COVID-19 lockdown in Spain: Psychological impact is greatest on younger and vulnerable children.

In 2020, quarantine home confinement measures were implemented in Spain to control a pandemic for the first time. The objective of this study is to assess both the psychological and social impact of that 'lockdown' on different age groups of children and adolescents and also the different strategies adopted by families in that situation. We collected data via an online questionnaire answered by 850 participants, parents of young people aged between 4 and 18, between 24th April and 8th May 2020. Our results show that living in a home smaller than 80 m2 is associated with an increased risk of presenting clinical symptoms of emotional or behavioural distress, with an odds ratio of 2.54 (95% CI: 1.07-6.02), p = 0.034; while increased age is a predictor of better psychological functioning during lockdown: coefficient of 0.25 (95% CI: 0.07-0.41), p = 0.004. Moreover, age is also a marker of higher scores on the scale of psychological symptoms, with a coefficient of 0.02 (95% CI: 0.01-0.04), p = .005. To conclude, younger children present poorer behavioural and emotional functioning and more symptoms of emotional distress than adolescents during lockdown. Living in a small home is a risk factor for presenting clinical symptoms. These findings should be taken into consideration when planning for future home confinement episodes and when considering preventative strategies in the realm of mental health care.

Introduction

The SARS-CoV-2 coronavirus outbreak originated in the city of Wuhan, China, in December 2019. The World Health Organization declared the corresponding COVID-19 pandemic on March 11, 2020. As Orgilés et al. (2020) report, Spain is one of the countries that has been most affected by the pandemic (Orgilés et al., 2020).

In Spain, as a consequence of the lockdown, schools throughout the country were closed. This meant that children and adolescents were suddenly deprived of the contact with peers and teachers that they usually experience, as well as having no extracurricular activities normally organised by their schools available to them, and they were obliged to stay at home.

Brooks et al., 2020; Clemens et al., 2020 observed that the longer a period of home confinement lasts, the greater the resultant deterioration in mental health; specifically, increased post-traumatic stress symptoms, avoidance behaviour and anger. Those authors also point out that during lockdown, families have to face other stress factors, such as the fear of infection, frustration and boredom, an inadequacy of supplies and a lack of clear and precise information. As the confinement lengthened, so the stressors also increased (possibly to include contagion, death of a family member, redundancy and the need to supervise children’s schoolwork, as well as having to continue to live together in a reduced space). Consequently, children and adolescents who are at home with their families experience increased stress coupled with reductions in the support and resources necessary to cope with such a situation; all of which contributes to generating a risk for their mental health (Clemens et al., 2020).

Current scientific evidence shows that in such circumstances, children are less active, spend more time in front of their screens, experience less regular sleep patterns, have a poorer diet, spend less time participating in outdoor activities and have far less interaction with their peers (Wang et al., 2020). Furthermore, social isolation is a known risk factor for several mental disorders, including major depression and psychosis (Fiorillo & Gorwood, 2020). In children and adolescents, the longer exposure to these stressors lasts, the greater the risk that any detrimental psychological effects will also last for longer, including suffering from anxiety disorders such as panic disorder, obsessive-compulsive disorder and post-traumatic stress disorder (Clemens et al., 2020; Wang et al., 2020).

Orgilés et al. (2020) carried out a study of a Spanish (n = 431) and Italian (n = 712) cohort of children and adolescents. They reported that 85.7% of parents had observed changes in the emotional status and behaviour of their children, with difficulty maintaining concentration being the most prevalent negative effect. In addition, 30% of parents stated that their children presented such symptoms as nervousness, irritability, restlessness, fatigue or a feeling of loneliness. Another finding of the study that we feel should be emphasised is that it confirmed that family routines change during lockdown, with more time in front of screens, less physical activity taking place and more time spent sleeping.

When considering negative effects on the mental health of young people, one of the most vulnerable groups consists of those who already suffer from a mental disorder (Fegert et al., 2020).

In addition to this, the COVID-19 pandemic threatens to disrupt the provision of mental health services. The rapid expansion of the epidemic forced professionals and the institutions they represent to rethink the provision of services and assistance. In response, policymakers, administrators and healthcare providers have taken bold steps towards enabling ‘telepsychiatry’ to fill this sudden gap in care provision for our most vulnerable populations (Kannarkat et al., 2020). There has been a generalised feeling that this new model of care is here to stay, which has created a need to develop best practice guidelines, especially for adolescents (Barney et al., 2020).

