{"id":45676,"date":"2022-09-29T10:54:19","date_gmt":"2022-09-29T10:54:19","guid":{"rendered":"https:\/\/biomedpharmajournal.org\/?p=45676"},"modified":"2022-10-01T04:18:29","modified_gmt":"2022-10-01T04:18:29","slug":"remote-schooling-during-covid-19-and-mental-soundness-of-adolescents-in-egypt","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol15no3\/remote-schooling-during-covid-19-and-mental-soundness-of-adolescents-in-egypt\/","title":{"rendered":"Remote Schooling During COVID-19 and Mental Soundness of Adolescents in Egypt"},"content":{"rendered":"

Introduction<\/strong><\/p>\n

In 12th<\/sup> January 2020, the WHO announced that a new Corona virus resulted in respiratory disease in Wuhan, China. The Egyptian ministry of health documented the first case in 14th<\/sup> February 2020. In March 11th<\/sup> 2020, the WHO tagged the Covid-19 as a worldwide pandemic. In 14th<\/sup> March 2020 Egypt took some precautionary measures, on top of which was the closure of schools and universities.<\/p>\n

The world has been facing a global public health crisis owing to the COVID-19 pandemic. \u00a0This pandemic showed a significant socio-economic, political and psycho-social impact 1<\/sup>. \u00a0Several disease control measures have been implemented by governments as social distancing, school closures and home quarantine2<\/sup>.<\/p>\n

Wide-ranging and long lasting psychological impacts of these measurements have been reported including post-traumatic stress symptoms, confusion, and anger3<\/sup>. For children and adolescents, school closures resulted in increased social distancing and loneliness which is a painful experience owing to the discrepancy between real and desired social contact. They suffered a physical isolation from their peers, teachers, extended families, and community networks. A well-established link between loneliness and mental health including stress, anxiety, and behavioral disorders has been reported2, 4, 5<\/sup>.<\/p>\n

Actually, COVID-19 pandemic is directly linked to student’s anxiety as they worry about health consequences, family finances, and education besides social isolation. More than 7 in 10 children and young people linked the pandemic with their stress, worry, and anxiety6<\/sup>. \u00a0Educators, school social workers, and counselors are the main source of emotional support for adolescents who firstly observe any warning signs of mental health problem or any unsafe situation. However, educators\u2019 support and intervention have been limited during school closings7<\/sup>. Indeed, connectedness of adolescent to school was significantly associated with positive consequences including decreased risk of depressive and anxiety disorders8<\/sup>.<\/p>\n

Moreover, adolescence during physical isolation may favorite psychoactive substance and other reinforcing behaviors as gambling, video gaming or using social media to reduce stress and to alleviate mood. These addictive behaviors may decrease engagement in usual social and daily living activities that may turn into habits difficult to break9<\/sup>.<\/p>\n

This has led school systems around the world to rapidly attempt remote learning. However, students had to struggle with technology access, shifts in routine and social isolation. \u00a0It is also unclear how prepared students are to respond to this challenge6, 10<\/sup>.<\/p>\n

We realized that a nonchalance of the scholastic role is critical as it negatively influences the acquisition of life skills and empowerment. Therefore, our study focused on the manifestations of anxiety and depression among Egyptian adolescents before and after school closure. The study was carried out to disclose the imprint of school closure and remote learning as a stressor exposing adolescents to anxiety and depression.<\/p>\n

Materials and methods<\/strong><\/p>\n

Ethical approval: The protocol of the study was approved by the \u201cEthical Committee\u201d of the NRC. Written informed consent was signed by the legal guardian of each child before participation in the study. The ethical approval number is 19224.<\/p>\n

One hundred twenty six adolescents were enrolled in our observational case control study. Personal data, social level, physical activity and anthropometry were evaluated for each participant. Two validated Egyptian inventories were used to screen for anxiety and depression. Sixty three candidates (controls group1) were assessed before school closure in comparison to another sixty three of their matched peers (cases group2) after school closure.<\/p>\n

Adolescents in group 1 were recruited through school visits of preparatory and secondary classes in schools of Giza governorate, after obtaining necessary approval from school district and from the Central Agency for public mobilization and statistics. Dates of school visits were: \u00a03\/3\/2020,\u00a0\u00a0 5\/3\/2020, 9\/3\/2020 and 10\/3\/2020<\/p>\n

On the other hand, those in group 2 were enrolled through appointments within the period from 23\\9\\2020 to 10\\6\\2021 in the clinics of the Medical Research Centre of Excellence as the schools were closed by then.<\/p>\n

Inclusion criteria; Egyptian adolescents (from 12-18 years) of both genders with no mental illness previously diagnosed<\/p>\n

Exclusion criteria: age below 12 or above 18, any mental illness and those who refused to participate.<\/p>\n

