School closure due to coronavirus disease 2019 (COVID-19) pushed children across ages and nationalities into a state of mental health crisis. In Japan, children between the ages of 6 and 18 were ordered to stay at home and observe social distancing for several months. This study is aimed at investigating the effects of quarantine due to COVID-19 on children belonging to different developmental stages in life. Data were collected from mothers of typically developing children aged between 6 and 18 years. The differences in psychological and behavioral changes following school closure during the COVID-19 pandemic were explored. A total of 535 children, including 145 students in lower grades of elementary school (6–9 years), 124 students in higher grades of elementary school (9–12 years), 132 students in junior high school (12–15 years), and 134 students in high school (15–18 years), were recruited. Children in lower grades of elementary school (lower grades group) gained significantly lower understanding about COVID-19 and the necessity of COVID-19 restrictions than children in the other groups. Moreover, they had more psychological problems: they easily cried and complained, were unable to keep calm, and were dependent on parents and family members. Changes in sleep patterns were more prevalent in junior and senior high school students. We concluded that mental health care should be provided based on the growth period of each child not only during school closure but also after school reopening.
The coronavirus disease 2019 (COVID-19) pandemic has been affecting substantial life events worldwide. On January 30, 2020, the COVID-19 pandemic was declared a public health emergency of international concern by the World Health Organization. Measures such as hand hygiene, wearing face masks, eye protection, and maintaining person-to-person physical distance, were recommended [
This is the first instance of school closure for more than two months in Japan. Therefore, it is unclear how long-term school closure and quarantine affects children’s mental health and behavior. To our knowledge, no study has explored the differences in psychological and behavioral changes caused by school closure and quarantine during the COVID-19 pandemic between children and adolescents in different developmental stages of life. We hypothesized that the effects of long-term quarantine are different for children as they belong to different developmental stages in life. The present study is aimed at exploring the differences in the effects of quarantine during COVID-19 in children belonging to different stages of development in life.
In this cross-sectional study, we recruited participants during school closure from April 30 to May 8, 2020. We calculated the sample size before starting the recruitment process. G
The online survey included three categories: (1) demographic data, (2) questions about stress and children’s understanding of COVID-19, and (3) questions about changes in children’s behavior.
Demographic data
Demographic data were categorized based on age, sex, and level of schooling. The children were classified into four groups based on the developmental stage that they were at, referring to the current educational system of the Ministry of Education, Culture, Sports, Science, and Technology (MEXT) [ Questions about stress and children’s understanding of COVID-19 Questions about changes in children’s behavior
These yes/no questions included in the questionnaire are shown in Tables
Between-group comparison of stress and children’s understanding of COVID-19.
Variables | Lower grade elementary school ( | Higher grade elementary school ( | Junior high school ( | Senior high school ( | Cramer’s | |
---|---|---|---|---|---|---|
Yes, | Yes, | Yes, | Yes, | |||
Has your child been stressed about COVID-19? | 113 (77.9) | 103 (83.1) | 104 (78.8) | 102 (76.1) | .573 | .061 |
Does your child have an adequate understanding of COVID-19, such as the person-to-person transmission, unavailability of the vaccine, and isolation of infected people? | 130 (89.7)‡ | 121 (97.6) | 130 (98.5) | 131 (97.8) | <0.001 | .182 |
Does your child understand and follow COVID-19 restrictions, such as the prohibition of nonessential meetings or playing outside? | 100 (69.0)‡ | 110 (88.7) | 125 (94.7)† | 133 (99.3)† | <0.001 | .359 |
Has your child been afraid of getting infected with COVID-19? | 18 (77.9) | 21 (83.1) | 20(78.9) | 24 (76.1) | .603 | .059 |
Has your child been stressed about the prohibition from playing outside? | 97 (66.9) | 88 (71.0) | 82 (62.1) | 79 (59.0) | .161 | .098 |
Has your child been afraid of infecting other people? | 5 (3.4) | 5 (4.0) | 10 (7.6) | 12 (9.0) | .158 | .092 |
Has your child been stressed about being restricted to staying with family? | 6 (4.1) | 8 (6.5) | 11 (8.3) | 17 (12.7) | .058 | .118 |
Has your child been stressed about not being able to see friends or teachers? | 61 (42.1)‡ | 75 (60.5) | 74 (56.5) | 75 (56.0) | .013 | .142 |
Has your child been stressed about not being able to live in the same way as before? | 52 (35.9) | 48 (38.7) | 50 (38.2) | 56 (41.8) | .757 | .047 |
Has your child been stressed about wearing masks? | 32 (22.1) | 27 (21.8) | 18 (13.7) | 22 (16.4) | .199 | .093 |
Has your child been stressed about washing hands? | 8 (5.5) | 10 (8.1) | 5 (3.8) | 3 (2.2) | .159 | .098 |
Has your child been stressed about being prohibited from visiting crowded places? | 48 (33.1) | 37 (29.8) | 29 (22.1) | 36 (26.9) | .208 | .092 |
Has your child been stressed about school closures? | 70 (48.3) | 77 (62.1) | 78 (59.5) | 75 (56.0) | .117 | .105 |
The chi-squared test and Fisher’s exact test were used for statistical analysis. COVID-19: coronavirus disease 2019.
Between-group comparison of changes in children’s behavior.
