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This study aimed to validate the PROMIS ® pediatric v2.0 Anger scale in the Dutch general population, provide reference data, and compare reliability and relative efficiency between the full-length scale, its short-form, computerized adaptive test (CAT), and Pediatric Quality of Life Inventory (PedsQL TM) emotional functioning (EF) subscale scores. Children (N = 1,328), representative of the Dutch population, were asked to complete the PROMIS pediatric Anger scale (8–18 years) and PedsQL TM (8–17 years). A graded response model (GRM) was fit to the data. Structural validity was assessed by checking item-fit statistics (S−X 2, p 0.50) was expected between the Anger scale and PedsQL TM EF subscale score. Dutch mean T score based on the U.S. model was calculated to provide reference data and cut-offs. Standard error of measurement (SE(θ)) was used to assess reliability (SE(θ) 2/N items) to compare how good the measures performed relative to the amount of items administered. In total, 527 children completed the PROMIS pediatric Anger scale, of which 482 completed the PedsQL TM. Structural validitywas sufficient as no items displayedmisfit (S−X 2 = 22.9–40.3, p >.001). The Anger scale score correlated moderately (Pearson’s r =.64) with the PedsQL TM EF subscale score. Dutch mean T score was 44.20 (SD = 11.39), with cut-offs of >52.2 for moderate and ≥62.3 for severe symptoms. Reliable measurements were obtained at the population mean and >2SD in the clinically relevant direction. CAT outperformed all other measures in efficiency. The PROMIS pediatric Anger scale displayed sufficient psychometric properties within the Dutch population and reference data are available.

Purpose During the COVID-19 pandemic in the Netherlands, governmental regulations resulted in a lockdown for adults as well as children/adolescents. Schools were closed and contact with other people was limited. In this cross-sectional, population-based study, we aimed to investigate the mental/social health of children/adolescents during COVID-19 lockdown. Methods Two representative samples of Dutch children/adolescents (8–18 years) before COVID-19 (2018, N = 2401) and during lockdown (April 2020, N = 844) were compared on the Patient-Reported Outcomes Measurement Information System (PROMIS) domains: global health, peer relationships, anxiety, depressive symptoms, anger, sleep-related impairment by linear mixed models and calculating relative risks (RR (95% CI)) for the proportion of severe scores. Variables associated with worse mental/social health during COVID-19 were explored through multivariable regression models. The impact of COVID-19 regulations on the daily life of children was qualitatively analyzed. Results Participants reported worse PROMIS T-scores on all domains during COVID-19 lockdown compared to before (absolute mean difference range 2.1–7.1 (95% CI 1.3–7.9). During lockdown, more children reported severe Anxiety (RR = 1.95 (1.55–2.46) and Sleep-Related Impairment (RR = 1.89 (1.29–2.78) and fewer children reported poor Global Health (RR = 0.36 (0.20–0.65)). Associated factors with worse mental/social health were single-parent family, ≥ three children in the family, negative change in work situation of parents due to COVID-19 regulations, and a relative/friend infected with COVID-19. A large majority (> 90%) reported a negative impact of the COVID-19 regulations on daily life. Conclusion This study showed that governmental regulations regarding lockdown pose a serious mental/social health threat on children/adolescents that should be brought to the forefront of political decision-making and mental healthcare policy, intervention, and prevention.

The aim of the study was to assess internalizing problems before and during the pandemic with data from Dutch consortium Child and adolescent mental health and wellbeing in times of the COVID-19 pandemic, consisting of two Dutch general population samples (GS) and two clinical samples (CS) referred to youth/psychiatric care. In each sample, measures of internalizing problems were obtained from ongoing data collections pre-pandemic (NGS= 35,357; NCS= 4,487) and twice during the pandemic, in Apr.–May 2020 (NGS= 3,938; clinical: NCS= 1,008) and in Nov.–Dec. 2020 (NGS= 1,489; NCS= 1,536), in children and adolescents (8-18 years) with parent- (Brief Problem Monitor) and/or child reports (Patient-Reported Outcomes Measurement Information System®). Results show significantly greater proportions of worrisome internalizing problems (based on validated cut-offs) and significantly higher internalizing problems mean levels from pre-pandemic to pandemic measurements in the general population. These levels stabilized or decreased over the course of the pandemic. In the clinical sample, we found an increase in child-reported internalizing problems measures over the course of the pandemic, but parents reported no differences in internalizing problems measures over the course of the pandemic, nor from pre-pandemic to during the pandemic. Overall, the findings indicate that children and adolescents of both the general and clinical population were affected negatively by the pandemic in terms of their internalizing problems. Attention is therefore warranted to investigate what long-term effects this may cause and to monitor if internalizing problems return back to pre-pandemic levels or if they remain elevated post-pandemic.