Anthropometric measurements were taken and plotted on WHO growth curves and AnthroCalc application served for data analysis11<\/sup>.<\/p>\n

Evaluation of social class was performed. Education and occupation indices of both parents were scored on a seven point scale (1 illiterate, 2 Primary, 4 Preparatory, 5 Secondary and 7 University) and (1 housewife or unskillful, 2 Industry, agriculture and general services, 4 skillful, 5 semiprofessional and 7 professional). Then both parental scores were summated and classified into Low < 8, Middle 9-18 and High 19-2812, 13<\/sup>.<\/p>\n

The Inventory to Diagnose Depression (IDD) covers the full spectrum of depressive symptoms included in the Fourth Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The inventory consists of 22 items. Each Item includes five sentences rated on an escalating scale of frequency and severity from 0 to 4. \u00a0The subject is asked to choose only one sentence from each item; the one which best describes his\/her feelings in the preceding week. The number next to that sentence is to be encircled (zero, 1, 2, 3, or 4). The total score is calculated by adding the value of the number marked in each of the 22 items14<\/sup>.<\/p>\n

The inventory for anxiety was constructed from the Children’s Manifest Anxiety Scale (CMAS)15<\/sup> and from personality scale of manifest anxiety16<\/sup>. The anxiety inventory evaluates five dimensions: physical, physiological, emotional, mental and social. Each of these dimensions includes 15 items. Thus a total of 75 items is obtained. The adolescent rates each item by always (scored 3), sometimes (scored 2) or rarely (scored1). The scale\u2019s total value is calculated by adding the scores given to each of the 75 items. An additional 15 items are included to assess and exclude lying children. The total score of the individual on the Lie Scale represents the extent of his truthfulness or falsehood, and the individual is excluded from the list of examinees if his estimation exceeds 15 degrees.<\/p>\n

Both inventories of depression and anxiety were translated into Arabic and were statistically validated by assistant professor Magdi Mohamed Eldesouki in 2002 and 2015 respectively. The final form was accomplished after several reviews by specialists in mental health and professors in the Arabic language at Menoufia University.<\/p>\n

Statistical Analysis: Quantitative data were statistically represented in terms minimum, maximum, mean, standard deviation (SD) and median. Comparison between groups was done using Independent samples T-Test for comparing two parametric groups, and using Mann-Whitney Test for comparing two nonparametric groups. Qualitative data were statistically represented in terms number and percent. Comparison between groups was done using Crosstab Chi-Square Test. A probability value (p value) less than or equal to (0.05) was considered significant. All statistical analysis was performed using statistical software SPSS (Statistical Package for Social Science) statistical program version (22.0). Graphs were done using SPSS statistical program version (22.0) and Microsoft Excel program version 2016.<\/p>\n

Results<\/strong><\/p>\n

Our study involved two groups: Group1 \u201cpre\u201d and group2 \u201cpost\u201d school closure. The children in both groups were matching as regards age and anthropometry with insignificant P-values except for the waist\/hip ratio with significantly higher values (P0.044) in group2, as shown in table 1.<\/p>\n

Table 1: Comparison between Pre- and Post-school closure groups as regards age range and anthropometric measurements.<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
<\/td>\nGroups<\/strong><\/td>\nN<\/strong><\/td>\nMin.<\/strong><\/td>\nMax.<\/strong><\/td>\nMean \u00b1 S.D.<\/strong><\/td>\nP value<\/strong><\/td>\n<\/tr>\n
Age in years<\/td>\nPre<\/td>\n63<\/td>\n12.00<\/td>\n17.00<\/td>\n14.94 \u00b1 1.29<\/td>\n0.251<\/td>\n<\/tr>\n
Post<\/td>\n63<\/td>\n12.00<\/td>\n18.00<\/td>\n14.65 \u00b1 1.48<\/td>\n<\/tr>\n
Weight – Percentile<\/td>\nPre<\/td>\n63<\/td>\n0.40<\/td>\n99.90<\/td>\n65.03 \u00b1 33.66<\/td>\n0.144<\/td>\n<\/tr>\n
Post<\/td>\n63<\/td>\n0.40<\/td>\n99.90<\/td>\n54.03 \u00b1 36.12<\/td>\n<\/tr>\n
Height – Percentile<\/td>\nPre<\/td>\n63<\/td>\n0.70<\/td>\n99.50<\/td>\n40.40 \u00b1 28.24<\/td>\n0.442<\/td>\n<\/tr>\n
Post<\/td>\n63<\/td>\n0.20<\/td>\n99.90<\/td>\n37.69 \u00b1 31.02<\/td>\n<\/tr>\n
BMI – Percentile<\/td>\nPre<\/td>\n63<\/td>\n0.20<\/td>\n99.90<\/td>\n71.50 \u00b1 31.29<\/td>\n0.215<\/td>\n<\/tr>\n
Post<\/td>\n63<\/td>\n0.20<\/td>\n99.90<\/td>\n62.18 \u00b1 36.24<\/td>\n<\/tr>\n
Waist\/Height<\/td>\nPre<\/td>\n63<\/td>\n0.36<\/td>\n0.68<\/td>\n0.48 \u00b1 0.07<\/td>\n0.666<\/td>\n<\/tr>\n
Post<\/td>\n63<\/td>\n0.35<\/td>\n0.87<\/td>\n0.48 \u00b1 0.10<\/td>\n<\/tr>\n
Waist\/HIP<\/td>\nPre<\/td>\n63<\/td>\n0.63<\/td>\n1.78<\/td>\n0.80 \u00b1 0.15<\/td>\n0.044<\/td>\n<\/tr>\n
Post<\/td>\n63<\/td>\n0.70<\/td>\n1.00<\/td>\n0.81 \u00b1 0.07<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Male and female sex was equally presented in both groups (P=0.278). High social level was predominant among group 1 while middle social level was more prevalent in group 2 with a percentage of 61.3% and 50.8% respectively (P=0.001).\u00a0 Adequacy of physical activity was judged in both groups according to adherence to WHO recommendations17<\/sup>. A significantly higher number of twelve adolescents were following WHO recommendations before school closure compared to only three after school closure (P=0.013) as illustrated in table 2<\/p>\n