All of this means that we now face a challenge that is still novel and largely unknown to us: how is the child and adolescent mental health network to respond to the psychological and social impact of lockdown on children and adolescents. In the light of this situation, the current study has two objectives. The first is to evaluate the psychological and social impact of lockdown on different age groups, while at the same time assessing the different strategies adopted by families to cope with this new situation. The second is to gauge concerns related to the mental health of young people in the post-lockdown period and to appraise telemedicine as an additional tool for providing child and adolescent mental healthcare services. Through these goals, our study aims to respond to this new challenge we are facing.

Method

Participants

The participants in this study were residents in Spain who were the parents of children aged between 4 and 18 years There were a total of 1007 initial participants. After exclusion of those respondents for children aged under 4 years old, 850 valid entries were included in the study.

Procedure

As face-to-face meetings were not possible during lockdown, the participants were recruited via social media and communication networks, and we created a specific ad hoc online survey to distribute among them. Adopting a non-probabilistic snowball sampling strategy, we sent out the survey via a messaging service (WhatsApp™); we also used probabilistic methods to recruit participants via an announcement posted on the Hospital Sant Joan de Déu social media accounts (Twitter™ and Instagram™) and the hospital’s Faros webpage (https://faros.hsjdbcn.org/es). The WhatsApp contact was initiated via our own personal contacts in the healthcare and other related professional sectors. All the participants responded anonymously. The approval of the Ethics Board of the authors’ institution was obtained for the research.

We collected responses between April 24th and May 8th, when the whole of Spain was in lockdown. On April 27th, for the first time since the State of Alarm had been declared on 14th March, and on every subsequent day until it ended, children up to the age of six were allowed to leave their homes during the time slot from 12 noon to 2 p.m., and those from six to 16 years old, between 4 p.m. and 6 p.m. After 6 p.m. and up to 8 p.m., adolescents aged over 16 could go out with a self-certificate of responsibility and the consent of their parents. On May 8th, when we finished collecting responses, Spain continued to be in lockdown and the State of Alarm was in full effect.

Instruments

In accordance with the academic literature we reviewed on studies of the psychological impact of quarantine measures, we adapted questionnaires used in previous studies of populations that have experienced confinement (Orgiles et al., 2020).

Our survey consisted of four parts. The first collected sociodemographic data related to the participating parents and their children. The second concerned the relevant clinical data. To assess behavioural problems of children and adolescents, we used items adapted to Spanish from the PSC scale (Pediatric Symptom Checklist, Massachusetts General Hospital). The PSC is a questionnaire designed by Jellinek et al. (1988) to screen for emotional and behavioural problems in children and adolescents (4–16 years) (Jellinek et al., 1988). It was designed for use by paediatricians and other healthcare professionals to improve recognition of psychosocial problems in young people in this age range. In total, it consists of 35 items to be answered by a parent or guardian; For our present study, the possible responses to each item were adapted to a Likert-type scale in which the parents supplied information that completed the statement: ‘compared to before lockdown, my child is …..’; and the options were: ‘much worse’ (1 point), ‘moderately worse’ (2 points), ‘slightly worse’ (3 points), ‘the same’ (4 points), ‘slightly better’ (5 points), ‘moderately better’ (6 point) and ‘much better’ (7 points). Thus, higher scores on this scale indicate that a child/adolescent suffers fewer problems during lockdown. We calculated Cronbach’s alpha for our study to be 0.958. For categorical study of the variables, we reclassified the previous scores of 1–3 as 1, indicating the group with poorer psychological functioning during lockdown; and from 4 to 7 as 0, indicating the group with similar or better psychological functioning. In addition, we added three novel items specific to a home confinement situation in order to generate information related to the behaviour of adolescents, these were: ‘runs away from home’, ‘has problems with video games’, ‘consumes drugs’. We also collected information on the overall psychological functioning of the child/adolescent before and then during lockdown, graded on a Likert-type scale from 0 to 10, with higher scores indicating better psychological functioning. Again, for categorical analysis of this variable, scores from 0 to 4 were recoded as 1, indicating the group with poorer psychological functioning; and from 5 to 10 as 1: the group with better psychological functioning. The third part of our survey requested information regarding the habits of the young people during lockdown: daily routines, sport activities, continuing with social/family relationships (0 = no; 1 = yes), and also whether family relationships improved during lockdown. Finally, the fourth part gathered information on the concerns of parents related to the mental health of their children post-lockdown, the measures that parents would consider useful to reduce the consequences of the prolonged quarantine and also their assessment of the use of ‘telemedicine’ as an additional tool for mental healthcare services.

