The closure of schools, Covid-19 and children’s mental health
Should schools be closed or kept open? This question has been one of the most asked since the start of the Covid-19 pandemic. Opinions have been expressed on this subject, both in scientific literature and the media, and usually in terms concerning the risks associated with the virus spreading. But what about the impact of such measures on the mental and behavioural health of children? As part of the SAPRIS project, a multidisciplinary team of researchers has been focusing on the emotional and behavioural problems of children from the moment schools closed in March through to June 2020.
Numerous measures, either more or less restrictive, were put in place throughout the world to combat the Covid-19 pandemic. The closure of schools to limit the spread of the virus (seen as a key measure) is still being hotly debated as regards its benefits and costs. Closing a school is not a trivial matter. For a child, their whole social world is put on hold and the whole trajectory of their life affected. How can the indirect effects of such a measure on children's mental health be assessed?
As part of the SAPRIS project (Health, practices, relations and social inequalities in the general population during the Covid-19 crisis), a multidisciplinary team of researchers, comprising mainly those from the Centre for Research in Epidemiology and Public Health (CESP – Univ. Paris-Saclay, UVSQ, Inserm), focused on the mental health of children during the first lockdown and on associated factors. The study, led by Cédric Galera from the ‘Bordeaux population health’ Research Centre, highlighted significant rates of emotional and hyperactivity-inattention disorders in children at the time of the school closures and detailed the various socio-economic factors associated with these disorders.
The SAPRIS study - an unprecedented study for unprecedented times
SAPRIS looked into the various somatic, psychological and socio-economic aspects associated with the shock of the Covid-19 pandemic. The study involved epidemiologists, sociologists, demographers and health economists, all of whom were mobilised to analyse the various effects of this crisis on the population. The resources assembled were unprecedented. The SAPRIS project involves five large national cohorts, with a total of over 300,000 subjects, some of whom have been followed for over ten years. The aim was to develop and present a standard questionnaire, specifically designed to assess the effects of the health crisis, and to send it to participants in the five cohorts.
To study the mental health and behaviour of children at the time of the school closures, the multidisciplinary team of scientists was particularly interested in the ELFE and EPIPAGE 2 cohorts. These comprised children who had been followed since their birth in 2011. These resources were crucial in exploring the effect of novel risk factors on a large number of children. The large-scale questionnaire developed by the SAPRIS group would collect enough information to provide material for as many different disciplines as possible. “Each discipline could work on the same sphere, but its approach would be different. Together, we formulated a questionnaire which was broadened to include as many disciplines as possible,” sums up Alexandra Rouquette, a researcher from CESP, a public health physician and member of the SAPRIS project.
Children’s mental health and the closure of schools
While the pros and cons of school closures are still being debated, research shows significant rates of hyperactivity, inattention and abnormal emotions in children aged between 8 and 9 between April and May 2020. The researchers also identify the socio-economic factors associated with these behaviours. Being male, having a disorder prior to the pandemic and being from a low-income family are, for example, criteria more commonly found in a child with a hyperactivity and inattention disorder. Coming from a low-income family, having an unstable parental situation or having a case of Covid-19 in the home are also linked to the occurrence of abnormal emotional symptoms in a child.
Now that the SAPRIS project is coming to an end in the ELFE and EPIPAGE cohorts, the researchers can pinpoint several limitations to their study, in particular the absence of certain factors in the analysis. “For example, we believe the impact of screen time during schooling on children's mental health is of great importance,” comments Alexandra Rouquette. A child’s quality of sleep and temperament are also factors which are very difficult to quantify. In addition, in order to better understand the effect of school closures, it is essential to compare children's mental health between periods when schools are closed and when they remain open using data available in France.
Important scientific and political issues
The unique nature of the work carried out here is unquestionable. Few other studies have looked at the indirect effects of anti-Covid-19 measures on children and, in turn, the impact of socio-economic inequalities on their lives. This results in real implications in terms of policy. Researchers believe that closing schools promotes certain conditions related to the emergence of mental health problems in children and, as a consequence, health inequalities. With the pandemic still very active and the prospect of more restrictive measures still looming, the results of this study raise important issues. They provide an initial tool for decision-makers to assist them in implementing measures. “Children from low-income families are the most affected. If the health crisis leads us to close schools again, we should think about adapting the measures for these particular children. Psychological support, for example, could be considered to limit the impact on their mental health,” suggests Alexandra Rouquette.
- Monnier, M., Moulin, F., Thierry, X. et al. Children's mental and behavioral health, schooling, and socioeconomic characteristics during school closure in France due to COVID-19: the SAPRIS project. Sci Rep 11, 22373 (2021).