The Psychiatrist : Clinical and Therapeutic Journal
Open Access

More than a year has passed since the onset of the pandemic, yet COVID-19 persists in affecting the lives and health of people worldwide. While there is considerable knowledge about the mental health impact of COVID-19 in the general population, less is known about its effects on specific vulnerable groups. This information is particularly crucial not only to better prepare for future pandemics but also to provide targeted interventions and support for particularly affected groups, such as children with chronic illnesses (CI).

Chronic childhood illness (CI) encompasses a diverse range of conditions affecting children and their families differently, with prevalence varying widely from 3.5% to 35.3%. The incidence of CI has steadily increased over the years, attributed to medical advancements allowing children to live longer, as well as changes in diagnostic methods and management. Diagnosing CI often involves multiple comorbidities, such as inflammatory bowel disease and psoriatic arthritis, which can have lifelong implications for a child's well-being and quality of life, especially concerning mental health and mood disorders [1].

The COVID-19 pandemic has led to significant increases in the prevalence and burden of major depressive and anxiety disorders in the general population. Social restrictions, lockdowns, school and business closures, income loss, and shifts in governmental priorities to address the pandemic have all negatively impacted mental health. Young people, in particular, have been disproportionately affected by the current pandemic, facing challenges in mental health, education, training, and employment [2].

To assess the impact of the pandemic on children with CI, a multicenter, cross-sectional study was conducted in pediatric patients from six public pediatric hospitals in Italy. Data collected from March 3, 2020, to May 17, 2021, included face-to-face interviews, telephone consultations, or online surveys during scheduled visits. Questionnaires were administered and evaluated by qualified clinical psychologists, with responses recorded and anonymized for analysis [3].

The interruption or delay of medical care, hospitalization, and diagnostic procedures has been a concern during the pandemic, particularly in hard-hit regions like Italy. Cases of delayed access to hospital care have been reported, resulting in adverse outcomes for pediatric patients with CI. Caregiver burden has been exacerbated by the pandemic, compounding economic and social challenges and creating a gap between family needs and available medical care [4].

Further research is needed to understand fully the impact of the COVID-19 pandemic on the mental health of children with CI. Despite initial recommendations to prioritize vulnerable groups, little data are available on how the pandemic has specifically affected this population. The multicenter cross-sectional study in Italy aims to analyze anxiety and depression symptoms in children with CI during the early stages of the lockdown, shedding light on this important aspect of pandemic response and management.

Discussion

The aim of this study was to assess the prevalence of anxiety and depressive symptoms among children with chronic illnesses (CI) and the factors influencing these symptoms. Depression and anxiety were evaluated using standardized questionnaires commonly employed in chronically ill populations. Our study population comprised children from various regions of Italy, primarily residing in the central part of the country, and affected by diverse chronic diseases. Most participants were adolescents or pre-teens (mean age 14.44 years, range 11-18 years), with a majority being females (201F; 133M) [5].

We found a remarkably high proportion of children exhibiting mild to severe depression and anxiety symptoms (approximately 68% and 63%, respectively). Although statistical significance was limited likely due to the small sample size, no significant differences were observed among affected children with different CI [6]. Larger-scale studies are warranted to explore whether specific medical conditions predispose children to mental health issues.

Regarding pharmacological and non-pharmacological therapies, similarly high levels of anxiety and depression were observed regardless of treatment status, with no statistical differences between groups. Regarding the duration of the chronic condition, our analysis revealed an inverse trend—longer illness duration correlated with lower levels of anxiety and depression, albeit not reaching statistical significance. This aligns with previous research suggesting long-term adaptation to chronic illness [7].

Gender differences were notable, with girls in our sample exhibiting significantly higher levels of both anxiety and depression than boys, contrasting with previous findings in non-chronically ill populations. Further investigation is needed to understand the factors contributing to these gender disparities.

Our study also highlighted the significance of age at diagnosis, with younger children showing higher levels of mood disorders, potentially indicating adaptive processes to illness or the benefits of early detection and intervention [8].

Mental health issues, particularly depression and anxiety, are increasingly recognized as major contributors to the burden of illness globally. Previous studies have reported varying estimates of depression and anxiety prevalence in children with chronic conditions, ranging from 8% to 33% for depression and 5% to 48.5% for anxiety. Our findings indicated much higher rates in our sample, with depressive symptoms at 67.96%, anxiety symptoms at 62.87%, and comorbidity prevalence at 53.89%.

The COVID-19 pandemic appears to have exacerbated emotional distress among this population, underscoring the need for targeted interventions and support services. School closures, among the earliest containment measures implemented globally, have particularly impacted children with chronic illnesses, affecting access to vital social, educational, and rehabilitative resources. Despite the valuable insights gained from our study, there are limitations, including the need for a more representative sample and a broader geographical scope. Urgent efforts are warranted to implement coordinated prevention and treatment programs addressing the unique needs of this vulnerable patient group [9,10].

Conclusion

In conclusion, our analysis revealed a high prevalence of anxiety and depressive symptoms among children and adolescents with CI during the initial COVID-19 lockdown in Italy. As the pandemic continues, ensuring continuity of care and tailored mental health support is paramount.

Acknowledgement

None

Conflict of Interest

None

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