Table 2: Gender distribution, social class and physical activity among both groups<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n
Parameters<\/strong><\/td>\n\u00a0<\/strong><\/td>\nGroup<\/strong><\/td>\nChi-Square<\/strong><\/td>\nP value<\/strong><\/td>\n<\/tr>\n
Pre (n (%))<\/strong><\/td>\nPost (n (%))<\/strong><\/td>\n<\/tr>\n
Gender<\/td>\nMale<\/td>\n23 (36.50%)<\/td>\n29 (46.00%)<\/td>\n1.179<\/td>\n0.278<\/td>\n<\/tr>\n
Female<\/td>\n40 (63.50%)<\/td>\n34 (54.00%)<\/td>\n<\/tr>\n
Social Class<\/td>\nLow<\/td>\n1 (1.60%)<\/td>\n14 (22.20%)<\/td>\n20.751<\/td>\n0.001<\/td>\n<\/tr>\n
Middle<\/td>\n23 (37.10%)<\/td>\n32 (50.80%)<\/td>\n<\/tr>\n
High<\/td>\n38 (61.30%)<\/td>\n17 (27.00%)<\/td>\n<\/tr>\n
WHO Recommendations<\/td>\nFollowed<\/td>\n12 (19.00%)<\/td>\n3 (4.80%)<\/td>\n6.130<\/td>\n0.013<\/td>\n<\/tr>\n
Not followed<\/td>\n51 (81.00%)<\/td>\n60 (95.20%)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

The self administered anxiety inventory revealed a significant discrepency between both groups concerning the rating by (always 3, sometimes 2 and rarely 1) for statements in the emotional, physical, physiological and social aspects of anxiety. \u00a0The social aspect statement was (I feel that others do not accept me), three statements in Emotional aspect (Annoyed by loud noises, I don’t feel good, I get upset easily when I have a difficult problem), two statements about the physical aspect (I suffer from indigestion a lot, I feel numbness in different parts of the body) and in the Physiological aspect one statement (I feel like my hands tremble when I’m exposed to embarrassing situations) with P-values of 0.007, 0.007, 0.043, 0.031, 0.021, 0.048 and 0.046 respectively as shown in table 3.<\/p>\n

Table 3: Comparison between both groups as regards the ratings of anxiety.<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Aspects of anxiety<\/strong><\/td>\nStatement<\/strong><\/td>\nrating<\/strong><\/td>\ngroups<\/strong><\/td>\nChi-Square<\/strong><\/td>\nP value<\/strong><\/td>\n<\/tr>\n
Pre<\/strong><\/p>\n

(N – %)<\/strong><\/td>\n

Post<\/strong><\/p>\n

(N – %)<\/strong><\/td>\n<\/tr>\n

Three emotional<\/td>\nAnnoyed by loud noises<\/td>\n1<\/td>\n3<\/p>\n

4.80%<\/td>\n

14 22.20%<\/td>\n10.02<\/td>\n0.007<\/td>\n<\/tr>\n
2<\/td>\n31 49.20%<\/td>\n19 30.20%<\/td>\n<\/tr>\n
3<\/td>\n29 46.00%<\/td>\n30 47.60%<\/td>\n<\/tr>\n
I don’t feel good<\/td>\n1<\/td>\n16 25.40%<\/td>\n21 33.30%<\/td>\n6.29<\/td>\n0.043<\/td>\n<\/tr>\n
2<\/td>\n35 55.60%<\/td>\n39 61.90%<\/td>\n<\/tr>\n
3<\/td>\n12 19.00%<\/td>\n3<\/p>\n

