The second in our JCPP Advances podcast series that focus on the papers and editors featured in the publication is with Dr. Tanya Poulain and Dr. Mandy Vogel of Leipzig University Hospital for Children & Adolescents. Tanya and Mandy discuss their paper ‘Well‐being and COVID‐19‐related worries of German children and adolescents: A longitudinal study from pre‐COVID to the end of lockdown in Spring 2020’, and the wider implications that the pandemic has had on the mental health and wellbeing of young people.
Interviewer: Hello, welcome to the In Conversation podcast series for the Association for Child & Adolescent Mental Health or ACAMH for short. I’m Jo Carlowe, a freelance journalist with a specialism in psychology. Today I’m interviewing Dr Mandy Vogel and Dr Tanya Poulain of Leipzig University Hospital for Children & Adolescents. Both are scientists at the Life Child study, which has followed children longitudinally since 2011.
Mandy and Tanya are authors on the paper, ‘Wellbeing and COVID-19 Related Worries of German Children and Adolescents.’ A longitudinal study from pre COVID to the end of lockdown in spring 2020, recently released in the first issue of JCPP advances. If you’re a fan of our In Conversation series, please subscribe on iTunes or your preferred streaming platform. Let us know how we did with a rating or review and do share with friends and colleagues. Mandy and Tanya, welcome, thank you for joining me. Can you each start with a brief introduction on who you are and what you do?
Dr. Tanja Poulain: Yeah, hello. Thank you for the invitation. I am Tanja Poulain, a Psychologist. And I have been a Research Assistant in the Life Child Team since 2015. I am particularly interested in the mental health and leisure behaviour of children and adolescents, for example, screen time or physical activity.
Dr. Mandy Vogel: My name is Mandy. And I studied mathematics and history, first to be a teacher. But then I began to work in the IT Department of the University’s Hospital in Leipzig. And since 2009 I am a Scientist in the Children’s Hospital. I also hold a Masters degree from the Johns Hopkins Bloomberg School of Public Health, and I’m mainly in charge of statistics. I help PhD students and medical researchers with their projects. And my main interests are in numbers and the stories behind these numbers.
Interviewer: And, can I ask you both, how did you come to be interested in child and adolescent wellbeing?
Dr. Tanja Poulain: Well, for me, it was during my studies of psychology when I heard a lecture on developmental psychology. At this moment, it was already clear for me that I wanted to work in this field. After my doctoral thesis, which I worked then in the field of language development, I wanted to explore what really preoccupies children and adolescents in their everyday lives, and how this may impact their mental health and their wellbeing. I was pretty happy to start as a scientist in the Life Child Team because the setting of this study is very well suited for such questions.
Dr. Mandy Vogel: As I said before, I’m working at a children’s hospital for more than ten years now. And first, most of the project I am I involved were about biological health. And then it becomes more, and more, important to also consider wellbeing as an important aspect of child health.
Interviewer: As you’ve mentioned, you’re both scientists at the Life Child Study. Can you tell me more about Life and, in particular, the child study?
Dr. Mandy Vogel: The study is conducted at Leipzig University’s Children’s Hospital. And the principal investigator of the study, Professor Wieland Kiess, is also the director of these hospitals. And we recruit children since 2011. We follow them from pregnancy until young adulthood. We collect bio samples. We also have many questionnaires and computer assisted interviews where we get information about medical history, the family background but also leisure activities, media use, physical activity. And we also test motor function, and we do developmental tests but also computer game like tests, for example, Tetris.
And another aspect we introduced very recently is the measurement of the environment of the kids. We use small biosensors, but also med data and we try to describe the healthy development of children and to identify risk and resilience factors. And therefore, we have many collaborations, for example, with different departments of the University Hospital, but also at the University at Leipzig and several Max Planck Institutes and international corporations, for example, with the Generation R cohort, in the Netherlands, or EU projects, for example, with Sweden.
Interviewer: So it’s incredibly comprehensive? And I understand it includes annual follow up visits, which will continue until participants are 20 years of age? How might this data be used in practice then to help children and their families?
