Impact of play restriction during the COVID-19 pandemic on mental well-being in children with a chronic condition.

This study is to investigate the effects of social restrictions, induced by the COVID-19 pandemic, on play behavior, and the associations with mental well-being in children with a chronic physical condition. Additionally, we explored potential moderating effects of environmental factors. Data from the PROactive cohort study including children with a chronic physical condition was used. Play behavior was measured with a self-developed questionnaire distributed during the pandemic with questions concerning behavior before and during the pandemic (with whom they most often played, where, and how many days/week (face-to-face and online)). Mental well-being, including life satisfaction, quality of life, and internalizing symptoms were assessed during the pandemic. Analyses were performed separately for the ages 8-12 years and 13-18 years. Differences in play behavior were analyzed with McNemar's and Wilcoxon signed-rank tests. Linear regression analyses were used to analyse associations between play behavior and mental well-being. P-values were adjusted for false discovery rate. Interaction terms were added with several environmental factors, to explore potential moderating effects. In total, 756 participants (8-12 years: n = 261; 13-18 years: n = 495) were included in this study. Differences in play behavior between pre-pandemic and during the pandemic were observed. With whom they mostly played (friends/family members), compared to playing alone, was related to mental well-being in both age groups. Moreover, for children between 13 and 18 years playing outside was positively associated with life satisfaction and negatively related to internalizing symptoms. Experiencing a negative influence of the pandemic on leisure time, social support, and distress of the child are potential moderators.

conclusionsThe COVID-19 pandemic induced changes in play behavior. During the pandemic, mainly not playing alone, but with friends or family members, and for older children playing outside, was related to better mental well-being in children with a chronic physical condition. WHAT IS KNOWN: • Children with a chronic physical condition are at risk for developing social and emotional problems, that include depressive symptoms, anxiety, aggression, physical impairment and problems in academic and social functioning. These problems may be related to limitations in play activities these children are thought to experience. However, there is limited empirical data to relate limitations in play and mental well-being in these children. WHAT IS NEW: • The COVID-19 pandemic presented an opportunity to investigate alterations in play behavior in relation with mental well-being among children with a chronic physical condition. Based on data from the PROactive cohort, including data for children with a chronic condition, we determined the impact of the pandemic on play in these children and related it to their mental well-being. Our data emphasize the importance of play, and particular playing with others, for mental-well-being and may facilitate prevention strategies for children growing up with a chronic condition.