key: cord-329708-ns7ehm02 authors: Xiang, Mi; Yamamoto, Shohei; Mizoue, Tetsuya title: Depressive symptoms in students during school closure due to COVID‐19 in Shanghai date: 2020-09-30 journal: Psychiatry Clin Neurosci DOI: 10.1111/pcn.13161 sha: doc_id: 329708 cord_uid: ns7ehm02 nan Since the first identification of a patient with COVID-19, this infection has spread rapidly worldwide, with a high case fatality rate among the elderly and individuals with chronic diseases. 1 While this virus is less likely to cause serious illness in the younger generation, many affected countries have adopted school closure as a measure to prevent its spread among the community. 2 Concerns may be raised about the adverse effects of school closure not only on education but also on the health of children. The drastic changes in children's lifestyle during school closure may deteriorate their mental health. 3 The present paper reports the changes in depressive symptoms among students in Shanghai caused by school closure due to the COVID-19 epidemic. The present study was originally designed to assess the health and health-associated factors using a web-based survey among schoolchildren (ages 6-17 years) and their parents from five schools across in Shanghai, China. Details of the study procedure are described in appendix S1. First survey was conducted during January 3 to 21, 2020 (before school closure) and the second survey was conducted from March 13 to 23, 2020 (during school closure). Depression was assessed using the Children's Depression Inventory-Short Form (CDI-S); 4 the total score ranges from zero to 20, with a higher score indicating more depressive symptomatology. We also asked positive aspects of lifestyle change during school closure. We calculated the mean and SD of CDI-S scores before and during school closure and tested the difference using paired t-test. A within-subjects ANOVA was conducted to determine the interactions of time × subgroup (sex, school levels, and income levels) in terms of CDI-S score. We declare statistical significance when p <0.05 for paired t-test and p<0.1 for interaction test. Of 3,042 students in the target schools, 2,641 (87%) participated in the first survey. Of these, 2,427 participated in the second survey. Overall, the mean CDI-S score significantly decreased between the two surveys: 4.19 before school closure and 3.90 during school closure (p<0.001). In stratified analyses, children in middle school showed a greater decrease in CDI scores than those in primary school (p for interaction = 0.09), whereas a lower CDI-S score during school closure was consistently observed across genders and household income categories. As regards positive aspects of lifestyle change during school closure, 71%, 80%, and 83% of children were satisfied with having more time "at home," "with their parents," and "doing their own things," respectively. This article is protected by copyright. All rights reserved. School closure with staying-at-home policy should drastically decrease the opportunity of direct contact with persons other than family members, decrease physical activity, and increase the time of screen viewing, all of which may deteriorate mental health of school children. However, the present result is at variance with prior hypothesis; rather, we observed fewer depressive symptoms during school closure compared to those measured before the closure. The present finding based on pre-and post-observation without comparison group should be interpreted with caution. Nevertheless, this unexpected finding could be attributed to relatively good educational environment at home. In Shanghai, nearly all families own a personal computer or smartphone, which has been used for communication with school before the pandemic. Soon after school closure, each school has started providing an online and TV program for education, and children have received interactive education at home from their teacher and communicated with classmates on a daily basis. Such remote educational system might have contributed to better mental health during school closure. Children, especially those under high academic pressure, might have less stress at home environment than at school setting. Analysis by school type showed that middle school students, who This article is protected by copyright. All rights reserved. had a higher depressive score before school closure than primary school students, showed a greater decrease in depressive symptoms during school closure. This may partly reflect greater academic stress preparing for entrance examinations in middle school. 5 As regards poisitive aspects of staying at home, most children reported being satisfied with having more time "at home," "with their parents," and "doing their own things." Taken together, a well equiped home-schooling system, together with fewer stressors and positive aspects of staying at home, may have jointly outweighed the potential harm of school closure to children's mental health. In conclusion, the present longitudinal study in Shanghai during the COVID-19 does not show any evidence of increased depressive symptoms among students after a two-month school closure. Additional study is required to assess long-term effect of school closure on mental health and educational attainment of children. ) . CDI-S, Children's Depression Inventory-Short version; CNY, Chinese Yuan. *Calculated using paired t-test. † Calculated using within-subjects ANOVA by the interaction effect of time × subgroup [sex, school levels (primary or middle school), or income levels (<100,000, 100,000 to 200,000, >200,000 to 400,000, or >400,000 CNY)]. People who are at higher risk for severe illness United Nations Educational, Scientific and Cultural Organization. COVID-19 educational disruption and response Mitigate the effects of home confinement on children during the COVID-19 outbreak Technical manual update. North Tonawanda, This article is protected by copyright. All rights reserved. NY: Multi-Health Systems Academic stress in Chinese schools and a proposed preventive intervention program This research was funded by the National Natural Science Foundation of China (grant number 71804110) for Mi Xiang. The study protocol was approved by the Ethics Committee of Shanghai, Jiao This article is protected by copyright. All rights reserved.tong University School of Medicine (SJUPN-201813). All authors have indicated they have no financial relationships relevant to this article to disclose. This article is protected by copyright. All rights reserved.