was to navigate. When asked how they thought results of this scoping review could be utilized, many suggested it should be used to direct where funding and resources are allocated (e.g., mental health resources for families and at home and within school settings) to support children, adolescents, and families manage unintended pandemic consequences.

Discussion

The aim of this review was to synthesize current evidence related to the unintended effects of the COVID-19 pandemic and resultant restrictions on children’s and adolescents’ mental, psychosocial, and physical health. Published evidence on this topic is vast, complex, and heterogeneous in nature. A scoping review approach enabled us to map available evidence from 826 peer-reviewed articles and highlights health concerns where future research efforts should be directed and where health services and related supports are needed. Utilizing an innovative visualization tool, this information was presented in an IEM. In a matrix format, this IEM presents a range of study designs and age groups to easily access articles for a given topic, country, or setting (Figure 2). Based on the visual nature of the IEM one can easily identify trends, as well as gaps in research, to help pinpoint key pertinent and emerging issues in child health. Additionally, the IEM has highlighted what research has already been conducted and where synthesis has been performed to avoid research duplication and waste.

By far, the most commonly reported topic related to children’s and adolescents’ mental health was the impact of COVID-19 lockdown orders. Although we did not collect data on the results of the outcomes included in the articles, others have reported that lockdowns have had significant impact on children’s and adolescents’ mental health (Bussières et al., 2021; Theberath et al., 2022). Specifically, mental health challenges such as anxiety, depression, and stress were reported most frequently. These findings are consistent with a recent systematic review of survey studies which investigated how children’s and adolescents’ mental health has been impacted by the pandemic (anxiety, depression, stress, and tension were the most observed symptoms) (Bussières et al., 2021). Regarding psychosocial impacts, most frequently reported outcomes included children’s and adolescents’ relationships with their parents and peers, and feelings of social isolation/loneliness. Similar findings were recently reported in reviews by Samji et al. (2021) and Hards et al. (2021), respectively (Hards et al., 2021; Samji et al., 2021). Only a small number of studies presented physical consequences as an outcome of the COVID-19 pandemic, including abuse or violent discipline that children and adolescents faced, and poisonings. While a review by Marmor et al. (2023) demonstrated an increased risk of abuse for children (Marmor et al., 2023), there are still many unknowns regarding mistreatment of children during the pandemic and its long-term impact. Although most included studies highlighted negative effects of COVID-19 restrictions, there were a small number of articles regarding the positive effects on parent–child relationships (Yamaoka et al., 2021), advances in technology (Charmaraman et al., 2022), and overall well-being (Ashworth et al., 2022).

It is evident that restrictions (e.g., lockdowns, social distancing, and school closures) put in place to reduce the spread of COVID-19 strained children’s and adolescents’ ability to cope, which impacted their mental health and well-being (Scott et al., 2021), as well as their relationships with family and peers (Browne et al., 2021; Hussong et al., 2022). Early in the COVID-19 pandemic Canadian (Gaucher et al., 2021) and American (Bowden et al., 2022) pediatric emergency physicians expressed concerns about an increase in mental health challenges if the pandemic continued over an extended length of time. We are now finding longitudinal evidence suggesting the prevalence of mental health concerns in children and adolescents has increased since the COVID-19 pandemic began (Deng et al., 2023). Specifically, a review including a large sample of adolescents found that symptoms of depression increased significantly for those under lockdown restrictions (Barendse et al., 2023).

Occurrence of the pandemic and its widespread impact on children’s mental, psychosocial, and physical health has likely also impacted healthcare providers and health service use (Saunders et al., 2021). Reports of changes in emergency department visits by children and adolescents for issues related to mental health were mixed, with some reporting an increase in visits (Fernandez et al., 2021; Radhakrishnan et al., 2022) while others witnessed a decline (Edgcomb et al., 2022; Finkelstein et al., 2021). This decline in mental health emergency department visits, as well as a general decrease in emergency visits, could be due to a number of factors including less infection transmissions, parents avoiding non-emergent hospital visits, and fear of being exposed to COVID-19 (Kim et al., 2022; Kruizinga et al., 2021). However, as certain restrictions were lifted, many acute settings seeing children and adolescents reported being overwhelmed and overcrowded (Beaudry et al., 2022; Valitutti et al., 2020) with other infectious diseases (Levy et al., 2022), making it very challenging with the additional increase of mental health visits.