Statistical analysis

First, we analysed the statistics that described sociodemographics and other characteristics of interest in the study. We then performed bivariate analysis between the age groups to study emotional and behavioural symptoms, as well as overall psychological functioning. For categorical variables, a chi-square test (χ2) was used and ANOVA for continuous variables. When p < .05, the Bonferroni post hoc correction was applied. Finally, we performed multivariate analysis with the variables for which p < .1. A logistic linear regression model was used for the dichotomous variables with the following model: house size (small = 1; medium/large = 0); age; PSC results in relation to the home confinement (equal or better = 0; worse = 1); and type of outdoor space (none or only a balcony = 0; terrace, garden or patio = 1). Similarly, a linear regression model for the continuous variables was applied with the following model: age, psychological functioning during confinement, loss of a relative (yes/no), current or past mental health treatment (yes/no) and family income affected during lockdown (yes/no).

Statistical analysis was performed using Stata 12 software (Stata Corporation, College Station, Texas) (Stata Corp., 2011).

Results

The final sample was 850. The mean age was 8.3 (SD = 3.4). As not all respondents answered all the questions, the total number varies from one category to another and is indicated as appropriate in the results (Tables 1 and 2). A total of 90.4% of the respondents were mothers, 8.2% were fathers, and 1.4% were some other family member who lived with the child or adolescent.

Table 1.

Sociodemographic characteristics, psychological functioning during lockdown, and emotional and behavioural symptoms. (n = 850).

	n (%)	Lockdown psychological functioning, M (SD)	p	Symptoms score, M (SD)	p
Population of home town/city (n = 847)
<1000 people	31 (3.7)	4.8 (2.7)	0.559	108 (21)	0.075
from 1000 to 10,000 people	187 (22.1)	4.9 (3.2)		102 (21)
from 10,000 to 100,000 people	300 (35.4)	5.0 (3.0)		100 (19)
>100,000 people	329 (38.8)	5.3 (3.0)		104 (17)
Total area of home (m2) (n = 750)
<60	46 (6.1)	4.6 (3.0)	0.088	87 (22)	< 0.001
60–80	159 (21.2)	4.8 (3.1)		100 (20)
80–100	228 (30.4)	5.1 (3.1)		101 (18)
100–120	135 (18.0)	4.9 (2.9)		104 (18)
>120	182 (24.3)	5.6 (3.0)		108 (16)
Total number of people living together during lockdown (n = 849)
2	53 (6.3)	4.7 (3.2)	0.407	98 (26)	0.105
3	222 (26.1)	5.1 (2.9)		101 (18)
4 or more	574 (67.6)	5.0 (3.1)		102 (19)
Outdoor space at home (n = 676)
Terrace	231 (27.2)	5.2 (3.0)		104 (17)	< 0.001
Balcony	311 (36.6)	5.0 (3.1)		99 (20)
Garden	134 (15.8)	5.3 (3.1)		106 (18)
Patio	92 (10.8)	4.8 (3.0)		106 (17)
None	81 (9.5)	5.0 (2.9)		95 (17)

Table 2.

Social and economic consequences and habits during lockdown (n = 850).

	n (%)	Lockdown psychological functioning, M (SD)	P	Symptoms score, M (SD)	p
Online contact with family/friends
Yes	841 (98.9)	5.10 (3.04)	0.431	102.28 (18.82)	0.242
No	8 (0.9)	4 (2.62)		92.25 (22.25)
Income affected by lockdown
Yes	386 (45.4)	5.05 (3.11)	0.143	101.33 (18.99)	0.222
No	464 (54.6)	5.12 (2.98)		102.81 (18.79)
Death of a family member
Yes	67 (7.9)	4.71 (3.35)	0.038	101.51 (19.24)	0.632
No	781 (91.9)	5.12 (3.02)		102.21 (18.88)
Mental health treatment (current or past)
Yes	724 (85.2)	4.05 (2.96)	< 0.001	100.10 (22.16)	0.324
No	77 (9.1)	5.26 (3.03)		102.57 (18.36)
Routine
Yes, parents and children	629 (74.0)	5.25 (3.03)	0.026	104.40 (18.22)	< 0.001
Only parents	70 (8.2)	4.16 (2.91)		93.34 (21.07)
Only children	14 (1.6)	5.57 (2.87)		100 (14.88)
No	131 (15.4)	4.85 (3.12)		95.95 (18.76)
Physical exercise
Yes	621 (73.1)	4.92 (3.10)	0.975	101.67 (24.06)	0.408
No	229 (26.9)	4.91 (3.02)		99.47 (17)
Meditation
Yes	149 (17.5)	4.95 (3.09)	0.381	101.60 (22.96)	0.726
No	515 (60.6)	5.20 (3.05)		102.30 (17.62)

