Impacts of COVID-19 on children and adolescents: A systematic review analyzing its psychiatric effects.

OBJECTIVE: To summarize the most relevant data from a systematic review on the impact of COVID-19 on children and adolescents, particularly analyzing its psychiatric effects. METHODS: This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and included experimental studies (randomized-individually or pooled-and non-randomized controlled trials), observational studies with a group for internal comparison (cohort studies-prospective and retrospective-and case-control) and qualitative studies in the period from 2021 to 2022. RESULTS: The search identified 325 articles; we removed 125 duplicates. We selected 200 manuscripts, chosen by title and selected abstracts. We excluded 50 records after screening titles and abstracts, as they did not meet the inclusion criteria. We retrieved 150 records selected for a full reading. We excluded 90 text articles and we selected 25 records for the (n) final. Limitations: Due to the short period of data collection, from 2021 to 2022, there is a possibility of lack of relevant studies related to the mental health care of children and adolescents. In addition, there is the possibility of publication bias, such as only significant findings being published. CONCLUSION: The impact of COVID-19 on the mental health of children and adolescents is of great concern to child and youth psychiatry. Situations such as fear, anxiety, panic, depression, sleep and appetite disorders, as well as impairment in social interactions caused by psychic stress, are punctual markers of pain and psychic suffering, which have increasing impacts on the mental health panorama of children and adolescents globally, particularly in vulnerable and socially at-risk populations.

Stolen innocence: Dishonor and taint in times of war.

As soon as they are taken prisoner, children and adolescents in times of war are inserted into a spiral of cruelty that progresses to rape or other countless forms of physical and psychological torture using sex as a weapon. Were these children and adolescents war sex slaves? Oral sex and other sexual barbarities are part of spaces of abuse and humiliation. The damage to the personality structure of these children and adolescents is severe. The psychological consequences are numerous. Over the years, a vicious circle has been observed around this brutality.

Ukraine: War, bullets, and bombs - millions of children and adolescents are in danger.

As the Russia-Ukraine conflict continues to unfold, the ever-evolving situation can be particularly difficult for children and teenagers. Children living in these areas face serious threats from bombing, landmines and unexploded ordnance. Their lives are also threatened by the destruction of vital infrastructure - health centers, schools and water supplies - because of the fighting. War can have a devastating effect on children's mental and physical health, with potentially lifelong consequences. Fears can generate fantasies of the end of the world, as well as the fear of losing a loved one or life itself, nightmares and regressions to previous evolutionary stages. This situation is creating dramatic scenes at train stations, where families are forced to say goodbye.

The impact of "the war that drags on" in Ukraine for the health of children and adolescents: Old problems in a new conflict?

The early months of 2022 have already included several distressing world events. From the ongoing COVID-19 pandemic, to protests against vaccine mandates and COVID-19 restrictions, to the Russian invasion of Ukraine. Escalating conflict in Ukraine poses an immediate and growing threat to the lives and well-being of the country's 7.5 million children. Humanitarian needs are multiplying - and spreading by the hour. Children have been killed. Children have been wounded. They are being profoundly traumatized by the violence all around them. Hundreds of thousands of people are on the move, and family members are becoming separated from their loved ones.

Afghan children and adolescents: The burden of poor mental health in contexts of widespread poverty, social inequality and persistent violence.

In Afghanistan, the burden of poor mental health arises in contexts of widespread poverty, social inequality, and persistent violence. Generations of Afghans were born during the conflict, and some never knew peace. Children make up more than half (57%) of the population in need of emergency humanitarian assistance in Afghanistan. Recent assessments indicate that more than a third of children have been exposed to psychological distress due to the loss of family and community members and the constant risk of death and injury. Children and teens are struggling with anxieties and fears, desperately in need of mental health support. The lack of social support manifested itself in various forms of suffering in both children and adolescents. The quality of the environment where children and adolescents grow up shapes their well-being and development.

Abuse and neglect among Ethiopian children and adolescents.

