Mental Health Trajectories of Children and Caregivers Using School-Based Health Centers During the COVID-19 Pandemic.
Sloane Jaye Freeman, Saisujani Rasiah, Justine Cohen-Silver and 3 others
PMID 37245129WHAT IT FOUND
Children who accessed school-based health centers during the pandemic had worsening parent-reported overall and emotional/peer difficulties compared with center users who did not access them.
Parents also reported worsening anxiety. The study cannot show the centers caused this.
Key findings
01Parent-reported total difficulties SDQ scores increased by 0.17 per month more for children who visited SBHCs during the pandemic than for SBHC users who did not visit.
02Internalizing difficulties increased by 0.14 per month more for children with SBHC visits during the pandemic, while externalizing difficulties did not differ.
03Parents/caregivers of children who visited SBHCs during the pandemic had a 0.16 higher monthly increase in self-reported GAD-7 anxiety scores than parents of children who did not visit.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study is observational, so it cannot show that SBHC visits caused worse mental health trajectories; families with more symptoms may have been more likely to seek care. Follow-up may have been too short to show improvement after mental health care. 840 of 1,804 parents/caregivers were not reached or could not be invited because of phone or language barriers. 366 consented surveys were excluded for missing SDQ or GAD-7 scores. At 12 months, only 42 children had complete SDQ scores and 98 parents/caregivers had complete GAD-7 scores. Only one participant in the cohort with SBHC visits during the survey period completed the SDQ at 12 months. The primary model did not adjust for family income, home arrangement, medication prescription, birthplace, or English as a first language because of missing data. The study did not know whether children accessed mental health care outside the SBHCs. The findings are from two SBHCs in one large urban school board and may not generalize to other urban or rural settings.
The easy way to misread this
Do not conclude that SBHC visits caused worse mental health. The study cannot separate cause from symptom-driven access; children and parents with more internalizing or anxiety symptoms may have been more likely to seek SBHC care.