The average score from the emotional and behavioural questionnaire was 102.2 (SD = 3.1) with scores ranging from 31 to 203. The mean psychological functioning score prior to lockdown was 6.0 (SD = 3.1), and during the quarantine, it was 5.1 (SD = 3.1).

When we compared the effects on psychological functioning and the number of symptoms pre-lockdown and during the home confinement, at the sociodemographic level, we observed no differences related to the size of the population in the town where the subjects lived (p = .559 and p = .075, respectively), nor were there any differences correlated with the number of people living together in the home (p = .407 and p = .105). In contrast, we did find statistically significant differences in the presence of symptoms in relation to the total area of the home (p = .88 and p < .001), as well as depending on whether the housing had any outdoor space (p = .88 and p < .001); see Table 1. For the Bonferroni post hoc correction applied to both these latter variables, the differences were established between living in a flat whose size was <60 m2 compared with living in one with an area of between 60 and 80 m2 (p < .001) and also living in a flat <60 m2 versus living in one 100–120 m2 (p < .001). Regarding outdoor space, the statistically significant differences were observed between having a terrace or a balcony (p = .043); a terrace versus no outdoor space (p = .008); a balcony versus a garden (p = .008); a balcony versus a patio (p = 003); and between having a garden and having no outdoor space (p = .002).

When considering the habits and social consequences of lockdown, we observed no differences between pre-lockdown psychological functioning and that during the home confinement, or in the number of symptoms when studying: online contact with family and friends (p = .431 and p = .242); income affected by lockdown (p = .143 and p = .222); physical exercise (p = .975 and p = .408) or meditation (p = .381 and p = .726). Meanwhile, differences were observed in the level of psychological functioning when having to deal with the death of a family member (p = .038), if they were in treatment for a mental health problem (p < .001) and in the performing of daily routines during lockdown (p = .026). In this last aspect, differences were also observed in the number of symptoms (p < 0001); see Table 2.

When studying the differences by age group, we saw that the younger the children were, the more symptoms were present (see Figure 1) and the poorer the psychological functioning became (see Figure 2), and these differences were statistically significant. When analysing each item by age group, we found statistically significant differences in the following symptoms: they become agitated and find it difficult to remain still (p < .001); they have problems and argue with their parents (p = .001); they are less interested in schoolwork (p < .001); they do not become tired (p < .001); they daydream frequently (p = .018); they are easily distracted (p < .021); they are frightened by novel situations (p = .040); they do the homework set by the school (p < .001); they have trouble maintaining their concentration (p = .015); they are less concerned about their friends (p = .002); they argue more with others (p < .001); they are worried that their school grades will go down (p = .04); they want to be close to their parents more than before (p < .001); they think that they are bad (p = .020); they frequently get hurt (p = .015); they act as if they were younger than they are (p = .003); they break the rules (p < .001); and they are easily irritated by others (p < .001) (see Supplementary Material, Table S1).

Figure 1.

Emotional and behavioural symptoms by age group. Mean (SD). Note. * p < 0.05; ** p < 0.001.

Figure 2.

Post-lockdown psychological functioning by age group. Mean (SD). Note. * p < 0.05; ** p < 0.001.

When studying the adolescents aged 14–18 years (n = 64, average age = 15.6, SD = 1.4), their parents reported that 12.5% were worse off in relation to drug use than before lockdown; 26.5% had more problems with excessive use of video games as a result of the confinement; and 14.2% had eluded lockdown at some point by sneaking out from home.

