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

虽然儿童和青少年（COVID-19）仅占全球冠状病毒病（COVID-19）患者的1-2%，但他们及其家人受到了大流行的严重影响。新出现的研究表明，反复间歇性封锁的长期后遗症、长期的社会隔离、对感染的恐惧、学校关闭和家庭压力的增加对儿童的心理健康产生了不利影响（例如，Newlove-Delgado等人，2021年）。此外，有些人还可能患上与新型冠状病毒感染有关的长期疾病（Long Covid-19），这可能进一步加剧不良的心理健康状况（斯蒂芬森等人，2022年）。预先存在精神健康问题的残疾人可能特别脆弱，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名儿童进行的调查显示，患有神经发育障碍的人受影响最大，情绪和行为变化更差，但在遵守社交距离和参与在线教育方面也更困难（Parlatini等人，正在筹备中）。因此，先前存在的心理健康状况可能会对儿童适应快速变化的弹性和灵活性产生负面影响。不幸的是，越来越多的人担心，由以往疫情的文献支持（Sprang & Silman，2013），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，对心理健康的影响可能会随着时间的推移变得更加明显。此外，已有心理健康状况已被确定为成年人长期新冠肺炎的风险因素，重要的是要了解已有心理健康状况的人是否也可能处于更高的风险中，以及他们如何受到长期新冠肺炎的影响。最后，大约三分之一的被调查家庭报告说，社区医疗保健服务没有满足他们的需要，目前还不清楚这是否与从面对面干预向远程干预的过渡有关。这也突出表明，有必要开发一个有效的系统，将个人调查结果迅速传达给临床医生，从而实现有效的后续行动和服务规划。疫情及其对儿童心理健康的限制的重要性已得到广泛认可;英国对COVID-18疫情及其处理的调查最近已专门扩大到包括儿童的心理健康。帮助临床医生了解哪些患者风险最大;随着时间的推移，社交距离限制和学校供应的变化如何对他们产生不同的影响;以及所提供的护理是否满足他们的需求，因此，对有效应对当前的大流行和规划未来的任何情况至关重要。为了了解大流行的不同方面，从社交距离到对家庭经济和教育的影响，以及与新冠肺炎前儿童因素的相互作用（例如年龄，性别和诊断）和社会人口特征（如种族和家庭情况），对先前存在精神健康状况的残疾人的精神健康产生不同的影响，通过建立一个临床结果的横断面探索模型。通过在显著时间点（例如学校关闭和重新开放）重新测试样本，并根据纵向数据对临床结果的轨迹进行建模，了解时间依赖性因素的影响，例如社交距离限制和教育提供随着大流行的演变而发生的变化。通过对既存心理健康状况的患者及其家人进行定性半结构化访谈，探索新型冠状病毒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.