4.80%<\/td>\n<\/tr>\n

I get upset easily when I have a difficult problem<\/td>\n1<\/td>\n23 36.50%<\/td>\n10 15.90%<\/td>\n6.94<\/td>\n0.031<\/td>\n<\/tr>\n
2<\/td>\n25 39.70%<\/td>\n33 52.40%<\/td>\n<\/tr>\n
3<\/td>\n15 23.80%<\/td>\n20 31.70%<\/td>\n<\/tr>\n
Two physical<\/td>\nI suffer from indigestion a lot<\/td>\n1<\/td>\n47 74.60%<\/td>\n32 50.80%<\/td>\n7.71<\/td>\n0.021<\/td>\n<\/tr>\n
2<\/td>\n12 19.00%<\/td>\n22 34.90%<\/td>\n<\/tr>\n
3<\/td>\n4<\/p>\n

6.30%<\/td>\n

9 14.30%<\/td>\n<\/tr>\n
I feel numbness in different parts of the body<\/td>\n1<\/td>\n21 33.30%<\/td>\n19 30.20%<\/td>\n6.06<\/td>\n0.048<\/td>\n<\/tr>\n
2<\/td>\n31 49.20%<\/td>\n41 65.10%<\/td>\n<\/tr>\n
3<\/td>\n11 17.50%<\/td>\n3<\/p>\n

4.80%<\/td>\n<\/tr>\n

physiological<\/td>\n <\/p>\n

I feel like my hands tremble when I’m exposed to embarrassing situations<\/td>\n

1<\/td>\n29 46.00%<\/td>\n42 66.70%<\/td>\n6.15<\/td>\n0.046<\/td>\n<\/tr>\n
2<\/td>\n17 27.00%<\/td>\n13 20.60%<\/td>\n<\/tr>\n
3<\/td>\n17 27.00%<\/td>\n8 12.70%<\/td>\n<\/tr>\n
social<\/td>\n <\/p>\n

I feel that others do not accept me<\/td>\n

1<\/td>\n14 22.20%<\/td>\n31 49.20%<\/td>\n10.05<\/td>\n0.007<\/td>\n<\/tr>\n
2<\/td>\n34 54.00%<\/td>\n23 36.50%<\/td>\n<\/tr>\n
3<\/td>\n15 23.80%<\/td>\n9 14.30%<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

The score of the social dimension of anxiety was higher before school closure as demonstrated in table 4 with a significant P value of 0.05.<\/p>\n

Table 4: Comparison between the total scores of each of the five dimensions of anxiety in both groups<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Parameters<\/strong><\/td>\nGroups<\/strong><\/td>\nN<\/strong><\/td>\nMin.<\/strong><\/td>\nMax.<\/strong><\/td>\nMean \u00b1 S.D.<\/strong><\/td>\nPercent change<\/strong><\/td>\nP value<\/strong><\/td>\n<\/tr>\n
Physic total<\/td>\nPre<\/td>\n63<\/td>\n15<\/td>\n36<\/td>\n23.21 \u00b1 5.28<\/td>\n100.00<\/td>\n0.230<\/td>\n<\/tr>\n
<\/td>\nPost<\/td>\n63<\/td>\n16<\/td>\n33<\/td>\n24.30 \u00b1 4.89<\/td>\n104.72<\/td>\n<\/td>\n<\/tr>\n
Physiol total<\/td>\nPre<\/td>\n63<\/td>\n15<\/td>\n41<\/td>\n26.46 \u00b1 5.66<\/td>\n100.00<\/td>\n0.281<\/td>\n<\/tr>\n
<\/td>\nPost<\/td>\n63<\/td>\n15<\/td>\n37<\/td>\n25.43 \u00b1 5.00<\/td>\n96.10<\/td>\n<\/td>\n<\/tr>\n
Emo total<\/td>\nPre<\/td>\n63<\/td>\n16<\/td>\n45<\/td>\n30.76 \u00b1 6.36<\/td>\n100.00<\/td>\n0.626<\/td>\n<\/tr>\n
<\/td>\nPost<\/td>\n63<\/td>\n20<\/td>\n45<\/td>\n30.25 \u00b1 5.26<\/td>\n98.35<\/td>\n<\/td>\n<\/tr>\n
Mental total<\/td>\nPre<\/td>\n63<\/td>\n15<\/td>\n41<\/td>\n29.35 \u00b1 6.07<\/td>\n100.00<\/td>\n0.388<\/td>\n<\/tr>\n
<\/td>\nPost<\/td>\n63<\/td>\n15<\/td>\n45<\/td>\n28.41 \u00b1 6.06<\/td>\n96.81<\/td>\n<\/td>\n<\/tr>\n
Social total<\/td>\nPre<\/td>\n63<\/td>\n15<\/td>\n43<\/td>\n28.06 \u00b1 6.54<\/td>\n100.00<\/td>\n0.050*<\/sup><\/td>\n<\/tr>\n
<\/td>\nPost<\/td>\n63<\/td>\n15<\/td>\n44<\/td>\n25.86 \u00b1 6.18<\/td>\n92.14<\/td>\n<\/td>\n<\/tr>\n
Anx total<\/td>\nPre<\/td>\n63<\/td>\n80<\/td>\n200<\/td>\n137.84 \u00b1 26.14<\/td>\n100.00<\/td>\n0.411<\/td>\n<\/tr>\n
<\/td>\nPost<\/td>\n63<\/td>\n87<\/td>\n202<\/td>\n134.25 \u00b1 22.54<\/td>\n97.40<\/td>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