Dr. Tanja Poulain: Well, we are always interested in transferring our research result into practice or into clinical practice. And one possible approach is to incorporate our findings into the development of prevention programmes, or intervention programmes, for example, based on our findings on child media use we are currently developing a media programme for children in psychiatry, together with our colleagues from the University Hospital. This project intends to teach those children the competent use with electric screen media, for example, to find other ways to spend their free time or to question messages on social media or on the internet in general.
Dr. Mandy Vogel: Another example is our school nutrition study, where we try to foster healthy nutrition in schools. Because schools are a very good environment to reach also families and children from lower social status.
Interviewer: We’ll return to the impact of media use, social media use later. But I want to turn now to the paper mentioned in the introduction. This is Wellbeing and COVID-19 Related Worries of German Children and Adolescents, a longitudinal study from pre COVID to the end of lockdown in spring 2020, which was released in the first edition of JCPP advances. Can you start by saying something about the methodology that you use?
Dr. Tanja Poulain: We sent online questionnaires to the Life Child participants in the last week of March 2020, and in the last week of April 2020. And we invited to parents and from the age of 11, 12, also the children, to answer a question related to their wellbeing, as well as COVID-19 related various. And baseline data, the pre COVID data were collected during 2019 at regular study results in our study centre. And, for example, we asked the children questions from the kids screen scales to measure physical and psychological wellbeing and, yes, about worries and media use during the lockdown. And we compare the baseline data to the March 2020 data, as well as the March to the April data. We used different statistical models to do these comparisons.
Interviewer: And what kinds of COVID related worries did the paper look at?
Dr. Tanja Poulain: First of all, we asked children and adolescents about worries about themselves. But we were also interested in worries about people close to them, so, family members or friends. And, in addition, we also recorded worries about at the home city, which is mainly Leipzig, about their country, so, Germany, and also worries about the whole world.
Interviewer: And in comparing the physical and psychological wellbeing of young people, pre COVID, and then during COVID, what key differences did you find?
Dr. Tanja Poulain: Yeah, all my main findings are that both physical wellbeing, but also psychological wellbeing, were significantly lower during the first COVID-19 related lockdown in spring 2020 than in the year before the pandemic. The same was also true for dissatisfaction with peer relationships. For example, the percentage of children who had no contact with their peers, neither in person, nor online, increased from 3% before the pandemic to nearly 14% in the first lockdown. And, furthermore, during the lockdown, a large majority of children it was 80% of them stated that they missed their friends.
Interviewer: Let’s look at social isolation then. Because it’s something one normally associates with older people, loneliness, and social isolation. What did your study reveal about its impact on children and young people?
Dr. Mandy Vogel: We found that loneliness is indeed an important subject, also in children, not only in older people. And, as Tanya said, we found that a lot of children had no contact with their peers at all through the lockdown. And we know from research that loneliness is important during puberty, as the children get older, the more they suffer from loneliness. And our results are supported by research, for example, also from the US who a study also done during the earlier COVID time in May and June 2020 found loneliness highly prevalent. And they also found that the loneliness was related to COVID related worries, but also with depression and anxiety in children between six and 18. And this was also found by a Norwegian study pre COVID. And, in general, loneliness during childhood has also severe consequences in adulthood. It’s related to higher rates and anxiety and depression later on.
Interviewer: That’s if you’re lonely as a child, that it has a knock on impact when you become an adult?
Dr. Mandy Vogel: It has an impact when you become an adult if you have to live through phases where you feel lonely. Yes.
Interviewer: And, in your study, did the problem of loneliness increase? I mean, clearly the problem of social isolation did?
Dr. Mandy Vogel: We didn’t have questions about loneliness, but we think that the question if the children miss their friends, and have contact with their friends, are closely related. And we think the children suffer from loneliness. We will follow up in another study to answer this question in our cohort.
Interviewer: Mandy and Tanja, your study included a look at changes in wellbeing and media use in nine to 18 year olds caused by the lockdown and social distancing. What has the impact been on media use, and its implications for mental health?
Dr. Mandy Vogel: What we found is that children do a lot more with media in their leisure time. We ask specifically for later time because school is also done online, but we excluded the school time. So in addition to the online school time, they use media much more. And we found also that the usage differed before COVID-19 between weekends and weekdays, and we see, during the lockdown, this difference vanished. So this also indicates a lack of structure in the day. And we did not ask for exact times, but we know from other studies who ask for exact hours and minutes that, for example, in an Italian study in obese children the screen time raised from two hours, four hours a day, and the Spanish children in general found two hours daily increase in screen time and this, of course, has also implications for mental health.