Given the dramatic situation observed in Ethiopia, the biggest humanitarian crisis in decades, children and adolescents have been the most affected. The country experiences climate change and disarrays in the political structure of the state, which increases the risk of insecurity, displacement, and protection. The outlook tends to remain in 2022 due to the expansion of the conflict and the decrease in the access of partners' humanitarian aid groups to the affected regions. The country has high rates of malnutrition, low vaccination coverage, need for educational assistance, water, and sanitation emergency, lack of services to protect against violence, and high rates of children unaccompanied by their families. During the conflict, children, often to save their lives - because they have extended families or unhealthy inter-family relationships - end up looking for work on the streets and falling into a situation of vulnerability. In this context, they become constant victims of sexual abuse and physical violence, leaving deep marks. Still, the country's folk traditions fall back on the girls, significantly in a negative way, when genital mutilation and child marriage are in considerable proportion among girls in the country. However, the humanitarian actions did not concern themselves with referring to the particular needs of adolescent girls, including the involvement of caregivers to reduce the risk of violence. In this sense, it is important to point out that the increase in discrimination, stigmatization, and xenophobia contribute negatively to local tensions and to the improvement of vulnerability and social risk of children and adolescents. Therefore, there is a need for interventions to multisectoral nutrition, due to the prevalence of thinness and stunting that are above the threshold level of public health importance, and the need for urgent humanitarian assistance care to the more than 15 million children affected by this unprecedented crisis.

Deaths announced in Brazil - A dark sweetness: COVID-19 among children and adolescents.

While the Ministry of Health of Brazil postpones the inclusion of children aged 5-12 years in the National Immunization Plan against COVID-19, current evidence highlights that the number of hospitalizations and deaths caused by COVID-19 in the pediatric population, of in general, including the group of children aged 5-11 years, it is not within acceptable levels. Unfortunately, child mortality and fatality rates in Brazil are among the highest in the world. In 2020, there were 1203 deaths from Severe Acute Respiratory Syndrome (SRAG). In 2021, there were 2293. Also 65 deaths were reported from Pediatric Multisystem Inflammatory Syndrome (P-SIM); an aggressive manifestation of the virus in children.

Domestic violence and suicide in India.

India has the highest number of suicides in the world. Indian men account for a quarter of global suicides, while Indian women account for 36% of all global suicides in the 15-39 age group. One suicide every 25 min. These are not isolated incidents. Mental health experts say that one of the main reasons for this situation is rampant domestic violence. India's official data are hugely underestimated and do not convey the true scale of the problem. Women from this country are responsible for 36% of global female suicide deaths. In a country like India, with its wide sociocultural variations, there can be multiple risk factors: hanging, pesticide consumption, drug overdose, and self-immolation. Access to these "lethal" resources is an important factor.

Reflections on early childhood education in the COVID-19 pandemic.

The COVID-19 pandemic is a complex and multifaceted event, and it is even argued that it should be seen as a syndemic and not a pandemic . Its impacts will still be felt over the years and, perhaps, are irreparable in some aspects. It is essential to mobilize Governments, civil society and non-governmental organizations to outline measures to combat school dropout and social inclusion.

Generation of innocents become enduring victims of a terrible war: Vulnerabilities of children and adolescents in Syria.

Estimates suggest that so far in 2021, about two children have died each week at Al Hol camp in northeast Syria. Current evidence states that more than 90% of children are under the age of 12, and that they face circumstances contrasting with severely restricted freedoms and human rights violations. They do not have access to clean water or adequate food. Recent examples of violence and fears of a massive outbreak of COVID-19 only increase the suffering. In this context, the global debate discusses exposure to these conditions and their psychological and physical effects on children's well-being, mainly due to reports of sexual violence, exploitation, harassment, trafficking, and indoctrination. It is important to emphasize that girls are particularly vulnerable to sexual abuse, needing gender-specific support through their physical and psychological pain.

Urgent call to action: Child rights and the state of child morbidity and mortality in Yemen.

More than 2.3 million children under the age of five in Yemen suffer from acute malnutrition. Approximately 450,000 are expected to suffer from severe acute malnutrition and may die if they do not receive urgent treatment. In this context, without security, stability, and better access for farmers to have the means to resume growing food, children and their families continue to sink deeper and deeper into hunger and malnutrition.

Challenges to food safety for children and adolescents in Brazil.

