Prolonged school closure may be detrimental not only to
education, but also to health:
Across the globe, educational facilities hold a pivotal role in the
promotion and maintenance of long-term health, which is complementary to
their didactic role. While online schooling partly ensured the
continuity of their didactic role, school-based screening and prevention
programs were severely disrupted throughout 2020-2021. More time will
need to elapse before the consequences of such loss become evident, but
a vast heterogeneity of the potential harmful consequences that
prolonged school closure and home confinement introduces for the
school-aged population and their families, were recognized early in the
pandemic by the scientific community operating in the field of
developmental paediatrics [56,57] and child psychiatry [58].
Multiple streamlines should be included in such a lifelong investigation
of today’s youth, examining changes in the epidemiology of obesity and
malnutrition [59], immunization rates, unattended domestic violence
and child abuse [60], delays or precocity in cognitive, physical or
social growth [57], later diagnoses of developmental conditions, and
overall rates of health inequity [61]. However, one year of pandemic
has been sufficient for the emergence of one indication of concern: a
potentially increased burden of paediatric mental health disorders.
Even on its own, a public health emergency creates multiple stressors
for children and adolescents irrespective of their previous mental
health status, due to fear of infection, elevated levels of stress and
anxiety of caregivers [62,63] and recommended or mandated social
isolation [64]. These are further exacerbated with school shutdowns,
especially if protracted to an indefinite time, and are supplemented by
other stressors, including a disrupted routine, reduced socialization
and physical activity, increased screen time and social media
consumption, increased boredom, unhealthy or insufficient nutrition,
exposure to parental burnout [63], stressors related to school
dropout, and others. The cumulative effect of these stressors was partly
registered in low-to-high quality studies published early in the
pandemic and during lockdowns, consistently finding scores above
thresholds for psychological distress, anxiety, depression in
substantial a percentage of participants [64-69] and, when
comparison was possible, higher than in pre-pandemic cohorts [70].
Adolescents were found to represent a particularly vulnerable cohort
[71]. Concomitantly, the clinical frontlines reported both a
significant decline in the incidence of admissions for psychiatric
emergencies during lockdowns [72-74] and increased suicide ideation
and self-harm rates [75]. Such a rise in psychiatric emergencies
overall, and specifically in suicide behaviours, is already documented
in manifold reports and news article easily found through a Google
search: we now await high-quality published studies empirically
confirming this alarming trend beyond the grey literature, framing it
developmentally as well as clinically. In the difficult trade-off of
school closures as pandemic mitigation strategies, policymakers will
need a larger body of strong evidences regarding the so-called “hidden
epidemic” hitting the younger populations.