In our multivariate analysis, we found that having a home with a total area of less than 80 m2 was associated with an increased risk of presenting more clinical symptoms of emotional and behavioural distress, with an OR of 2.54 (95% confidence interval (CI) = 1.07–6.02), p = .034 (adjusted for death of a family member, routine, affected income, history of mental health treatment, age and size of the town where the subjects lived). In the linear regression analysis, age turned out to be a predictor of better psychological functioning during confinement with a coefficient of 0.25 (95% CI = 0.07–0.41), p = .004 (model adjusted for total size of the home, age, death of a family member, routine, and current or past mental health treatment). The older the children/adolescents, the better they functioned psychologically during lockdown. In addition, age predicted higher scores on the symptom scale with a coefficient of 0.02 (95% CI = 0.01–0.04), p = .005 (adjusted for age, current or past mental health treatment, affected income and death of a family member).

When studying the concerns that parents expressed regarding the different symptoms, we observed that they reported a high degree of concern that their children would develop increased fears, in 16.5% of cases; that they might have a traumatic experience, in 7.6% of cases; that they would become more moody, in 24%; and that they would become more aggressive in 18.8%. Meanwhile, in relation to the situation that they were experiencing, 7.2% of the parents expressed a belief that their children would need help from a mental health professional; while 24.6% saw this as a possibility. Furthermore, 6.3% of the parents said that they expected that they themselves would need help from a mental health professional, and 30.8% considered this to be a possibility.

Finally, in relation to telemedicine and mental health care, 71.6% of respondents stated that they thought that regular online visits at child/adolescent mental health centres would be useful, 59.2% considered an initial online visit would be useful, 58.3% considered online follow-up visits would be useful to monitor psychotropic drug use, and 46.6% considered it would be useful to hold online group therapy sessions.

Discussion

The aim of this research was to study the impact of lockdown on children and adolescents aged between 4 and 18, via an online survey answered by their parents or guardians. We also studied the concerns parents expressed about the impact of home confinement on their children, as well as whether they considered telematic measures to be a usefulness means of response during lockdown and possibly afterwards too. The data we collected show that home confinement has had an impact on the young population and our results thus support previous evidence that social isolation caused by the COVID-19 pandemic and lockdown affect the psychological wellbeing of children and adolescents (Loades et al., 2020). Our main findings indicate that the lockdown has had the greatest impact on families living in small homes with no outdoor space, and that in general, home confinement has affected young children more than adolescents. This has generated considerable concern for many parents who worry that both they and their children may need help from mental health professionals.

When we analyse the factors that have had the greatest influence on increased emotional distress, one of our first conclusions is that the lockdown has affected mostly those groups who were already vulnerable and had few resources at their disposal (Viner et al., 2020). We have seen that living in poor conditions, and especially having to endure home confinement in a small flat with no or extremely reduced outdoor space, has worsened the lockdown experience and increased suffering. These results agree with those obtained by Orgilés et al. (2020): more psychological symptoms and more behavioural affectation are observed in Spanish than in Italian children. Those authors conclude that one of the reasons for the increased degree of affectation in young Spaniards is related to the characteristics of Spanish flats (fewer of them include a substantial outdoor space), as well as the fact that Italians have more possibilities of accessing parks and gardens.

At the same time, suffering a prior mental health disorder is a key factor in presenting more mental health problems during quarantine (Viner et al., 2020). Furthermore, some studies suggest (Brooks et al., 2020; Orgilés et al., 2020; Viner et al., 2020) that an additional risk factor is the difficulty that some young people experience of establishing routines during lockdown. This is especially true for patterns of behaviour related to access to telematic tools and also to being in contact with a parental level of education that is sufficient to accompany and assist children in academic tasks, as well as offering the possibility of search for leisure activities and routines in a confined situation. These factors are crucial for prevention. Such studies agree with the results we have obtained here, in which we observed that in families which had managed to maintain some type of routine, the children and adolescents showed better psychological functioning and exhibited fewer symptoms during lockdown. We consider the fact that we did not observe differences related to the impact of lockdown on family income is due to the specific moment when we carried out the study. However, from data on the social and psychological impact of previous economic crises and recessions, specifically that suffered in Spain in 2010 (Salvador-Carulla & Roca, 2013), we believe that in the short term, the psychological distress experienced by the most vulnerable groups will increase (Fegert et al., 2020; Salvador-Carulla & Roca, 2013).

All of this leads us to consider that previous studies, and also the present one, can be of considerable help when it comes to designing strategies of planning for the demand that may emerge in reaction to a situation of generalised home confinement. Such strategies need to be aimed especially at the most vulnerable groups and focus on preventing the disadvantages these groups already suffer from becoming worse (Viner et al., 2020).

