Introduction
This chapter presents a brief of the scientific literature and reports from multilateral organizations and other regional NGOs on how the COVID-19 pandemic affected the psychosocial development of children and adolescents in Latin American (LA) countries, between March of 2020 and July of 2022. In this context, the term “psychosocial” refers in a broad way to different emotional, cognitive and social processes, which children and adolescents use for adaptive purposes in their everyday life.
After running several bibliographic searches in Pubmed, EBSCO, Google Scholar, governmental and multilateral organizations’ websites, and abstracts presented at conferences on child and adolescent development, 223 empirical papers and reports have been consulted. When the available information is analyzed, two main aspects emerge: (a) the increment of studies on mental health since the start of the pandemic (Caballero-Apaza Luz M., 2022); and (2) the little empirical material collected experimentally related to the impact of the pandemic on psychosocial development. “Experimentally” means information based on the implementation of methods and techniques that developmental science usually uses to explore psychosocial processes. In addition, after reviewing the abstracts of some of the main international conferences on child development (e.g., Society for Research on Child Development), it is possible to anticipate that new scientific literature on the topic in Latin America will begin to appear in the following two years. This means that to date there is no experimental published material of this type in LA, and that the information available comes mainly from reports made by researchers, governments, NGOs, think-tanks and multilateral organizations (e.g., UNICEF, UNDP, ECLAC, and IDB), which are based on surveys and questionnaires conducted virtually or remotely. Consequently, it is important to consider that this information does not allow us to measure adequate incidences, prevalence nor mechanisms (Silverio-Murilloa Adan, 2021).
In general, in LA, the implementation of studies or surveys applying longitudinal designs is not frequent. Although there is available indirect information on such aspects collected by some researchers and Observatories, the type of indicators that are used are approximations to such phenomena, but not direct information on the performance or state of the psychosocial development of children and adolescents by themselves (Tuñón Ianina, 2021). Furthermore, as in almost the entire world, scientific activity was also widely interrupted since the beginning of the pandemic, and in general there were many difficulties in resuming field work, as well as in carrying out remote studies more specific than surveys. Nonetheless, some research groups began to make changes in their methodologies and to carry out virtual studies – some of them with longitudinal designs – that are still under development (Segretin Soledad, 2021). In any case, such kinds of efforts did not occur to the same extent in LA than in high income countries.
Most of the available information to date corresponds to the first year of the pandemic. In most cases, the effects refer to the implementation of confinements. In a few countries, follow-up rounds were verified between 3 and 6 months after their start. The information on the effects of the pandemic on children and adolescents’ psychosocial development in later stages of the pandemic, when vaccination and reopening of schools were verified, is still being collected or analyzed.
In summary, the available information that is presented here does not necessarily imply decreases or increases in cases, but rather the difficulties in the detection capacity because of the caregivers’ perceptions under stress during the development of a different type of pandemic experiences collecting papers and reports. These conditions pose some limitations in the quality of the information from a scientific perspective, due to the generation of potential sampling and other eventual methodological biases. This implies to consider at least three aspects: (a) Caution in the use of this information (2) Reconsideration of the implemented methods. And (3) investments in efforts aimed at periodically collecting information based on the implementation of controls that could increase its quality, and consequently its predictive value.
Prepandemic socioeconomic circumstances in LA
LA has been a region characterized by high levels of socioeconomic inequality for decades. It is still considered the region with the highest income inequality in the world, in which the richest 10% own about 80% of the wealth. In particular, current markets are characterized by tending to be dominated by a small number of large companies with high levels of power. These monopolies contribute to the maintenance of high social inequality, low productivity growth and the distortion of fiscal policies that translates into a weak redistribution power. (PNUD, Atrapados: Alta Desigualdad y Bajo Crecimiento en América Latina y el Caribe. Informe Regional de Desarrollo Humano 2021, 2021).
