Return to school and mask-wearing in class during the COVID-19 pandemic: Student perspectives from a school simulation study.

Objectives: This study examined children's perspectives about returning to in-person school following lockdown due to the pandemic and about mask-wearing in class, as well as the mental health of children and parents during the pandemic. Methods: This cross-sectional study was part of a 2-day school simulation exercise that randomized students to different masking recommendations. Parent-report of mental health and post-simulation child-report of COVID-19-related anxiety and mask-wearing were analyzed using descriptive and multiple regression analyses. Semi-structured focus groups were conducted with older students to supplement questionnaire data. Results: Of 190 students in this study, 31% were in grade 4 or lower 95% looked forward to returning to in-person school. Greater child anxiety about COVID-19 was predicted by increased parent/caregiver anxiety (ß=0.67; P<0.001), and lower parental educational attainment (ß=1.86; P<0.002). Older students were more likely than younger students to report that mask-wearing interfered with their abilities to interact with peers (χ2(1)=31.16; P<0.001) and understand the teacher (χ2(1)=13.97; P<0.001). Students in the group that did not require masks were more likely than students in the masking group to report worries about contracting COVID-19 at school (χ2(1)=10.07; P<0.05), and anticipated difficulty wearing a mask (χ2(1)=18.95; P<0.001). Conclusions: For children anxious about COVID-19, parental anxiety and education about COVID-19 may be targets for intervention. Future research should examine the impact of prolonged implementation of public health mitigation strategies in school on academic achievement and children's mental health.

School and learning contexts during the COVID-19 pandemic: Implications for child and youth mental health.

Despite significant disruption to school during the COVID-19 pandemic, research on the impact on children is sparse. This study examines in-person and virtual learning contexts and the impact of school format on mental health (MH). Children and adolescents were recruited from community and clinical settings. Parents and children completed prospective online surveys about school experiences (November 2020) and MH symptoms (February/March 2021), including school format and activities. Standardized measures of depression, anxiety, inattention, and hyperactivity were collected. Hierarchical regression analyses tested associations between school format and MH. Children (N = 1011; aged 6-18 years) attending school in-person (n = 549) engaged in high levels of participation in COVID-19 health measures and low levels of social learning activities. Learning online in high school was associated with greater MH symptoms (B = -2.22, CI[-4.32,-.12] to B = -8.18, CI[-15.59,-.77]). Children with no previous MH condition that attended school virtually experienced a similar magnitude of MH symptoms as those with previous MH conditions. However, children who attended school in a hybrid in-person format, with no previous MH condition, experienced less hyperactivity as same-age peers with prior MH problems (B = -8.08, CI[1.58,14.58]). Children's learning environments looked very different compared to before the pandemic. Removing children from school environments and limiting opportunities that support their MH, such as social learning activities, is problematic. Efforts to address the learning contexts to protect the mental health of children are needed.

Disruption to Education During COVID-19: School Nonacademic Factors Are Associated with Children's Mental Health.

OBJECTIVE: Few studies have examined aspects of the school environment, beyond modality, as contributors to child and youth mental health during the coronavirus pandemic. We investigated associations between nonacademic school experiences and children's mental health. METHODS: Parents of children ages 6 to 18 years completed online surveys about school experiences (November 2020) and mental health (February/March 2021). Parent-reported and child-reported school experiences (i.e., nonacademic factors) included school importance, adapting to public health measures, and school connectedness. Children's mental health symptoms of depression, anxiety, inattention, and hyperactivity were collected using standardized parent-reported measures. RESULTS: Children's (N = 1052) self-reported and parent-reported nonacademic factors were associated with mental health outcomes, after adjusting for demographics and previous mental health. Lower importance, worse adapting to school changes, and less school connectedness were associated with greater depressive symptoms ( B = -4.68, CI [-6.04, -3.67] to - 8.73 CI [-11.47, 5.99]). Lower importance and worse adapting were associated with greater anxiety symptoms ( B = - 0.83 , CI [-1.62, -0.04] to -1.04 CI [-1.60, -0.48]). Lower importance was associated with greater inattention (B = -4.75, CI [-6.60, -2.90] to -6.37, CI [-11.08, -7.50]). Lower importance and worse adapting were associated with greater hyperactivity (B = -1.86, CI [-2.96, -0.77] to -4.71, CI [-5.95, -3.01]). CONCLUSION: Schools offer learning opportunities that extend beyond curriculum content and are a primary environment where children and youth develop connections with others. These aspects of school, beyond academics, should be recognized as key correlates of child and youth mental health.