Child mental health and social risks: A Q&A with Andrea E. Spencer, Assistant Professor of Psychiatry, Boston University School of Medicine

A study led by researchers at Boston Medical Center found that the first year of the COVID-19 pandemic saw increased depression, anxiety, and social risks among urban children of color between the ages of 5 and 11. Based on surveys of caregivers of 168 children—of whom 54 percent of identified as “non-Hispanic Black” and 29 percent as “Hispanic” and 22 percent were non-English speaking—rates of emotional and behavioral symptoms rose from 8 percent in September 2019 to 18 percent in January 2021. The children’s families also faced higher social risks during the pandemic, with 50 percent reporting food insecurity mid-pandemic, up from 16 percent; 38 percent having difficulty paying bills, up from 16 percent; 12 percent reporting housing insecurity, up from 3 percent; 10 percent having difficulty with dependent care, up from 1 percent; and 10 percent experiencing unemployment, up from 3 percent.

According to the study, the share of children with depression and anxiety problems increased from 5 percent pre-pandemic to 18 percent mid-pandemic. The study also found that, while mental health symptoms in children were significantly correlated with the number of social risks before the pandemic, this was not the case mid-pandemic; the symptoms were worse due to factors beyond those unmet social needs, such as their caregivers’ anxiety or depression.

The study’s lead author, Andrea E. Spencer, is a child and adolescent psychiatrist, director for pediatric integrated behavioral health care at Boston Medical Center, and assistant professor of psychiatry at the Boston University School of Medicine. PND asked Spencer about the study’s implications for public health, health equity, and public policy.

Philanthropy News Digest: The study, “Changes in psychosocial functioning among urban, school‑age children during the COVID‑19 pandemic,” found that before the pandemic, the children’s emotional and behavioral symptoms were associated with unmet social needs such as food or housing insecurity. How significant was the correlation, and what are the implications?

Andrea E. Spencer: Our clinic screens for mental health symptoms and social needs as part of routine child annual visits to be sure we know when a child and family is struggling with symptoms or needs that we might be able to address at our hospital or via our partnership with community organizations. For the study, we were able to access this information from participants’ medical records to obtain a pre-pandemic baseline.

We saw a significant and moderate correlation between unmet social needs and emotional/behavioral symptoms before the pandemic. This is similar to our findings in another paper published several years ago that also used data from our electronic medical record system. The significance of the finding refers to the probability that random chance generated the data. A small p-value means that the results are very unusual if they were due to chance only. We set our significance level at 0.05, which means that we considered the finding “statistically significant” if there was a 5 percent or lower random chance of getting that result if there really is no correlation. The correlation between unmet social needs and mental health symptoms before the pandemic was in fact highly significant with a p value of less than 0.001—meaning that this finding would have been generated only 0.1 percent of the time if only due to chance. The moderate correlation indicates that as social risks increased, mental health symptoms also increased, but that this relationship is not perfectly linear. This makes sense, because we know there are other factors that relate to child mental health other than social risks. What this doesn’t specifically tell us is the directionality of the association.

PND: The study also found that during the pandemic, by contrast, the children’s symptoms were not significantly correlated with unmet needs, knowing someone with COVID-19, or exposure to COVID-related media. What, then, are the factors that contributed to the jump in children’s mental health issues, especially anxiety and depression?

AES: In our study, the increase in anxiety and depression symptoms during the pandemic were associated with increased screen time, low school engagement, and parent depression symptoms. In addition, families felt that the lack of activities outside of the house, the change in normal routines, social isolation, stress and fear of COVID-19, and lack of physical activity were negatively impacting their child’s well-being....

Read the full Q&A with Andrea E. Spencer, director for pediatric integrated behavioral health care at Boston Medical Center and assistant professor of psychiatry at the Boston University School of Medicine.