A nationwide survey of thousands of children and their guardians finds that economic policies to contain Covid-19 in the United States negatively impacted the mental health and well-being of children, with family economic hardship the greatest driver of stress, sadness, and COVID-related worry.   
The study, co-led by investigators from Columbia University and Weill Cornell Medicine and published March 13 in JAMA Network Open Network, examined the relationship between remote schooling and financial disruptions to children’s sleep and mental health during COVID-19, accounting for a variety of pandemic-related policies. 
“Our work shows that the driving force for children’s well-being during public health emergencies is the economic resource capacity of the home,” said J. John Mann, MD, the Paul Janssen Professor of Translational Neuroscience (in psychiatry and radiology) and senior author of the study. “The implications for public health policies are clear: We need to have policies for disease containment, but we also must consider the economic impact on families due to these measures, in part to protect child mental health.”
First longitudinal observational study
Dr. Mann said that previous research has examined the associations of the COVID-19 pandemic on mental health, but little information has been published on its causal effects on children. This study, he added, is the first longitudinal observational study in children to estimate bias-corrected associations of school and financial disruptions with mental health and sleep.
Surprisingly, the researchers found no association between policy-associated school closures and children’s mental health. Neither school nor financial disruptions had an impact on children’s sleep. One possible explanation for this unexpected result is that protective factors like increased parental care at home during lockdown helped mitigate more negative effects.
Survey of 6,030 children
To conduct their research, investigators used data from the NIH-funded Adolescent Brain Cognitive Development Study, a long-term study of 6,030 children between 10 and 13 years old across 21 U.S. cities, and surveyed children and their guardians five times about mental health and sleep, as well as their pandemic-related experiences between 2020 and 2021. They also collected information on COVID-19 policy, COVID-19 incidence, and unemployment rates to measure the relationship between children’s mental health outcomes and these factors during the pandemic.
The research team included Yunyu Xiao, PhD, assistant professor of Population Health Sciences at Weill Cornell Medicine and first author of the study, and Drs. Timothy Brown, Lonnie Snowden, and Julian Chun-Chung Chow from the University of California, Berkeley.
The work builds upon a previous publication by Dr. Mann and Dr. Xiao and colleagues, reporting that children’s psychological status was influenced by socioeconomic factors like access to health care, food insecurity, and vaccination rates.
“Children’s mental health and exposure to stress in early life may have a long-term impact in later life,” said Dr. Xiao. “We need to understand the impact of these policies on children’s mental health to better prepare for public health emergencies, so when we have containment policies in place, we can mitigate their effects.”
Toward more targeted and equitable policies
While the study provides important insights into the impact of COVID-19 policies on child mental health, the researchers said there is still much to be learned about the complex interplay between social determinants of health, structural racism, and mental health outcomes for children and youth.
“By examining the structural factors that contribute to mental health disparities, we can identify key intervention points and develop more targeted and equitable policies to support the well-being of all children and youth,” Dr. Xiao said.

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