Pediatric COVID-19 and Development of Anxiety and Depression

Frederick Dun-Dery ¹ Jianling Xie ¹ Roger Zemek ² Kathleen Winston ¹ Brett Burstein ³ Vikram Sabhaney ⁴ Jason Emsley ⁵ Jocelyn Gravel ⁶ April Kam ⁷ Ahmed Mater ⁸ Darcy Beer ⁹ Robert Porter ¹⁰ Gabrielle Freire ¹¹ Naveen Poonai ¹² Anne Moffatt ¹³ Simon Berthelot ¹⁴ Marina I Salvadori ³ Deepti Reddy ² Bruce Wright ¹⁵ Stephen Freedman ^1*

• ¹ University of Calgary, Calgary, Alberta, Canada
• ² University of Ottawa, Ottawa, Ontario, Canada
• ³ McGill University, Montreal, Quebec, Canada
• ⁴ University of British Columbia, Vancouver, British Columbia, Canada
• ⁵ Dalhousie University, Halifax, Nova Scotia, Canada
• ⁶ Montreal University, Montreal, Quebec, Canada
• ⁷ McMaster University, Hamilton, Ontario, Canada
• ⁸ University of Saskatchewan, Saskatoon, Saskatchewan, Canada
• ⁹ University of Manitoba, Winnipeg, Manitoba, Canada
• ¹⁰ Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
• ¹¹ University of Toronto, Toronto, Ontario, Canada
• ¹² Western University, London, Ontario, Canada
• ¹³ Queen's University, Kingston, Ontario, Canada
• ¹⁴ Laval University, Quebec, Quebec, Canada
• ¹⁵ University of Alberta, Edmonton, Alberta, Canada

Objective: It remains unclear whether emerging mental health concerns in SARS-CoV-2infected children are a direct impact of infection or are due to the indirect effects of the pandemic. As such, we sought to assess the frequency of new diagnoses of anxiety and/or depression among children diagnosed with and without SARS-CoV-2 infection tested in pediatric emergency departments.Methods: Prospective cohort study with 6-and 12-month follow-up across fourteen Canadian tertiary-care pediatric emergency departments of the Pediatric Emergency Research Canada (PERC) network. It included children < 18 years tested for SARS-CoV-2 infection between August 2020 and February 2022. The primary outcome was a reported diagnosis of anxiety and/or depression reported during follow-up. The surveys included a modified version of the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) Long-COVID Pediatric Questionnaire. Results: Among SARS-CoV-2-positive and negative participants eligible for 6-and 12-month follow-ups, 64.7% (268/414) and 71.9% (743/1033) completed follow-up at these time points, respectively. Median age was 7.0 (IQR: 5.0, 11.0) years, and 54.2% (548/1011) were male. New diagnosis of anxiety and/or depression reported on either survey, did not differ between testpositive (4.1%, 11/268) and test-negative (2.8%; 21/743) participants; difference=1.3% (95%CI: -1.3, 4.2). There was a higher prevalence of new diagnoses of anxiety and/or depression among SARS-CoV-2-negative participants ≥ 12 years of age relative to those < 12 years [8.7% (13/149) vs. 1.3% (8/594); difference=7.4%; 95%CI of the difference=3.0, 12.5], but not among SARS-CoV-2-positive participants [4.4% (2/45) vs. 4.0% (9/223); difference=0.4%; 95%CI of the difference=-5.6, 9.4]. At 6-or 12-months, SARS-CoV-2-positive participants were more likely to experience confusion and/or lack of concentration, abdominal pain, and insomnia. Conclusions: Although there was no association between SARS-CoV-2 infection and new diagnoses of anxiety and/or depression, SARS-CoV-2 positive participants were more likely to experience confusion/lack of concentration, abdominal pain, and insomnia. This finding, in the context of an increased prevalence of new diagnoses of anxiety and depression underscores the impacts of societal changes on the mental health of children. Our finding that some non-specific symptoms were more frequently reported by SARS-CoV-2-positive participants, speaks to the need for further investigation of the underlying pathophysiologic mechanisms.