Interviewer: Tanja, can you talk about the implications on mental health?
Dr. Tanja Poulain: Yes, OK, our finding is in line with other studies and several other studies already suggests that long screen times on the one hand, and wellbeing, social interaction, or, for example, school achievement, on the other hand, may negatively affect each other also in the long run. So when children are not doing well, they sometimes seek escape into the virtual world. And too much screen time, on the other hand, may also contribute to children developing behavioural difficulties, for example.
And in our own study, another study, we could show that adolescents reporting to use computers and the internet for more than two hours per day report more analysing behavioural difficulties and a lower psychological wellbeing one year later. And, at the same time, those children and adolescents already having more behavioural difficulties at baseline showed in higher media use one year later. This shows that wellbeing and media use can interact in the long run. And during a pandemic or in times of social isolation, this risk may be particularly high, we assume.
And, moreover, patterns of behaviour, for example, the high media use, or also doing things alone, as this might be the case when schools are closed, this behaviour might not immediately return to normal after a lockdown or a pandemic. And that’s relevant for their mental health in general.
Interviewer: Let’s turn to socioeconomic status, which is something you looked at in the paper. What impact did this have on the wellbeing of children and young people during the pandemic?
Dr. Tanja Poulain: Children react differently to the challenging situations such as school closures or social isolation. And while some manage to cope well, and to develop new coping strategies, others need more support from their environment, for example, parents or their siblings. And, interestingly, our analysis showed that the drop in life satisfaction from before the pandemic to the time during the first lockdown was significantly stronger among those children and adolescents from families with a weaker social status than among children from families with a higher social status, which is also in line with other study findings.
This suggests that in socially weaker families, the family support may sometimes not be as helpful as it should be. And one possible reason for this finding is differences in housing conditions. For example, children from socially weaker families more often live in smaller apartments and are less likely to have their own room. Some are also less likely to have a suitable learning environment consisting of their own computer or their own desk. So this is one reason which might explain those findings.
Another reason why socially weaker families may be less able to cope with challenging situations is that they more often have to cope with health problems, or with financial worries, especially in the times of the pandemic.
Interviewer: Your study focused on a German cohort. Can we assume that the findings hold true for other countries, too?
Dr. Mandy Vogel: As I said before, there are international studies who found similar results. For example, there is a study in the UK who found also that children showed lower wellbeing scores during the COVID-19 pandemic, and different studies who showed higher media use in Italy and the US and also in the UK. But, of course, there are regions in the world where the consequences are even worse. For example, in Africa, where school closures are causing an increase in child marriages.
UNICEF estimated that there are more than ten million additional child marriages caused by the COVID-19 pandemic in the last month. So I think there are serious problems for children in the Western countries, but there are also regions in the world who suffer much more.
Interviewer: The paper in JCPP Advances concludes that pandemic measures have to be balanced against adverse public health effects. What should that balance look like, in your view?
Dr. Mandy Vogel: We think school closures can be necessary. But there might be other measures possible and also feasible. And it’s important that during a pandemic we have to reflect about measures as scientists learn more about how infections occur, how they can prevent it, and, also, who are the most vulnerable groups. And, so, we have to learn, and adapt, the measures when we go forward. And even if it’s necessary to close schools, and kindergartens, we have to develop strategies to mitigate the consequences, and to help families, especially single parent families or socially disadvantaged families.
And hence, balancing is not a single decision, but a continuous process. If we get new knowledge about the disease, and preventive measures, we have to change our behaviour, balance the needs of different population groups. And, when it comes to children, the society has to be careful. Because, unlike other groups, children do not have a lobby. And so, both scientists and child psychologists have to stand in for children. Everybody needs a voice at times like these.
Interviewer: What are the implications, then, of your findings for professionals working in child and adolescent mental health?
Dr. Tanja Poulain: Our findings suggest, or strongly show, that isolation can have a negative impact on the wellbeing of children and adolescents. And, in this context, it is important to keep in mind that the Life Child study mainly involves healthy children and children from higher social classes. But even there we observe this significant drop in wellbeing from before the pandemic to during the pandemic. Therefore, children who were already not so well before the pandemic did what was probably even stronger. And while many children may be resistant or manage to cope, others will not succeed, in our point of view.