Malnutrition increases the chance of cognitive delay, recurrent infections, micro and macronutrient deficiencies, stigmatization. According to the Brazilian Society of Pediatrics (Sociedade Brasileira de Pediatria), more than half (58%) of Brazilian families with children and adolescents reported changes in eating habits in the same period. For 31%, there was an increase in consumption of processed foods such as chocolate, filled cookies, instant noodles, and canned foods. Therefore, despite food security being a human right contemplated in article 25 of the Universal Declaration of Human Rights and reiterated by article 6 of the Brazilian Federal Constitution in 2010, the country still has a long way to go. With the advent of the COVID-19 pandemic, there was a deepening of poverty, misery, and hunger in the country, which directly reflected on the income of families and placed children/adolescents in a situation of extreme vulnerability.

Pandemic of hunger: The severe nutritional deficiency that kills Yanomami ethnic children.

Chronic malnutrition is the painful reality that Yanomami children face in Brazil's largest Indigenous Land and is pointed out by specialists as one of the results of the federal government's "anti-indigenous policy". The lack, or scarcity, of medical care, together with the lack of environmental inspection, pushes the Yanomami into a desperate scenario. It is estimated that 20,000 illegal miners operate in the territory. Mining activity contaminates rivers with mercury and has caused deformities and illnesses in women and children. They live on the largest indigenous reserve in Brazil. There are nine million hectares within the Amazon Forest. Malaria has persistently advanced in Yanomami land: there are more than 16,000 cases this year alone. Several children are dying.

Children are in need of humanitarian aid in Afghanistan.

Almost 60% of Afghans forced to flee their homes in 2021 because of the Taliban advance are children. They are starving. It is estimated that approximately one million will suffer from severe, life-threatening malnutrition by the end of 2021. Many have been separated from their families by the chaos that has ensued in Afghanistan after Taliban took power, and hundreds of them were driven out of the country unaccompanied. How must these children have been when they suddenly found themselves without their relatives during the chaotic crisis, or when they boarded an evacuation flight? It is vital to identify them quickly. Too many children witnessed scenes that no child should see. Children and teenagers are dealing with anxiety and fear and desperately need help and mental health care. This is the sad reality facing Afghan children, regardless of ongoing political developments and changes in government.

Cemetery, tombstones, tears and hidden silences: Suicide in children and adolescents.

Recent studies have reported a deterioration in children's mental health since the onset of the COVID-19 pandemic, with an increase in anxiety and mood disorders leading to significant suicidal ideation and suicide rates. Suicide is complex, and individual tragedies and circumstances can diverge. Evidence suggests that the mental health and well-being of some children and youth were substantially affected because of and during the pandemic. Those with pre-existing mental health problems that experienced the most negative impacts compared to pre-pandemic data.

Echoes of Global Silence: Is there protection and safety for Venezuelan children and adolescents?

As the crisis in Venezuela deepens, an increasing number of children urgently needs shelter, protection, and access to basic services, including food, medicine, clean water, and sanitation. Children and young people in transit are particularly at risk of criminal activity or being separated from their families. The consequences of the humanitarian crisis for children could be devastating for the country's future. The child labor problem was fueled by a mass migration of more than five million Venezuelans that turned many children into livelihoods for their families. The pandemic has aggravated risk factors for child labor. The work ranges from working in dumps to agricultural fields, adding that children in rural areas are more likely to depend on public assistance and are at greater risk of being recruited by gangs. Some Venezuelan women and girls are traveling for hours or days to cross the Colombian border and earn money as sex workers. The complex and multifaceted reality of international migration reveals enormous challenges that directly affect the lives of children and adolescents, especially the most vulnerable, and demand urgent responses from the constituted powers and civil society in the face of countless human rights violations those people experience.

Victims of sexual exploitation and violence in Brazil.

At least 8.9% of Brazilian women have already suffered some type of sexual violence in their lives. Every hour, Brazil has 2.2 cases of sexual violence against children and adolescents. Of the approximately 35,000 cases of violence against children and adolescents in 2021, in around 12,000 ethnic groups were not identified, 10,064 were white, 9634 were brown, 2505 black, 141 yellow, and 61 indigenous. If compared to age groups, boys from zero to 6 years reach 30%, but when the age is 12 to 18, women reach 91% of the victims. The whistleblowers are almost always anonymous, unlike in the case of violence against women, which are usually the victims themselves who complain or when they are third parties, they are usually identified. According to official data, around 96% of sexual violence takes place at home. The data are frightening and prove that sexual violence is the result of a scenario of gender inequality because it affects the lives of girls and women in a much more profound way.