In the inventory of depression, a significant discrepancy was found between both groups as regards the scores given to three statements as shown in table (5). The statements evaluate the interest in sex, the self esteem and the ability to concentrate with P values of 0.046, 0.015 and 0.016 respectively. The total scores to the inventory of depression were equivalent in both groups as noted in table 6.<\/p>\n

Table 5: the scores of depression in group1 compared to group2<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Score and statement<\/strong><\/td>\nType<\/strong><\/td>\nChi-Square<\/strong><\/td>\nP value<\/strong><\/td>\n<\/tr>\n
Pre<\/strong><\/p>\n

(n (%)<\/strong><\/td>\n

Post<\/strong><\/p>\n

(n (%)<\/strong><\/td>\n<\/tr>\n

Interest in Sex<\/strong><\/p>\n

Zero My interest in sex has not changed recently<\/p>\n

1 My interest in sex has become slightly less than usual<\/p>\n

2 My interest in sex has become noticeably low<\/p>\n

3 My interest in sex is now too little<\/p>\n

4 I’ve lost all interest in sex<\/td>\n

38 60.30%<\/td>\n51 81.00%<\/td>\n9.692<\/td>\n0.046<\/td>\n<\/tr>\n
5<\/p>\n

7.90%<\/td>\n

6<\/p>\n

9.50%<\/td>\n<\/tr>\n

2<\/p>\n

3.20%<\/td>\n

1<\/p>\n

1.60%<\/td>\n<\/tr>\n

3<\/p>\n

4.80%<\/td>\n

1<\/p>\n

1.60%<\/td>\n<\/tr>\n

15 23.80%<\/td>\n4<\/p>\n

6.30%<\/td>\n<\/tr>\n

Self esteem<\/strong><\/p>\n

Zero I don’t feel like I have a tendency to fail<\/p>\n

1 My self esteem is sometimes low<\/p>\n

2 I feel inferior to others<\/p>\n

3 I feel a tendency to fail<\/p>\n

4 I feel like a worthless person<\/td>\n

26 41.30%<\/td>\n26 41.30%<\/td>\n12.332<\/td>\n0.015<\/td>\n<\/tr>\n
14 22.20%<\/td>\n24 38.10%<\/td>\n<\/tr>\n
16 25.40%<\/td>\n4<\/p>\n

6.30%<\/td>\n<\/tr>\n

5<\/p>\n

7.90%<\/td>\n

3<\/p>\n

4.80%<\/td>\n<\/tr>\n

2<\/p>\n

3.20%<\/td>\n

6<\/p>\n

9.50%<\/td>\n<\/tr>\n

Concentration<\/strong><\/p>\n

Zero As always, I can focus on anything<\/p>\n

1 My ability to focus is a little less than usual2 My level of attention is not as good as usual although I find it difficult to gather my thoughts but it does not cause me any problems<\/p>\n

3 My ability to read or engage in conversation is not as good as usual<\/p>\n

4 I can’t read, watch TV, or engage in conversation without finding it difficult<\/p>\n

 <\/td>\n

19 30.20%<\/td>\n32 50.80%<\/td>\n12.140<\/td>\n0.016<\/td>\n<\/tr>\n
35 55.60%<\/td>\n19 30.20%<\/td>\n<\/tr>\n
8 12.70%<\/td>\n6<\/p>\n

9.50%<\/td>\n<\/tr>\n

1<\/p>\n

1.60%<\/td>\n

4<\/p>\n

6.30%<\/td>\n<\/tr>\n

0<\/p>\n

0.00%<\/td>\n

2<\/p>\n

3.20%<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Table 6: Comparison between the two groups as regards the total score of depression.<\/strong><\/p>\n\n\n\n\n\n
Parameters<\/strong><\/td>\nGroups<\/strong><\/td>\nN<\/strong><\/td>\nMin.<\/strong><\/td>\nMax.<\/strong><\/td>\nMean \u00b1 S.D.<\/strong><\/td>\nPercent change<\/strong><\/td>\nP value<\/strong><\/td>\n<\/tr>\n
Total score<\/td>\nPre<\/td>\n63<\/td>\n0<\/td>\n63<\/td>\n22.59 \u00b1 12.09<\/td>\n100.00<\/td>\n0.442<\/td>\n<\/tr>\n
<\/td>\nPost<\/td>\n63<\/td>\n2<\/td>\n60<\/td>\n20.94 \u00b1 11.95<\/td>\n92.69<\/td>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Discussion<\/strong><\/p>\n