Background: The COVID-19 lockdown increases psychological problems in children and adolescents from the general population. Here we investigate the mental and social health during the COVID-19 lockdown in children and adolescents with pre-existing mental or somatic problems.Methods: We included participants (8–18 years) from a psychiatric (N = 249) and pediatric (N = 90) sample, and compared them to a general population sample (N = 844). Measures were assessed during the first lockdown (April-May 2020) in the Netherlands. Main outcome measures were Patient-Reported Outcomes Measurement Information System (PROMIS®) domains: Global Health, Peer Relationships, Anxiety, Depressive Symptoms, Anger, and Sleep-Related Impairment, as reported by children and youth. Additionally, socio-demographic variables, COVID-19-related questions, changes in atmosphere at home from a parent and child perspective, and children's experiences of lockdown regulations were reported by parents.Results: On all measures except Global Health, the pediatric sample reported least problems. The psychiatric sample reported significantly more problems than the general population sample on all measures except for Anxiety and Peer Relationships. Having a COVID-19 affected friend/relative and a COVID-19 related change in parental work situation negatively moderated outcome, but not in the samples with pre-existing problems. All parents reported significant decreases in atmosphere at home, as did children from the general population.Conclusion: We observed significant differences in mental and social health between three child and adolescent samples during the COVID-19 pandemic lockdown and identified COVID-19-related factors influencing mental and social health.

Background: The COVID-19 lockdown increases psychological problems in children and adolescents from the general population. Here we investigate the mental and social health during the COVID-19 lockdown in children and adolescents with pre-existing mental or somatic problems. Method: We included participants (8-18 years) from a psychiatric (N = 249) and pediatric (N = 90) sample, and compared them to a general population sample (N = 844). Measures were assessed during the first lockdown (April-May 2020) in the Netherlands. Main outcome measures were Patient-Reported Outcomes Measurement Information System (PROMIS) domains: Global Health, Peer Relationships, Anxiety, Depressive Symptoms, Anger, and Sleep-Related Impairment. Additionally, socio-demographic variables, COVID-19-related questions, changes in atmosphere at home from a parent and child perspective, and children's experiences of lockdown regulations were assessed. Results: On all measures except Global Health, the pediatric sample reported least problems. The psychiatric sample reported significantly more problems than the general population sample on all measures except for Anxiety and Peer Relationships. Having a COVID-19 affected friend/relative and a COVID-19 related change in work situation negatively moderated outcome, but not in the samples with pre-existing problems. All parents reported significant decreases in atmosphere at home, as did children from the general population. Conclusion: We observed significant differences in mental and social health between three child and adolescent samples during the COVID-19 pandemic lockdown and identified COVID-19-related factors influencing mental and social health. Our findings contribute to current and future policies during pandemic related lockdowns regarding the mental and social health of children and adolescents.

ImportanceIt is unknown how a lockdown during the COVID-19 pandemic impacts children’s and adolescents’ mental and social health.ObjectiveTo compare mental and social health of children and adolescents during the COVID-19 lockdown versus before, identify associated factors, describe the change in atmosphere at home and qualitatively assess the impact of COVID-19 regulations on daily life.DesignCross-sectional study comparing two Dutch representative samples of children and adolescents (8-18 years); before COVID-19 (Dec2017-July2018) and during the COVID-19 lockdown (April/May 2020).SettingPopulation-basedParticipantsChildren and adolescents aged 8-18 years (M=13.4, 47.4% male), representative of the Dutch population on key demographics.Exposure(s)COVID-19 pandemic lockdownMain Outcome(s) and Measure(s)Patient-Reported Outcomes Measurement Information System (PROMIS®) domains: Global Health, Peer Relationships, Anxiety, Depressive Symptoms, Anger and Sleep-Related Impairment. Single item on atmosphere at home and open question regarding the impact of the regulations on the child/adolescent’s daily lifeResultsChildren and adolescents reported significantly worse PROMIS T-scores on all domains (absolute mean difference range, 2.1-7.1; absolute 95% CI range, 1.3-7.9) during the COVID-19 lockdown as compared to before COVID-19. More children reported severe Anxiety (during 16.7% vs. before 8.6%; relative risk 1.95; 95% CI 1.55-2.46) and Sleep-Related Impairment (during 11.5% vs. before 6.1%; relative risk 1.89; 95% CI 1.29-2.78). Fewer children reported poor Global Health (during 1.7 vs. before 4.6%; relative risk 0.36; 95% CI 0.20-0.65). More mental and social health complaints during the COVID-19 lockdown were found in children and adolescents growing up in a single-parent family, having ≥three children in the family, a negative change in work situation of parents due to COVID-19 regulations, and having a relative/friend infected with COVID-19. A small effect was found on atmosphere at home during the lockdown compared to before (mean difference, −3.1; 95% CI, −4.1 −−2.1). A large majority (>90%) reported a negative impact of the COVID-19 regulations on their daily life.Conclusions and RelevanceThis study showed that governmental regulations regarding lockdown pose a serious mental and social health threat on children and adolescents that should be brought to the forefront of political decision making and mental health care policy, intervention and prevention.Key pointsQuestionWhat is the impact of lockdown during the COVID-19 pandemic on mental and social health in children and adolescents compared to before COVID-19?FindingsThis population-based study shows that during the COVID-19 lockdown children and adolescents report lower mental and social health, especially on anxiety and depressive symptoms.MeaningIn proposing new COVID regulations (e.g., closing schools) governments should be mindful of the negative impact of a lockdown on mental and social health of children and adolescents.