Anxiety problems in children and adolescents: a population-based cohort study on incidence and management in Dutch primary care

Lukas BM Koet; Evelien IT de Schepper; Arthur M Bohnen; Patrick JE Bindels; Heike Gerger

doi:10.3399/BJGP.2021.0557

Published eLetters

eLetter submission guidelines

Submit a Response to This Article

Compose eLetter

Title *

Author Information

Contributors

First Name and Middle Initial *

First or given name, e.g. 'Peter'.

Last Name *

Your last, or family, name, e.g. 'MacMoody'.

Email Address *

Your email address, e.g. higgs-boson@gmail.com. PLEASE NOTE: your email address will be published.

Occupation *

Your role and/or occupation, e.g. 'Orthopedic Surgeon'.

Affiliation *

Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.

Statement of Competing Interests

Competing interests? *

Yes

Please describe the competing interests

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

Jump to comment:

Children and adolescents' anxiety problems in the COVID-19 pandemic needs more attention
Wenshu Cao and Qiwei Lv

Published on: 10 May 2022

Published on: (10 May 2022)
Page navigation anchor for Children and adolescents' anxiety problems in the COVID-19 pandemic needs more attention
Children and adolescents' anxiety problems in the COVID-19 pandemic needs more attention
Wenshu Cao, GP, Xuhui District Tianlin Community Health Center, 500 Liuzhou Road, Shanghai, China
Other Contributors:
Qiwei Lv, Professor of General Medicine, Xuhui District Tianlin Community Health Center, 500 Liuzhou Road, Shanghai, China
We read with interest the research by Koet et al.¹ During the COVID-19 pandemic, the role of GPs as gatekeepers to focus on anxiety in children and adolescents becomes even more critical.

The prevalence of depression and anxiety among Chinese adolescents affected by COVID-19 was significantly increased.² In a meta-analysis of depression and anxiety symptoms in children and adolescents worldwide during COVID-19, one in five adolescents experienced clinically exacerbated anxiety symptoms, and the prevalence was an alarming 20.5%.³Such results already far exceed the prevalence of 5.36% before the outbreak in the study by Koet et al. As mentioned in their article, more than half of GPs are more confident in identifying anxiety disorders in children and adolescents than in managing these disorders.⁴ Therefore, it is essential for GPs to identify anxiety disorders in children and adolescents through timely identification and referral to specialist healthcare providers during the COVID-19 epidemic.

COVID-19 may not be as deadly in children and adolescents as it is in middle-aged and older populations, but the closed management of some communities causes additional psychological distress in this age group. Initially, home confinement may bring benefits through increased family cohesion,⁵ but as the duration of confinement increases, parental anxiety, the disruption of family life, and less social interac...
Show More

We read with interest the research by Koet et al.¹ During the COVID-19 pandemic, the role of GPs as gatekeepers to focus on anxiety in children and adolescents becomes even more critical.

The prevalence of depression and anxiety among Chinese adolescents affected by COVID-19 was significantly increased.² In a meta-analysis of depression and anxiety symptoms in children and adolescents worldwide during COVID-19, one in five adolescents experienced clinically exacerbated anxiety symptoms, and the prevalence was an alarming 20.5%.³Such results already far exceed the prevalence of 5.36% before the outbreak in the study by Koet et al. As mentioned in their article, more than half of GPs are more confident in identifying anxiety disorders in children and adolescents than in managing these disorders.⁴ Therefore, it is essential for GPs to identify anxiety disorders in children and adolescents through timely identification and referral to specialist healthcare providers during the COVID-19 epidemic.

COVID-19 may not be as deadly in children and adolescents as it is in middle-aged and older populations, but the closed management of some communities causes additional psychological distress in this age group. Initially, home confinement may bring benefits through increased family cohesion,⁵ but as the duration of confinement increases, parental anxiety, the disruption of family life, and less social interaction can lead to acute and chronic stress in children and adolescents. It can even induce depression, self-harm and suicidal behaviour.⁶

The latest reports highlight the significantly higher rates of youth suicide during the COVID-19 epidemic, again elevating their mental health to unprecedented heights.⁷ The ongoing anxiety of children and adolescents during the COVID-19 epidemic closure must be addressed and ameliorated. GPs within the closed community can play an essential role in this process, and they need to be recognised and trained in the identification and management of paediatric psychological problems. Primary health care worldwide needs GPs to turn their attention to the continued elevated prevalence of anxiety disorders in children and adolescents as the COVID-19 epidemic continues.

References
1. Koet LB, de Schepper EI, Bohnen AM, Bindels PJ, Gerger H. Anxiety problems in children and adolescents: a population-based cohort study on incidence and management in Dutch primary care [published online ahead of print, 2022 Jan 24]. Br J Gen Pract. 2022;BJGP.2021.0557. doi:10.3399/BJGP.2021.0557.
2. Chen X, Qi H, Liu R, et al. depression, anxiety and associated factors among Chinese adolescents during the COVID-19 outbreak: a comparison of two cross-sectional studies. Transl Psychiatry. 2021;11(1):148. Published 2021 Mar 2. doi:10.1038/s41398-021-01271-4.
3. Racine N, McArthur BA, Cooke JE, Eirich R, Zhu J, Madigan S. Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19: A Meta-analysis. JAMA Pediatr. 2021;175(11):1142-1150. doi:10.1001/jamapediatrics.2021.2482.
4. O'Brien D, Harvey K, Creswell C. Barriers to and facilitators of the identification, management and referral of childhood anxiety disorders in primary care: a survey of general practitioners in England. BMJ Open. 2019; 9(4):e023876. Published 2019 Apr 23. doi:10.1136/bmjopen-2018-023876.
5. Bruining H, Bartels M, Polderman TJC, Popma A. COVID-19 and child and adolescent psychiatry: an unexpected blessing for part of our population?. Eur Child Adolesc Psychiatry. 2021;30(7):1139-1140. doi:10.1007/s00787-020-01578-5.
6. Patra S, Patro BK. COVID-19 and adolescent mental health in India. Lancet Psychiatry. 2020;7(12):1015. doi:10.1016/S2215-0366(20)30461-2.
7. Charpignon ML, Ontiveros J, Sundaresan S, et al. Evaluation of Suicides Among US Adolescents During the COVID-19 Pandemic [published online ahead of print, 2022 Apr 25]. JAMA Pediatr.2022;10.1001/jamapediatrics.2022.0515. doi:10.1001/jamapediatrics.2022.0515.

Show Less

Competing Interests: None declared.