School Reopenings Linked to Significant Improvement in Children’s Mental Health During Pandemic
A new study reveals that reopening schools after pandemic closures was associated with a notable decrease in mental health diagnoses among children, offering crucial insights for future public health responses. The research, published online today in Epidemiology, underscores the critical role schools play in supporting the social and emotional well-being of students.
Study Highlights Key Findings
Researchers analyzed data from 24 California counties and 224 school districts, encompassing a period from March 2020 through June 2021. The analysis, utilizing claims data and information from the California Department of Education, focused on 185,735 children aged 5 to 18, representing over 2.1 million observations. The findings demonstrate a complex relationship between school closures, mental health, and access to vital resources.
Initial Surge in Mental Health Diagnoses
The study initially documented a significant increase in mental health challenges following school closures. Overall, there was a 25% jump in total mental health diagnoses and a 30.5% increase in related monthly medical costs during the study period. Specifically, monthly medical costs rose from $49.50 to $64.60. This initial surge highlights the immediate impact of disrupted routines and social isolation on children’s mental well-being.
Reopening Schools: A Turning Point
However, the research revealed a positive trend as schools began to reopen. By the ninth month after schools reopened, researchers observed a 1.2 percentage point reduction in the number of children diagnosed with any mental health condition. This improvement was most pronounced in diagnoses of depression, with a 0.6 percentage point decrease. The probability of a student being diagnosed with a mental health condition dropped from 60% to 43% among the preopening sample.
Further analysis showed that by the fifth month after reopening, diagnoses of depression, anxiety, and attention-deficit/hyperactivity disorder (ADHD) all began to decline. While anxiety diagnoses saw a slight rise between months six and seven, they ultimately experienced a substantial drop by month nine, suggesting a “delayed effect of the reopening,” according to the study authors.
Financial Impact of Improved Mental Health
The positive impact extended to healthcare spending. Decreases were observed in spending on non-drug medical care, prescription drugs, and ADHD-specific medications, beginning around the sixth month after schools reopened and continuing through month nine. Total non-drug medical costs fell by 10.6%, drug costs decreased by 7.5%, and ADHD drug costs dropped by 5.0%.
Gender Disparities in Mental Health Response
The study also revealed that the benefits of school reopening were more pronounced for female students. They experienced a 1.9 percentage point drop in overall mental health diagnoses by the ninth month, with significant reductions in medical and pharmacy costs (15.34% and 9.94% respectively). In contrast, the decline in mental health-related spending among male students was more modest, at 2.69% by month six and 6.0% by month nine.
Factors Contributing to Mental Health Decline During Closures
Researchers identified several factors that likely contributed to the worsening of student mental health during school closures. These included changes in social interactions, disrupted sleep patterns, increased screen time, less healthy diets, and learning difficulties. Socioeconomic hardship, loss of access to school-based mental health services, and societal gender norms were also cited as contributing factors.
Implications for Future Public Health Emergencies
“As we consider future public health emergencies, this study suggests we need to prioritize safe school reopenings and ensure children have access to the social and emotional resources that schools provide,” said Rita Hamad, PhD, MD, MPH, professor of social epidemiology and public policy at Harvard TH Chan School of Public Health. “Policies should focus not only on infection control, but also on the mental well-being of children, recognizing that schools are a critical part of their support system.”
The study acknowledges certain limitations, including the possibility that school reopenings coincided with other policy changes or declining infection rates. Additionally, the findings may not be fully generalizable due to the study’s focus on children in California. Despite these limitations, the research provides compelling evidence that schools are essential for supporting children’s mental health, particularly during times of crisis.