Different distribution of the manifestations of anxiety was observed between both groups. Three negative manifestations of anxiety were more frequently rated after school closure. One emotional and two physical were detected. The emotion of getting easily upset was described \u201crare\u201d by more than one third (36.5%) of adolescents in group 1 while only by (15.9%) in group2 (P value 0.031). The percent of those who \u201calways\u201d suffered of indigestion was (6.3%) in group1 but more than the double of this percent in group2 (14.3%) (P value 0.021). Less than the half (49%) and more than the half (65%) in group1 and group2 respectively, \u201csometimes\u201d complained of numbness (P value 0.048). This goes in agreement with the study done in the United Kingdom by McElroy et al, who detected a rise in anxiety in relation to the lockdown18<\/sup>.<\/p>\n

On the other hand, four manifestations of anxiety were commoner before school closure. They encompassed two emotional, one social and one physiological aspect. \u00a0The emotion of getting annoyed by loud noise was scored \u201crare\u201d by 4.8% of children in group1 as opposed to 22.2% in group2 (P value 0.007) .The emotion of not feeling good was \u201calways\u201d experienced by 19% of adolescents before school closure in contrast to 4.8 % after school closure (P value 0.043). The social feeling of rejection by others was \u201csometimes\u201d experienced by 54% before school closure but was \u201crarely\u201d felt by 49.2% after school closure (P value 0.007). The physiological aspect of hand tremors when embarrassed was \u201calways\u201d present in 27% before versus 12.7% after closing schools (p value 0.046).<\/p>\n

A possible explanation for the attenuation of some anxiety\u2019s aspects post school closure is that a quality family support is able to alleviate the harm of home isolation. Same argument was mentioned by Wang et al who deduced that the bonding and the mutual \u201cparents-child\u201d relationship can protect against the repercussions of being prevented from going to school19<\/sup>. Also, Tang et al noticed some gains from home isolation resulting from stronger relations with parents20<\/sup>.<\/p>\n

The total score for social aspect of anxiety was higher in group1 with a significant P-value of 0.05 between both groups. This may be due to the prevalence of bullying among teenagers and limited acceptance of others. This can render the school environment a stressful one for some adolescents.<\/p>\n

The holistic anxiety score was similar in both groups with an insignicant (P-value of 0.411). This matches with Chen et al in their analogous study in China on adolescents21<\/sup>.<\/p>\n

Concerning the depression inventory, there were highly significant differences in the scores of three components.<\/p>\n

The interest in sex was lost in 23.8% of group1 but only in 6.3% of group2 (P value 0.046).<\/p>\n

While more children (9.5%) felt worthless after school closure than their peers (3.2%) who attended schools. \u00a0None from group1 found difficulty in reading, watching TV, or engaging in conversation, on the contrary 3.2% of adolescents in group2 found it difficult. Comparably, a negative effect of COVID-19 on mental health was stated by Oosterhoff et al, in their study in the United States and by Zhang et al in China22, 23<\/sup>.<\/p>\n

The total scores of depression were equivalent in both groups (P 0.442). Similarly, in Japan Isumi et al found no significant drawback of COVID-19 on adolescents\u2019mental health24<\/sup>.<\/p>\n

The highly significant disparity in the social level (P value 0.001) between the two groups may be one of the main influencers on the impact of school closure on children. More than half the candidates in group1 were from the high class (61.3%), while more than half of the candidates in group2 were from the middle class (50.8%). This goes with the conclusion of Gesturd et al in their comparable study on adolescents in Norway. They attributed a great imprint to the social level as an exposure risk for anxiety and depression25<\/sup>.<\/p>\n

Unfortunately physical activity is neglected in our country although it is of utmost importance in adolescence. The community\u2019s investment in ensuring the physical health of adolescents is a very rewarding investment. It is a safety valve in the event of exposure to various life stresses. The majority of the participants in both groups were not following the WHO recommendations for physical activity with exaggerated increment after school closure (81% of group1 and 95.2% of group 2 P-value 0.013). This view is supported by the research carried out by Abd El-Shaheed et al, on physical activity in Egyptian adolescents17<\/sup>.<\/p>\n

