Levels and predictors of PTSS in young children aged 3-12 years at the hardest-hit area of China during early COVID-19 outbreak.

backgroundPublic crisis has a profound impact on mental health, particularly among young children, since that they are often encountered with disrupted routine, restricted movement, school closure, caregiver illness or distress, greater likelihood of aversive or neglecting parenting etc. However, the mental distress of young children aged below 12 years-old has been less attended. Based on the Risk Factor Model, this study aims to observe the levels and predictors of posttraumatic stress symptoms (PTSS) in children aged 3-12 years at the hardest-hit area of China during the early stage of the Coronavirus Disease 2019 (COVID-19) outbreak.

methodsChinese children who aged 3-12 years at Hubei province (the hardest-hit area, n = 1444) and other areas (n = 262) were surveyed through an online questionnaire from February 24 to March 21, 2020, with hyper-arousal and avoidance sub-scales of Posttraumatic Stress Disorder Check list-Civilian Version. For children who could not read Chinese or could not fully understand the questions (mainly third grade in primary school or lower grade), parents were encouraged to assist to fill in the answers based on their observations, explanation and inquiry.

resultsThe rate of avoidance and hyper-arousal symptoms among the surveyed children was 5.51% and 6.10% respectively. Chi-square tests showed that children from the hardest-hit area and other areas reported equivalent levels of avoidance (5.75% V.S. 4.20%, 858.98 V.S. 823.27, p > 0.05) and hyper-arousal symptoms (5.89% V.S. 7.25%, 847.41 V.S. 887.06, p > 0.05). Children reported less avoidance and hyper-arousal symptoms, in sub-population who aged 3-6 years-old, not experiencing negative life-events, not perceiving negative emotions, with unchanged caring from parents, while centralized isolation group reported the highest scores on the hyper-arousal symptom. Hierarchical linear regression analysis revealed that older age, having been quarantined at home, having perceived negative emotions, and having experienced negative life-events, were predictors of both avoidance and hyper-arousal symptoms, while death of family member due to infection, and unchanged or more help from parents were negative predictors of avoidance symptom, and unchanged help and gentleness, more gentleness and respecting from parents were protective predictors of hyper-arousal symptom. Notably, having heard horrible news about the pandemic was the strongest prediction for both symptoms.

conclusionsThe results are among the first to reveal the levels of PTSS in young children aged 3-12 years under crisis. The rate of avoidant and hyper-arousal symptoms in children is 5.51% and 6.10% respectively, which is equivalent in children at hardest-hit and other area, and lower than that of pre-COVID disasters such as earthquakes (13.1%), but higher than those reported in college students during COVID-19 (2.7%). Due to omission of intrusion-symptom observation, the findings may indicate partial symptoms and result in lower PTSS rate. Risk and protective predictors of PTSS help to recognize high-risk sub-populations and prevent PTSS in young children under crisis.