Another factor that has had an impact on the suffering of children and adolescents, as expected, is the death of a family member during lockdown. Not being able to accompany the sick relative when they were admitted to hospital and, in many cases, not even being able to see them during the last days of their life, is an important factor in the suffering endured by children and adolescents [8]. In agreement with other authors, we consider that some of these young people may require professional attention to overcome these traumatic situations (Fegert et al., 2020).

In our study, we observed significant differences between the different age groups. Specifically, the youngest group of children (4–8 years) presented more problems than older adolescents did. The most common type of symptomatology we observed was adaptive, with predominance of anxiety and fear, and in many cases, behavioural expressions of this in the form of irritability or restlessness. Our data thus provide important information on the significance of problems related to anxiety in this group of younger children, since previous studies which did not differentiate by age group showed a higher prevalence of depressive disorders (Loades et al., 2020). A probable explanation of this type of expression of reduced wellbeing has to do with the children’s understanding of what they are experiencing in a confined pandemic situation: the older the young person is, the greater their understanding of the reasons why the lockdown was necessary. These results could agree with previous studies which conclude that when confinement is voluntary and for reasons of solidarity (to avoid contagion), symptoms of anxiety and depression are fewer (Brooks et al., 2020). Such a level of understanding is more difficult to reach in younger children and consequently they express more discomfort in the form of anxiety and restlessness.

This has led to a high degree of parental concern regarding how to manage their children’s behaviour and the possible future repercussions of lockdown. Although there are no conclusive data on what the real impact will be at the level of the onset of mental problems, and it is even difficult to start to predict these effects (Fegert et al., 2020; Orgilés, 2020), it is clear that many parents consider that there is a high possibility that they themselves or their children will need professional help. This concern is consistent with studies which indicate that loneliness is associated with mental health problems that may present up to 9 years after the triggering event (Loades et al., 2020).

During lockdown, in attempts to maintain regular contact with patients, clinical assistance offered via telematic means has increased exponentially, through telephone calls, videoconferences and online groups. Our study shows that parents evaluate this option positively and think that it is important for to have it available to them. However, despite this addition, mental health services may temporarily not be as widely available as they usually are and a lack of access to support services can be particularly harmful for vulnerable children or families who experience increased stress. Thus, school closures exacerbate inequities, disproportionately affecting already disadvantaged children (Clemens et al., 2020; Fiorillo & Gorwood, 2020).

Our study suffered from numerous limitations. In the first place, it would have been interesting to collect data differentiated by sex, but this distinction was not included in the survey. Secondly, the people who responded to the survey probably have easy access to new technologies and a decent network connection, and they show a high degree of motivation when it comes to the mental health of their children. This would tend to exclude families in a more vulnerable socioeconomic position, who should also be evaluated. Thirdly, because it is an online survey with a large number of subjects, the children were not directly evaluated via a semi-structured interview to determine the presence of mental health problems or disorders: reports from parents are not as reliable. Fourthly, although the PSC scale was used as a base, the responses were modified on a specific ad hoc basis in order to provide us with information better suited to studying the reality of home confinement. However, at the time of the study, there were no validated tools to assess the mental health of children and adolescents in confined quarantine situations. It is also for this reason that we followed a similar structure in the evaluation to that of previous studies carried out in the Spanish population (Orgilés, 2020). Finally, in relation to telematic assistance, more controlled and randomised studies are required to determine its efficacy.

Taking into account these limitations of this study, we still believe that the data obtained here allow us to conclude that the lockdown in the context of COVID-19 has been a stressor for children and adolescents, especially the youngest of them. This situation is most evident in more vulnerable families, specifically those that have been confined in small flats with no or very limited access to outdoor space. Faced with these facts, and especially considering possible future resurgent outbreaks, it is necessary to continue studying the impact of home confinement on the mental health of children and adolescents in the medium and long term. It is also necessary to design and develop useful and validated telematic tools for these situations and this population.

Click here for additional data file.

Supplemental Material, sj-pdf-1-ccp-10.1177_13591045211055066 for COVID-19 lockdown in Spain: Psychological impact is greatest on younger and vulnerable children by Josep Matalí-Costa and Ester Camprodon-Rosanas in Clinical Child Psychology and Psychiatry