The Trajectory of Depression and Anxiety Among Children and Adolescents over Two Years of the COVID-19 Pandemic

Longitudinal research examining children’s mental health (MH) over the course of the COVID-19 pandemic is scarce. We examined trajectories of depression and anxiety over two pandemic years among children with and without MH disorders. Parents and children 2-18 years completed surveys at seven timepoints (April 2020 to June 2022). Parents completed validated measures of depression and anxiety for children 8-18 years, and validated measures of emotional/behavioural symptoms for children 2-7 years old; children ≥10 years completed validated measures of depression and anxiety. Latent growth curve analysis determined depression and anxiety trajectories, accounting for demographics, child and parent MH. Data were available on 1315 unique children (1259 parent-reports; 550 child-reports). Trajectories were stable across the study period, however individual variation in trajectories was statistically significant. Of included covariates, only initial symptom level predicted symptom trajectories. Among participants with pre-COVID data, a significant increase in depression symptoms relative to pre-pandemic levels was observed. Children and adolescents experienced elevated and sustained levels of depression and anxiety during the two-year period. Findings have direct policy implications in the prioritization and of maintenance of educational, recreational, and social activities with added MH supports in the face of future events. ### Competing Interest Statement Dr. Evdokia Anagnostou has received consultation fees from Roche and Quadrant, research funding from Roche, in-kind supports from AMO pharma, editorial Honoria from Wiley and book royalties from APPI and Springer. She holds a patent for the device, Tully, formerly Anxiety Meter. She has received royalties from APPI and Springer. Dr. Monga reported receiving book royalties from Springer Publishers outside of the submitted work. The other authors have no other conflicts of interest to disclose. This research is funded by the Canadian Institutes for Health Research, #173092, the Ontario Ministry of Health, #700, Centre of Brain and Mental Health, SickKids, Leong Centre for Healthy Children, SickKids, and the Miners Lamp Innovation Fund in Prevention and Early Detection of Severe Mental Illness, University of Toronto. In-kind support was provided by the Ontario Brain Institute for all POND data. Spit for Science was funded by the Canadian Institutes of Health Research, PJT-159462. The views of the Ontario COVID and Kids Mental Health Study do not necessarily represent those of the Province of Ontario and the Ontario Ministry of Health. These agencies had no role in the design, collection, analyses or interpretation of the results of this study or in the preparation, review, or approval of the manuscript. ### Funding Statement This research is funded by the Canadian Institutes for Health Research 173092, the Ontario Ministry of Health 700, Centre of Brain and Mental Health, SickKids, Leong Centre for Healthy Children, SickKids, and the Miners Lamp Innovation Fund in Prevention and Early Detection of Severe Mental Illness, University of Toronto. In-kind support was provided by the Ontario Brain Institute for all POND data. Spit for Science was funded by the Canadian Institutes of Health Research PJT 159462. The views of the Ontario COVID and Kids Mental Health Study do not necessarily represent those of the Province of Ontario and the Ontario Ministry of Health. These agencies had no role in the design, collection, analyses or interpretation of the results of this study or in the preparation, review, or approval of the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The ethics committee of the Hospital for Sick Children, Holland-Bloorview, Queen's University, McMaster University and Lawson Health Research Institute gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data produced in the present work are contained in the manuscript.