So some may really develop serious abnormalities such as a depression or anxiety or social withdrawal. This could then also be relevant for clinicians, because it is highly probable and there are studies that already show that the number of children in need of treatment will increase during the pandemic. And then therapists have to work with those children, and their families, to help them to develop new coping strategies.
Interviewer: So it’s going to have an impact on resources? What about policy makers then? What do you hope they will take away from your findings?
Dr. Tanja Poulain: What we would like to emphasise is the importance of social interaction, and also on school for the wellbeing of children and young people. Our results underline that schools should only be closed when there is really no other measures that is effective. And, in this context, it is important to implement effective concepts in school so that children can return there very quickly, or remain there for a long time. For example, masks, or smaller classes, and, more recently, also tests for students, and teachers, but also vaccinations for teachers might, for example, be mentioned here.
Dr. Mandy Vogel: We hope that we underlined that a pandemic is also a burden for children. And we want to emphasise that it is important to consider the needs of vulnerable population groups like children. We suggest that we need a constant dialogue between stakeholders of different administrative levels and science.
Interviewer: Mandy and Tanja, is there anything else you want to highlight from this research?
Dr. Tanja Poulain: Yes. As mentioned before, our results suggested the lockdown, the pandemic, social isolation, reinforced a social bias in the society. This is also shown by other studies. And, in our point of view, this is a big danger. Because this gap is already too big at the moment and should not become bigger. Finally, it will be the weakest in our society and not only elderly, or vulnerable, adults, but also children who will probably suffer most during this pandemic, who will, for example, lose educational opportunities, or lack important interactions.
In other societies and countries this might be even more dramatic because their children no longer go to school, but go to work, because their parents have lost their job, to give just one example. So we think that it will be challenging to reverse or halt this trend.
Interviewer: Are you planning some follow up research that you can reveal to us?
Dr. Mandy Vogel: Yes. Besides the JCPP advances paper, we published another one on the same cohort but a younger age group which XM and media use and Asia activities. We have also research on the weight development of children during the lockdown. And we found tremendous weight gain, especially in children who were already overweight and obese. This paper is in review, and there’s also a short report about the well child visits, and visits to preventive medical examinations in Germany.
And we see also there a heavy drop in the participation rates during the COVID-19, which may have important implications that serious diseases might be diagnosed later against a more serious state. And, of course, we want to follow up our cohort, and look how they deal with the pandemic. We had two other waves, one already in 2020. And we also send out online questionnaires in January 2021.
Interviewer: And is there anything else in the pipeline that you’d like to mention?
Dr. Tanja Poulain: We are also interested in the topic of vaccination in general. And especially…and the willingness to vaccinate in young families. For example, wonder, also, how children, and adolescents, themselves, feel about vaccination and whether there are other characteristics or facets of the lifestyle, or of personality in parents, but, also, in children, or adolescents, that may be associated with the willingness to vaccinate. But this is a project we have no clear plans about it.
Interviewer: Finally, Mandy and Tanja, what are your takeaway messages?
Dr. Tanja Poulain: One take home message is that a pandemic, school closures, or social isolation, can have a negative impact on the wellbeing of children, and adolescents, and, above all, children lack the contact with friends. Another take away message is that the impact on wellbeing is bigger in children from socially weaker families than in children from higher social classes.
Dr. Mandy Vogel: We also want to emphasise that we have seen that children suffer from the pandemic, but we know that children are not the only vulnerable group in the society. And so, we do not have only balance school closures, but also the needs of all these vulnerable groups, and, of course, also, of the other groups, that we can go through this pandemic as a whole society, and not split up into groups. The groups should not compete, but try to find a way to go through the pandemic together.
OK, so united we stand, divided we fall?
Dr. Mandy Vogel: That’s what we hope for, yes.
Interviewer: Well, thank you both so much. For more details on Dr. Mandy Vogel and Dr. Tanja Poulain, please visit the ACAMH website www.acamh.org and Twitter at ACAMH. ACAMH is spelt A C A M H. And don’t forget to follow us on iTunes or your preferred streaming platform. Let us know if you enjoy the podcast with a rating or review and do share with friends and colleagues.