The progressive deterioration of socioeconomic factors before the pandemic (ECLAC, 2020) significantly reduced social protection. Almost 50% of the economically active population gained its living in the informal sector with high gender gaps in labor participation. The projection of monetary poverty for children and adolescents in the region in 2020 was 51%; and over 65% of children lived in households without access to social security (Blofield Merike, 2020; PNUD, COVID-19: El desarrollo humano va camino de retroceder este año por primera vez desde 1990, 2020). Until February 2020 the most critical threats to children were those derived from the crisis in climate, poverty, migration, malnutrition, lack of access to adequate housing, education, social protection, and the commercial marketing of harmful products. In other words, before the pandemic, a great proportion of people in LA were not able to meet minimum health and human development standards, which already posed a risk to the development of children and adolescents, especially those who were in situations of vulnerability due to poverty, violence, and human trafficking. Once the pandemic began, the unequal circumstances became more harmful. Actually, findings from a 2020 study based on Argentina, Brazil, Colombia and Mexico data showed that the impact was strongly asymmetric and affected particularly the human capital of children from disadvantaged families (Binns Colin, 2021; ECLAC, 2020; ECLAC-UNICEF, 2020; Chancel Lucas, 2022; Cuartas Jorge, 2020; Lustig Nora, 2020; PNUD, COVID-19: El desarrollo humano va camino de retroceder este año por primera vez desde 1990, 2020).
Microsystemic and ontosystemic effects
A synthesis of the reviewed literature on impacts at the family microsystemic level allows us to verify the following profile of results:
(a) Loss of income in a range of 30% (e.g., Mexico) to 69% (e.g., Chile). (b) Increase in debt (e.g., 68% of households in Colombia). (c) Increase in job instability and informality (e.g., Costa Rica, El Salvador and Peru: between 60% and 70% job loss). (d) Increase in governmental reception of cash transfers (e.g., Chile 26%, Mexico and Colombia 30%, Argentina 59%). (e) Suspension in the purchase or reduction of food portions in a range of 30% to 60% (e.g., Argentina 39%, Colombia 30%, Peru 60%, Dominican Republic 37%). In Colombia, a recovery of 20% was reported after the first period of the 2020 confinement. (f) Increased signs of anxiety and depression in caregivers in a range of 15% to 85% (e.g., Dominican Republic: 15%; Peru: 40%; Costa Rica, El Salvador: 85%). (g) Gender violence (e.g., Argentina: 59%). (h) Domestic burden on women (e.g., Argentina: 44%). (i) Report of concern in caregivers regarding: the effects of confinement; job demands, unemployment and job instability, decreased income, contagion on the return to school, adult low emotional control in the face of uncertainty, fear of contagion and death (e.g., Chile, Peru). And (j) report of concern in caregivers about parenting aspects such as: self-regulation, emotional development, organization of time and routines (e.g., Chile), learning (e.g., Peru: 72% of families with a child with a disability), and behavioral problems (e.g., Peru: 37% in single-parent households) (Attanasio Orazio, 2020; CEDEP, 2020; ECLAC-UNICEF, 2020; Chile Crece Contigo, 2020; Curcio Javier A., 2021; Duarte Fabián, 2021; UNICEF México, 2021; Guerrero Gabriela, 2020; Hincapié Diana, 2020; UNICEF Colombia, 2020) (Naslund-Hadley E., 2020; Naciones Unidas República Dominicana, 2020; Sandoval-Reyes Juan, 20021; United Nations, 2020; UNICEF, La respuesta a la COVID-19. Informe Anual., 2020; UNICEF, En mi mente. Promover, proteger y cuidar la salud mental de la infancia., 2021; UNICEF A., 2021)
At the individual level, the following phenomena were verified: (a) Sleep disturbances (e.g., Chile 29%, Argentina 42%). (b) Alterations in feeding (e.g., Argentina: 50%) and increase in food insecurity. (c) Suspension of health controls in a range of 17% (e.g., Argentina) to 65% (e.g., Chile). (d) Suspension of immunizations in a range of 4% (e.g., Argentina) to 35% (e.g., Colombia). (e) Increase in signs of anxiety and depression in a range of 10% to 60% (e.g., Argentina: 43%; Chile: 37%; Colombia: 35%; Costa Rica, El Salvador: 60%; Mexico: 36%; Peru: 43%; Dominican Republic: 13%; and Uruguay: 10%). In Colombia and Mexico these values were maintained after the end of the year 2020 confinements. In Argentina, a reduction of 17% in anxiety and 6% in depression was verified after the long confinement of almost three months. In Costa Rica, El Salvador, Colombia, and Peru, this type of incidence was greater in children who were victims of violence. Regarding the changes in symptoms of depression and anxiety in adolescents during the pandemic, a study with a longitudinal design carried out in Peru suggests only a decrease in anxiety after months of the start of the confinements (Barendse Marjolein E.A., 2022). With respect to the study of emotional well-being reported by the children themselves, in a preliminary study carried out in Mexico, differences were verified between girls and boys in the expression of their positive and negative emotions from 8 years of age (Armenta Hurtarte Carolina, 2022; UNICEF A., 2021). (f) Increase in communication problems inside homes in a range of 7% to 34% (e.g., Argentina: 24%; Mexico: 34%; Dominican Republic: 7%; Uruguay: 10%). (g) Increased expression of anger and fights inside homes in a range of 15% to 59% (e.g., Argentina: 15%; Chile: 59%; Colombia; 20%). (h) Decrease in times and spaces for free play (e.g., Chile: 28%); (i) increase in screen exposure (e.g., Chile: 68%). And (j) mourning for the death of a family member (e.g., Chile: 15%). From March 2020 to April 2021 10.2, 3.5, 2.4, 2.3, and 1.1 per thousand in Peru, Mexico, Brazil, Colombia and Argentina, experienced the death of at least one primary or secondary caregiver, respectively (Andrés María Laura, 2022; CEDEP, 2020; Chile Crece Contigo, 2020; Curcio Javier A., 2021; Grupo de Investigación Relaciones Vinculares y Desarrollo Socioemocional, 2020; Guerrero Gabriela, 2020; Hillis Susan D, 2021; Hincapié Diana, 2020; Naciones Unidas República Dominicana, 2020; Naslund-Hadley E., 2020) (UNICEF Colombia, 2020; UNICEF, En mi mente. Promover, proteger y cuidar la salud mental de la infancia., 2021; UNICEF A., 2021).
Implications of the available evidence
As in other many regions in the world, even considering the limited available information, in LA the pandemic has disrupted the functioning of systems that support human well-being and development at many levels, from individual biology to families, health care, education, local and national governments, economies, and many other interconnected systems in profound and varying ways (Katz Carmit, 2022). Consequently, the pandemic can be represented as a “multi-systemic shock” event (Dhaliwal Mandeep, 2022).
Although the initial measures of physical distancing made it possible to contain the contagion (United Nations, 2020), they also confined a large proportion of caregivers, children and adolescents to their homes. Consequently, this increased children’s exposure to parental job loss and income instability and its effects on the dynamics of emotional interaction inside homes. In turn, these phenomena made the distribution of tasks within the home and the care of children more complex (Guerrero Gabriela, 2020). In addition, childcare, justice, and educational programs have been disrupted imposing challenges to parents and children’s self-regulatory and learning development (Ravetlat Ballesté, 2022; Gassman-Pines Anna, 2020; UNICEF, La respuesta a la COVID-19. Informe Anual., 2020). This drastically limited the possibilities of teachers and other caregivers to detect cases of violence, to provide accompaniment and advice to children with this and other special needs, and to activate primary and secondary prevention actions (Urizar Jr Guido G., 2022). Children may have different reactions to the loss of a caregiver and grieving is highly individually variable. However, when the loss is experienced as traumatic it can affect emotional development by increasing the probability of developing post-traumatic stress disorder, which in turn can lengthen the mourning process and prevent from focusing on everyday activities including learning and social interactions (Hillis et al., 2020). At the same time, the phenomena of resilience and agency of children and adolescents were verified that gave rise to socialization processes in which there was an innovation in the ways of bonding, playing and inhabiting family spaces (Aguilar-Farias Nicolas, 2020; Barcala, 2022; Vinícius Paiva Albarado Kaio, 2022).
In some countries (e.g., Brazil) there was a significant absence of state intervention and an increase in the intervention of community organizations to address vulnerabilities (Basile Patricia, 2022).While the prevalence of mental health problems was high in the region, heterogeneity between countries was also verified, which raises the need to implement approaches that adequately identify different population groups with different characteristics and needs (Zhang Stephen X, 2022). In particular, the groups of children and adolescents most affected by the increase in signs of impact on mental health were those who already suffered from some type of disorder, those who lived in households with socioeconomic deprivation, in single-parent households (especially headed by women), and in households with caregivers from families with younger children (Ben Brik A., 2022; Gómez-Salgado Juan, 2021; Katz Carmit, 2022; Palomera-Chávez A., 2021;Vilar-Compte Mireya, 2022). In some cases, it was verified that the use of negative parenting strategies was associated with an increased risk of negative signs of mental health in children (Oliveira Thaís Dell’Oro, 2022).