In the event of a future pandemic or simply a rise in children and adolescents suffering from serious mental health challenges, there should be an increased investment in outpatient services to recognize and manage mental health concerns (Marques De Miranda et al., 2020). For example, innovative screening tools such as MyHEARTSMAP (Virk et al., 2019) can be used to identify concerns early when children or adolescents are presenting to an emergency department and connect them with appropriate mental healthcare. Mental health supports need to be accessible through other avenues (e.g., online) to assist those not seeking care at the emergency department (Blattert et al., 2022). Previous work has explored child and adolescent mental health during this pandemic in the context of Bronfenbrenner’s (1986) ecological framework (Bronfenbrenner, 1986). Applying this ecological systems theory can help to better understand how the pandemic impacts various interacting systems within this model, such as the exosystem (i.e., community healthcare and education support) and microsystem (i.e., healthcare, education, and family support) (Lin et al., 2021). Integrating multi-disciplinary strategies into mental health supports for children and adolescents via a structured framework may assist in establishing a long-term implementation plan.

Providing support and better access to mental health services, as well as primary prevention and evidence-based management strategies, will be key in responding to future public health emergencies (Moroz et al., 2020). As seen during the COVID-19 pandemic, in future health emergencies clinicians will need to have the proper resources to deal with mental health, psychosocial, and related family dynamics that may negatively affect children and adolescents (Saunders et al., 2021). These resources will also be needed as we emerge from the COVID-19 pandemic, as mental health issues that arose or were exacerbated will likely persist. Additionally, during public health emergencies resources need to be directed to immediate mental healthcare for children and adolescents. In a recent Lancet commission on lessons learned from the COVID-19 pandemic, one of the five pillars identified to fight against emerging infectious diseases is to ensure a continuity of other health services including mental health (Sachs et al., 2022).

This scoping review included a consultation component with a parent advisory group, which confirmed that what we found in the literature aligned with parent experiences and concerns (Buus et al., 2022). These findings could provide signals for healthcare needs that may emerge, such as increased availability of services for mental health concerns.

Limitations

We recognize several limitations of this project. Firstly, we included only English language articles and this was primarily due to funding and resource implications. Secondly, we did not include specific disease or clinical categories in our search as part of physical consequences (e.g., delayed diagnosis of diabetic ketoacidosis and appendicitis) of the COVID-19 pandemic. However, we acknowledge that this may be of interest in future reviews to help understand health-seeking behaviors and clinical care pathways during a pandemic. Since our aim was to categorize existing literature, we did not examine intervention effectiveness or effects of the pandemic in relation to different population characteristics such as gender, ethnicity, or age. Finally, due to limited resources our study was only able to monitor and capture research over a single year.

An interesting observation was the number of duplicate publications that were seen month to month. In some cases, articles were being indexed up to three times as authors sent their work to multiple pre-print servers/journals which would then be published at various times. Keeping track of articles and duplicates at this scale and pace proved to be a complex process (Ioannidis et al., 2021).

Implications for practice

Our scoping review displayed an abundance of mental health outcomes being reported such as anxiety, depression, and stress which were also observed in many acute care settings (Radhakrishnan et al., 2022). However, most articles we included were primarily composed of cross-sectional data collected while public health measures such as lockdowns were in effect; therefore, it will be important to examine the ongoing mental health impacts as children and adolescents resume and try to navigate normal pre-pandemic activities (Agorastos et al., 2021). While this review captured emerging data during the height of the pandemic, study designs that utilize validated measures and capture longitudinal data will greatly improve our understanding of longer-term pandemic impacts (Samji et al., 2021). Further, discrepancies between an increase in mental health concerns apparent in the literature and a decrease in accessing health services needs further attention to ensure that children and adolescents are receiving needed supports (Zandy et al., 2023).

Conclusion

This scoping review highlights healthcare concerns where future research efforts can be directed and where health services and related supports are needed. Additionally, the IEM has highlighted what research has already been conducted and where synthesis has been performed to avoid research duplication and waste.

Based on the body of literature we included over a year of the COVID-19 pandemic, it is clear that the mental health of children and adolescents was greatly impacted. More studies are continuing to emerge on how the pandemic and resultant restrictions continue to affect children’s and adolescents’ mental health and psychological well-being, which may result in long-term consequences (Cianfarani and Pampanini, 2023). While removal of previous lockdowns/restrictions has occurred, the impact this has had on the mental health and social behavior of children and adolescents may be long lasting and may influence how and when they seek healthcare. Awareness of the social, psychological, emotional, and mental burden the pandemic has inadvertently placed on children, adolescents, and their families is paramount to addressing their healthcare needs. Additional efforts are needed to track longer-term mental, psychosocial, and physical consequences of the public health measures implemented in response to the pandemic, especially in children and adolescents.

Supplemental Material

Supplemental Material - Consequences of the Coronavirus disease 2019 pandemic on child and adolescent mental, psychosocial, and physical health: A scoping review and interactive evidence map

Supplemental Material for Consequences of the Coronavirus disease 2019 pandemic on child and adolescent mental, psychosocial, and physical health: A scoping review and interactive evidence map by Liza Bialy, Sarah A Elliott, Alison Melton, Samina Ali, Shannon D Scott, Lisa Knisley, and Lisa Hartling in Journal of Child Health Care.