Finally, multiple risks and precipitating factors predispose adolescents to anxiety and depression. No single cause effect can be defined. This goes in harmony with the conclusion done by Jones et al. They conducted a large systemic review and deduced that a plenty of risks mitigate the role of school closure as a sole influencer on mental soundness26<\/sup>.<\/p>\n

Conclusion<\/strong><\/p>\n

Attending school is not only about efficient academic achievement but mental wellbeing too. Many lines of defense should integrate to compensate for remote schooling. A quality family support and adherence to physical activity are the main outlets for adolescents when banned from going to school.\u00a0<\/strong><\/p>\n

Limitations<\/strong><\/p>\n

The dates of the four school visits were all in the first 10 days of March 2020 which was very close in timing to the governmental decision of schools\u2019 closure mid March 2020. The children were already under stress by the disturbing worldwide news about the novel COVID-19. This was the reason why the scores of both groups were very close as for anxiety as for depression.<\/p>\n

Recommendations<\/strong><\/p>\n

Further studies are needed in the field of adolescents\u2019 mental well being and special emphasis on their \u201cright\u201d of having alternatives other than going to school for creativity and physical activity.<\/p>\n

Acknowledgement<\/strong><\/p>\n

We would like to thank the National Research Centre for funding this work. Also, we are grateful to the personal of \u201cnutrition and immunology clinic\u201d and the \u201ctherapeutic nutrition clinic\u201d at the Medical Research centre of Excellence.\u00a0 Our gratitude is due to schools\u2019 administrators who facilitated our visits to schools. Last but not least we appreciate the participation of all children in our study.\u00a0<\/strong><\/p>\n

Conflict of Interest<\/strong><\/p>\n

\u00a0<\/strong>The authors declare having no conflict of interest\u00a0<\/strong><\/p>\n

Funding Source<\/strong><\/p>\n

The Fund for the study was provided by National Research Centre as part of a Project. The project ID: 12060137.<\/b><\/p>\n

