Understanding the impact of the Covid-19 pandemic on the mental health of children and young people with pre-existing mental health conditions

尽管儿童和青年(儿童和青年组)仅占全球冠状病毒病(新冠肺炎)患者的1-2%，但他们及其家人已受到这一大流行的重大影响。新出现的研究表明，反复断断续续的封锁、长期的社会隔离、对感染的恐惧、学校停课和家庭压力增加的长期后遗症已经对CYP的心理健康产生了不利影响(例如NewLove-Delgado等人，2021年)。此外，一些人还可能患上与新冠肺炎感染(长新冠肺炎)有关的长期疾病，这可能会进一步加剧糟糕的精神健康(Stephenson等人，2022年)。既往有精神健康状况的CYP可能特别脆弱，但关于这一人群的代表性流行病学数据有限。我们之前在儿童和青少年心理健康服务(CAMHS)下对2500名CYP进行的调查显示，患有神经发育障碍的人受到的影响最大，情绪和行为变化更严重，但在遵守社交距离和参与在线教育方面也更困难(Parlatini等人，正在准备中)。因此，先前存在的心理健康状况可能会对CYP适应快速变化的适应力和灵活性产生负面影响。不幸的是，在以往疫情文献(Sprang&Silman，2013)的支持下，人们越来越担心，由于持续的不确定性、教育机会的快速变化、家庭压力和服务支持的减少，对精神健康的影响可能会随着时间的推移变得更加明显。此外，既往有精神健康状况已被确定为成人长期寒冷的风险因素，了解有先前精神健康状况的CYP是否也有更高的风险，以及它们可能如何受到长期寒冷的影响是很重要的。最后，约三分之一的受访家庭报告说，保健和保健服务没有满足他们的需要，尚不清楚这是否与从面对面干预向远程干预过渡有关。这也突显了开发有效系统的必要性，以便将个人调查结果快速传达给临床医生，从而实现有效的后续行动和服务规划。大流行及其对儿童心理健康的限制的重要性已得到很好的认识；英国对Covid-18大流行及其处理的调查最近已具体扩大到包括CYP的心理健康。帮助临床医生了解哪些患者面临的风险最大；随着时间的推移，社交距离限制和学校教育的变化可能会对他们产生怎样的不同影响；了解流行病的不同方面，从社会距离到对家庭经济和教育的影响，如何与以儿童为基础的前期因素(例如年龄、性别和诊断)和社会人口学特征(例如种族和家庭情况)相互作用，并通过建立临床结果的横断面探索性模型，对有既往精神健康状况的CYP的心理健康产生不同的影响。通过在显著时间点(如学校关闭和重新开学)重新测试样本，并根据纵向数据模拟临床结果的轨迹，了解依赖时间的因素的影响，例如随着大流行的演变，社会距离限制和教育提供的变化。通过对既往心理健康状况及其家庭成员进行定性的半结构式访谈，探讨新冠肺炎期间结局变化的潜在机制。

Although children and young people (CYP) represent only 1-2% of those with Coronavirus disease (Covid-19) globally, they and their families have been significantly affected by the pandemic. Emerging research suggests that the long-term sequelae of repeated intermittent lockdowns, prolonged social isolation, fear of infection, school closures and increased family pressures have had detrimental effects on the mental health of CYP (e.g. Newlove-Delgado et al., 2021). Moreover, some may also develop long-term illness linked to Covid-19 infection (Long Covid-19), which may further exacerbate poor mental health (Stephenson et al., 2022). CYP with pre-existing mental health conditions may be particularly vulnerable, but there are limited representative epidemiological data on this population. Our previous survey of 2500 CYP under Child and Adolescent Mental Health Services (CAMHS) showed that those with neurodevelopmental disorders were the most affected, with worse emotional and behavioural change, but also more difficulties with complying with social distancing and engaging with online education (Parlatini et al., in preparation). Thus, pre-existing mental health conditions may negatively affect CYP's resilience and flexibility to adapt to rapid changes. Unfortunately, there is increasing concern, supported by the literature on previous outbreaks (Sprang & Silman, 2013), that the effects on mental health may become more apparent over time due to ongoing uncertainty, rapid changes in education access, family stress and reduced support from services. Further, having pre-existing mental health conditions has been identified as a risk factor for Long Covid in adults, and it is important to understand whether CYP with pre-existing mental health conditions may also be at higher risk, and how they may be affected by Long Covid. Finally, about one third of the surveyed families reported that CAMHS was not meeting their needs and it is not clear whether this was related to the transition from face-to-face to remote interventions. This also highlighted the necessity to develop an effective system to rapidly communicate individual survey results to clinicians, enabling effective follow-up and service planning. The importance of the pandemic and its ensuing restrictions on children's mental health is well-recognised; the UK inquiry on the Covid -18 pandemic and its handling has recently been extended specifically to include CYP's mental health. Helping clinicians understand which patients are at greatest risk; how they may be differentially affected by changes in social distancing restrictions and school provision over time; and whether the care provided meets their needs, is therefore pivotal to effectively respond to the current pandemic and to plan for any future scenarios.To understand how the different aspects of the pandemic, from social distancing to the effects on family economics and education, interplay with pre-Covid child-based factors (e.g. age, sex and diagnosis) and sociodemographic characteristics (e.g. ethnicity and family circumstances) and differentially impact on the mental health of CYP with pre-existing mental health conditions, by building a cross-sectional exploratory model of clinical outcome. To understand the effect of time-dependent factors, such as changes in social distancing restrictions and education provision as the pandemic evolves, by re-testing the sample at salient time points (e.g. school closure and re-opening) and modelling the trajectory of clinical outcomes over longitudinal data. To explore the potential mechanisms of change in outcomes during Covid-19 by conducting qualitative semi-structured interviews with CYP with pre-existing mental health conditions and their families.