Background Children are mostly infected with SARS-CoV-2 through household transmission. All children diagnosed with COVID-19 in Singapore require hospital isolation in one of Singapore’s 2 paediatric units. Discharge was initially upon nasopharyngeal clearance. This was revised on 29 May 2020 to time-based discharge of well patients, regardless of viral clearance, after Day 21 of illness. Concerted efforts are made to admit infected children together with their caregivers as a family unit.
Objectives This study aims to explore the psychological experiences of children and their caregivers isolated in hospital due to COVID-19.
Methods A prospective mixed-methods design was used to evaluate the psychological status of hospitalised family units where at least one child < 18 years had SARS-CoV-2 infection.
Patient medical records were reviewed for demographic and clinical information. Parents and children >7 years old underwent a telephone-based interview performed by a trained psychologist to explore their understanding of the infection, hospital isolation, and pandemic.
Two self-reported questionnaire instruments were used to assess anxiety and depression – the Short Mood and Feelings Questionnaire (SMFQ) and Screen for Adult Anxiety Related Disorders (SCAARED) in adults; SMFQ for children with the Screen for Child Anxiety Related Disorders (SCARED) Questionnaire in children ≥7 years old.
Parents were asked to score their opinion and emotions relating to their experience in isolation on a Likert scale of 1 to 5 on a series of qualitative questionnaires.
Results Fifteen family units were admitted in our institution between March-May 2020 and were invited to participate. 11 (73%) family units were recruited- 9 child-adult dyads, a triad of 2 children and 1 adult, and 1 child who was admitted alone. The mean length of hospitalization was 25.5 days (range 20–31 days). The mean age of children admitted was 5.1 years (8 months – 12.3 years). Five children were ≥7 years old and all completed interviews and questionnaires. All caregivers interviewed were positive for COVID-19. Nine parental questionnaires and 10 adult interviews were completed.
Parents were overall more anxious for their children than themselves. Most common sources of anxiety were the frequency of swab tests, and uncertainty regarding swab results and duration of isolation. 44.4% of adults vs 60% of children had symptoms indicative of generalized anxiety disorder, and 66.7% of adults vs 80% of children had symptoms indicative of separation anxiety disorder. 80% of parents reported being sad about separation from other family members who were not admitted. None of the participants met criteria suggestive of depression on the SMFQ.
Conclusions Families were anxious about their admission despite being admitted as a family unit. Main sources of anxiety were procedural discomfort and prolonged isolation of the child. Children appeared more susceptible to separation anxiety, possibly due to limited understanding of the situation.
Clear timely parental communications to provide information on clinical management and anticipated discharge should be encouraged. We recommend routine psychological assessment for all children and family units, with focus on reassurance and early recognition of evolving anxiety disorders. Time-based discharge criteria and alternative SARS-CoV-2 diagnostic sampling may ease anxiety during the pandemic.
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