References<\/strong><\/p>\n

    \n
  1. Perkins KN, Carey K, Lincoln E et al. School Connectedness Still Matters: The Association of School Connectedness and Mental Health During Remote Learning Due to COVID-19. J Prim Prev 2021;42:641\u20138.
    \nCrossRef<\/a><\/li>\n
  2. Kir\u00e1ly O, Potenza MN, Stein DJ et al. Preventing problematic internet use during the COVID-19 pandemic: Consensus guidance. Compr Psychiatry 2020;100:152180.
    \n    CrossRef<\/a><\/li>\n
  3. Shochet IM, Dadds MR, Ham D et al. School connectedness is an underemphasized parameter in adolescent mental health: results of a community prediction study. J Clin Child Adolesc Psychol 2006;35:170\u20139.
    \n    CrossRef<\/a><\/li>\n
  4. Masonbrink AR and Hurley E. Advocating for children during the COVID-19 school closures. Pediatrics 2020;146:20201440.
    \n    CrossRef<\/a><\/li>\n
  5. Asanov I, Flores F, McKenzie D et al. Remote-learning, time-use, and mental health of Ecuadorian high-school students during the COVID-19 quarantine. World Dev 2021;138:105225.
    \n    CrossRef<\/a><\/li>\n
  6. Rajmil L, de Sanmamed MJF, Choonara I et al. Impact of the 2008 Economic and Financial Crisis on Child Health: A Systematic Review. Int J Environ Res Public Heal 2014;11:6528\u201346.
    \n    CrossRef<\/a><\/li>\n
  7. Wang J, Lloyd-Evans B, Giacco D et al. Social isolation in mental health: a conceptual and methodological review. Soc Psychiatry Psychiatr Epidemiol 2017;52:1451\u201361.
    \n    CrossRef<\/a><\/li>\n
  8. Brooks SK, Webster RK, Smith LE et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet 2020;395:912\u201320.
    \n    CrossRef<\/a><\/li>\n
  9. Loades ME, Chatburn E, Higson-Sweeney N et al. Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19. J Am Acad Child Adolesc Psychiatry 2020;59:1218-1239.e3.
    \n    CrossRef<\/a><\/li>\n
  10. Banerjee D and Rai M. Social isolation in Covid-19: The impact of loneliness. Int J Soc Psychiatry 2020;66:525\u20137.
    \n    CrossRef<\/a><\/li>\n
  11. Dietians of Canada. WHO growth charts for Canada, 2014 revision. Available at: https:\/\/www.dietitians.ca\/growthcharts https:\/\/play.google.com\/store\/apps\/details?id=appinventor.ai_dlmetzger58.AnthroCalc&hl=en&gl=US (last accessed May 2022).<\/li>\n
  12. Gabr AA, Mahfouz NN, Abu Shady MM et al. Socioeconomic position as a risk factor for BPA exposure in a sample of Egyptian children Journal of Applied Pharmaceutical Science 2017; 7 (12), 084-089. DOI: 10.7324\/JAPS.2017.71211
    \n    CrossRef<\/a><\/li>\n
  13. Park JE, Park K. Textbook of preventive social medicine, 7th edition, Messers Banarsidas, Bhanot Publisher, 1268, Napier Town. 1979:81.<\/li>\n
  14. Zimmerman M and Coryell W. The Inventory to Diagnose Depression (IDD): A Self-Report Scale to Diagnose Major Depressive Disorder. Journal of Consulting and Clinical Psychology 1987; 55(1):55-9. DOI:1037\/0022-006X.55.1.55
    \n    CrossRef<\/a><\/li>\n
  15. Casta\u00f1eda A, McCandless BR and Palermo DS. The Children’s From of Manifest Anxiety Scale (CMAS). Child Development 1956; 27(3), 317-26.
    \n    CrossRef<\/a><\/li>\n
  16. Taylor A Personality Scale of Manifest Anxiety<\/em>. The Journal of Abnormal and Social Psycholog 1953; 48<\/em>(2), 285\u2013290. https:\/\/doi.org\/10.1037\/h0056264.
    \n    CrossRef<\/a><\/li>\n
  17. Abd El-Shaheed A, Mahfouz NN, Elabd MA et al. Physical activity patterns in Egyptian obese and nonobese adolescents assessed using a validated WHO questionnaire Journal of The Arab Society for Medical Research 2020; 15:6\u201310. DOI: 10.4103\/jasmr.jasmr_27_19
    \n    CrossRef<\/a><\/li>\n
  18. McElroy E, Patalay P, Moltrecht B et al. Demographic and health factors associated with pandemic anxiety in the context of COVID-19. Br. J. Health Psychol. 2020, 25, 934\u2013944. [CrossRef] [PubMed]\nCrossRef<\/a><\/li>\n
  19. Wang J, Wang H, Lin H et al. Study problems and depressive symptoms in adolescents during the COVID-19 outbreak: poor parent-child relationship as a vulnerability. Globalization and Health 2021; 17:40 https:\/\/doi.org\/10.1186\/s12992-021-00693-5
    \n    CrossRef<\/a><\/li>\n
  20. Tang S, Xiang M, Cheung T et al. Mental health and its correlates among children and adolescents during COVID-19 school closure: The importance of parent-child discussion. J. Affect. Disord. 2021; 279, 353\u2013360. [CrossRef]\nCrossRef<\/a><\/li>\n
  21. Chen, F, Zheng, D, Liu, J et al. Depression and anxiety among adolescents during COVID-19: A cross-sectional study. Brain Behav. Immun. 2020; 88, 36\u201338. [CrossRef]\nCrossRef<\/a><\/li>\n
  22. Oosterhoff, B, Palmer CA, Wilson J et al. Adolescents\u2019 Motivations to Engage in Social Distancing During the COVID-19 Pandemic: Associations with Mental and Social Health. J. Adolesc. Heal. 2020; 67, 179\u2013185. [CrossRef]\nCrossRef<\/a><\/li>\n
  23. Zhang C, Ye M, Fu Y et al. The Psychological Impact of the COVID-19 Pandemic on Teenagers in J. Adolesc. Health 2020; 67, 747\u2013755. [CrossRef]\nCrossRef<\/a><\/li>\n
  24. Isumi A, Doi S, Yamaoka Y et al. Do suicide rates in children and adolescents change during school closure in Japan? The acute effect of the first wave of COVID-19 pandemic on child and adolescent mental health. Child Negl. 2020; 110, 104680. [CrossRef]\nCrossRef<\/a><\/li>\n
  25. Gertrud SH, Sjur SS, Tore W-L et al. Adolescents\u2019 symptoms of anxiety and depression before and during the Covid-19 outbreak _ A prospective population-based study of teenagers in Norway. The Lancet Regional Health – Europe 2021; 5: 100093. https:\/\/doi.org\/10.1016\/j.lanepe.2021.100093
    \n    CrossRef<\/a><\/li>\n
  26. Jones EAK, Mitra AK and Bhuiyan AR. Impact of COVID-19 on Mental Health in Adolescents: A Systematic Review Res. Public Health 2021; 18, 2470. https:\/\/doi.org\/10.3390\/ijerph18052470
    \n    CrossRef<\/a><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Introduction In 12th January 2020, the WHO announced that a […]<\/p>\n","protected":false},"author":15,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[100],"tags":[],"class_list":["post-45676","post","type-post","status-publish","format-standard","hentry","category-vol15no3"],"_links":{"self":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/45676","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/users\/15"}],"replies":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/comments?post=45676"}],"version-history":[{"count":5,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/45676\/revisions"}],"predecessor-version":[{"id":46119,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/45676\/revisions\/46119"}],"wp:attachment":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/media?parent=45676"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/categories?post=45676"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/tags?post=45676"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}