Mental health trajectories of children and adolescents up to five years after the onset of the COVID-19 pandemic: a longitudinal study

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ABSTRACT Background The COVID-19 pandemic had heterogeneous effects on the mental health of children and adolescents according to individual experiences, with some consequences persisting beyond the lifting of restrictions. We aimed to examine whether the perceived impact of the COVID-19 pandemic was associated with 2022-2025 trajectories of mental health difficulties in children and adolescents, and to identify associated risk and protective factors. Methods Data was drawn from the population-based SEROCoV-KIDS cohort study conducted in Geneva, Switzerland. The multidimensional perceived impact of the pandemic, as well as potential socio-demographic, health, family, social, and behavioral risk and protective factors were parent-reported at baseline, in 2022. Mental health difficulties were collected annually between 2022 and 2025. Generalized mixed effects models were used to estimate mental health trajectories by pandemic impact, and to assess risk and protective factors. Results Of 1907 children aged 2-17 years, 9.3% and 7.9% had experienced a negative and positive pandemic impact, respectively. Compared to their unaffected peers, negatively impacted children had more mental health difficulties in 2022 (incidence rate ratio [IRR]: 1.51; 95% confidence interval [CI]: 1.34-1.70) and improving trends between 2022 and 2025 (IRR: 0.97; 95% CI: 0.95-1.01). An average-to-poor financial situation was related to a milder mental health response to a negative impact in 2022 (IRR: 0.64; 95% CI: 0.46-0.89). A positive pandemic impact tended to be associated with higher difficulties in 7-12 years old children only (IRR: 1.36; 95% CI: 0.98-1.89) in 2022, with stable trends over time. Conclusion About five years after the onset of COVID-19, the lasting mental health difficulties presented by negatively impacted children had largely improved. Although globally reassuring, these findings call for proactive measures to prevent such long-term consequences on youth mental health in the event of future crises.

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