Attendance of online classes by school students with mental health problems fell during pandemic

Study involving 672 Brazilians aged 16-24 with internet access showed that distance education did not have a direct impact on mental health.

By Luciana Constantino  |  Agência FAPESP – Attendance of online classes by students who had mental health problems before the COVID-19 pandemic was lower than average during lockdowns and periods of mobility restriction when schools were closed. Many students who had internet access did not take part in distance education. On the other hand, mental health appears not to have been affected among those who did.

These are the main findings of a study conducted by Brazilian researchers to compare the effects of mental health problems such as hyperactivity and difficulties in peer relationships on adolescents and young adults before and during the pandemic. 

An article on the study has been posted to PsyArXiv Preprints, and is waiting peer review. The platform belongs to the Society for the Improvement of Psychological Science (SIPS) and the Center for Open Science (COS).

“Student mental health is a significant factor in terms of its impact on education, so we set out to see how it influenced attendance of online classes. We concluded that prior problems increased inequality of access to distance education, but online classes as such had no impact on mental health,” Patrícia Pinheiro Bado, first author of the article, told Agência FAPESP. Bado is a neuroscientist at Hospital de Clínicas in Porto Alegre, a large teaching hospital run by the Federal University of Rio Grande do Sul (UFRGS).

The study was supported by FAPESP and analyzed data for 672 students aged 16-24 with internet access, 511 (76.1%) of whom reported having enrolled for online classes while schools were closed, while 161 did not. They were assessed before and during the pandemic by answering the self-report version of the Strengths and Difficulties Questionnaire (SDQ), widely used by researchers to identify behavioral and emotional problems in schoolchildren. 

The researchers scored the results on four subscales, for emotion, conduct, hyperactivity and peer problems, analyzing the data with the aid of regression models adjusted to allow for the influence of previous school events such as suspensions and repetitions, as well as the number of days since school closure, socio-economic status, gender, and age.

The aim was to investigate the effects of online education on mental health and vice-versa. In particular, the researchers wanted to find out whether mental health problems prior to the pandemic were associated with access to online learning, and whether students who attended online classes had lower levels of mental health problems during confinement.

The analysis showed that children with mental health problems before the pandemic were significantly less likely to have access to online classes. According to the authors, every one-point increase in the total SDQ score (on a scale from 0 to 40) before the pandemic was associated with a 6% increase in the likelihood of not taking online classes during it.

The comparison of two periods was possible because the students were participants in the Brazilian High-Risk Cohort Study for Childhood Psychiatric Disorders (BHRC), a large community-based survey involving 2,511 families with children aged 6-10 when it began in 2010.

Also known as Project Connection – Minds of the Future, the BHRC is considered one of the most ambitious childhood mental health surveys ever conducted in Brazil. It is led by the National Institute of Developmental Psychiatry (INPD), which is supported by FAPESP and the National Council for Scientific and Technological Development (CNPq), an arm of the federal government.

More than 80 university professors and researchers affiliated with 22 institutions are involved with INPD. Its principal investigator is Eurípedes Constantino Miguel Filho, a professor at the Psychiatry Department of the University of São Paulo’s Medical School (FM-USP). 

Analysis by gender

In the study discussed here, the researchers did not find an association between attending online classes and manifesting symptoms of mental illness. Students who attended online classes apparently had fewer cases of deficit/hyperactivity disorder than those who did not, but this was fully explained by the symptoms reported before the pandemic. 

Gender differences were significant: girls were 2.3 times more likely to attend online classes than boys. “During the pandemic, the factors that influenced students’ mental health were having had problems previously, financial difficulties for the family, and gender, as girls reported more mental health problems than boys,” Bado said.

The researchers noted that they could not measure the impact of school closure on mental health by comparing students who had online classes and students who attended school. Almost all the participants in the study sample were prevented from going to school by mobility restrictions and lockdowns. Only four attended classes in person at some point during the pandemic. 

For Mauricio Scopel Hoffmann, a professor in the Neuropsychiatry Department at the Federal University of Santa Maria (UFSM) and a co-author of the article, the findings will contribute to the formulation of projects designed to identify children and young adults with mental health problems. “The findings should be analyzed in conjunction with those of our previous study, which showed how externalizing disorders [such as aggressiveness, attention deficit and hyperactivity] affect the school performance of children, especially girls. Diagnosing at-risk students as early as possible could help mitigate this kind of educational inequality,” he said.

The findings to which he referred were reported in an article published late last year in Epidemiology and Psychiatric Sciences. Among the negative effects of externalizing disorders on educational outcomes mentioned there is the estimate that 5%-10% of grade repetitions and age-grade distortions (when children are older than the appropriate age for their school year) would not occur if mental health problems were prevented or treated (more at: agencia.fapesp.br/37741). 

Hoffman believes that detecting whether young people are at risk of dropping out of school and prioritizing adequate treatment as a matter of public policy could reduce dropout rates and contribute to engagement with distance education. “Leaving them outside the educational system is worst of all,” he said. “They may never resume studying, and could be underemployed in future, with little income, perpetuating inequality.”

In Brazil, some 244,000 children aged 6-14 were shut out of school in the second quarter of 2021, a 171% increase over the same period of 2019. The percentage of this age group enrolled in primary and secondary schools fell in the same period from 99% to 96%, the lowest since 2012, according to a report by the non-governmental organization Todos Pela Educação based on the Continuous National Household Sample Survey (PNAD Contínua) conducted by IBGE, Brazil’s census and statistics bureau.

“It’s increasingly clear that mental health is a very important factor in whether students attend school and don’t drop out,” Bado said. “For this reason, educational policies shouldn’t be formulated without taking into account not only mental health but health generally.” The next step, she added, will be to analyze the impact on learning for the students who attended online classes during the pandemic.

According to another report issued by Todos pela Educação, this time early in February 2022, almost 41% of Brazilian children aged 6-7 were unable to read or write last year. The number reached 2.37 million in 2021, sharply up compared with 1.43 million (25%) in 2019.

The article “Mental health problems predict inequalities in accessing online classes during COVID-19 pandemic in youth” by Patrícia Bado, Mauricio Scopel Hoffmann, Pedro Pan, Eurípedes Constantino Miguel, Luis Rohde and Giovanni Salum is at: psyarxiv.com/knq49/.