Variables | Lower grade elementary school ( | Higher grade elementary school ( | Junior high school ( | Senior high school ( | Cramer’s | |
---|---|---|---|---|---|---|
Yes, | Yes, | Yes, | Yes, | |||
Has your child spent more time at home since schools were closed? | 133 (91.7)‡ | 124 (100)† | 130 (98.5) | 132 (98.5) | <0.001 | .143 |
Has your child spent more time studying since schools were closed? | 56 (38.6) | 46 (37.1) | 65 (49.2) | 62 (46.3) | .134 | .112 |
Has your child spent more time exercising since schools were closed? | 25 (17.2) | 16 (12.9) | 11 (8.3) | 15 (11.2) | .151 | .094 |
Has your child had fewer opportunities to attend after-school activities? | 123 (84.8)† | 111 (89.5)† | 93 (70.5)‡ | 90 (67.2)‡ | <0.001 | .225 |
Has your child been confused by the change in their schedule and daily routine due to COVID-19? | 35 (24.1) | 39 (31.5) | 45 (34.1) | 43 (32.1) | .285 | .084 |
Has your child cried and complained easily during the quarantine? | 18 (12.4)† | 6 (4.8) | 1 (0.76)‡ | 1 (0.75)‡ | <0.001 | .227 |
Has your child gotten angry and annoyed easily? | 52 (35.9) | 39 (31.5) | 40 (30.3) | 31 (23.1) | .141 | .101 |
Does your child have decreased motivation? | 51 (35.2) | 45 (36.3) | 60 (45.5) | 62 (46.3) | .122 | .104 |
Has your child’s ability to keep calm decreased? | 23 (15.9)† | 7 (5.6) | 6 (4.5) | 6 (4.5) | <0.001 | .182 |
Is your child excessively scared? | 5 (3.4) | 1 (0.8) | 1 (0.8) | 1 (0.7) | .161 | .098 |
Has your child’s dependence on parents and family increased? | 43 (29.7)† | 32 (25.8)† | 15 (11.4)‡ | 7 (5.2)‡ | <0.001 | .263 |
Have your child’s eating habits changed (e.g., overeating and refusing food)? | 24 (16.6) | 30 (24.2) | 27 (20.5) | 27 (20.1) | .488 | .067 |
Has your child’s sleep pattern changed (e.g., insomnia, difficulty falling asleep, and nightmares)? | 34 (23.4)‡ | 44 (35.5) | 64 (48.5)† | 73 (54.5)† | <0.001 | .249 |
The chi-squared test and Fisher’s exact test were used for statistical analysis. COVID-19: coronavirus disease 2019.
The chi-squared test and Fisher’s exact test were performed to explore the differences in categorical variables among the four groups. Adjusted residuals were used to compare the answers between the groups at a significance level of
A flowchart of the recruitment process is shown in Figure
Flow diagram of the recruitment process. Figure legend: in order to study the effects of school closure, only participants attending school were enrolled. The participants were divided into four groups according to their developmental stage and grade level: lower grade elementary school, higher grade elementary school, junior high school, and senior high school.
Table
Table
We investigated the differences in the effects of long-term school closure during the COVID-19 pandemic in 535 children categorized based on level of schooling. To the best of our knowledge, this is the first study to explore psychological and behavioral effects of school closure during the COVID-19 pandemic in Japanese children aged between 6 and 18 years. We found that almost 80% of children across all grades were stressed about COVID-19, and that behavioral problems varied according to development stage.
Children in the lower grade elementary school group had more psychological reactions such as crying easily, complaining, difficulty in keeping calm, and dependency on parents and family than those in other groups. Although children have a lower rate of COVID-19 infection and less severe clinical manifestations compared to adults, psychological problems are more serious in them, especially in younger children [
In contrast, junior and senior high school students had more physical reactions, such as changes in sleep patterns. Children belonging to these groups tend to have irregular sleep patterns during summer vacations because they were both physically and mentally inactive due to social distancing [
Schools provide children with a sense of normalcy and are places where in addition to academic subjects, children learn about public health, preventing diseases, healthy exercise and eating, and orderly living. Children have decreased opportunities to learn due to school closures [
Our study has several limitations. First, we were unable to use probabilistic sampling; therefore, we applied the snowball sampling method. Second, the purpose of our questionnaire was only to collect information about the children’s stress and behavioral and psychological changes; therefore, we could not understand the family background, and history of developmental disabilities or mental illness in parents or siblings. In addition, there was also a lack of information about the children’s background, such as their intellectual level, developmental history, mental status, and experience with counseling. Third, the answers represented the opinion of the mothers. It is necessary to create a self-administered questionnaire for future studies. Fourth, although the recruitment area of the Ehime prefecture is suburban and relatively nearly rate of the number of children aged 6-18 in Tokyo metropolis (9.6%), our findings may not be generalizable to the entire Japanese adolescent population. Fifth, because this survey was filled out anonymously, it was not possible to follow the children’s progress after school reopened. Finally, the questionnaire used in this study was original, and we could not investigate the children’s anxiety and sleep quality in detail. In future studies, it will be necessary to use validated scales.
Our survey showed that the psychological and behavioral effects of quarantine during COVID-19 vary based on developmental stages in children and adolescents. Children in low grades of elementary school had lesser knowledge about the infection and virus and had more psychological reactions than older children. Mental health care should be provided, especially for children in lower grades, not only during school closures but also after school resumes. Moreover, future studies should conduct indepth investigations of psychological and behavioral effects of school closure for more effective education of children in all grades.
The data in this study are not publicly available. The study participants were informed that the data used in this study will not be provided to third parties other than the researchers and the participants in accordance with the protocol.
The authors declare that there is no conflict of interest regarding the publication of this paper.
The authors thank all the participants.