Perhaps one of the hallmarks of the pandemic has been at the extent to which it has impacted the predictability of daily life. There is an extensive scientific literature showing that lack of predictability and control can have long-term effects on biological stress response and immune systems, two of the main mechanisms involved in self-regulation processing in adaptive circumstances (Rettie Hanna, 2021). In such a relational dynamic the information on effects suggests that children from economically disadvantaged backgrounds, those subjected to structural inequalities, with additional health and/or special needs, from families in which there are mental health issues have been the most impacted by the pandemic.
In summary, also in LA the pandemic can be conceptualized as an unanticipated and uncontrollable chronic stressors phenomenon that is detrimental to the mental health of children, adolescents and families, particularly in those with disabilities, from migrant, refugee, culturally and ethnically diverse and socioeconomically deprived communities. In this sense the COVID generation can be conceptualized as one with an exacerbation of exposure to psychosocial stressors than those of the pre-pandemic stages which effects on mental health and well-being are expected to last years in the context of a complex intergenerational dynamics (Figure 1) (APPG, 2020; Arnsten Amy F.T., 2021; Masten Ann S., 2021; Rao Nirmala, 2021; Guerrero Gabriela, 2020). Consequently, such a sort of “stress-tsunami” may impact several self-regulatory competences for coping with adaptation challenges in the mediate and immediate future (AP-PG, 2020; Arnsten Amy F.T., 2021; Gassman-Pines Anna, 2020; Masten Ann S., 2021; Rao Nirmala, 2021; Guerrero Gabriela, 2020; UNICEF, La respuesta a la COVID-19. Informe Anual., 2020).
Conclusions and future directions
Any consideration of such a complex problem necessarily requires a relational perspective approach (Lerner Richard, 2018), which necessarily should involve a complex set of planning and actions to allow the identification of variable trajectories eventually expressed by different vulnerable groups exposed to know and new constellations of risks and opportunities, and orient the corresponding and adequate interventions.
Regarding the conceptual understanding of the available information, although insufficient, it is possible to interpret it in a preliminary way from the pre-pandemic conceptual models based on a rich history of developmental theories and empirical research on ecological and family systems, family stress and parenting, and resilience of children, adolescents, and families in complex and adverse contexts. However, the COVID generation imposes new challenges that could update and/or modify previous theoretical proposals. The pandemic is teaching key lessons about how people respond to crisis and misinformation and is promoting changes in the way scientists study public-health questions (Aschwanden Christie, 2021). A full understanding of the impact of massive, everyday unpredictably over time will depend on the implementation of theoretical and analytical models that can capture multiple variable trajectories of different aspects of psychosocial development, at different levels of analysis and stages of development, in different developmental contexts. Such capture of complexity necessarily requires new methods of collection and analysis of the complexity of human development. In this sense, perhaps the COVID generation constitutes an opportunity to channel efforts that allow important conceptual and methodological advances in the knowledge of psychosocial development in LA and other regions. Now, there is an urgent need for research to address how mental health consequences for vulnerable groups can be mitigated under pandemic conditions. In more mediate stages, discovery, evaluation, and refinement of mechanistically-driven interventions to address the psychological, social, and neuroscientific aspects of the pandemic are also required. Rising to this challenge will require integration across disciplines and sectors, and should be done together with people with lived experience.
With respect to the collection of information, efforts require methodological improvements at the level of: (a) sampling; (b) selection of specific indicators of psychosocial development, preferably combining direct information on child development and caregiver reports; and (c) periodic assessments. There are already some examples of international collaboration projects that consider these aspects (Solmi Marco, 2022), and even some of them specific to LA and in relation to issues of inequality in women, children and adolescents considered in the SDGs (Sanhueza Antonio, 2021). Such innovations could benefit from the specific financing of inter-sectoral efforts that involve different Observatories of human development, researchers from different disciplines related to child development that already carry out their activities in the region, as well as other stakeholders and policymakers. In particular, such efforts would be of great value for the exploration and identification of onto-, micro- and macro-systemic impact mechanisms that could guide different upgradable intervention efforts.The continuous collection of information is a shortcoming in the region that requires specific financing plans, while it is a minimum requirement necessary to face the effects of the pandemic on mental health and the self-regulatory development of the COVID generation in the short and long term.
