The pandemic within the pandemic: the surge of neuropsychological disorders in Italian children during the COVID-19 era

The COVID-19 pandemic had a major impact on children's health. Although the percentage of children hospitalized was minimal compared to adults, the consequences on their neuropsychological development were extremely severe [6, 7]. Our study showed an overall increase of 83.1% and 39.5% for NPD admissions for pED access and pediatric wards admissions, respectively, during the COVID-19 pandemic. Thus, despite reduction in children admission to pediatric hospitals, likely due to fear of COVID-19 and reduced spread of other common infections, the need for NPD help was so pressing that Italian families were persuaded to reach out for pED. Other reports confirmed our findings, emphasizing the neuropsychological impairment that young people are facing [9, 10]. For example, despite an absolute reduction of weekly visits for mental health conditions (MHCs) during the COVID-10 pandemic, the US CDC reported a relative increase of visits for overall MHCs compared to all pediatric visits in the same period [9]. An earlier report indicated the same trend, with more frequent involvement of white females over the age of 12 [10].

Thus, while school closures were initially a valuable tool to protect children from infection at the onset of the pandemic, they ultimately produced a negative impact on their mental health. Indeed, building, maintaining, and enjoying social connections with peers plays a crucial role in the development of mental health during childhood and adolescence [11].

Over the study period, suicidal ideation (+ 147%), depression (+ 115%), eating disorders (+ 78.4%), and psychosis (+ 17.2%) were the most observed NPDs during the COVID-19 pandemic in children. According to our data, the admission of suicidal ideation in pEDs increased dramatically after the onset of COVID-19 in children (+ 147%). Suicidal ideation is closely related to stressful events, such as pandemic fear and social isolation of vulnerable individuals [12,13,14].

Among the risk factors for suicidal ideation, eating disorders have been specifically identified [15, 16].

Of note, a 78.4% increase in eating disorders in children was observed on admission to pED, consistent with recent reports [17]. Daily life restrictions, stress, and exposure to social media have been commonly identified as predictors of the onset of eating disorders in youth during the first wave of COVID 19 [17, 18].

Of note, in COVID-19 affected people, a prolonged sense of smell and tasting may potentially contribute to a decreased appetite [19, 20].

Although social media and smartphones have been crucial for children and adolescents to communicate during restraints, pathological use has been widely linked with promoting self-injurious behaviors and eating disorders. Platforms such as “Tik Tok “ have recently been blamed for the spread of pro-anorexia, pro-suicide, and self-harm videos [21,22,23].

In addition, a large percentage of websites (56%) such as Twitter or Instagram accounts promote “pro-anorexia” content, being particularly followed by adolescents aged 13–17 years [24,25,26].

An increased occurrence of depression and anxiety during the pandemic has been confirmed by previous reports [3, 27]. A recent meta-analysis demonstrated that approximately 25% and 20% of children globally experienced clinically elevated depression and anxiety symptoms, respectively, in the first year of the COVID-19 pandemic. The authors also showed that these estimates were twice as high as pre-pandemic values [28].

Finally, our study highlights an increase in pediatric NPD hospitalizations during the COVID-19 pandemic (+ 39.5%), mainly for suicidal ideation (+ 134%), depression (+ 41.4%), eating disorders (+ 31.4%), and drug abuse (+ 26.7%). This result is noteworthy as it highlights the seriousness of the situation. Indeed, daily treatment was not sufficient to address the situation for affected children.

Future studies are needed to investigate the long-term consequences of increased NPD in childhood.

For now, it is important to highlight the existence of a “Second Pandemic,” which did not affect the body, but primarily the brain of vulnerable individuals. Parent-reported mental health problems were more likely to affect children with low socioeconomic status, complex chronic diseases, and those whose parents tested positive for depression [29].

Appropriate services should be made available for people in crisis and those with new or existing mental health problems. Considering that child and adolescent mental health services were already overburdened and underfunded before the onset of the pandemic, there is an urgent need for government investment to support and improve existing services and youth mental health research [30]. It is critical to emphasize early identification of signs that may be related to an NPD, such as reduced interest in food, reduced time spent with peers, changes in behavior, and close association with social media. Neuropsychological assessment should be pushed at the primary level, in the pediatrician's office, to facilitate early capture of the sign of impairment, emphasizing social-relational dimensions and affective-behavioral skills. The aim of the assessment is to ascertain the need for an individualized program to prevent or address difficulties that have arisen during the COVID-19 period. When necessary, with the use of validated instruments capable of recognizing potentially critical situations that may require second level assessments. Integration and connections in individual district areas between health services, schools, support services and social services, through the work of psychologists, educators and community nurses should be developed.

A limit of the study is that we clinical characteristic of patients can not be examined as it was based on ICD classification. Further researches may focus on detailed aspects.

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