Regarding the continuous and dynamic identification of vulnerable groups, the information available before and during the pandemic accounts for known vulnerable groups. In addition, it is possible that during the development of the pandemic, other constellations of risks and resilience will emerge in caregivers, children and adolescents of the COVID generation, which require specific, different, and innovative solutions.These scenarios impose the need for continuous and dynamic research work to identify them; as well as the creation of new instances of building capacity that contributes to the training of professionals who can deal with information from multiple sources and very fast dynamics of change. These types of efforts could benefit from the implementation of artificial intelligence methods, which during the pandemic have served to analyze scaling communications phenomena, provided platforms for understanding how COVID-19 spreads, and speed up research and treatment even in LA (Mhlanga David, 2022; Ormeño Pablo, 2022). However, the design and implementation of such types of algorithms require an adequate analysis of ethical, technical and methodological aspects that are still under debate at the international level (Gibney Elizabeth, 2022; Peeples Lynn, 2022).
In relation to the immediate necessary actions, given the previous and current exposure to stressors that challenge the psychosocial development of children and adolescents, and the lack of adequate investment in mental health services in practically the entire region (Busso Matías, 2021), one of the priority aspects is the provision of primary psychosocial care services for the population in general, which allow to prevent and treat mental health disorders such as depression, anxiety, and stress in caregivers, children and adolescents. Likewise, such immediate interventions should seek to promote assertive and healthy parenting and communication practices between different social actors, including adolescents and youth in the design of community programs (Bishop Stephanie, 2022). In other words, innovation should include a concept of primary care in mental health that transcends the work in health centers, and the use of information technologies in innovative ways to promote mental health at as least the microsystemic level (Breed Ananada, 2022). Although several countries have implemented portals and other information mechanisms, this does not replace the provision of specific mental health interventions through primary care settings.
With respect to the synergistic effects of investment in psychosocial development, it is possible that, if implemented, this type of planning and actions will contribute to generate solutions to the effects of the pre-pandemic inequity on the self-regulation development of children and adolescents. In this sense, multilateral efforts could consider the design of policies and investments in the context of the SDGs (Sachs Jeffrey, 2021), to help generate equity in access to mental health care and contribute to the psychosocial development of children and adolescents in the region (Tausch Amy, 2022). In such a context, the role of the researchers must be oriented at least towards the continuity of impact assessment and the generation of continuous and dynamic knowledge that can anticipate medium and long-term impacts and involving communities in specific roles based on different type of available resources (Merlinda Santi, 2021). This requires also considering the development of algorithms that allow generating answers online, instead of waiting for the completion of stages of the interventions. This is also related to the professionalization and sustainability of public management processes that need to be reinforced or built.
For all these efforts, the recommendations made by the WHO-UNICEF-Lancet Commissioners in 2020 (Clark Helen, 2020), before the beginning of the pandemic, remain valid: (a) Put child health and wellbeing at the center of recovery plans. (b) Include experts on children’s issues in the relevant task forces and legislative working groups. (c) Engage their ministries to work together for children. And (d) ask children and adolescents what changes they would like to see. An important factor that could contribute to amplifying this type of action would be the planned development of communication frameworks that contribute to (a) making visible the problems to be faced, as well as the importance of the commitment and participation of all sectors of society; and (b) reduce as much as possible the construction of communication frameworks that contribute to infodemic (Bhatt Shumaila J. i, 2022; Ball Phillip, 2020).
Finally, what is needed to face the challenges that the COVID generation presents us not only requires multilateral collaboration, innovation in financing and maintaining high-quality clinical and research standards, but also to base any effort on a moral premise of solidarity and gender perspective that can navigate the trouble waters of the inertia of the pre-pandemic effects which have made Latin America one of the most unequal regions in the world.
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